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Thursday
Aug112011

Ignorant Bliss

I had a doula-friend ask me a question about one of the babies she saw born a few weeks ago, a baby that she can’t stop thinking about, so she finally decided to ask me what she should have done and if there’s anything she should do now. 

The baby was born, had some stress during the birth (meconium, needing a little bit of resuscitation), but did okay afterwards. The baby looked sort of odd to the doula and one of the nurses confided in her she thought so, too. There were a couple of reasons the baby could stay in the NICU for a couple of days, so he did and some tests were run. Infection? Nope. Omething physical? Nothing they could find. He’s home now with his parents, nursing is going so-so, but how unusual is that, right? 

The doula wanted to know if she should tell the mom that something is bothering her, that she still thinks something’s going on with the kid. This is my answer. 

Sometimes it can be hard to decide what to say and not say. And saying it as a doula is totally different than as a midwife who was hired to care for the mom and baby. Since the hospital’s seen the kid and he’s doing well so far, this is the place of watchful waiting. Or, a better attitude perhaps, one of release. 

Because I know you’re considering midwifery, I’ll speak to that, too. It’s great you’re worrying about the baby, wondering if you should tell the mom your thoughts and concerns. But, I encourage you to stay in the “What would I do if I were the care provider?” place instead of becoming the care provider. I know it can be frustrating as all get out when the hospital and pediatrician sends a baby home without answering the initial (and subsequent) question/s, but we have to believe they’ve looked at the most obvious causes and ruled them out. Could they have missed something? Of course. Might something come up they should have found earlier? Of course. But, NICUs are pretty thorough. Too thorough for many of the babies we’ve seen in there, right? 

I’ve had a couple of babies I’ve referred to Children’s with distinct problems who left with exactly the same problems, but no cause for it being found. I still remember gasping when they told me the newborn with the heart rate of 70 was going home fine and dandy. What do I say to those parents who got so scared when I was responsible for their child’s hospitalization? Those bills? When the hospital insinuates, “You really didn’t need to come in for that.”? My pat answer is: I’d much rather they say, “You didn’t need to come in” than “Why the hell didn’t you come in?” (“Hell” wasn’t what I wanted to say.) And it is that belief that certainly made my transport rate higher than some/many other midwives, but erring on the side of caution was important to me. 

For now, however, as the doula, you don’t have to worry about those things. Embrace this time! Taking that responsibility can be very tough. Right now, as a doula, you can be there as a doula, loving and supporting the mom where she is and how she needs you to help her right now. Even if that means nothing more than supporting her desire or need to do nothing. 

If you’re in the child’s life for any length of time, you will learn if there is something wrong or, better yet, see that nothing is wrong at all. If there is something wrong with the baby, the mom will eventually see it and take the kid in. But, perhaps there’s nothing more wrong than the baby not being fully “in his body” yet and he just needs to climb in and things will be better. Know, though, that some kids are just FLKs – Funny-Looking Kids. (Yes, this is a term many midwives use.) Nothing at all wrong with them that we can see or test for, just a quirk of biology. 

But, what do we do with those feelings that something isn’t quite right? Why do we have them in the first place. I’ve written before about premonitions versus fear (Premonitions, from June 8, 2006.) and how we can only say it was premonition in retrospect. Intuition is much the same; we can only have the intuition validated after the fact. What do we do with it? As I said above, as the doula, you get to sit on it and let mom and baby unfold their own story. 

Knowing nothing about this baby other than what you’ve shared with me, and I have zero premonition about what’s going to happen, but I wanted to mention something that was taught to me early in my midwifery training. 

At the birth center where I was, a baby was born that was obviously very deformed and probably not long for the world if the outer body was any indication of the inner workings. We all saw the problems immediately, but the mom was in total bliss about her new baby! She was all over her, kissing her, cooing, touching her all over… loving on her, obviously oblivious to the baby’s probable incompatibilities with life. I was in a position to pull someone out of the room and ask why the heck no one was telling mom they needed to take the baby to the hospital? Why were they letting her be in ignorance instead of telling her there was something seriously wrong with her baby? 

I was told that sometimes, the best thing a midwife can do is leave moms in their place of ignorant bliss so they can bond with their babies deeply and without prejudice (i.e. seeing their kid very sick or even gone already). That this “pure” bonding time will only last until someone bursts the bubble with “Your baby is quite ill,” and that time is so very precious and should be preserved and protected as long as possible. I’ve never forgotten that lesson. 

But what of those feelings you have that something isn't quite right? Maybe they are about something on a deeper, more spiritual level. Perhaps he's going to be schizophrenic, but that won't appear until he's 22 years old. Perhaps he's going to be profoundly autistic. Perhaps he has a cancer cell already that's going to take him when he's 6. And maybe there's nothing you will ever know about this child, but that, on some level, you are aware of. I really have learned to just let some things lie and let them unfold in their own time. Patience is the hallmark of a midwife, now isn’t it. We never know all the answers. And that can be very frustrating, but can also be extremely freeing if we let it be. 

One last thing. As you play the What Would I Do game, be careful not to get too wrapped up in someone else not doing what you would do. That’s another part of the letting go of the situation. Everyone, ourselves included, are allowed to make our own choices… and mistakes. As a parent, you know this lesson very well. It is the same with clients; letting go and watching them make different choices teaches us our own lessons… on many, many levels. 

Take care of your Self through all of this.

Barb

Reader Comments (11)

Even I, having 7 born, have looked at one of my children and thought, "something is wrong." This baby was the one with all the swelling in her face from the birth and the eye that wouldn't blink. Even after a few months. She grew out of it. And then there was the baby who shook her head a lot and I thought maybe she was self stimulating. Turned out she needed glasses and is blind without them. So, something CAN be wrong, but it might be minor...

