THE SMILE

By Jane Scoggins

It had been a long night on the maternity ward. Not only were the new Mums tired, but the midwives and doctors too. Eleven babies had been born. All were sleeping in their clear perspex cots beside their mother's beds. All except one. Baby Brown. Male. Full term.53.34cm. 3.47kilos it read on the little wristband. He was fast asleep and wrapped in a blue blanket in his tiny cot, but in the nursery, not beside his Mum. The labour had been quite long, but not difficult. Sally had not needed anything stronger than gas and air for pain, and her husband had been beside her all the way encouraging, and soothing her. A healthy baby boy with all his fingers and toes. But there were problems and it was the midwife and the doctor that had to tell the parents what they were. Baby Brown had been born with a cleft lip and palate, and when placed in the outstretched arms of his mother, she had screamed out in fear and panic. Despite all efforts from the maternity staff, Sally was inconsolable, and had handed him back to the nurse and turned her face into the pillow. Jeff, the baby's father had no idea what to say or do, so he said and did nothing for the first couple of hours. He sat by Sally's bed and stroked her hair and although outwardly calm, was crying inside.

        On day two following the birth, when Sally was up and about on the ward, the nurses tried again to encourage her to hold the baby, and give him a name. But although Sally peeped briefly into the cot to see the sleeping infant muffled to the ears in a blanket, she could not bring herself to touch him or pick him up.

        On day three she agreed to see the ward doctor with her husband so he could explain the condition to them. They sat holding hands as the young doctor explained that the cleft palate and lip could be operated on in a few months time. Several operations would be necessary over the next few years. He quoted the high success rate and showed them before and after pictures. Sally and Jeff tried to take it all in but struggled to assimilate the information. All they knew was that their precious first child had a huge gaping hole in his face where his mouth and part of his nose should be.

        On day four Sally sat beside her sleeping baby and after a while reached in and touched his curled up fingers and stroked his downy head. She then went back to her room and cried herself to sleep.

        A plastic surgeon visited the ward and examined the child. After a discussion with the ward doctor and nurses, he sat down with the parents in the doctor's office and explained in great detail what he could do for their son to make him better. Sally and Jeff could hardly believe what he explained about the procedure he had in mind. It seemed like some sort of miracle. They both wept when the surgeon asked if they had any questions as they felt hopelessly inadequate as parents and had no idea what questions to ask. They were numb. The hot sweet tea that the nurse had brought was untouched and went cold in the cups.

        Although Jeff went to see his unnamed son in the nursery every day, Sally found it difficult to bring herself to do more than glance at him and had withdrawn from touching him. The nurses did all they could to encourage her to watch, as they bathed and fed him. Watching the nurses spoon tiny amounts of Sally's expressed milk into the pink gaping cavern unnerved Sally. However skilful the nurses were there was no escaping the fact that some of the milk ran down his chin and even worse, out of his nose. It was a time consuming laborious task feeding baby Brown six times a day. Sometimes he became distressed by the sheer difficulty of feeding and when Sally saw this happen she would walk away.

        At the request of the ward staff, the ward Social Worker was asked to see the parents and consider what she could do to help support them through their distress, and so far, lack of attachment.

 Christine, one of the hospital Social Workers who was experienced in childcare, bonding and attachment issues met with the parents in a comfortable private room with easy chairs, away from the ward. She engaged them in conversation about their preparations for this first baby and the expectations they had. She listened to them as they told her of the hopes and dreams that had been shattered by having a baby with such a deformed face. She did not flinch when their initial tearfulness turned to anger at why this had happened to them. She did not waver when Sally admitted that she didn’t think she could love him. After this revelation, and a short silence.  Sally almost whispered ''I expect you will want to put him into Care if I can't love him. I won't be a very good mother if I can't even face picking him up. I’m not sure I feel anything for him, He is not what I wanted.''

       ''What about you Mr Brown?'' asked the Social Worker. ''How do you feel?''

