When I went into labor at 34 weeks, I knew what all the possible outcomes were. Reinforcing my worst fears, the neonatologist doing my antepartum counseling warned me that no matter how well the baby was doing at birth, he would go straight to the resuscitation bed for evaluation. So although I had waited my entire life to meet my child I would have to wait a few minutes… hours?… more, depending on how sick he was. I cried about losing the opportunity to be the first to hold my baby, to do the skin-to-skin care as I had hoped, and to initiate breastfeeding in the delivery room. However, I intimately knew about how important it was for the neonatologists to do their exam and provide whatever interventions were needed, so I provided no interference in this plan.
Much to my relief, N was born pink and yelling, two reassuring signs for a pediatrician mommy, and while he went immediately into the hands of the neonatologist I was provided quick reassurance that he would be in my arms momentarily. Some of the most magical minutes of my life were the few I spent with N before he went to the NICU, as this was when I became a mother. I was already so proud of my little fighter, who despite his prematurity was a healthy weight and breathing on his own. The neonatologist gave me reinforcement and informed me that once in the NICU he likely wouldn’t need any interventions. I remember him saying, “no IV, no NG, room air,” which meant that my baby would be unlike most of the NICU babies. He made it seem like he would just be in the NICU for observation per protocol based on his age. Relief washed over me.
As soon as my OB allowed, I went down to the NICU and as I approached his bedside, I saw that he had IV tubing and monitor wires entangling his tiny body. He lay naked on a warmer bed with bruises splattered up his forearms from multiple blood draws and IV attempts. His nurse informed me that they were going to put him in an isolette, rather than an open crib, and that he would be starting IV antibiotic infusions. It became apparent that this was a NICU baby, not the healthy, normal baby that I thought I was holding moments earlier. Confused about what had changed, another neonatologist approached me to explain the situation.
She said, “we know you are a resident and we want your baby to do well because you are one of us.” She continued to explain though that she was going to put that aside and “do what the baby needs, not want we want him to need.” It seemed that we had all looked at him with rose-colored glasses in the delivery room, hoping for the best possible outcomes rather than objectively viewing the baby in front of us. “He is a 34-weeker, so I’ll treat him as a 34-weeker,” she continued. So he had an IV, he was on a monitor, and he was in an isolette to help regulate his temperature. The neonatologist confided in me that her daughter had been born prematurely too, so she understood the fears I had as a physician mom and reassured me that someday I would look at my college-bound child and that this would be a distant memory, as that was her current experience. I took comfort in knowing that I wasn’t alone.
Those neonatologists did not see another NICU mom, they saw themselves. They had empathy for me rather than the more neutral compassion that doctors feel toward patients. I don’t think that we were treated differently in terms of the quality of care received, but the emotional connection with the medical team did feel unique. I recently read a piece in the New York Times Well blog called “When doctors treat patients like themselves,” which describes that treating like-minded patients may make the experience more pleasant, but we do not know how it affects outcomes. In my experience, it initially led my son’s treatment team to underestimate the severity of his condition based on their hopes for his success, as if willing it to be true. Ultimately though, they were able to treat him like any other, putting aside that his mother could easily have been them.
I find myself facing this bias in my clinical practice whenever seeing a former 34-week infant. I often cannot help but share some of my own personal experiences with these parents and wish them the same positive outcome that I experienced. My professional training though has allowed me to see the range of outcomes, with some premature babies being indistinguishable from their full term peers and others having lifelong handicaps and chronic diseases, so I know that I can’t expect them all to be the same or share my personal experience. Although these 34-weekers hold a special place in my heart, I often remember the objectivity of that neonatologist and the peace that came from knowing my son was given the care he needed rather than an overly optimistic view of what we would want for our children. The best I can do is to treat each child as him/herself and allow each parent their own experience, while sharing that I have walked this path before as a mother and will walk it again with them as their doctor.