Nolan announced his arrival in dramatic fashion following 30 tense minutes when his heart rate fell precipitously with his head already engaged in the birth canal. An emergency forceps delivery, during which Darla’s tailbone was fractured, led to his gloriously healthy newborn cry. “Here I am!!!” But for Darla whose history of unimaginable abuse as a child growing up in a home filled with violence and drug use, that dramatic arrival precipitated a tragic chain of events. Darla had been in recovery for several years, diligently attending groups, taking her daily dose of medication assisted treatment for her opioid use disorder, and all that she knew she was required to do to keep custody of this child. But her experience of vulnerability, pain, and fear during the final moments of her pregnancy triggered a cascade of events that led to an emotional breakdown and removal of her child from her care.
My colleagues and I entered the story at its breaking point. As her sense of threat escalated when maternity nurses questioned her need to smoke a cigarette, she lashed out at them. For the few nurses who held fast to stigma of substance use disorders, Darla’s behavior provided ample evidence for their suspicions. They called child protective services. As Darla’s worst fears bloomed into an impending reality, her capacity for regulating her emotions evaporated. Her screaming rage and the unfolding crisis proved the very thing she most wanted to avoid; she could not in her current state care for this baby. She could see her baby one last time if we were present to supervise.
As the infant-parent mental health specialist in a program for families with substance use disorders, my role is to focus on the power of this relationship to promote healing and recovery. Janice, the program director, Nancy, the peer recovery coach, and I would have an hour to spend with them to enroll Darla in the program as she faced this wrenching separation. Holding lessons from pediatrician T. Berry Brazelton in my mind, I used the time to observe Nolan’s behavior while bringing out Darla’s natural expertise even in this dire moment.
I focused on my own breathing through awkward moments of silence as we saw the pair through the mundane tasks of feeding, diaper changing, dressing, and back to quiet sleep. I injected a few comments about how well she knew her baby, offering encouragement without advice. Nancy wept quietly from a seat in the corner of the room while Janice kept herself together with the task of filling out forms. Finally it became too much. An anguished Darla asked us to take Nolan to the nursery. Nancy and Janice stayed to finish the paperwork of enrollment as I wheeled the baby back to the care of the maternity nurses.
Almost a year later Janice shared with me that this visit had changed her life. Like nothing else she learned from a myriad of books and trainings, it demonstrated to her that in her work with mothers in recovery, the baby must be part of the story. This pair faced a long and difficult road. While Darla was hospitalized to address her mental illness, Nolan entered the foster care system. We lost them from our program. But the five of us together in that room felt the undeniable power of the parent-infant relationship.
For those who have the privilege in our work to be brought into the lives of vulnerable families, this story offers an important lesson. No matter how messy the situation, a singular focus on facilitating moments of meeting between parents and their children brings a sense of calm purpose to the work. Again and again we see how such moments can produce extraordinary changes in families, shifting the narrative from generational trauma and disconnection to possibility for healing and growth.
In his highly acclaimed book The Examined Life (Norton 2013) Stephen Grosz draws on his experience as a psychoanalyst, telling stories from his adult practice to reveal, “how we lose and find ourselves.” In my decades of practice as a pediatrician and infant-parent mental health specialist I recognize how taking time to listen to the voice of a child helps people who feel lost and disconnected both to find themselves and to find each other. That voice comes in many forms- from the immediate compelling cry of the newborn, to a tantrum in the middle of the street of a three-year-old recently removed from custody of his mother, to the child voice of an estranged grandmother, who, having grown up with daily beatings with a broom, now has trouble connecting with her grandson.
While we are not all parents, we were all once babies. We can learn a great deal from paying attention to the young child’s extraordinary capacity for honest communication- both in real time and in memories revealed in a safe space for storytelling. I have the privilege of a from row seat to this transformative process as clinician, teacher and also as parent and daughter. I intend in the coming months to use this blog to share these stories of powerful moments of meeting. As always, cases in my writing are composites with identifying information changed to preserve confidentiality.
Many people today feel disconnected and unheard. We are experiencing what 2020 presidential candidate and Biden cabinet appointee Pete Buttigieg called a “crisis of belonging.” New life inevitably brings with it a sense of hope. I wonder if a singular focus on the voice of the child will help address this crisis. When I listen to a family, I approach the story from a stance of “not-knowing,” letting things unfold naturally. Even after decades of listening in this way, I find myself repeatedly amazed and delighted by the meaningful connections that reveal themselves. In a similar way. I approach this writing project not knowing exactly where it will go. I hope you will join me.