Every year, 10 to 15% of babies born in the U.S. end up in the NICU (neonatal intensive-care unit), with preterm births being the leading cause. The length of stay in a NICU varies, ranging from 4.9 days among infants born at 39-41 weeks to 46.2 days among infants born prematurely at 32 weeks or earlier. It’s no surprise that parents face unique hardships when returning to work after this experience. And the impact on companies can be profound from a retention, productivity, and cost standpoint. Here, Jackie Stone, M.D., a Maven OB-GYN, shares her insights on the work-related challenges and potential solutions.

Q. What challenges do parents of NICU babies face when they return to work?

Any expectations a parent may have had of joy-filled moments with a newborn are often tempered as soon as their baby is whisked away to the NICU. Instead of thinking about heading home with their little one, they’re having difficult conversations about an ongoing stay in the hospital.

To understand the challenges of returning to work, first you have to understand the challenges surrounding leave for all parents—regardless of any complications. Unfortunately, the only federal law (the Family and Medical Leave Act (FMLA)) guaranteeing maternity leave in the U.S. is unpaid—and it doesn’t apply to all employees. Sure, some parents are lucky to be employed by one of the private employers that fund paid parental leave, but this is by no means the majority.

This means that for many people, leave time is too short. And when a baby has had a stay in the NICU, parents may be forced to parse out whatever leave they do have in ways that aren’t ideal. For instance, I’ve had patients return to work within just one week of giving birth (leaving other relatives to spend time with a baby who is still in the NICU and could be there for months) just to save what maternity leave they had for when their baby got to come home from the hospital. Other patients have spent all of their paid and unpaid leave by their new baby’s side in the NICU, only to return to work days after bringing their baby home.

“The first thing is to make sure that parents have sufficient leave time (ideally paid) so that they can be with their infant in the NICU and still have some time with their infant after they come home.”

Q. What mental health challenges do parents face following a child’s stay in the NICU?

Research shows that parents of babies in the NICU are diagnosed with post-traumatic stress disorder (PTSD) at an alarming rate. One study showed that up to 60% of mothers and 47% of fathers develop PTSD within a year of their infant being admitted to the NICU. Another recent study found that symptoms of anxiety, depression, and PTSD can persist for months after a child is out of the NICU. It’s important to note that these symptoms are also common among parents of moderate and late-preterm infants (32-36 weeks) who usually thrive and ultimately do well—not only in parents of very preterm infants who typically have poorer outcomes.

Q. What are some ways that parents’ work lives are affected after having a baby in the NICU?

The symptoms related to the mental health issues I mentioned above—such as anxiety, depression, and PTSD—can have a direct impact on work. For instance, sleep deprivation and changes in mood can lead to decreased work performance when left untreated and when parents don’t have the support they need. What’s more, some very premature infants may have ongoing health problems, requiring that parents have more access to pediatricians and other doctors even after a baby leaves the NICU. Without a convenient way to check in with practitioners, parent may endure an added work stress of physically running to doctor’s appointments more than they need to.

Q. What do you wish everyone better understood about the experience about having a baby in the NICU?

While parents who experience a perinatal loss (a stillbirth or a baby who dies soon after birth) need to grieve, parents who have babies in the NICU may also go through a grieving process. They were likely expecting a normal, full term birth and a healthy baby—and accepting a different reality means grieving a huge loss.

Q: How can companies better support employees in this situation?

The first thing is to make sure that parents have sufficient leave time (ideally paid) so that they can be with their infant in the NICU and still have some time with their infant after they come home. I’ve seen so many parents unable to fully focus on their infant’s health needs as they would like to because they are concerned about losing their jobs if they do not return to work.

Another area where there’s plenty of room for more support: parental mental health. Access to mental health services for parents whose infants are in the NICU is vitally important. In fact, studies show that elevated maternal anxiety predicts worse outcomes for infants in the NICU. Cognitive-behavioral therapy, which can be done via telemedicine while the parents are in the hospital, has been shown to improve symptoms of anxiety in mothers with infants in the NICU. It’s also one of the mainstays of treatment for PTSD and depression. Often, medications to treat this disorder can also be prescribed via telemedicine.

Lastly, parents need convenient access to practitioners they trust as well as Care Coordinators who can help them navigate their next steps. There are so many things parents have to wrap their heads around that they may not understand—including hospital protocol for NICU babies and medical procedures their little one may need to receive. Making it easier for them to ask questions of trusted providers or get a second opinion can quickly alleviate their anxiety.

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