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Last May, when Afton Shaw was 34 weeks pregnant, she came down with several agonizing headaches that were determined to be signs of severe preeclampsia. She was sent to the hospital for an emergency cesarean section, after which her new baby was whisked off to the neonatal intensive care unit (NICU), while she spent a week in the hospital recovering.

A few days prior to Mother’s Day, she was well enough to go home.

“Leaving him on the Wednesday before Mother’s Day was horrifying. I don’t know how else to describe it,” said Shaw, 34.

On the holiday itself, her feelings yo-yoed wildly. Shaw and her husband brought their two older children to the NICU ― it was the first time the whole family had been together in one room.

“It was wonderful but also heart-wrenching,” Shaw recalled. “I knew I’d have to leave him. It was so hard.”

When a baby is admitted to the NICU for any length of time and for any reason, it can take a toll on parents’ mental health. Around 70% of moms with babies in the NICU develop some form of postpartum depression. And up to a quarter experience at least some symptoms of post-traumatic stress disorder.

Mother’s Day — marketed to American families as an obligatory day of celebration, upon which we spend more than $23 billion a year ― can be fraught for women whose babies are in the NICU fighting for their lives. Every day in the NICU has the potential for emotional turbulence, but health care workers say they see firsthand that Mother’s Day is almost universally hard.

“To not acknowledge the emotional significance of this day would be to do a disservice to our families,” said Dr. Rachel Chapman, medical director of the newborn and infant critical care unit at Children’s Hospital Los Angeles.

“The experience, particularly for our brand-new mothers, is not anything that anyone imagined,” Chapman said. “It’s not breakfast in bed. It’s not cuddling with your kids. It’s ‘I have to get up and go visit my critically ill baby.’”

Many hospitals have made a concerted effort to be sensitive to that fact. At Children’s Hospital Los Angeles, for instance, staff take photos of all the babies in the NICU and place them in cards in front of their cribs or isolettes, so they are the first thing the mothers see when they come for a visit. Social workers and peer support groups talk about how to handle the emotions of the day.

“It’s not breakfast in bed. It’s not cuddling with your kids. It’s ‘I have to get up and go visit my critically ill baby.’” - Dr. Rachel Chapman, Children’s Hospital Los Angeles

Chapman said that when possible, staff will also encourage special moments of bonding. For a mom who perhaps hasn’t been able to touch her baby yet, “nurses and staff will say, ‘How can I help you get your hand in there?’” Chapman said. “Or ‘Today is a good day for skin-to-skin.’”

For Sarah Genovese, Mother’s Day 2013 was the first day she was able to hold her twins at the same time, after they’d already spent 31 days in the NICU.

“It was a huge day for us,” Genovese, 37, recalled. “To finally have them back together and hold them together.”

At the same time, the day brought to the surface feelings of uncertainty she had about her new role, exacerbated by the facts that she could not hold and feed her children all the time and that for much of the day and night they were being cared for by other people.

“You know you’re a mom, but it’s hard to feel like you’re a mom,” Genovese said. “You’ve got a piece of paper that says you’re a mom, you know they’re yours, but you’re kind of detached.”

After visiting the twins on Mother’s Day, her husband suggested they head out to brunch to mark the occasion. At the restaurant, servers handed out flowers to all of the women who were clearly there celebrating, but with no kids around her, Genovese was skipped over. At home afterward, she sat in their unfinished nursery, pumped and wept.

Other NICU moms struggle with the logistics of the day, particularly when they have older children at home.

“All signs pointed to my twins coming home before Mother’s Day, but they’re keeping them there to make sure everything’s OK,” said Michal Lopatin, 39, who gave birth to twin girls at 32 weeks last month.

Lopatin plans to celebrate part of the day in the NICU with her babies and part of the day at home with her two other kids. Her own mother will also be coming in for a visit.

At the same time, Lopatin is feeling hormonal and still reeling from her C-section, adding a layer of physical challenge to an already complex day.