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.
I thank god every day that I had two healthy boys. I am honestly not sure how I would have reacted or handled the news that there was something wrong. I don’t even want to imagine.
You’re right that the anxiety level doesn’t stop just because you know the procedure to fix something, like floating bowels is fairly procedure. They’re so tiny when they start out in life that every little thing is a big deal that’s not just right. It’s hard to stay calm when something could be amiss.
It’s easy to be wrapped up in your own little perfect world of a healthy baby and not think of the other moms that may not hear the good news you are hearing. I was lucky enough to have healthy babies, until birth. My son’s heart valves hadn’t closed all the way (he is fine now), but its just so easy to ignore the hurt in the world when the dr says “your baby is doing just fine.”
I have been immensely blessed with three health pregnancies. but I’ve also suffered from a miscarriage, my sister has had 5 miscarriages, and 3 premature births leaving the babies in the NICU for Months. It can be quite painful when the pregnancy doesn’t proceed normally as we all would hope.
I’m very blessed to have one healthy baby and another one on the way (hopefully she’s healthy like they say). It would be heart wrenching to find out your baby has a problem like these.
Great post. I was worried every day of my 3 pregnancy’s until I was holding my babies in my arms
One of my family members just lost her baby because of a tubal pregnancy. When I was pregnant I was constantly worried that something was wrong. It’s scary not really knowing.
I was pregnant twice and every time I had my doctor’s appointment, it always made me nervous about how my baby was doing inside. I was fortunate for having a normal pregnancy and for having two beautiful and healthy babies!
Not being able to see your baby while you are pregnant is hard! My first pregnancy was very easy, but we lost our baby during our second. I think if I were to get pregnant again I would be even more nervous!
Frankly I have issues with the idea of “normal baby”. I know most people don’t mean it in a bad way but who’s to say what’s normal. I wish instead the word common or typical would be used. My son is perfectly normal for him and I’m lucky to have him.
My little one may have came earlier but he was a fighter and is now a healthy 14 year old.
Thankful for my 2 healthy boys and now thinking about the miscarriage that I had.
I feel so much for the women who do not carry healthy babies to term. And I thank God every day for my two babies that were born fine!
I believe everything happens for a reason though we may never know what that reason is. That couple was extremely strong. I am blessed to have two healthy boys, one had heart issues that he needed surgery for but he is perfectly healthy now.
What a great post. It sounds like you have a wonderful way of interacting and helping your patients. Thank God for doctors like you!
Thats so weird! thats what the dr always told me! I wonder if thats what they have to say that as part of legality issues!
I feel very blessed to have had 2 healthy babies. My best friend really suffered through her pregnancies that left the babies in NICU for a few weeks after premature births. I am sure I would continue with the pregnancy no matter if the doctor said there was something wrong or not.
I have been blessed in that both my pregnancies were healthy and without any complications. regular visits to the OBGYN is so important during pregnancy
Good article. Seeing your doctor is critical during pregnancy, but when there appears to be something wrong–the decision should be made completely by the parents, after being given factual information.
When my daughter-in-law was about 7 months pregnant with our first granddaughter, she and my son were told there was a very high likelihood that the baby would have trisomy 13. Needless to say,the next two months were anxious and stressful for everybody involved, and we spent lots of time praying for that baby! Apparently, the medical staff was so sure– an entire neonatal intensive care team (about a dozen people) were in the room as she delivered— the most perfect, beautiful and healthy baby girl ever! We like to think those prayers had something to do with our miracle baby, even though we weren’t immediately stricken down (because you know that is the deal both my husband and I made in those prayers– take me and let her live!) She is now a perfect, beautiful and healthy 12 year old middle schooler— but she will always be our miracle baby!
Everyone one of my pregnancies have been high risk. I was always walking on egg shells when I was pregnant. I thank God for the group of doctors that I had monitoring me. Thanks for sharing this post with us. Pregnancy is such a blessing and it can be so stressful too.
I’m very thankful we didn’t had any complications with our son. What a touching story.
Goodness. We’ve been trying to get pregnant for a while now. That’s the first hurdle for us. I can’t imagine if something was wrong with the baby AFTER we finally get pregnant.
I remember being really stressed about my baby’s health. Asked every time we had a visit, if our daughter was ok 🙂
I like that she understands a woman’s intuition. So very true..sounds like a good book
I thank God too that I have two healthy labor and babies though the 2nd one was 1 month early.
My daughter was born healthy and I am so thankful for that everyday. I had toxemia and had to have induced labor and things could have gone so differently.
The fear of not knowing if your baby is healthy or not is horrible. Every expectant mother wants to know that their little one is okay and I feel so badly for any woman that may hear otherwise.
I think it’s normal for every woman to want a healthy baby, myself included when the time comes. I know I’ll be a worrywart about my baby’s development in utero in the future.
I’m so happy that I have 2 healthy kids, but I still think of our third lost pregnancy. I still choose to count my blessings everyday.
Anxiety is something I struggled with when I was pregnant as well. I loved getting the MD’s perspective!