We spoke with Helen Aitchison, Psychotherapist at Barts Health NHS Trust, about how health professionals can support parents and themselves.
We have also included some statistics from a survey Bliss ran of parents who have had a neonatal experience – they shared information with us about how that impacted their mental health.
Helen Aitchison, Psychotherapist at Barts Health NHS Trust, told us:
“It’s important for health professionals on a neonatal unit to recognise that many parents of premature or sick babies have had a traumatic birth experience, and the psychological impact of that may continue and be made worse by being on the neonatal unit.
“Many neonatal units sadly do not have specialised mental health support in place. That’s why it is crucial for healthcare professionals on a neonatal unit to familiarise themselves with the symptoms of perinatal mental health problems.
“Being able to recognise the symptoms of perinatal mental health problems can help staff tell the difference between normal psychological reactions that may require a ‘watch and wait’ approach, and more long-term or severe conditions which may need a referral for psychological assessment and treatment. We know that mental health problems can harm a parents’ relationship with their baby, which can later impact the child’s development.”
95% of survey respondents told us that they ‘strongly agree’ or ‘agree’ that their mental health was negatively affected by their baby/babies’ neonatal stay.
Here are Helen’s recommendations to support parents on the neonatal unit:
Be kind and compassionate. Being on a neonatal unit can be one of the most terrifying and distressing things that can happen to a parent.
Be welcoming and smile when they come on to the unit. Many parents have said that when staff don’t smile, they assume that something is wrong with their baby.
Spend time with them, when you’re able to. Sitting next to the cot can be a lonely and frightening place. Parents have told us that they sometimes didn’t feel able to talk to neonatal staff because they were busy treating babies, or because parents didn’t realise that staff are there to support them too. Even a few minutes with parents can make a difference.
More time to talk things through with staff [would have been useful support]. They are so busy, I felt bad taking them away from patient care to talk about anything.
Listen to them and answer their questions as best you can. Be patient if they need you to repeat anything. If they are struggling, acknowledge their distress, and ask what help they feel they need. You can signpost families to Bliss’ website or direct them to [email protected] which may help answer some of their questions and support them while they are on the unit and beyond.
Contact the multidisciplinary team. Make them aware of anyone who is struggling so they can coordinate ongoing support.
Involve them as much as you can in their baby’s care. Help them feel like they are “being parents”, have some degree of control over what’s happening and have a sense of purpose. Show parents our pages on being involved in their baby’s care to support them in being involved.
Ask who is supporting them. Are there friends and family around? If not, help them think about who might be able to offer support and develop a plan for when the baby is discharged.
In our mental health survey, the largest proportion of support for parents came from speaking with friends and family (22%).
Connect with other professionals involved in their care. This could include case workers or counsellors, so there is a network of people aware they need support.
Find out what they are doing when they are not visiting the hospital. Encourage self-care, exercise, keeping up with things they enjoy, seeing friends and family around commitments like work and looking after other children.
Help them access useful resources and support organisations. This could be support within the unit or hospital, such as chaplains, or external community groups or charities.
Our Bliss Champions are volunteers who are trained to understand neonatal care and experienced in supporting families. They are available on some units and for one-to-one conversations via video call.
Think about their ability to access support. Do they have a language barrier? Do they need more help to understand their options?
Refer to their GP. If they need further medical support, the GP will be able to help.
Parents have told us that getting to know the many different staff and how their individual levels of compassion vary can be a source of anxiety for them.
Here, Helen shares her guidance on what healthcare professionals should look out for when meeting with parents on the neonatal unit:
Use observational and listening skills to pick up how parents are feeling and coping. As health professionals you have invaluable experience of being with people; what are you hearing and seeing? What do you feel? Speak to the parents separately, if you can, to give each one a chance to speak openly about any birth trauma or distress they are experiencing.
Listen carefully. Parents may be subtly telling you they are struggling with their mental health but do not want to tell you explicitly for fear of being judged as a ‘bad parent’. It can take a while to build up trust with some parents. Don’t necessarily take ‘I’m fine’ at face value; it’s always worth exploring a bit more. This might mean coming back on a different day to ask again, keep checking in and create lots of opportunities for families to talk to you, don’t just ask once.
See how they’re interacting with their baby. Feelings of anxiety and low mood can come from not understanding their role on the neonatal unit and they may need support in caring for their baby. Encourage them to bond with their baby by being involved in their care.
Check if they are caring for themselves. Do they look well? Tired? Unkempt? Are they taking breaks for food and water? Do they seem withdrawn and unable to engage with you in a conversation? Are they displaying signs of worry and anxiety without being able to feel reassurance from staff on the unit?
Notice how often they are visiting. If they come rarely, then it might be worth exploring why this is the case. It may be that it is a long way to travel, or they have other childcare commitments, however it might also mean that they are avoiding coming in due to anxiety or the trauma of the experience. Similarly, if parents are there all the time, think about whether they are looking after themselves, and consider exploring how they can get some rest. It could also be a sign of anxiety about leaving their baby.
Many parents find it hard to be told to go home if it means leaving their baby on the unit. If there are options for parents to rest somewhere nearby, this might help.
Financial concerns can also impact how often parents might be visiting. Let them know their what support is available for them if they are struggling as this often brings a lot of worry and guilt. You can also direct them to Bliss’ financial information and support hub.
Ask about their mental health history, what treatment have they had/are they having (if any) and how they coped, in a sensitive and supportive way. Past (and current) mental health problems increase the risk of someone becoming unwell in the perinatal period.
Although uncommon, postpartum psychosis is a severe mental health condition that usually occurs in the first few weeks after giving birth and needs immediate psychiatric assessment and treatment. Learn about symptoms including hallucinations, delusions and mania, and always refer the parent for immediate assessment if you have any concerns.
Be aware of any changes in parents’ mood, and their behaviour and interactions during their time on the unit. Some parents’ reactions to the trauma of birth will transition over time, however if the symptoms appear to remain, for example, low in mood or anxiety over a number of weeks, then this may indicate a more chronic problem.
If you think someone is struggling, discuss it with the multidisciplinary team so that a support plan can be put in place whilst the baby is in the unit. If appropriate, work with other professionals involved in their care – for example a social worker, midwife, or counsellor in order to create a support network around the family.
You might want to discuss referral to their GP or local perinatal mental health services if you think that they need more specialist input.
In this clip from our longer podcast focusing on the experiences two Black parents had while their babies were in neonatal care, Manuella shares how she felt she needed to stay quiet and not complain about anything to the staff on the unit.
I didn’t feel ready [to talk to anyone], like if I opened up, I would crack and fall apart.
Helen also shares some tips about how to look after yourselves as staff on a neonatal unit:
Further sources of information include:
Faiths, beliefs, cultures and communities | Child Bereavement UK
Neonatal care: parents may need long-term psychological support
Psychology Staffing on the Neonatal Unit | ACP UK
Psychosocial support provision for parents: an audit of UK neonatal units | Article | Infant journal
Recommendations | Antenatal and postnatal mental health: clinical management and service guidance
Supporting mental healthcare in a maternity and neonatal setting | NHS England
