Friday, April 07, 2006

Primal

The 20 year old mother of the full term baby seemed pretty calm at first.

"Your baby has jaundice," I explained. I went into my typical spiel about jaundice, explaining what caused it and telling her it was unlikely to be a serious problem for her baby. I went on to talk about phototherapy, how we treat the jaundice by shining light on the baby. Her eyes began to moisten.

"The lights won't hurt him", I said quickly, trying to reassure her and keep her from crying. "He'll only need to be under the lights for one or two days probably."

Tears welled up in her eyes, filling her lower lids. "You mean he won't be able to come home with me?" she asked.

"No," I replied, "he has to stay here for the light treatment."

That did it. The floodgates opened and tears streamed down her face. She was scheduled to go home that day, and the idea of going home without her baby was too much to bear. This is a common reaction. Even if a baby is not very sick, even if you assure them the baby will be fine, there is something about being pregnant for nine months and then going home empty handed that really hits the wrong emotional button in a woman. I shouldn't be surprised by this, of course, but I'm embarrassed to admit how long it took me to figure it out. It shows how strong the natural maternal-baby bond is; it is inherent, instinctive, almost primal.

As neonatologists, we see a lot of very sick babies. Babies with just jaundice who need to be hospitalized only an extra day or two seem pretty lucky to us compared to our other patients. But that is small comfort to a mom heading home without her child.

Fortunately this baby was able to go home the next day. Unfortunately, he needed to be readmitted the following day for more phototherapy because his jaundice level shot back up too high. When mother heard that her baby needed to be readmitted, she really unloaded on my partner, saying some pretty unkind things in her frustration. A day and a half later, when the baby could go home again, I was lucky enough to be on duty, and mom was all smiles and thank yous. People like you a lot better when you give them good news rather than bad.

15 Comments:

Anonymous Anonymous said...

"People like you a lot better when you give them good news rather than bad"

You're beginning to sound like Andy Rooney

12:29 PM  
Anonymous Anonymous said...

Boy, the number of times I've had that happen.... And of course, all too often its the emotionally exhausted mothers who are terribly uncomfortable with the hospital setting, who are trying their damnedest to breast feed but can't get let down because WHO CAN BARE THEIR BREASTS AND GET RELAXED IN A TYPICAL NICU (where people are constantly walking around privacy screens or asking questions through the curtain)? In the old days, women and children stayed in the hospital long enough to ensure that feeding was adequate and that jaundice had peaked and was declining. Now most hospitals throw them in the NICU if jaundice persists and mom overstays her insurance limit. I imagine on the whole that it saves money, but I think its a fallacy to think that we haven't contributed to creating this mother's angst (at least in some of the cases).

cherubsinthelandoflucifer.com

1:38 PM  
Blogger Judy said...

My hospital allows moms to stay for free for at least 48 hours if there's a room available and the baby is still a patient either in the Well-baby nursery (jaundice) or the NICU (any reason). If mom is a patient, the baby can board in our well-baby nursery until mom is discharged, no matter how long and at no charge. This is much less common, of course. The first mom to benefit from the baby boarding was a friend of mine who had an amniotic fluid embolus and who was an inpatient for nearly a month. I think her doc actually convinced her insurance company to pay for several extra days for the baby when she was critically ill on the grounds that her health would be severely compromised if she was separated from the baby.

Moms who have been discharged get meals but not medical or nursing care and have to go to the ER if they have a problem after discharge, just as they would if they were at home.

You might want to lobby for a similar policy.

4:11 PM  
Blogger Dream Mom said...

Yes, it's pretty sad to go home without a baby. I had a special outfit all picked out that I was going to take Dear Son home from the hospital. I had bought a boy outfit as soon as I learned I was pregnant; I bought a girl outfit a week before I delivered but left the tags on (I thought I was having a boy). I looked around for a "special" outfit to take him home in. Unfortunately, he was transferred to "another" hospital since he required more care than the hospital we were in. That was so hard; I was afraid they were going to mix the babies up and I was going to go home with another baby. I was worried about that because there had been some tv movies made after a real mix up had happened. My fears of course were silly because at 8 pounds 12 oz he was the biggest baby in the NICU. The other little babies were only a pound or two.

