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Don and Mary, both aged 42, married late in life and were joyfully looking forward to their first child. They were very upset when the daughter was born with Down syndrome. We had long discussions in hospital and I persuaded the parents to keep the child and promised the necessary support.
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At the six-week postnatal check Mary entered my rooms weeping bitterly and stating that she could not cope. She wished Claire had never been born and she wondered why I had not smothered the child at birth. She talked about adoption and even sterilisation, although these were against her Catholic religious beliefs. A long counselling session followed and she was prescribed antidepressants for her obvious postpartum depression.
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Two weeks later she was coping better, but she stated that she was concerned about Don who was very irritable and rejecting her sexually.
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On review four weeks later she seemed quite bright and said, ‘You grow very fond of these little people, Doctor—they have a very loving nature’.
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Then five days later a distraught Mary rang to say that Don had run away with a 19-year-old girl and was living with her in a flat in Melbourne.
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After four weeks Don rang Mary, stating that he wanted to return home. Mary, following advice, agreed to this and eventually the family unit settled into a serene relationship. Nine months after Claire’s birth, Mary became pregnant. They considered an abortion but eventually decided to accept the risk.
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Counselling proved very difficult but was supportive. The story ended happily with the arrival of John—a picture of vigorous health.
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DISCUSSION AND LESSONS LEARNED
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The main pitfall was that inadequate counselling and support had been given to this couple, particularly the husband. This includes early and late antenatal and postnatal support. He had rarely been present at counselling, which had been mainly directed towards the wife.
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There is no doubt that the family’s physician should take the main load of the support and not leave it to allied health professionals. Unannounced house calls when all the family is likely to be home can be enormously helpful. This allows the family physician to assess the home atmosphere and provide anticipatory guidance where appropriate.
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Throwing baby out with the bathwater
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Wendy, aged 26, was the self-possessed, dynamic theatre sister of a nearby hospital who was married to a logging contractor. She was delighted with her first child delivered under our care. Over subsequent weeks she presented for help and advice at least weekly with her baby boy. There was some uncharacteristic irritation when we advised against circumcision. However, knowing her competence, I reassured her (and myself) that she would cope just fine.
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Her husband rang me to say that ...