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Mental Health in the Neonatal Intensive Care Unit: An NICU Nurse's perspective

When Kullein asked me to write a piece about a nurse’s perspective on maternal mental health, I was of course flattered by the request and said yes immediately. Fast forward to a few weeks later and I finally got around to finishing my post. Yes, life did get in the way, like settling into my new job and country across the world, but I admittedly procrastinated because I didn’t know where to begin. As a Neonatal Intensive Care Unit Registered Nurse, maternal mental health is something that I encountered every day that I went to work. However, on a personal level it’s not something that I had ever experienced. Since I don’t have children of my own, I feared coming off as a know-it-all, insensitive, or a poser. I began to think of my own mental health, especially in relation to my profession. I realized that although my own perspective was not from the standpoint of a mother, I could offer my own experience with mental health and the observations that I was able to make in the time I spent with my patients and their families.

The first words that came to mind were alarm fatigue. Alarm fatigue is a term used in healthcare settings to describe the repeated exposure to the nonstop sounds of medical devices (IV pumps, cardiac monitors, ventilators, beds) often leading to sensory overload. It’s a concept I became familiar with then I began working in the NICU. As a nurse, often throughout a 12, 13, sometimes 14-hour shift, you are pulled in many different directions. Yes, our profession is often synonymous with the words compassion and caring, but what often goes unnoticed are the additional roles that we take on of advocate, educator, and counselor.

When I began working in the NICU, I felt completely overwhelmed. I had thought I was confident in my skills and clinical knowledge, but quickly felt that fade upon entering the unit. I was working alongside fellow nurses who had spent upwards of 20 to 30 years on the unit, and who had a fierce confidence and intuition that I would only aspire to have a fraction of one day. It was my responsibility to care for the most premature, critical, and medically fragile newborns, and I wasn’t sure I could handle the pressure. Leading back to the concept of alarm fatigue, I felt myself becoming desensitized to the unit. The sounds of alarms that would play in my head as I laid my head on my pillow following a marathon long night shift, the sights of nurses performing resuscitation measures on a 24-week-old premature newborn eventually began to fade and I could feel myself becoming numb to it all. I quickly realized that if I was going to be successful in my job and career, I had to seek out ways in which I could cope with the intensity of the unit.

As time went on, my self-confidence grew. I began to utilize my colleagues for support, not only by calling on their medical expertise for reinforcement (which I often did) but also as an outlet to express my feelings. I realized that I was focusing too much on trying to appear as though I was unfazed by my surroundings rather than embracing the opportunity to learn and connect with my colleagues, patients, and their families. By confiding in my colleagues, I became aware that even the most seasoned nurses were also going through similar mental health struggles. The pressure of the job, the caregiver strain, and the weight that we carried of needing to be there for our patients with every ounce of our being. I learned that it was okay to feel like that. It was okay to feel overwhelmed and unsure of myself at times. By recognizing that, I felt myself grow immensely in my role and my ability to work through my feelings in a positive way.

Drawing on my personal struggle with mental health in relation to my profession, I began to think more about my patient’s families, particularly mothers. As a NICU Nurse, your patient load often encompasses more than just 1 or 2 babies, it also includes a range of family members merely attempting to understand new medical terminology, scary looking machines, and statistics. I attempted to put myself in the shoes of a NICU mother. There is the notion that one gets pregnant, gives birth, and in that period following childbirth the expectation that you are supposed to live happily ever after and relish in the joys of a new baby. Missing from the narrative is a scenario in which a baby is whisked away from his/her mother seconds following a delivery to a group of doctors, nurses, and respiratory therapists performing life saving measures. Missing from the narrative is the opportunity to bond with your new baby though immediate breastfeeding and kangaroo mother care (KMC). Instantly a mother’s new normal can become countless hours spent on a hospital unit and the only way she can connect with her baby is through a small port in an incubator.

I began to think of the stigma surrounding mental health, and particularly maternal mental health. Why is it that although Postpartum Depression is one of the largest public health concerns, the words still ring taboo? The postpartum period is a time of change and transition, and often the most critical period in which feelings of sadness, exhaustion, worry, and loss of interest may often heavily present themselves. In the NICU setting, it may mean missing out on the important moments of bonding and forming an attachment with your new baby, merely because you cannot touch or hold him/her. It may mean having to watch a virtual stranger, like a nurse, feed your child or hold your child before you ever get to do so.

Following the first few hours and days of life, it is imperative for a newborn to have regular checkups and medical attention. Yet, it was clear that maternal mental health was not being prioritized and no one was checking up on the mother. I felt as though there was little support for our new mother’s in terms of addressing mental health, both in relation to the stress of parenthood but also the emotional and financial strain of having a child in the NICU. Furthermore, add in stresses such as recovering from the physical strains of childbirth and the pressure to breastfeed and pump in order to feed your child.

My thoughts came back to alarm fatigue. If I as a nurse felt myself becoming desensitized, couldn’t the same be true for a mother who has spent upwards of three or four months in the NICU, unable to take her new baby home? Couldn’t the same be true for a new mother who recently took her baby home and is adjusting to having to care and provide for her child? In the hospital and beyond, addressing mental health in all mothers is extremely important to a child’s long-term development. Improper treatment of mental health may lead to a lack of attachment, thus causing things like failure to thrive and the inability to meet development milestones. Without proper acknowledgment, it can have detrimental effects on both the mother and child.

The pregnancy and postnatal period are the most pressing and psychologically stressful times for women. Across the world, effective interventions need to be implemented in order to improve the health and well-being of all mothers, not just mother’s with newborns in the NICU. This includes the importance of screening all mothers and treatment options for those who are in need. It includes creating a safe space and support groups with fellow mothers to have an open dialogue so others know that these feelings may be common. As I thought back to my own realizations regarding my mental health, I now view it as an additional role as a nurse to always reinforce to my patient’s mother’s, and all mothers, that it is okay to feel overwhelmed and unsure of yourself at times. That is part of the long journey of mental health.

About the author: Bridget Hartnett was born and raised in New Jersey, USA. Bridget has worked in communications and public relations in New York City, as well as in Ghana for Volunteer Partnerships for West Africa, and in Kenya for Lwala Community Alliance. In 2016, Bridget pursued her Bachelor of Science in Nursing at the University of Miami’s Accelerated RN, BSN program and became a licensed Registered Nurse in 2017. As a Registered Nurse, Bridget has worked in emergency and trauma services, and spent the last two years working in the Neonatal Intensive Care Unit. Bridget is now a 2019-2020 Global Health Corps Fellow working as the Communications Specialist for the Ministry of Health Rwanda and Rwanda Biomedical Services. Bridget is passionate about global health and promoting health initiatives, programs, and treatments for the maternal and child health population.

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