He stayed a week in the other hospital and I made several trips there to see him.

I think there are two things every Mom wants: 1) to have a natural birth (no C-section) and 2) to take that baby home with them. It's all part of that dream of being a mother.

4:39 PM  
Anonymous MyssiAnn said...

If jaundice was Baby's only problem, why not send him home with a phototherapy blanket and have Mom bring him in for bilirubin checks or have a home health nurse go out and do the checks?
I'm biased toward Home Health because I work for a Home Care provider (nurses and equipment), but it would have been cheaper than keeping and readmitting Baby and better for the family to be in their familiar surroundings. Besides, it worked for my youngest 6 years ago. :-)

5:47 PM  
Anonymous Anonymous said...

I am a neonatal nurse and see this reaction from new moms just about every day that I work. I never realized the great emotional turmoil they must feel until I was pregnant and my water broke at 35wks. One of the residents scanned me and said that the baby only weighed 4lbs and the amniotic fluid showed that his lungs were immature. I started to cry then, not because my baby may need to be vented, but because I realized that if I delivered that night, I would not be taking him home with me. He wasn't even born yet and I was crying about leaving him behind! Luckily (depending how you look at it) I was hospitalized for two weeks before I delivered, and by that time his lungs had matured and he was able to be discharged with me. Believe me, I have never been flippant with a mother since then when discussing her impending discharge without her baby.

6:10 PM  
Blogger Fat Doctor said...

Son was in NICU for 28 days, a mere blink compared to some kids' lengthy stays. During that time, I had competing miseries. I was miserable that I didn't have him in my arms at home and miserable that I didn't still feel him dancing inside my uterus. Then the real misery (guilt) set in, when I started realizing I wasn't missing him at home quite as much and was leaving the NICU at 9 pm instead of midnight...

7:22 PM  
Blogger La Lubu said...

When I was discharged (I had spent a week-and-a-half in the hospital on bed rest), I had some roses and baby presents with me as I was in the wheelchair waiting to be picked up---and an elderly lady coming in to the hospital to visit someone congratulated me for becoming a mother---and then asked, "so...where's your baby?"

God, but that hurt. It was an in-my-face reminder that she may never come home. I smiled, looked at the ground, and told the lady that she was born premature, and weighed about a pound-and-a-half. The lady scooted out of there in a hurry. It still hurts remembering that---mentally going back to that time. I made a mental note to myself then to never ask any new mother I may see where her baby is---if her baby isn't with her, I probably don't wanna know.

Also, I sure wish someone had told me the plot of the "Joy Luck Club" before I found myself watching that while my daughter was still in the NICU, going through the worst of her sepsis. Luckily, I missed the infanticide part, but unluckily caught the abandoning-twins-by-the-side-of-the-road part. I lost it, crying "BWWWAAAAHHH! NOOOOO! DON'T LEAVE THE BAY-BEEES!! WAAAAHHH!", a fine moment in film criticism, I'm sure. When the delivery guy arrived with the stuffed shells and saw my tear-streaked face and red-rimmed eyes, I had a hard time explaining to him that no, I didn't need the police, I just saw a sad movie. Poor guy didn't speak much English, and my Italian is pretty much limited to hearty cursing and barked-out household orders. I think he finally understood about the "movie" part, but he never did get the "premature baby" part (you know, the real reason I reacted to the movie the way I did) until his cousin explained it to him (I ordered a lot of take-out while recovering from my C-section.)

No Joy Luck Club for new mothers, especially those leaving the hospital without their babies. No, no no.

8:33 PM  
Blogger neonataldoc said...

Thanks for all the great comments. I'm not surprised that other people have noticed the same thing. Our hospital also lets moms stay for 48 hours after a vaginal delivery, but that's still not very long. As for a biliblanket, this baby had hemolytic desease and a biliblanket would not have been appropriate.

Andy Rooney? I don't know if that's good or bad, but it gave me a laugh.

2:06 PM  
Blogger neon88 said...

We have a "rooming in" room off the NICU that mom's can use in preparation for D/C but offer the room to mom's in just the situation you describe when it it available. Plan is to build one more such room.

6:12 PM  
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