• Reference Number: HEY1398-2023
• Departments: Neonates
• Last Updated: 30 November 2023

Introduction

Having a baby in the Neonatal Intensive Care Unit (NICU) may be very different to how you imagined things. This can be a highly stressful time for many parents. This information sheet aims to help you recognise and understand the common emotional reactions you may experience due to your baby’s admittance to NICU.

Your baby is currently being cared for by the neonatal team at Hull University Teaching Hospitals. Whilst you are here you have access to support from a Clinical Psychologist as part of the team. Should you feel you would like to speak to a Clinical Psychologist please contact the ward staff who will be able to arrange a referral for you.

What do we mean by a trauma event?

Parents often describe being on NICU as an ‘emotional rollercoaster’. You may have expectations of parenthood which have being challenged by your baby’s admittance to NICU. The unexpected preterm birth or birth of a sick baby is a shocking and traumatic experience for parents.

We often go through life not expecting these difficulties to happen to us. We know that sometimes these experiences do occur, but we don’t usually expect to be personally effected by them. We often think this way because life would be too overwhelming and stressful if we anticipated such events, and we understand they are not a common occurrence.

However, unfortunately they do sometimes happen to us, and that can come as a big shock.

How can psychologists help me?

Often, when people experience a traumatic event, they experience an emotional reaction to the incident and its consequences and they may need some support. Everyone is different, and as such will have different needs, but here are some ideas of how a Psychologist can help you with common difficulties;

• Help you to better understand the emotional reactions you are experiencing.
• Review your usual coping strategies, and offer guidance on developing some new approaches to help you cope in the early stages of adjustment.
• Provide a supportive space for you to discuss and explore thoughts, worries and beliefs that you have experienced.
• Support you to discuss pre-existing psychological or mental health difficulties if you feel these are being impacted or worsened by your baby’s stay on NICU.
• Assess your ongoing support needs and signpost you to local services for further support.

Understanding the effects of traumatic events

When we experience a traumatic event it is outside of our usual expectations about life. Therefore, we may experience unfamiliar feelings, thoughts and reactions that fluctuate or feel more extreme or different to normal. These are normal reactions to difficult and stressful situation; it is your body’s response to shocking circumstances and how many of us process stress. It can feel strange, scary or like you’re not yourself, but remember it’s the circumstances that are strange, not you.

There is no right or wrong way to react

Here are some example of things you may notice, and how experiences change over time:

• Shock, “shaken up”, numbness, fear, confusion, gratitude for surviving and/or feeling it’d be better if you hadn’t survived.
• Exhaustion, denial, anxiety, helpless, angry, relief, gratitude, irritable, hope.
• Memories of trauma, personal growth, pride, life affirming, a positive opportunity to re-evaluate life.

Common emotional responses to admittance to NICU

Below are some examples of how parents may feel after their baby has been admitted to NICU.  These are not mutually exclusive and you may experience different ones at different times.

• Fear and apprehension – You may be feeling worried, in shock or scared about how your life may be changing. You may also be struggling with the amount of uncertainty you are facing. It is normal to feel like this when faced with unfamiliar circumstances.
• Out of control – You may feel completely overwhelmed by the environment, high-tech equipment and amount of people caring for your baby. You may be struggling to maintain any sense of control over your situation and not know what to do to help your baby. Feeling like this can be frightening.
• Anger –You may feel angry that your birth experience did not go as expected, or you may be angry at your inability to control events in NICU. It is ok to feel like this – you did not ask for this to happen and the circumstances surrounding your baby’s stay in NICU is difficult.
• Guilt- You may ask yourself, “What did I do to cause this?” or “What could I have done to prevent this?” This can be difficult when there may be no known reason why your baby needs the support from NICU. Most pregnancy and birth complications are not anyone’s “fault” and many NICU admissions are unforeseen.
• Loss – Throughout your pregnancy, you probably had an image of your baby. For most parents, this picture was that of a healthy full-term infant. Seeing your premature or ill baby for the first time may lead to feelings of loss for what you had expected. It is natural to grieve.