       ''I don’t know. I feel numb, I can't bear to see his little face like that, it is horrible, but to take him into Care! That would be shirking our responsibilities. We created him, we must somehow cope. But how? I don't know how.''

      ''I have only just become a mother and I am already a terrible one'' sobbed Sally.

       ''Not at all, you have had a shock and you are understandably distressed and completely unnerved. You are not a bad mother, I assure you.''

      ''But how can I love him when I feel like this?''

      ''Little steps at a time '' answered Christine gently, handing them the box of tissues.

       ''We are a team here in this hospital, and we will help you. What you feel is not unusual. There are lots of mother's who do not initially bond with their newborn baby, lots of mother's who do not feel that initial surge of love that everyone expects will happen automatically. It is not always because there is something physically wrong with the child. You have told me about the love you had for your unborn child and how you had so much looked forward to his birth. I know you are very upset but don’t be alarmed at what you feel right now. Give yourself time and let us support you in getting to know your baby, there is so much to learn about him. His physical appearance will change dramatically after his first operation and the surgeons here are very experienced in this procedure. How about you meet me in the nursery after lunch?''

      ''Have you seen his face?'' asked Sally.

      ''I have'' replied Christine.

      ''Have you seen anything like it before?''

       ''I have.''

       ''And what do you think?''

       ''I think he is a lovely contented baby, a good weight, with perfect little fingers and toes, soft downy blond hair, and when he is awake, a pair of the most beautiful eyes.''

        ''But his mouth and nose!''

        ''With an operation, he will be transformed, I have seen it several times since I have worked in this hospital.''

        When Sally and Jeff arrived at the baby nursery after lunch, they could see Christine sitting in an easy chair holding a baby in a blanket. She smiled when she saw them and when they walked over to her they could see from the top of the baby's downy blond head that it was their baby.

 ''I hope you don’t mind. He was a bit grumpy waiting for his feed so I asked the nurse if I could hold him whilst I waited for you.''

   ''No not at all'' answered Sally.

    ''He is quiet now so I will put him back, but he is clinging to my finger so I may need some help'' laughed Christine. Jeff reached down to gently uncurl the tiny fingers, As he did, baby Brown opened his eyes and looked quizzically at his father.

    ''Look Sal, he is looking straight at me, look at those blue blue eyes!''

 Sally peeped cautiously at the baby, and her movement caused the baby to turn his head in her direction and transfer his gaze to his mother. Whilst he gazed, and she gazed back, he gave an enormous hiccup that surprised him into giving a little wail. This surprised not only the baby but Sally and Jeff, causing them to laugh, and automatically reach out to touch him. Sally touched his hand and Jeff stroked a tiny foot that had suddenly stuck out from under the blanket.

       ''Would you like to hold him, if I sit with you for a while?'' asked Christine to both parents.

        ''OK'' replied Sally hesitantly. She sat down in the easy chair next to Christine and slowly held out her arms. Jeff gently reached down and picked up the blanketed baby and slowly and carefully transferred him into Sally's arms. He then sat on the arm of her chair and put his arm around her.

They didn’t stay for long, but it was a start. The following day they arrived after the baby's morning feed and held him again. Little by little their distress lessened and their confidence grew. The nurses and Christine spent time with them putting them at their ease and answered questions about his care, his feeding and the operation to come. Within a week they were helping the nurses to bath and feed the baby and had announced that they had named him James. They continued to be upset about his appearance and were worried that he had very little facial expression to encourage them in developing their feelings of love and attachment.

        And then came a turning point when a nurse overheard Sally exclaim to her husband.

    ''Look Jeff he is smiling!''

     And for Jeff to say ''How is that possible then?''

     ''Look Jeff, look at his eyes...he is smiling with his eyes.''

     ''Oh yes, so he is, he is smiling at me too now Sal. Our little boy is smiling. I think he knows who we are. Just look at his beautiful big blue eyes and long eyelashes.''

Copyright Jane Scoggins