The Durable Feeling That a Child Is Always at Risk


The Durable Feeling That a Child Is Always at Risk
he was born in the afternoon, in February, and his heart wasn’t beating. The labor had been long—his mother had grown exhausted of pushing but still he would not come. His head was stuck in the birth canal. His heart rate started dropping low and stayed down with every contraction—deep decelerations, we call it—and so the obstetricians knew it was time to rescue him with a Caesarean section.

The three of us on the baby team—my intern Caroline, the respiratory therapist, and me, the senior pediatrics resident—were paged to the operating room after the ob-gyn surgeons had scrubbed in. We pulled on hats and yellow gowns and gloves and masks, then quickly began setting up the baby bed with oxygen, suction, and heat. Caroline went to introduce our team to the parents. It’s a variation of the same introduction every time: “We’re the baby doctors! We’re so excited to meet your baby! Do you have a name picked out? When he’s born, we’ll bring him over to the baby bed . . . ” I could hear the baby’s heartbeat projected across the room, and when his b.p.m. slowed to the sixties I checked to make sure we had supplies to place a breathing tube and run a code on a newborn if we had to.

I think, now, of the contrast of that moment: Caroline reassuring the mother, just as she is supposed to do, while I prepare for a possible nightmare, just as I ought to do. We on the baby team try to hold the peril of these moments inside ourselves, because the way we communicate about risk and injury around birth can have lifelong consequences for parents and children. If we get this communication wrong, studies suggest, the family can be beset by what pediatricians call vulnerable-child syndrome: a durable feeling that this particular child is always at risk, and an irresistible urge to shelter the kid that can actually hamper his development and harm his relationship with his parents.

The baby’s heart rate, projected from inside the uterus, came up again, and my own heart rate slowed in relief.

“Skin,” the ob-gyn called, and the surgery began. She was moving quickly, with her team all in long blue scrubs huddled around the mother’s body. The surgeon called “uterus” and Caroline brought blankets from the warmer for the baby we would soon catch. Once the surgery is in full swing, the baby’s heartbeat can’t transmit anymore, and so we lost that beep that connects the baby team to our little patient until he is born.

Then there was a long, strange pause. The surgeons seemed to be pulling, and the baby was stuck. His head was stuck. I wished I could hear his heartbeat.

“Do you want me to call a 911?” the labor-room nurse asked me. She meant sending a page to the neonatal I.C.U. team with the text “peds 911,” which sends a cavalry of doctors, nurses, and an extra respiratory therapist running up two flights of stairs to help us.

“Not yet,” I said.