Helping Parents after the Birth of
a Baby with a Malformation
John H. Kennell, M.D.
Marshall H. Klaus, M.D.
... it is well you should know that it is entirely natural that a mother should want to get to know her baby right away after birth. This is not only because she longs to know him (or her), it is also —and it is this which makes it an urgent matter —because she has had all sorts of ideas of giving birth to something awful, something certainly not so perfect as a baby. It is as if human beings find it very difficult to believe that they are good enough to create within themselves something that is quite good. I doubt whether any mother really and fully believes in her child at the beginning. Father comes into this too, for he suffers just as much as mother does from the doubt that he may not be able to create a healthy normal child. Getting to know your baby is therefore in the first place an urgent matter, because of the relief the good news brings to both parents. (p. 24)
But what if the news is not good? The birth of a newborn blighted with a malformation is
a crushing blow to the parents and to everyone else who has shared in the event. The baby is the culmination of the parents' best efforts and embodies their hopes for the future. To help parents develop ties to their malformed infant is difficult: parental reactions are turbulent, the child's birth often precipitates a major family crisis, and the usual pathways for the development of close parent-infant bonds are disrupted.
Bettelheim (1972) probably best describes the goal of efforts to help the parents of a malformed infant. "Children can learn to live with a disability. But they cannot live well without the conviction that their parents find them utterably loveable.... If the parents, knowing about the child's] defect, love him now, he can believe that others will love him in the future. With this conviction, he can live well today and have faith about the years to come" (pp. 34-35).
During the course of a normal pregnancy, the mother and father develop a mental picture of their baby. Although the degree of concreteness varies, each has an idea about the sex, complexion, coloring, and so forth. One of the early tasks of parenting is to resolve the discrepancy between this idealized image of the infant and the appearance of the real infant (Solnit and Stark, 1961). The dreamed-about baby is a composite of im____________________
The work for this report was done in close collaboration with Dennis Drotar, Ann Baskiewicz Mostow, Pauline Benjamin, Robin Geller, Nancy Irvin, Steven Robertson, Mary Anne Trause, Carolyn Rudd, and Michele Walsh. Their assistance made our study possible. Particular thanks go to Robin Geller and Michele Walsh for their patient and meticulous organization and analysis of the data, a small portion of which is included in this manuscript.