Postpartum depression affects 1 in 7 mothers nationally and 1 in 5 mothers in Illinois. Typically, mothers in Illinois receive a depression screening at the first infant pediatrician appointment, approximately one week postpartum. However, neonatal intensive care unit (NICU) infants born before 30 weeks gestation may be hospitalized for months, and mothers of critically ill newborns are at a higher risk of depression, anxiety and post-traumatic stress related to traumatic birth experiences and infant conditions.
According to the Centers for Disease Control and Prevention (CDC), mothers coping with these symptoms have more difficulty caring for their child. Support at the bedside helps keep mothers actively participating in their infant’s care and improves parent engagement. Advocate Children’s Hospital Oak Lawn developed a support service for new mothers in the NICU that significantly reduced symptoms of postpartum depression—the Therapeutic Listening Program.
How the program works
The Therapeutic Listening Program is a nurse-led initiative designed for the population and demographics of Advocate Children’s Hospital’s Oak Lawn NICU. It began with a multidisciplinary task force that developed a protocol and process for postpartum depression screenings. The task force included a NICU social worker, child life specialist, music therapist, developmental nurse specialist, and members of the pediatric rehabilitation team.
The program uses the Edinburgh Postpartum Depression Scale (EPDS) to screen all mothers with infants born before 30 weeks, or mothers referred by the bedside team. If their score meets the threshold determined by the protocol, they are offered supportive therapeutic listening sessions. These one-on-one sessions with a therapeutic listening nurse focus on the medical care of the infant and the parental stress associated with caring for an infant in the NICU setting. Topics covered include:
- Birth experience
- Anxiety management
- Sleep hygiene
- Reflective listening
- Cognitive-behavioral techniques
- Collaborative solution building
The nurse providing the sessions is perinatal mental health certified (PMH-C) and skilled in NICU infant conditions, bedside care and communication with NICU parents. The nurse’s goal is to bridge the information gap with the medical team and help engage the parent at the bedside with infant care. All mothers sign paperwork explaining that the program is not a replacement for mental health therapy.
After the session, the nurse performs a second EPDS screening to measure the program’s effectiveness and provides group sessions to continue building on the coping skills developed during the one-on-one sessions. All NICU parents are welcome to attend this support group, facilitated through Zoom.
Program results
The team kicked off the program during the NICU’s first annual Mental Health Awareness Week, which incorporated events for parents focused on mental health education and resources. During the week, providers screened 10 NICU mothers using the EPDS, with eight of them qualifying for the one-on-one sessions with the therapeutic listening nurse. Five mothers with the highest scores were referred to the listening visits, and three were placed on a wait list and given other supportive service resources. All mothers were invited to participate in the support group “Managing Stress in the NICU.”
Over three months, 30 mothers received screenings. Nineteen (67%) met the EPDS threshold for mild-to-moderate postpartum depression/anxiety. Fourteen of them completed the therapeutic listening program and took the EPDS assessment after the program and before discharge. All 14 showed a decrease in scores. Twelve mothers (86%) were considered non-symptomatic after the listening sessions. Half of the mothers screened continued to attend the “Managing Stress in the NICU” group sessions facilitated by the therapeutic listening nurse until the infant’s discharge.
EPDS scores before and after therapeutic listening sessions
