BIRTHDAYS AT HOME BY

June Willlamr’

Recently I have been working in the Rooming-In unit of the Pres- byterian Medical Center here in New York City. Since most of my professional career as a nurse has been spent in maternity nursing I welcomed this opportunity to observe a relatively novel type of hospital care for mothers and their new-born babies. Rooming-In allows the mother to have her baby with her throughout the day, to participate in his care and to become acquainted with him while there are nurses and doctors present to give counsel and support. The husband is able to visit his wife and baby at allotted hours. He puts on a gown over his street clothes, washes his hands, and then may hold and get to know his baby. It is hoped that this bringing together of the family within the hospital restores some of the emotional satisfaction that once accompanied the experience of childbirth when it took place at home and was a family affair.

The new provisions for postpartum care are a far cry from the traditional isolationism that once characterized hospital obstetrics. The old way allows the mother to have her baby with her for about twenty minutes five times a day. The father’s only contact with his child is a quick look through the glass window of a central nursery. These parents take a little stranger home with them on the day of discharge. I am not zealot enough to say that irreparable harm is done to the family by this. I do feel, however, that a lot of joy is missed. There has been shortchanging on an experience that can add richness to life. Rooming-In makes a positive attempt to give the parents and the new baby a sense of unity and belonging together. It is only when I compare Rooming-In with the maternity experience at home that I am dissatisfied, for then I remember members of the family who are not included in the hospital experi- ence, but, who participate actively in a “birthday” at homa. They are the real losers.

I have worked for five years with a large home-delivery service in Chicago. Teams of doctors and nurses, under the auspices of the Chicago Maternity Center, go into three hundred homes a month to attend women during labor and childbirth. The outstanding observation I have made is that this experience is the most satisfying when it includes the whole family, not just Mother and Dad but Johnny and Jimmie and baby Anne, Aunt Josephine and Grandma Smith, the people upstairs and those across the street. Birth is an event! The congregation that collects in the front room or in the kitchen of nearly every home where a new arrival is anticipated is

‘Miss Williams, R.N., M.A., C.N.M. was a student in the masters degree program in maternity nursing and nurse-midwifery, Columbia University and Maternity Center Association, N. Y. at the time this article was written. She has resumed her work at the Chicago Maternity Center.

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5 0 routine that to enter a home and find a woman alone is to be at once suspicious that all is not well in her social order.

I t has seemed to me that of the many participants in this occasion, the little children alrcady born to the family can profit the most from it. Birthdays at home, wisely conducted, are a firm foundation for sibling acceptance and pride. I have never ceased to be amazed a t the delicate handling of this situation by many a mother in labor at home. Often one is conscious of an unspoken conspiracy between wife and husband to make this day special for the other children. If the mother is in rarly labor she usually prefers to be up and about, getting lunch for the children or watching their favorite television program with them. When she feels like resting in bed, therr is a spot beside her for the baby of the family and an arm for the other children, if they come to her. I t is a good lesson for doctors and nurses. I find us, again and again, including the children in the activities, making a point of their importance and acceptance. This is a time to take time, to see and hear childish fears and childish questions and to meet them with as much insight and understanding as we have. What we say and do is not lost of the adult audience. They listen and smile and nod and I have observed that when labor becomes more active and all our attention is given to the mother an aunt or grandmother or neighbor will carry on with the children’s support.

Ordinarily, if the mother begins to show signs of discomfort, a trip upstairs or downstairs or outdoors is organized for the smallfry. It is impressive, however, to see how many women will maintain a calm and a control “for the children” that is totally lost in the hospital labor. Especially at night, in the homes, it is possible to observe this acceptance of self-control. I have seen women living in one-room apartments almost silently give birth “so as not to wake the other babies.” We read a lot about the dangers of separating Emall children from their mothers. I wonder if the separation necessi- tated by hospital delivery does not deprive the mother of a source of strength more than it does the children.

Probably the most delightful part of a home delivery is the hour after the new baby arrives. The whole family gathers around the bed to count the ten fingers and toes, to get acquainted, to take turns being cuddled by Mother and Dad, and to take turns holding the newcomer. There can be the excitement of singing “Happy Birthday” and, in one home, the father had prepared a birthday cake complete with a candle to add pleasure to the celebration. I have watched closely for signs of jealousy. The one most apt to manifest inward reservations is the displaced “baby” of the family. Often this is sensed by the mother, and she will make room for the older baby to be beside her. too. If not, the doctors and nurses do much to make the adults sensitive to and aware of the need for added love to be expressed.

Older children who have ( k e n made to feel a part of this family experience evidence a pride in this family accomplishment. They

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have their friends waiting in the back yard to receive detailed reports about “our” baby. One little girl was so excited on her way out of the house to spread the news, that she collided with another child on the sidewalk, caused him to drop a family-sized bottle of Coca- Cola, and careened on oblivious of his howls. I went out to comfort him and could faintly hear her voice in the distance shouting. “We’ve just had a brother.” Many children will bring playmates to the door and ask if they may see the new baby. I comply with this wish if a t all possible.

Altogether, my experience in home deliveries makes me feel that things get off to a better start for everyone concerned, if birth is a family affair. I am not brave enough to suggest that there be a reduc- tion of hospital deliveries and a return to home deliveries in the United States. Most of the cities in this nation are not equipped to handle home care safely. But if every city had the provisions that Chicago has for domiciliary births, I would be very vocal in my approval. In fact, if I were going to have a baby, I would make every effort to be in Chicago for the event, so that I could have my baby at home.

As a nurse, I find that I am no longer satisfied to work in hospital obstetrics. It distresses me to see a mother, who should be Queen for the Day, competing for attentim with many other women in labor: to see husbands banished as though this were none of their business. Most of all, I am aware of the difference between postpartum mothers in the hospitals alone, and postpartum mothers at home with their families. The former are so often deprived of that sense of accomplishment that lends a glow to motherhood at home. I notice that one of the most popular spots on the postpartum floor in the hospital is the telephone booth where a woman can talk to her family. Many of the tears dismissed as “mood swings” in the hos- pitalized patient can be traced to concern about those at home, if one is sensitive to the mother’s needs and feelings.

It is gratifying to see a growing number of hospitals making great efforts to restore the values inherent in the home delivery situation- those almost intangible values, which were lost during the transition of maternity care from home to hospital. Admission of husbands to labor rooms, the provision of rooming-in arrangements, and the attention focused on helping each couple derive maximum satisfac- tion from their childbearing experience in leading maternity services, are all indicative of the high goals of maternity care toward which the medical-health profejsions are working.

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