By Silvio Aladjem MD
Every obstetrician, at one time or another, was asked this question. In most circumstances he/she would answer without hesitation: “Looks fine”. At other times, unfortunately, that quick answer was not there.
When the answer is not clear cut, one has to ponder which would be the best answer. There are many shades of gray and in those cases where “Looks fine“ is not the appropriate answer, “Does not look good” would be a foolish, insensitive and inappropriate answer.
Pregnancy is supposed to be normal. A perfect baby should always be the result of any pregnancy. Unfortunately, in some cases, that does not happen. It has been my experience, in 40 years of practice, that maternal instinct knows, even before told that something may not be right with the baby. Maternal instinct is so powerful, that, somehow, mothers know. The question, “How’s my baby?” in those circumstances, is asked with trepidation, not with joy. Sometimes it is phrased differently, like: “Is the baby ok?” a distinct indication of the mother’s doubt, hoping against hope, that her premonitory feelings were wrong.
Not all bad news, however, is really bad and in some circumstances may be manageable. For example, in a malformation known as gastroschisis, the bowels of the infant are floating into the amniotic fluid due to a defect in the closure of the abdominal wall. In gastroschisis the abdominal wall does not completely close allowing the bowels to get out of the abdomen and float freely in the amniotic fluid. In such circumstances, shortly after birth, the defect is surgically closed. The only reminder of it will be a scar on the baby’s abdomen.
That does not minimize maternal anxiety. Not having a perfect baby creates an unhealthy psychological mental state of guilt and frustration. The mother may blame herself. What did I do wrong? Why can’t I have a normal baby like everybody else?
How the obstetrician approaches the problem may make the difference between the mother having a miserable pregnancy, from a psychological point of view, or a normal one, understanding what the problem is and how it is going to be resolved.
At the other extreme, we find cases where the infant’s problem may be so severe, that it is incompatible with life. It is heart wrenching to the parents, and it is hard on the obstetrician who cares for the mother. In my book, 10,000 babies: My life in the delivery room, I wrote a chapter entitled “A labor of love”. I related there how a couple coped with the news of their baby being an anencephalic. In such a rare condition, during the early development of the embryo, the neural tube -the origin of the nervous system- remains open instead of closing. As a result the skull bones do not form and the brain does not develop properly. These babies die either before or shortly after birth.
As devastating as the news was, this particular couple decided against termination of the pregnancy. They considered that child, no different than the other children they had. During labor they wanted to listen to the baby’s heart. Shortly after birth, they named the child, and their Pastor baptized him. A few hours later, the newborn died in his parent’s arms surrounded by the entire family.
Such events teach us that when all is not well, one learns to accept life, the good with the bad. In this particular instance the family cared with love for the child, even if it lived for a few hours only. After the baby died, the family mourned together and they will always remember the little son or brother they had and knew.
In between these two extremes, the pregnancy road can be full of situations that may be emotionally exhausting, demanding and in need of decisions that you never thought you may have to face when you got pregnant. Such problems, sometimes, may extend for a long time, with surgeries and special care, for months or years.
Fortunately, the vast majority of pregnancies are normal and a happy event. So, when you ask your obstetrician “How’s my baby” and he or she answers, “Looks fine”, count your blessings and, just for a moment, think of those mothers that do not have the joy of hearing the answer you heard.
You can read more of Dr. Aladjem’s posts on Imperfect Women by clicking here. Dr Aladjem also answers questions of medical interest related to pregnancy in a monthly post here at Imperfect Women. You can read more details about this feature and ask a question by filling out the form here.
Dr. Silvio Aladjem, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem is published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. He can be reached through his website, www.drsilvio.com.