Monday, September 6, 2010

Family Medicine: Babies, Immunizations and the Heart of a Mother

Newborn babies and infants are always interesting in family medicine. I even take care of several who were delivered at home, due to parental preference, most of whom I saw in their home (yes, a home visit- they are still fun and meaningful) soon after they were born. My father and aunt were born at home, so I consider home delivery to be a normal process that is chosen by a small number of couples as their preferred birth method.

We also have several home and hospital delivered children whose parents opt not to immunize or to modify immunization schedules for their children.  Five or six of our families came to us because they were evicted from Pediatric practices for their immunization preferences.  These variations on standard immunization protocols are challenging, partly because of the degree of difficulty of understanding immunity and immunizations and partly because of limiting beliefs of patient, physician and society.  None of us have hit belief perfection yet, so we do the best we can in the context of a caring relationship.

How do we analyze the actual understandings of the parents to be able to make their best decisions about immunizations versus diseases?  I don't know, but, when asked, they usually profess to understand what they need to know.  They "own" their children and they have been informed of  their options for immunizations versus no immunizations or some immunizations.  I believe they have the right to decide how to raise their children, informed by the context of their world and its laws.

A parent who chooses not to immunize her two month old infant is here today.  During our interaction about how everything is going with her, the baby's father and the baby, I ask how she is staying informed about the diseases and the immunizations that her child may face over the next few years.  She says she feels that it's best to wait for the "shots", but she's not sure why she knows.  She does not want any more information about the diseases or the immunizations at this visit.  I chart that she does not want to immunize her child at present and that I offered some information about the immunizations and some about the diseases, but she was not interested in the information at present.  I would feel better if she looked at some of the information, but she chose not to read it.  A touch of physician guilt happens, about whether I did my best to share information and about documenting my efforts (for the system that audits my behavior regarding immunizations and can exclude me from participation if I go astray- this takes me away from the best connection with mom and baby for a short time) but then I can feel the contentment in the mom and I have peace, too.  A mother has made a decision about her baby and I honor it.  Her decision from her heart is one of love, a wholehearted love decision. 

The heart of a mother is not well studied electrically or technologically, but it has a huge role in families.  Sometimes, mothers just know in their heart what's right or best.  They can hurt in their "mother's heart" when they can't protect their "babies" (even their adult children).  This isn't a medical issue in our literature, but it is an issue in the world's literature (e.g.,the Bible, music, poetry, art, novels, etc.) and definitely a human issue in families and communities.

I complete the exam of the healthy infant, congratulating the mom on how well she's doing so far and how healthy her baby seems to be.  As I listen to the proud mother talk of her baby and how her own mother is very helpful and understanding, I get a good feeling about the Heart of a Mother.  It is powerful and important in the decision processes of mothers and families.

Medically, we might find more ways to understand and connect with it.

1 comment:

  1. Your writing so touched my own mother's heart that I ended up getting a bit be so completely understood seems to be so deeply meaningful (and desired) to a mother. Particularly, mothers who face adversity for being expected to do what they cannot do in their hearts, yet other doctors expect them to defy their own protectiveness of their children under the guise of herd immunity, irresponsibility and issue punishment for not cooperating with the medical community.

    How can a mother contradict her own heart? If the mother is not convinced the shot is helpful, letting her wait is a great option, not the usual demeaning and use of education as a trump card to cause her to go against every grain of protectionism she has within her (the same protectionism that will help her child navigate and survive life itself).

    Bravo to you for understanding us on a level that seems almost rare in medicine. You haven't let your job change you on a human(e) level. And why do I feel certain some of your patients must hug you, or even leave you with a kiss! :)