Defining the Emotional Toll of High-risk Pregnancies

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In Utero Insights

A high-risk pregnancy takes an emotional toll on expectant parents, and newborn admission to the NICU further elevates the risk for psychological distress in parents after birth. Our multidisciplinary Psychosocial Support Team works closely with our medical and nursing teams and offers a wide array of counseling and supportive services to help parents and families cope and feel emotionally supported through the time of fetal diagnosis and beyond neonatal discharge.

Mental health screening tool

A key interest of the team is determining the rate of perinatal mood and anxiety disorders in expectant parents in order to create standards for mental health care services within the center. We have developed a universal mental health screening tool to identify significant symptoms of depression, anxiety and traumatic stress among parents with babies with birth defects.

The goal of the tool is to help better identify the potential risks for psychological distress prenatally so the team can decrease it prior to the postnatal period. Rather than waiting to screen women at their six-week postpartum visits, our center has incorporated the screening tool into routine practice at two points: two to three weeks after parents receive the fetal diagnosis, and after parents visit their newborns in the NICU one to two days post-birth.

Obstetric nurses are uniquely positioned to leverage their roles in the daily care of mothers, their partners and their critically ill newborns to develop a holistic approach to supporting psychosocial health for the family unit in the early postpartum period. A system for mental health triage and referral to one of our in-house psychiatrists, psychologists or social workers is available for parents at elevated risk.

This research helps to identify the unique risk factors within this vulnerable population so that therapeutic intervention can be implemented at the earliest point of care, with the goal of decreasing symptoms of trauma and depression in pregnancy and within the postpartum period.

Screening results have inspired me and my team to create ongoing psychosocial programming to help parents and families mentally prepare and better cope with the diagnostic uncertainty. Early perinatal intervention has been shown to increase levels of personal control, minimize anxiety and depressive symptoms, and reduce traumatic stress after birth. One of the program initiatives is Serenity Sessions, a weekly therapeutic support group where mothers and partners learn mindfulness stress reduction techniques to help reduce symptoms of sadness and worry.

Perinatal Palliative Care and Bereavement Program

We have also helped develop the Perinatal Palliative Care and Bereavement Program, which helps families plan for and cope with the death of a baby or the knowledge that their baby might not survive long after birth. For those parents who give birth in our Garbose Family Special Delivery Unit and experience an intrauterine or neonatal loss, the program sends surveys one year after the loss to better understand how parents were cared for while on the unit as well as how families cope, in order to improve patient care and contribute to the limited literature about perinatal loss. Currently, the team is writing a manuscript to describe the program’s development of a bereavement outreach program. In addition, we will be publishing results from the fathers’ bereavement survey that highlights the male perspective of perinatal loss.

Milk donation

Some expectant women who have chosen perinatal palliative care support due to a life-threatening fetal diagnosis may choose to donate their breastmilk in the postmortem period. My colleagues within the nursing and midwifery groups and I recently published an article that offers insight into the complexities within the patient experience of milk donation and aims to help providers discuss milk donation within the context of palliative care with patients and families. In the article, two patients shared their personal stories and how they utilized milk donation as a way to support their grief processes.


Cole JCM, Olkkola M, Zarrin HE, Berger K, Moldenhauer J. Universal postpartum mental health screening for parents of newborns with prenatally diagnosed birth defects. J Obstet Gynecol Neonatal Nurs. 2018;47(1):84-93.

Cole JC, Moldenhauer JS, Berger K, Cary MS, Smith H, Martino V, Rendon N, Howell LJ. Identifying expectant parents at risk for psychological distress in response to a confirmed fetal abnormality. Arch Womens Ment Health. 2016;19(3):443-453.

Cole JCM, Schwarz J, Farmer MC, Coursey AL, Duren S, Rowlson M, Prince J, Oser M, Spatz DL. Facilitating milk donation in the context of perinatal palliative care. J Obstet Gynecol Neonatal Nurs. 2018;47(4):564-570.

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