Common emotional and physiological responses to traumatic experiences

• Hyper arousal:  Feeling jumpy, panicky, or sensitive to particular sensations or sounds more than normal. This happens as your body is in a heightened state of arousal, paying more attention to your surroundings in an attempt to feel safe.
• Re-experiencing: You may experience dreams or flashbacks; in some cases, you may see/hear/feel/smell the event again. It may feel very real at the time, like it is happening in the present moment, and these may come with no warning or seemingly no conscious control, making these experiences unpleasant and distressing at the time.
• Changes in mood: You may find your emotions are more changeable or rawer than usual or that you experience lots of different emotions in a short space of time. Some people feel numb or find it difficult to work out how they feel.
• Avoidance: You may prefer not to think or talk about your experience of NICU, want to be alone, or avoid places or situations that cause distress.
• Depersonalisation: It may feel like you are disconnected from the birth or your baby’s NICU stay. You may feel aware of what is going on around you but you feel numb or as though it is not happening to you, perhaps dream-like or as though you’re watching it happen in a film. This depersonalisation and numb feeling may be a way of slowly, gradually opening up and feeling the distress of the event.
• Physical symptoms: As your body is processing this stressful event, you may notice physical symptoms such as palpitations (feeling your heart beating strongly in your chest), changes to breathing, poor sleep, nausea, headaches, poor concentration, tension or pain.

Understanding the effects of traumatic events

In most cases these feelings and reactions are short-term and will pass after a few days or weeks as you process the stressful event. However, sometimes these reactions can last longer depending on your circumstances and emotional response. Factors such as length of your baby’s hospital stay, contact with reminders of the event, or the significance or meaning of the event to you could impact on your reaction. This is also normal in the early stages of adjustment to a traumatic event.

What can I do to help?

• Remember your reaction is normal – Learning about common emotional reactions can help you understand what you are experiencing is ok. Allow yourself to feel this range of emotions. Do not worry about crying or if you are struggling to make sense of it all to begin with.
• Allow yourself the time to process and accept what has happened. It is similar to other times of loss, you may need to grieve for the changes in your life, your expectations and take time to heal.
• Talk to people about your experiences; simply sharing your feelings can help you process them and help your body calm. You may wish to talk to new parents of babies with similar problems. You may find contact with other parents who “have been there” helpful.
• Take care of yourself. Rest and eat well. This will have been a physically and emotionally exhausting experience, and you will benefit from taking time to rest and let your body get sufficient sleep, and maintain energy by having a good diet.
• Think about some activities that you usually enjoy and return to these when possible. Some people also find having a structure or routine around them helpful.
• Seek help and ask for support, either from the staff here or from your GP if you are worried about your symptoms and experiences.
• Control – Separate out the elements of your life that you can control, and the element you cannot control at this time. Focus your attention on the things you can control and try to let go of the things you cannot for now.
• Practice the stress management techniques that work for you. We will all have been through difficult and uncertain times in the past – try thinking back to these times and how you coped. Are there things you could take from this and apply to the current situation?
• When we feel high moments of distress try grounding yourself to the present moment. A simple technique for doing this is the 53421 method: thinking of 5 things you can see, 4 things you can hear, 3 things you can feel, 2 things you can smell, and take 1 deep breath.
• Welcome relaxation, try taking some deep breaths for at least 2 minutes and try visualising somewhere that makes you feel calm and comfortable. This helps our body feel safe and relaxed.
• Allow yourself to take some time off from NICU. The stresses of NICU can take an emotional toll on you. These can cause you to be run down and ineffective – take a break.

Things that are best avoided

• Try not to distract yourself from thinking about it, for example by being very active or taking on too much. This again may prevent you from processing what has happened; instead take some time to help you come to terms with any changes.
• Avoid alcohol and manage medication well. Other ways people may try to distract themselves is by using alcohol or medication to “numb the pain” and avoid thinking about the traumatic event. Your brain is needing to process the traumatic event, and a high level of distraction or avoidance can disrupt this process.
• Do not bottle up your emotions. We are sometimes taught to manage our emotions and not “let it all out”, but emotions are a physiological natural response to circumstances around you. Allowing ourselves to feel and express them can help give us a sense of relief.

Accessing support

Your local Improving Access to Psychological Therapies (IAPT) NHS Service can help you, if you feel you would benefit from some further emotional wellbeing support.

You can gain access to this support through your GP, or can refer yourself by phoning them directly. To find out how, search online for your nearest service, and below are the contact details for some local services. If you need urgent mental health care, contact your local Crisis Response Team.

Additional helpful numbers:

• Mind Info line – 0300 1233393
• Samaritans – 116 123 (free at anytime, from any phone)
• Citizens Advice – 01482 328990 or 0300 3300 888 (e-advice@hull-eastridingcab.org.uk)