Each year on the second Sunday in May, people across the United States and around the globe honor and celebrate mothers (Our use of the term “mothers” includes anyone who identifies as a mother, grandmother, gestational parent, or caregiver.) on Mother’s Day. This holiday is full of joy, celebration, pride, and gratitude for many. There may be hugs, handmade and store-bought cards, photos posted and shared on social media, breakfast in bed, family gatherings, flower bouquets, and tokens of appreciation. Mother’s Day can be challenging and emotionally fraught for some, including mothers with an infant hospitalized in a neonatal intensive care unit (NICU). With the help of NICU staff and providers, mothers can anticipate and cope with the challenges and emotions that they may experience this Mother’s Day, on May 8th. This article will discuss the emotions and challenges NICU mothers may experience on the holiday and suggest ways to acknowledge, support, and celebrate NICU mothers and caregivers.

Parents in the NICU may grieve the loss of anticipated postpartum plans and ex- periences, such as caring for and bonding with their baby at home. Mothers in the NICU may also grieve the loss of expected holiday events and experiences (1). Grief is one of the many normal and common reactions NICU parents may have. On Mother’s Day and the days surrounding this holiday, mothers in the NICU may feel disappointed, disheartened, and sorrowful if their expectations, visions, and anticipations for Mother’s Day do not match their current reality—one that is often characterized by long hours at their baby’s bedside and concern and worry about their baby’s health and survival. Current realities may also involve difficult decisionmaking about treatment options and end-of-life care. NICU parents may be juggling multiple responsibilities, such as caring for older children and work. Parents may also experience physical separation from their baby when the gestational parent is recovering from childbirth, the baby is in an isolette, the baby is undergoing a surgical procedure, or when parents leave the hospital to go home or to their temporary residence. Furthermore, by spending time in the NICU, mothers may miss traditional family gatherings and their usual Mother’s Day celebrations (1). Not being present for these events may exacerbate feelings of isolation as many families begin to reunite after separations due to COVID-19 restrictions.

Some mothers in the NICU may have difficulty or delays in forming their maternal identity due to limited opportunities for caregiving and interacting with their infant, shared caregiving responsibilities with NICU staff providers, disrupted mother-infant bonding, perceived lack of control, and increased psychological distress (2–5). Difficulty or delays in forming maternal and parental identity are part of an array of normal reactions and experiences that a parent may have. In a qualitative examination of NICU mothers’ perceptions of the development of their maternal role in the context of NICU, the thematic analysis revealed that some respondents characterized themselves as mothers only while they were in the NICU; they reported not feeling like mothers when they left the hospital because they were not with their babies or serving as a primary caretaker (3). Researchers have found that mothers’ perceived loss of parental role was one of the most stressful aspects of their infant’s NICU hospitalization (6,7) predictors, and child outcomes associated with NICU-related stress for mothers of infants born very preterm (VPT). For mothers in the NICU who have not yet fully developed their maternal identity or perceive a loss of their parental role, Mother’s Day may feel conflicting and isolating. Of note, mothers in the NICU who have experienced neonatal losses or are anticipating and planning for neonatal loss may experience an intensification of grief and have particularly difficult emotional experiences on Mother’s Day.

We encourage NICU staff and providers to thoughtfully acknowledge and celebrate mothers and caregivers in the NICU this Mother’s Day. Listed below are some suggestions:

Acknowledge Mother’s Day 

Staff and providers can communicate their acknowledgment of Mother’s Day, even when it may not be a “happy” Mother’s Day for mothers and other caregivers in the NICU. If this is the case, instead of wishing mothers a “happy” Mother’s Day, one can express, “I am thinking about you today on Mother’s Day.” 

Validate and reflect emotions 

NICU staff and providers can help mothers and caregivers cope with emotions that may arise during this holiday by validating and reflecting on mothers’ expressed feelings. Offering opportunities for parents to share their feelings by asking open-ended questions about how they are feeling and allowing time to listen to the responses can be very empowering for parents. Responding with statements that validate their experience also can be very helpful. For example, one could respond to a mother who expresses grief about the loss of expected Mother’s Day experiences by stating, “it makes sense why you would feel especially sad and disappointed today.” 

Provide opportunities for caretaking 

If possible, NICU staff and providers can find ways for parents to interact with their babies more on Mother’s Day. For example, mothers could be encouraged to take on a meaningful hands-on caretaking task, like feeding or bathing their baby or changing a diaper. Mothers also can be encouraged to engage in skin-to-skin care. 

Encourage mothers to communicate with their babies 

On Mother’s Day, NICU mothers can communicate and bond with their babies by reading them a book, story, or poem. Mothers could write and share a personal letter to their babies about their love, their family, and what it means to be their mother. Mothers may also wish to sing to their babies. 

