Disclaimer: all midwifery-related posts change key details to protect privacy and preserve anonymity.
She was a new mum of only a few hours, recovering from an elective caesarean section at 38 weeks. I have taken handover for 5 mothers and 4 babies in my care for my shift. We have approximately 10 minutes to hand over pertinent information at shift change times. Buzzers are going off, patient charts and folders we need to refer to are invariably missing as pharmacists, doctors and allied health professionals also need them, and interruptions are inevitable. We are supposed to do this handover at the patient bedside and we do where we can but realistically there is simply not enough time. Also, may I add that the language and presentation of handing over information about a patient has to be quite different if doing this in the patient’s presence. She needs to feel like more than a room number, more than a “G3P2 fresh caesar” for example (she’s had 3 pregnancies, this is her second baby born, and she has only recently arrived on the ward from recovery after a caesarean section). You must take more time, more care, be more delicate and nuanced with your language. It’s a wonderful ideal, but in the realities of a busy public hospital, there is no time.
This one of my ladies is giving me palpitations. I don’t know why she had the elective caesar but I assume (one should never but I don’t have time to read the chart!) it has something to do with her severe bipolar manic depressive disorder which I am told has a very swift escalation from lucid to manic. She is at high risk for postpartum psychosis, a rare and terrifying condition, and we are all on high alert. I am briefed of her warning signs, her triggers, and what to do if I or her support people notice any concerning changes in her presentation. I feel somewhat reassured, but I am still hyper vigilant, as are her support people. She is articulate, intelligent, polite and absolutely delightful. I start to feel calmer as I spend more time caring for her. She is very appropriate and postnatally well.
Except that her baby is not with her. Baby is in the nursery on CPAP (continuous positive airway pressure) to keep baby’s lungs slightly inflated at the end of every breath he takes, because he has been working too hard to do this on his own. There may be other complications, but I don’t know. I have no time to read her extended history or even call the nursery myself to get more details. She has not been able to hold him, and she is being stoic, but starts to crumble when they tell her he won’t be coming out of the nursery tonight or even the next morning. She asks me if it’s normal for babies to be admitted to the nursery after a caesarean.
No it’s not normal, but it is quite common. (Look up ‘transient tachypnoea of the newborn’ if you’re interested.) “For this long?”, she probes, to which I can only reply that I don’t know the stats, but it is not overly surprising when it happens, especially when a baby has been born from a “cold” caesar- ie no labour. Baby has been not had any time to prepare him for birth and transition to the outside world. He has not had the fluid squeezed from his lungs and reabsorbed as he travelled down the birth canal and out of the vagina. Initial difficulty breathing is common, and very often temporary.
She is sad she hasn’t been able to hold him. I empathise. It must be awful. She is worried that he will develop some kind of insecure attachment from not having skin to skin contact. It’s true the benefits of skin to skin are many and indisputable (look it up!), but missing out on it because your babe requires medical treatment is not a direct road to psychological trauma. I try to reassure her. Personally I refuse to believe that this initial separation at birth from loving, attentive parents will inevitably lead to this. They may well have issues down the track of course (who doesn’t?) but will it be due to this very day? Perhaps. Perhaps not. I told her that even kids with all the skin to skin in the world can develop challenges later in life. I try to normalise things and make a joke about my own girls having uninterrupted skin to skin contact, yet they still hate me some days. She smiles but her anxiety is wrestling with her pragmatism. I stopped faffing with the catheter bag, stood up and looked her in the eyes.
“The thing is, you can’t control this. He is there for medical treatment. There is nothing to gain from worrying about something you can’t control and can’t change. You will get past this stage, you will have that skin to skin, you will hold your baby, you just haven’t got there yet. But you will.”
She looked grateful for the straight talk and I know she got it, but tears welled as she said, “I just keep thinking it’s my fault… If I hadn’t had the caesarean…”
We had some more talking to do.
I see this all the time- this tendency to assign blame to ourselves in our desperation to make sense of what’s happening. Why do we do this? Why do we blame ourselves? I’m talking particularly to the women. I’m talking to the mothers. Why? If we have to assign blame, why can’t we blame the doctors who may have convinced us this was the best option? Why can’t we blame all the people who shared their traumatic birth experiences and put the fear of god in us? Better still, why assign blame at all? It is what it is. It is done. All we can do is be kind to ourselves, those around us, learn and move forward- when we’re ready.