No “Typical” Birth: NICU Experiences and Post-traumatic Stress Disorder (PTSD)

Leslie Butterfield, PhD, Vice President, PATTCh

Having a baby in the Neonatal Intensive Care Unit (NICU) can be a heart-wrenching, overwhelming, and potentially traumatic experience.  Not only have many mothers just been through a harrowing birth experience, but the fragility of their baby is staggering, and the NICU itself is full of sights, sounds, and smells that are unfamiliar and anxiety provoking.  Research tells us that 15–53% of mothers and 8–33% of fathers with babies in the NICU suffer from Posttraumatic Stress Disorder (PTSD).  PTSD is enormously distressing for the individuals who are experiencing it, and can also negatively impact family relationships, including the marital bond and the attachment to the new baby.

Following a “typical” birth experience, parents return to a familiar home environment in which they interact with their baby in routine, repetitive ways. These interactions – including feeding, bathing, holding, and protecting the baby from harm and discomfort – allow each parent to develop a sense of competency as a parent. Feelings of competence allow us to develop an increasingly pleasant experience of attachment, one that offers a profound sense of connection and well being to both parents and child. When a baby hovers at the threshold of life vs. death, or experiences frequent ups and downs in terms of overall medical condition, parents are continually exposed to threats around the baby’s life or physical integrity.  Parents may notice that they alternate between feeling numb and wanting to avoid the NICU – or even the baby. They may be aware of re-experiencing their painful feelings in unexpected floods of emotion, repetitive dreams, or flashback types of experience.  The negative emotional valence of the NICU experience, together with compromised attachment, puts parents at high risk for all postpartum mood disorders, but particularly PTSD.

We can see that NICU parents are unable to provide the “usual” caretaking activities for their babies. NICU babies, in turn, are unable to engage in the usual infant behaviors (mutual gaze, breastfeeding, vocalizing, snuggling in) that engage parents emotionally.  Instead, parents and babies alike are subjected to bright lights, noisy machines, funny smells, frequent staff changes, and intrusive medical interventions.  The constant threat of loss or physical damage has a profound impact on parents in spite of the hard work and devotion of most NICU staff.

How can parents find relief? How can they avoid developing PTSD?  How can they lay the groundwork for fond attachment to their NICU babies in spite of all the difficulties?  First, it is important to redefine what it means to be a “good” parent.  In the NICU, good parenting might mean NOT doing all those things you would typically do with or for your baby.  Instead, it might mean keeping aural and visual stimulation of baby to a minimum. It might mean pumping breast milk for the baby’s feeding tube. It might mean learning how to monitor the life maintaining machines your baby is using.  The main thing is to recognize that you can still be a good parent, but it is going to look quite different from what you expected.

Second, keep a journal of the experiences you and your baby have.  Research suggests that journaling, in and of itself, offers psychological relief.  In addition, it gives parents a way to cohesively organize their otherwise chaotic and overwhelming experience.  Recent studies show that parents who can think about their own experiences in a clear, narrative way are better able to respond to their children’s needs without being “hijacked’ by their own tumultuous emotions.  Finally, journaling allows a future possibility of helping a child understand his or her own history as a contributor to the survival and healing process.

Third, seek help! There are numerous strategies being successfully utilized in the treatment of PTSD. These include Exposure and Response Prevention therapy (ERP), Eye Movement, Desensitization and Reprocessing (EMDR), cognitive behavioral therapy (CBT), and various forms of art and movement therapies.  Because many moms have been physically compromised themselves during the pregnancy or birth, and because they have such strong feelings of failure or shame about not being able to produce a “perfect” baby and protect him/her….healing in the physical body becomes much more of a necessity than it does in other losses.  Get a massage, go to yoga, take warm baths, go on long walks, get sleep, and eat well.  Taking care of your body at this stressful time can go a long way toward providing both prevention and healing.

Above all, remember that you are not alone, help is available, and you can feel better!


Leslie Butterfield, PhD is a clinical psychologist specializing in perinatal and reproductive health concerns. For twenty five years she has maintained a clinical and consulting practice (Transition to Parenthood) providing psychotherapy and designing workshops and trainings for organizations that provide perinatal services. She has worked with organizations such as University of Washington Maternal and Infant Care Unit, La Leche League, Catholic Family Services, Attachment Parenting International, and Pacific Association for Labor Support. Since 2010 she has been the Chairwoman of Postpartum Support International for Washington State and has recently assumed the Vice President position for PATTCh (an organization devoted to the Prevention and Treatment of Traumatic Childbirth). She has additionally been an instructor for the Seattle Midwifery School and the Department of Midwifery at Bastyr Naturopathic University for over a decade, developing and teaching a yearlong class in counseling skills for midwives.