Praise mothers’ efforts to care for their babies 

On Mother’s Day (and regularly), NICU staff and providers are encouraged to acknowledge and praise mothers’ efforts to care for their babies in the NICU. A simple phrase like “you are doing a great job” can be meaningful and impactful to mothers who may be lacking confidence and feeling uncertain about their maternal role. 

Encourage mothers to attend parent support groups 

NICU staff and providers can encourage mothers to attend parent support groups on Mother’s Day. Peer sharing of positive and negative maternal experiences in NICU support groups can strengthen social relationships and networks, provide therapeutic benefits, foster feelings of safety and comfort, and encourage parent advocacy (3,9). On Mother’s Day, NICU parent support groups can feature topics related to Mother’s Day. Mother’s Day themed activities, such as scrapbooking, crafting, and even expressive writing or journaling that allow for both positive and adverse feelings can also be incorporated. 

Create cards or keepsake gifts for mothers 

There are several ways Mother’s Day can be celebrated in the NICU. One way to celebrate the holiday is for NICU staff to take a photo of each baby or each mother with their baby and put it inside of a card that can be placed by the baby’s bedside. Staff may also wish to create small keepsake gifts for mothers. At Denver Health Medical Center, NICU nurses make keychains to give to each mother (8). Each keychain contains a photo of the mom with their baby. 

Enlist volunteer assistance from past NICU graduate families 

Staff and providers can consider enlisting volunteer assistance from past graduate families of the NICU to help support and celebrate mothers in the NICU on Mother’s Day (1). Former NICU mothers and caregivers with first-hand lived experience and expertise could write cards with encouraging and supportive messages to current NICU mothers and assist with running parent activity groups. 

It is important to remember that each mother in the NICU will experience Mother’s Day differently, and some families may not be open to celebrating or participating in Mother’s Day activities. 

As a final note, we would like to acknowledge NICU staff, providers, and readers this Mother’s Day. We recognize those who are mothers, grandmothers, and caregivers. We recognize those who have or have had infants hospitalized in the NICU. We recognize those who have lost children and those who have lost mothers. We recognize those with strained relationships with their mothers, those with strained relationships with their children, those who have chosen not to be mothers, and those who are yearning to be mothers. We honor you all and wish you a peaceful Mother’s Day. 

References:

1. Spiecker NC, Geller PA, Patterson CA. Coping with Infant Illness in the NICU During the Holiday Season. Neonatology Today. 2019 Dec;14(12):46–8.

2. Lean RE, Rogers CE, Paul RA, Gerstein ED. NICU Hospitalization: Long-Term Implications on Parenting and Child Behaviors. Curr Treat Options Pediatr. 2018 Mar;4(1):49-69. Epub 2018 January 24th. PMID: 29881666.

3. Rossman B, Greene MM, Meier PP. The role of peer support in the development of maternal identity for “NICU Moms”. J Obstet Gynecol Neonatal Nurs. 2015 Jan-Feb;44(1):3-16. doi: 10.1111/1552-6909.12527. Epub 2015 January 7th. PMID: 25580732.

4. Chertok IR, McCrone S, Parker D, Leslie N. Review of interventions to reduce stress among mothers of infants in the NICU. Adv Neonatal Care. 2014 Feb;14(1):30-7. doi: 10.1097/ANC.0000000000000044. PMID: 24472886.

5. Turner M, Chur-Hansen A, Winefield H. Mothers’ experiences of the NICU and a NICU support group programme. Journal of Reproductive and Infant Psychology. 2015 March 15th;33(2):165–79.

6. Woodward LJ, Bora S, Clark CA, Montgomery-Hönger A, Pritchard VE, Spencer C, Austin NC. Very preterm birth: maternal experiences of the neonatal intensive care environment. J Perinatol. 2014 Jul;34(7):555-61. doi: 10.1038/jp.2014.43. Epub 2014 March 20th. PMID: 24651730.

7. Baía I, Amorim M, Silva S, Kelly-Irving M, de Freitas C, Alves E. Parenting very preterm infants and stress in Neonatal Intensive Care Units. Early Hum Dev. 2016 Oct;101:3-9. doi: 10.1016/j.earlhumdev.2016.04.001. Epub 2016 July 6th. PMID: 27393922.

8. Celebrating Mother’s Day in the NICU [Internet]. Denver Health. 2020 [cited 2022 Apr 3]. Available from: https://www.denverhealth.org/news/2020/05/celebrating-mothers-day-in-the-nicu

9. Hall SL, Ryan DJ, Beatty J, Grubbs L. Recommendations for peer-to-peer support for NICU parents. J Perinatol. 2015 Dec;35 Suppl 1(Suppl 1):S9-13. doi: 10.1038/jp.2015.143. PMID: 26597805.

Disclosure: The National Perinatal Association www.nationalperinatal.org is a 501c3 organization that provides education and advocacy around issues affecting the health of mothers, babies, and families.