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Mourning Sarah:  A Case for Testing Group B Streptococcus

Theresa Huttlinger Vigour

Oxford:  Radcliffe Publishing, Ltd., 2008, 148pp.

 

            Mourning Sarah is a astonishing and frightening book about how medical practice ineffectively copes with the birth experience. The book is written in an extremely clear and lucid prose, one that is accessible to the professional and lay person alike. The book describes Vigour's journey into darkness and loss after losing a one day old baby to group B streptococcus. I was absolutely entranced with the book. I cannot understand, much less comprehend, how a mother could carry on after the loss of a baby to an infection that was so preventable. It is probably the worse loss that a woman is capable of living through. The grieving of the death of a baby is especially difficult since the mother carried and bonded with the baby for nine months in a way that is indescribable. This book underlies the importance for all babies to be tested for group B streptococcus at birth. Otherwise, mothers will continue to needlessly lose babies to a condition that is treatable.

            Vigour's book also underlies the necessity for a paradigm shift in how medical practitioners deal with the birthing experience. There is far too much shame and lack of communication surrounding the natural birthing process. Vigour clearly shares the confusion, pain, and devastation she and her family experienced around the time of her daughter, Sarah's, birth and untimely death from a preventable group B streptococcus infection. Vigour has given the reader a gift.  She has borne witness to an important pivot point in the history of birthing.  Individually, women must each summon the kind of courage that Vigour exemplifies to break through the barrier of fear and denial that stops parents from asking for, and even thinking about group B streptococcus tests. Culturally, we need to find the will to use all the knowledge and resources we have to help infants who, were it not for group B streptococcus, would live healthy lives.

            There are many ways that Sarah's death could have been prevented. I will examine some of these mistakes below. First, Theresa should have gone to the hospital sooner when her water broke and the neonatologist should have not told her to wait. Theresa should have followed her intuition and gone to the hospital as soon her water broke. Instead, she just stifled her feelings and stayed home much longer than she should have.

            Second, Theresa experienced an excruciating amount of pain during delivery. Yet no one, not even the midwife, really paid much attention to that.  Apparently, the intense pain was related to the group B streptococcus. Theresa did not have a normal delivery yet no one tested the baby for the infection.  Obviously, even the mid-wife didn't clue into the possible dangers of having a birth that was so pain filled. None of the hospital staff thought of testing the baby for group B streptococcus.

            Third, the hospital staff were not being adequately trained to be gentle with Theresa after the baby died. Several fundamental omissions occurred at that time. First, why didn't someone from the hospital call Theresa's husband or mother and ask them to be with Theresa while Sarah was so sick and at the moment that she learned that she died?  Taking a tranquilizer wouldn't have helped her cope with the shock of Sarah's death. It might have helped the hospital staff but not Theresa. Second, how could a nurse come and tell Sarah that the hospital morgue couldn't keep the body after 10 a.m.? Why not explain that funeral homes are open 24 hours a day? Third, why didn't someone call Theresa's husband or her mother to tell either of them to do something with the baby's body? That would have been better than asking the grieving mother directly. Fourth, how could a nurse have the indecency to say: "You can cry now", as if she was giving Theresa permission to grieve. The nurse shouldn't have a schedule for Theresa's grief.  Who granted the nurse that right?

            Theresa had every right to be angry.  Most of the above omissions were caused by a complete breakdown of compassion or communication on the part of the nursing and the medical professionals. It is quite obvious that the health-care staff were not trained to cope with such grief themselves, let alone help a grieving mother cope with the shock of losing her baby. The staff in this case did not understand the process of grieving. Nurses and doctors, under the guise of hospital/doctor policy, interfered with so many natural instincts.  For instance, when Theresa wanted to hold the baby, they didn't let her.  Second, when she wanted to breastfeed Sarah, they didn't allow it. Third, when Theresa wanted to see the baby, she was refused to do so.  How can such strong maternal needs be ignored by hospital staff?  Why does hospital policy counter a mother's and baby's instincts?  If anything, hospital policy should reflect a mother's intuition.

            It is said that nurses are taught to distance themselves from a patient's emotions, out of necessity.  Some have argued that if a nurse was to allow herself to imagine the pain from the death of a baby, or the emotional and physical pain of losing a baby, she would be ineffective to take adequate care of the patient. I believe that the opposite is the case:  if a nurse would allow herself to empathize with Theresa's predicament, it would make her much more able to deal with Theresa's loss and pain. Nurses should not distance themselves completely so that they are cold to suffering. Nurses must be able to treat not merely bleeding wounds but also broken hearts. This is especially the case in a maternity ward. In other words, the nurses should learn to treat the whole patient, especially in a situation like Theresa's.

            In sum, nurses and the hospital staff should have been much more empathic and understanding. And any hospital policy that separates the mother from her baby must be wrong. In short, mothers should be able to hold their babies, breastfeed them, and see them whenever they want. To do otherwise is completely unnatural. To treat the whole patient, the nurse and neonatologist should have been empathic with Theresa's predicament. They should have spent time talking to Theresa and asking how she felt. The treatment that Theresa received by the hospital was inexcusable. As it was, Theresa had to grieve Sarah's death, and come to terms with the lack of emotional care that she received at the hospital. Knowledge is power in this case and I'm sure that Vigour's book will go a long way towards remedying such tragedies in the future. Mothers must have the courage to express their concerns and follow their intuitions. If something feels wrong, it most probably is!

 

Irene Sonia Switankowsky, University of Wales, Lampeter