They were a lovely couple.  Recent immigrants from Algeria.  A young couple, who were well supported by family.  The maternal grandparents never left the room.  Grandma (Jadda)  was short, beautiful and vibrant in her long robes and head covering.  She mumbled frequent prayers, and jumped up to help her daughter at the slightest murmur. She had given birth to seven of her own children and saw her own face in her daughter’s.  She knew the facial expressions, and vocalizations, and tears used to bring a new life into the world.  She felt her daughter’s pain as her own. Giving birth was a genetic and ancient,  and blessed act.   “Inshallah,” Jadda whispers repeatedly…..if God wills.

The young mom spent many hours in the final throes of labor.  She refused all pain medication, and leaned on her mother for support.  She cried, and screamed, and prayed for the baby to be born.  The baby would not come.  After many hours she was brought to the operating room for delivery.   The young mom was petrified and panicked, she could not be calmed.   “Inshallah,”  Jadda whispered in her daughter’s ear.  “Inshallah.”

I met the family on their third postpartum day.  All had been going well, and the family was ready to go home.  She was nursing well with support from Jadda, who had nursed seven of her own children.  Breastfeeding was a natural, an ancient and blessed act.  The lactation consultant had seen them and the baby had a very good latch and suck.  On day three of life, the lactation consultant had a day off, and I had a day on.

On the third postpartum day, the seeds of doubt were sown.  “It does not seem as if the baby has been urinating enough,” the morning  nurse tells the family. “maybe we should supplement to see if he will pee.”  “I will call your baby’s doctor to let him know your baby may not be getting enough fluids.”  “I will intervene.”

No, I will intervene.  I intercept the phone call to the pediatrician.  I plead to let me examine the baby, and assess breastfeeding before he orders supplementation, or a bladder catheterization of the newborn to check for urine, or a delay in discharge, or a downward spiral of maternal confidence.  Please, let me intervene.

I meet the lovely family on their third postpartum day.  Mom was quiet, and down cast, staring at her baby in the crib.  Dad was very expressive, and adamant that the baby do not receive formula.  He wrote down everything I said in a little pocket notebook that he kept.  He was desperate and helpful and very inquisitive.  I examined the baby in front of the whole family.  I explained everything about their vigorous and healthy normal newborn.  I showed them how to swaddle, and soothe and change the diaper of the baby.  The entire family watched me change the diaper as if I was performing a cardiac bypass.  Dad continued to take notes in his tiny pocket notebook.  Now, I told the anxious family, let’s see how the baby eats.

I laid the baby stomach to stomach on mom, avoiding her fresh incision.  The baby latched on immediately, and nursed.  The family looked on, unconvinced that the baby was actually receiving nutrition.   I spent an hour and a half helping and counseling the mom on nursing her infant.  When I helped to latch the baby on the opposite breast, breast milk started to pour out.  I showed the family.  “See, your body can, and is, producing milk!”

“Inshallah!  Inshallah!“  Jadda shouted over and over again.  She grabbed me close and hugged me.  I teared up at the thought of bringing such simple happiness to this family, when in reality, I did nothing.  I was offered multiple middle eastern sweets and pastries for their gratitude.  Of course, I did not refuse  in order to not insult the family (at least that’s how I justify eating thousands of calories of sticky sweet pastries!)

I notified the pediatrician and reassured him that all was well with the newborn.  The discharge order was written and the family went home.

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Two weeks later the father came to the hospital to revise the baby’s birth certificate, and to ask for more formula to feed his baby…..Those seeds of doubt are powerful and lasting.

Inshallah

RR