Bringing Solace to the NICU

Mothers whose infants end up in the neonatal intensive care unit (NICU) after delivery say their most difficult moment is when they are discharged from the hospital—without their baby. “They’re leaving their new baby, often inside of a plastic box, connected to machines, behind locked doors, and with total strangers,” says NICU psychologist Rochelle Steinwurtzel, PsyD. “I tell mothers I work with that it makes sense that they’re devastated—it’s the most unnatural thing for a mother to be separated from her baby.”

Infants often end up in the NICU after a pregnancy that did not go as planned. The parents may have struggled with infertility for years, or the mother had pregnancy complications that resulted in prolonged bedrest. Women often have had C-sections, very medicalized deliveries, or lost a lot of blood. They’ve delivered a baby that’s very premature, and that may not look anything like they expected. “It’s not surprising that stress and anxiety are very common experiences for these parents,” says Dr. Steinwurtzel.

CUMC researchers in the Nurture Science Program have demonstrated the importance to a child’s long-term emotional health of being talked and sung to, touched and held. But parents of NICU babies often say they’re afraid to touch their infants. “They tell me, ‘the baby’s skin is translucent, and her heartbeat, ribs, and every vein is visible, and she’s attached to all kinds of wires,’” Dr. Steinwurtzel says. “So I help them ask questions about what they can do with their baby.” Some parents are so traumatized and scared of what they are going to find when they come through the NICU doors that they don’t even visit their new baby, she says. Or they may live far away, have other children who are too young to come to the hospital, or have had to return to work while their babies are still in the NICU.

Sixty-five to 80 infants are in the NICU at any time, and Dr. Steinwurtzel works closely with the NICU’s three social workers, who assess every parent for signs of distress, and with the unit’s nurses, who, she says, “are the emotional umbilical cord between parents and the babies. Parents look to them to guide them to the babies.”

Dr. Steinwurtzel meets with as many of the families with infants on the unit as possible. “Parents who are depressed and anxious are less likely to attach well to their infants, and that lack of attachment can affect the child’s development in the long run, so when I meet with them I try to impart to them their critical role as parents,” she says. “I really work to strike a balance between helping them take care of themselves and also making sure they understand the value of their role in their babies’ lives.”

When the NICU staff identifies parents who need help, Dr. Steinwurtzel offers to meet them more regularly, “and for a lot of parents that is sufficient. Many feel they can’t talk with anyone about what they’re going through, so talking to me can help them feel less alone.” She also co-leads a support group for parents, where they can share their emotional experiences. “The emotions that come out in our group are extremely layered. There’s guilt, despair, joy, shame, worry, anxiety, trauma—and they can all exist at the same time.”

Because NICU staff members do not have a good sense of how many parents are really struggling and for how long, they are piloting a screening project to better describe the link between the baby’s medical experience and the parents’ emotional experiences. One benefit of this research project will be to make a better case for why more services are needed in these settings, says Dr. Steinwurtzel. “We’re very fortunate that CUMC’s neonatology administration supports me and my work, because it’s really rare to have a psychologist on a NICU. And that’s surprising since this area is rife with trauma.”

Dr. Steinwurtzel’s current research projects include:

• work with multidisciplinary teams in the NICU examining stress in parents
• attachment and comfort-related support interventions for families with infants on the cardiac unit
• a parent-to-parent mentor program designed to provide stress relief
• printed materials and in-person support services to help parents navigate the different stages of the NICU experiences
• qualitative and quantitative research investigating grief and growth in the context of trauma, in patient families as well as staff.