August 11, 2011 | Unregistered CommenterDawn

Loved this, thanks.

August 11, 2011 | Unregistered CommenterRachel

I have a cousin with fairly significant developmental issues, and in retrospect, there was something "off" about her even as a baby, though she wasn't diagnosed (so to speak ... she doesn't actually have any specific condition or syndrome, she just has a collection of issues that make life more challenging for her) until she was four or five. The thing is, there wasn't anything that could have been done, certainly not at the newborn stage, that would have changed that. Nothing would have been better or happier about her life or her mother's life if that seed of worry had been planted in the first days or weeks of life.

And this:

We all saw the problems immediately, but the mom was in total bliss about her new baby! She was all over her, kissing her, cooing, touching her all over… loving on her, obviously oblivious to the baby’s probably incompatibilities with life.

How wonderful for that baby to come into the world with so much love, to be held in its mother's arms and enveloped with love, if its time was to be so short. The tubes and wires and painful interventions of NICU are worth it when that baby lives or even when there is a decent chance of the baby living. But if there is nothing to be done, let the baby feel the love and comfort of its mother.

August 11, 2011 | Unregistered Commenterchingona

I remember a particular situation like this. Only it was the MD and I (the RN) at the birth, along with the family. As soon as this baby was born, the MD and I both looked at each other - we KNEW! - this baby had Trisomy 21. But did either of us say anything to the parents and family? Heck no. The family (mom, dad, aunts, grandparents) were all loving on this baby. She was definitely a very wanted and loved baby! None of the family asked "why did she look" the way she did? (She was classic Down Syndrome features.) Instead, when we notified the pediatrician of her birth, we passed along the info of the features that she had. The pediatrician was the one who suggested testing. She ultimately was + for trisomy 21.

But you know what? It changed NOTHING of how much her family loved her. I would think that the initial several hours of uninterrupted bonding with the baby had some part of that superb bonding that took place.

August 11, 2011 | Unregistered Commenteratyourcervix

I too have been at the birth of what was initially a FLK... only to realise as the seconds ticked into minutes that everything that could be wrong with a baby was wrong with THIS baby. The dad noticed before the mum.... & together they started exploring their baby & realising that something was very, very wrong. I still think about those few moments of pure joy they had though.

August 11, 2011 | Unregistered CommenterLiz

I would like to add my support to your post! My baby has significant problems, none of which were apparent at birth - they showed up in force around his first birthday. There were signs of things wrong before that, but we missed them. And it was WONDERFUL to have his entire first year bonding with him before we had to start worrying about "what's wrong?" and dealing with the medical community. Having people fuss and question would only have ruined our first-year bliss (my mom did fuss, as a matter of fact, but I pretty much ignored her because she tends to freak out without cause anyhow, LOL!). Agree completely.

August 11, 2011 | Unregistered CommenterDiana

atyourcervix -

I had the EXACT same birth about a month ago, a cesarean for breechness... baby looked classicly trisomy 21. But mom and dad were blissfully happy with her, loving on her, snuggling her.... it wasn't until day 2 that the medical team broached the subject with mom and dad. They both looked at her, looked at them, smiled and said 'she's a perfect and beautiful DS baby, though, isn't she? Where do we go from here so that she can stay that way?'.

I wonder if their reaction would be the same if they had been 'prepped' for DS and not been given that pure bonding time...

August 11, 2011 | Unregistered CommenterCole

Another great post on doulaing. You have a lot of wisdom from years of experience, thank you for sharing it with us.

August 11, 2011 | Unregistered CommenterKimberly

I definitely agree when it's just a vague feeling or impression that something is wrong. When there is a specific symptom though I think in most cases that should be communicated to the parents. If our nurse had told us our daughter's meconium did not look normal we would have had evidence she did have cystic fibrosis, and might have been able to push to get her evaluated at the CF clinic based on symptoms. Then she wouldn't have spent 3 weeks slowly starving due to her severe pancreatic insufficiency while we waited for her genetic testing results. So if the baby might be able to be treated and there is something you can specifically point to that isn't right, I think that is a different case than an odd feeling or a baby with an untreatable condition.

August 11, 2011 | Unregistered CommenterKelly O.

If my baby was born with Down's Syndrome it wouldn't make one bit of difference to me! I would love and adore my baby no matter what and I wouldn't want anyone interrupting my first few hours of bonding with my baby to point out the abnormalities. My husband and I have already talked about it and we would not abort if our child had Down's Syndrome and as long as there was no heart defect or other life threatening conditions we wouldn't want us or our baby treated any differently! I have been privileged to have several wonderful people with Down's Syndrome in my life and let me tell you the world is a lot better off with them in it!

August 12, 2011 | Unregistered CommenterRain

" As you play the What Would I Do game, be careful not to get too wrapped up in someone else not doing what you would do." Oh yes. It is very humbling as a student of birth to learn to surrender to WHAT IS. Just as it's very easy for a childless person to make righteous black-and-white statements about parenting, it is also very easy to make righteous black-and-white statements about birth attendant decisions when you're a student. When you become the care provider and the responsibility of decision-making falls squarely on you (in tandem with the family you serve, of course), the grey area becomes a vast gulf. You soon realize you must never sit in judgment on another birth attendant's decisions. That you never have 100% true information about a story you read on the internet, or heard second- or third-hand across town. And that your own clinical judgment can and does change as you mature.

August 12, 2011 | Unregistered CommenterAdrienne

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