I noticed the unusually somber mood as I waited among the staff of the maternity unit for rounds. After the nurses went through their more typical cases, I learned the reason why. Uncontrolled bleeding had led a young mother, Tanisha, to have an emergency hysterectomy following the birth of her healthy first child. Sunk in despair, she refused all forms of help. She lay curled in her bed, barely acknowledging her daughter. One of the maternity nurses who had recently spent time with me learning the NBO– a set of observations that aim to support parent-newborn relationships- turned my way. “Perhaps you can help?" she asked.
I entered the room with a medical student in tow. After introducing myself as a pediatrician who specializes in working with parents and infants, I asked if we might learn about their daughter. The baby’s father Craig readily agreed, and Tanisha too reluctantly accepted our presence. “I’m sorry for your loss,” I said, leading with acknowledgement of the heaviness in the air. But I saw my task as using our brief time together to support Tanisha’s connection with her daughter, I immediately shifted our focus. “Can you tell us what you’ve noticed about Natalie?" I asked. Craig immediately jumped in to share his observations while Tanisha quietly listened. He took the lead when I suggested we unwrap the sleeping baby and see what she could tell us about herself.
I was guided in my work by pediatrician T. Berry Brazelton who was among the first to take time to observe the tremendous capacity for connection and complex communication babies bring with them into the world. In our recent book The Power of Discord my colleague Ed Tronick describes the origins of the influence of Dr. Brazelton on our understanding of the newborn.
“It was Berry who, on our Saturday visits to the maternity ward at Mount Auburn Hospital, in Cambridge, Massachusetts, opened my eyes to what newborns were capable of….Berry always carried a man’s toiletry kit under one arm on these visits. It was stocked with his tools, which included a flash- light and a plastic box filled with just the right number of pop- corn kernels to serve as a gentle rattle, among other things…When we stepped into the nursery, I’d trail behind Berry and watch as he scanned the rows of sleeping infants and then picked one to focus on. He would talk softly to the babies, pick them up in his large hands, shift their body position, shake the rattle near their ears, and flick the flashlight above their faces to elicit their reactions. He’d tap at reflex points — the palm of the hand to trigger the grasp reflex, the cheek to trigger the rooting reflex, when the infant turns toward the source of touch to locate the breast or bottle.
Much of what he did was standard stuff for a pediatric exam. But Berry added his own twist; he assessed the babies’ social capacities by noting such things as the way each engaged with a face and voice and the ability to self-comfort. What was also uniquely Berry’s was the way he would tune in and observe. These babies had his complete attention. As I watched, I saw that the babies visually followed both inanimate objects and faces, tracking their movement. The babies’ expressions changed, as did the movement of their extremities, depending on whether they were looking at objects or people. At just a few hours old, babies could differentiate between people and things! How did they know? What meaning did they make of their world? Clearly, there was a lot more to these tiny people than I had expected.”
Many decades later, I refer to this process as “bringing in the baby” in clinical work with parents struggling emotionally around the time of childbirth. While certainly this mother’s grief remained front and center in my thinking, my unique role was to support her relationship with her newborn child. I have found that rather than various forms of “talk therapy,” the actual baby and their communication often offers the most powerful voice for growth and change.
“She seems to prefer to be unwrapped to move her arms and legs,” Craig shared as we watched Natalie begin to awaken and fuss, wriggling inside the swaddled blankets. He told me that he had noticed how when she was crying and he put her down, she became calm, seeming to prefer to observe the world on her own terms. Sure enough, with the blankets off, Natalie moved her arms and legs while her remarkably alert newborn gaze landed on the people and things around her. Tanisha propped herself up on her arms in the bed and leaned in closer. “What does she do when you call her voice? I asked. I lifted Natalie out of the bassinet and suggested that Tanisha come closer and speak to Natalie just outside her line of vision. “Hi Natalie” she said, tentative at first and then with a more lilting tone. Natalie turned her head a full 90 degrees to meet her mother’s gaze. When we shifted position Natalie followed as intently to the other side. Tanisha’s whole posture relaxed as her expression shifted from guarded to warm and open. The compelling nature of Natalie’s attention led me to silently move my head and watch how she locked on my gaze and followed my face for a full 180 degree sweep. Both Tanisha and Craig looked on in wonder and delight. “She’s so attuned to faces and voices, “I remarked.” Then Natalie began to tell us that she had had enough. A gentle fuss quickly escalated into an all-out cry. Tanisha took her from my arms and put her to her breast. “Wow she is really good at letting you know what she needs!” I said.
Soon after, the obstetrician and maternity nurse entered the room. My student, electrified by the exchanged, began to speak with me as soon as we were in the hall outside. He marveled at the transformation. We were still engaged in animated conversation when the nurse emerged and spoke with us. “Tanisha wants to see the social worker.” she told us. Tanisha had shared with her nurse that all her interactions prior to our visit had focused on her trauma and loss. We were the first who spoke with her as a parent. “Natalie needs me to listen and pay attention” She was motivated to address her own grief so that she could be more present to meet her daughter’s needs. “After all,” she had said, “I’m her only mother.”
Note: This writing was originally posted to the Child in Mind blog on my website.
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