(Photo courtesy of http://www.ihi.org/knowledge/Pages/ImprovementStories/TravelsinGhanaPart2.aspx)
A baby was born by emergency cesarean section because he had sudden decrease of heart beat while the mother is in labor. It turned out that the umbilical cord is being compressed every time the head tries to go down. Baby didn’t have lusty cry upon coming out and needed some stimulation. Baby became active thereafter but in doing the skin-to-skin contact and awaiting baby’s first breastfeeding, baby never suckled from the mother.
He was brought to the nursery thereafter for routine care, and while we wanted to feed the baby, he did not exhibit any vigor in sucking. He stayed in the NICU for monitoring. He doesn’t cry much, he doesn’t suck strongly and would only take few mL of milk by cup.
Was it a probably infection? I worked up baby for infection as a possible cause, but it turned out unremarkable. I feared it was the effect of the “cord accident.” I observed baby but still, he had a very fair suck and decreased activity.
It was already third day from birth, and baby wasn’t faring well still. I was already highly considering a sequela of the cord accident to the baby’s brain, and thus this could possibly explain why baby isn’t vigorous and active, including his sucking.
I wanted to refer baby to a neurologist, and told the mother of a possibility of doing EEG and CT scan, as the father was not around during my rounds. But she told me she needs to talk first with the husband before carrying out the referral. I heeded her request. I gave her my number so that when he arrives, they will call me so I will explain my consideration. But later in the day, they asked via SMS if we could talk about it personally.
I did my rounds the next day, and was trying to explain why I am considering neurologic consultation and clearance when the father immediately interrupted me saying outright that he objects to the CT scan; that every time they talk to me, I always tell them worst case scenario, and I always make them feel that the baby is doomed.. I was shocked and dumbfounded. I wanted to be honest, prepare them what to expect so that when it happens, they will be ready, and they won’t blame me for lack of disclosure. It is our duty and obligation as physicians, to tell all possibilities.
The father was vehemently refusing the neurologic consult. He said it will be up to the Lord to make baby well. I reminded him that the Lord wont do much if we haven’t done our part. I told him I will respect whatever his decision will be and if something happens to the baby in the future, they should not blame me for having not done anything as they refused my advice.
I wanted to do the neurologic consult to lay down the status of baby before he goes home. If he has some neurologic deficits, then we could start rehabilitation early. But if baby turns out unremarkable and there’s no significant finding, the refusal to suck is merely a transient thing, then there would be nothing to worry about; I would be happy for the baby… Unfortunately, the father’s mind is under the charm “protego totalis;” it’s impenetrable.