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Abbie experienced a high-risk pregnancy with her twin girls. They were born at 27 weeks gestation and weighed in at just 677g and 500g. After 150 nights in Neonatal Intensive Care Unit (NICU), both of Abbie’s daughters came safely home.  In this blog, Abbie highlights the importance of building a trauma-informed, clinical network around women whose babies have spent time in NICU. Drawing on her own experience and insights, she offers suggestions for how midwives, GPs and health visitors can support their mental health postnatally.  The post-partum period is important. A mother recovers and heals physically from birth, but it also is a strong influencing factor on the long term physical and emotional wellbeing of both mother and baby. I want to consider a quote I saw recently, ‘Remember to hold the mother, not just her baby.’ Whilst I welcome society recognising that women shouldn’t be forgotten once their baby has been born, my immediate thought was - but what if the mother isn’t even holding her baby? What if the baby hasn’t left the hospital yet? Who holds the mother then, and ensures she feels safe, heard and supported? We know that parents who have experienced time on a NICU Unit are 80% more likely to experience psychological distress, than parents who haven’t. Care for a woman during and after, needs to be trauma-informed, supportive and personalised; their mental health must be prioritised. As the data demonstrates, the contacts during the postnatal period, affect the weeks, months and even years that follow. Frequent, open communication asking how she is throughout, will ultimately support her wellbeing safety. Here’s are some of my thoughts on how midwives, GPs and health visitors can help support women who have had babies in NICU… Community midwives It is important that women whose babies remain in NICU, feel considered and counted too. We once were the patient too. Never let women fall down a gap in accessing their postnatal care, because their baby was not discharged to home, when they themselves were discharged. These appointments provide important opportunities to talk postnatally about maternal mental health. Women may be feeling frightened and scared about their baby in NICU. They may also be feeling guilt about their baby being early or sick. Acknowledge that these feelings are all entirely normal for the circumstances they are in. Acknowledge that it is hard and difficult. Acknowledge that the separation between mum and baby, rather than both home together, is not how it should be. Ask what she needs. These early days can often feel fast, and our minds have not caught up yet. Be prepared to sit with silence as she starts to process what is happening. Hold that space open to listen. Take early opportunity to refer or signpost for support where appropriate. Early identification can often avoid crisis. General practitioners Ensure that postnatal follow up is completed at 6-8 weeks post birth. It is not exclusive to those whose babies are home and able to also attend this appointment. Access to this must be equitable for all women. It may be an initial telephone appointment, or have to be considerate of time that the woman wishes to spend on the NICU. A degree of flexibility is needed here to achieve access, as the surrounding circumstances are different to the regular postnatal check up alongside baby. Continue the dialogue about postnatal mental health. Be considerate of language here too. I know I personally found phrases such as, ‘still in NICU’, or ‘at least they’re in the right place,’ difficult. Support us by knowing NICU can feel like a marathon and all we want too, is for our baby to come safely home with us. Normalise talking about postnatal maternal mental health in primary care, from the beginning. Trusting relationships are built this way, and women will feel safer reaching our to their GP if they are struggling. Whether that’s in the first few weeks, or even a year down the line, GPs can empower women postnatally and equip them with choice regarding support. It is important to know support exists and that other mothers have needed this too. Health visitors Often it is after the much yearned for hospital discharge, there is more time to reflect and consider what happened in the immediate postnatal period. This can be when women start to really feel the effects of spending time in NICU. Balancing this processing of events, with the demands of raising your baby, and adding in more sleep deprivation on top, can often lead to the perfect storm. Babies who have spent time in NICU usually leave with an array of outpatient appointments and there can be a theme, that they remain the patient and centre of support beyond. Developmental assessments, ‘milestones’ and even birthdays, can all evoke the feelings we had in NICU right at the start. Often our feelings of fear, guilt, and even a grief regarding the path we thought antenatally, we would follow, re-emerge. Anxiety regarding baby’s development and their continued health can be at the forefront of our mind because of the experiences we have had. The health visitor is such a valuable continued contact here in these following months for mother and baby. Rather than viewing their NICU experience as simply in the past, let mothers know there is space to talk about it postnatally. Demonstrate an understanding that a mother’s experience of NICU, is not simply left at the NICU doors when discharged. Listen and validate the feelings that come up, do not dismiss them. Tell them about the support choices available. Approaching appointments or contacts like this will really help mothers feel able to speak openly and ask for support if and when they need it. Final thoughts Spending time in NICU with your baby is traumatic. Whether your baby was there for a day, a few weeks or even months. Building trusting, listening relationships that validate how women are feeling postnatally, can empower them with choice and information about support they can access, at the right time for them. It recognises that whilst the trauma cannot be erased, care can go a long way to mitigate the experiences postnatally. Related reading Women who experience high-risk pregnancies are too often forgotten when their babies are born My Black Motherhood: Mental Health, Stigma, Racism and the System (by Sandra Igwe) Racial disparities in postnatal mental health: An interview with Sandra Igwe the Founder of The Motherhood Group Patient safety and maternal mental health during covid Neonatal herpes: Why healthcare staff with cold sores should not be working with new babies Leading for safety: A conversation with Jane Plumb, Founder of Group B Strep Support

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