Breaking the Silence on Preterm Labor and Maternal Mental Health
Introduction
While many expect childbirth to have positive outcomes for both the mother and baby, not all pregnancies go as planned. Preterm labor, which occurs when regular and intense contractions happen before 37 weeks of gestation, affects a small percentage of pregnancies. In this blog, we will delve into the topic of preterm labor and its impact on the mother's mental health, including the specific mental health issues that can arise and the importance of support and care for both the mother and her family when dealing with a baby born with low birth weight.
Preterm Labor
Approximately 13% of pregnant women experience preterm labor before 34 weeks of gestation, characterized by symptoms such as mild and irregular contractions, low back pain, vaginal spotting or bleeding, and ruptured membranes. The main causes of preterm labor include infection, antepartum hemorrhage, and multiple pregnancies. Preterm labor can be confirmed through physical examination, ultrasound, and laboratory tests.
The management of preterm labor typically focuses on controlling infection and protecting premature babies from Respiratory Distress Syndrome. If the baby is less than 34 weeks and birth is not imminent, doctors may administer medication (tocolysis) to slow down labor and Steroids (Betamethasone) to develop the baby's lungs. In cases of preterm labor between 24-32 weeks of gestation, doctors may use Magnesium Sulfate for the baby's neuroprotection.
Preterm labor can be an emotionally distressing experience for the expectant mother, who may experience fear, stress, and anxiety, as well as her family, who may be concerned about the care of the premature baby. Depending on the gestational age and medical conditions of both the mother and fetus, the premature baby's birth weight can range from 400-2500 grams. A birth weight of less than 1500 grams often indicates that the baby's care will be complex and associated with a high morbidity and mortality rate, which can lead to postnatal anxiety, depression, or Post-Traumatic Stress Disorder (PTSD) for the mother.
If the baby or mother's condition is clinically unstable, delivery of the preterm baby is typically done through emergency cesarean section. In this case, the father is usually not permitted to be present during the procedure.
The Psychological Trauma related to preterm birth
Approximately 40% of mothers with low birth weight babies reported experiencing significant depressive symptoms as measured by the Edinburgh Postpartum Depression Scale (EPDS). Postnatal depression can impede the bonding process between the mother and baby and negatively impact the mother's relationships with others.
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The ongoing care for a preterm baby after the delivery
The ongoing care for a preterm baby after delivery can be a challenging and emotionally distressing experience for the mother. In cases of emergency delivery, the mother may not have enough time to fully understand her and her baby's situation before the delivery. Recovery from an emergency cesarean section is also typically slower than vaginal delivery. The premature baby will be transferred to a neonatal intensive care unit (NICU) for intensive medical care after initial resuscitation, which can impact the bonding process between the mother and baby both physically and emotionally. The length of separation can vary depending on the baby's progress, but a couple of months in NICU is standard for premature babies with a very low birth weight of under 1000 grams.
However, in many developed countries, such as New Zealand and Australia, mothers and their families usually have full access to visit their babies in NICU, and mothers are encouraged to stay with their babies as much as possible. Many neonatal teams also recommend "Kangaroo care," which is the practice of skin-to-skin contact between the mother and baby to promote bonding. The nursing team encourages the mother to provide primary care for the baby during her visits, such as changing diapers, cleaning the baby's face, and washing clothes. If the baby is able to breastfeed, the mother is supported by the nursing staff, midwife, or lactation consultant in establishing breastfeeding as early as possible.
In addition, some tertiary hospitals have specialized mom and baby units within the NICU that provide family-centered care, such as a tea room, a bed for the mother to rest, and private rooms for breastfeeding mothers to pump in a warm and comfortable environment to reduce fear and anxiety.
My Reflection On Preterm Labor-related Postnatal Depression
In my 15 years of midwifery practice in New Zealand and Australia, I have delivered over 1000 babies, with the majority being born between 37-42 weeks. However, approximately 10% of the babies were born between 25-36 weeks, with birth weights between 500 grams and 2500 grams. I have observed that when preterm labor occurs, especially with very immature and low birth weight babies, standard care includes a prolonged stay in the neonatal intensive care unit (NICU) for a couple of months. In most cases, the outcomes for the babies are positive, but their long-term motor, immune, and neurological development requires continued monitoring.
Furthermore, I have noticed that almost every woman who has a premature baby experiences different levels of emotional stress and depression six weeks after delivery. Some of them require additional social and financial support, and those with stable relationships during stressful times seem to fare better. The women were screened for postnatal depression by the NICU team and/or their midwife using the Edinburgh Postpartum Depression Scale. If a mother showed any symptoms or signs of postnatal depression, she was referred to a mental health team in the same facility for further support.
Conclusion
In conclusion, Premature birth, particularly in cases of low birth weight, can have a significant impact on a mother's mental health. It is important for healthcare providers to use robust screening tools, such as the Edinburgh postpartum depression Scale, to identify and diagnose antenatal and postnatal depression early on in order to minimize the risk of maternal mental health disorders.
As someone who is passionate about women's mental health, I am dedicated to serving women globally through my medical, midwifery, and spiritual practice. I have founded Childbirth Collective, a global community for childbirth healing, which aims to empower and support women in healing any childbirth-related trauma through holistic and integrated healing programs.
If you have any fears, doubts, anxieties, or concerns about pregnancy and childbirth due to a previous experience of premature birth, please click the button below and let me help you right now.
Reference:
https://www.uptodate.com/contents/premature-birth
