Sammie’s Story: Footprints in the Sand
Patricia J. Murphy, LMSW, IMH-E(III)
Author’s note: This is a story about the importance of a mother listening to her own intuition and feelings. As well as the importance of a professional stepping back to look at the parallel process which we can feel but not see and understand until we give it space and time. (names in this story have been changed to protect confidentiality).
She called our office after her obstetrician referred her. We don’t get many women who realize or admit that something is wrong; it’s hard when there is a perfect new life in your arms. Amanda wasn’t sure what was wrong, why she was not bonding with her new baby boy, the feelings she wished would be there were not happening no matter how hard she tried.
It had been her fourth pregnancy. Three previous pregnancies had all miscarried. Amanda had not believed she would carry this baby to term. It had been a very difficult nine months. She had not been able to enjoy it. She had been ready to break up with her boyfriend before she learned she was pregnant. So she stayed. The relationship did not improve. But she continued to hope. After a long, difficult labor, she gave birth to a full term baby boy. The cord was wrapped around his neck and he had low blood sugar. He was hospitalized for three days. She stayed with him, curled up in a chair.
Now Amanda sat before me on our first visit. Her slender frame slightly stooped as she cradled her baby. Her dark brown eyes stared at me. With her free hand she pulled back her straight black hair. Then she placed a blanket over her shoulder and began to breastfeed her 3 month old. She had named him Samuel and over time would call him Sammie.
I sat and listened to Amanda tell me her concerns. She did not feel like a mother. She was in shock that she had actually borne a live baby. And she told me more of her story although it was not a complete story. There were parts that were left hanging, like icicles waiting to thaw. I did not probe those parts of her background, those parts only a sentence long with so much detail left out. There was already so much to work on. So much in the way of bonding and attachment—multiple losses, three miscarriages, a very difficult pregnancy, a conflicted and emotionally abusive relationship with an alcoholic, unemployment, financial stress, significant lack of supports and, lastly a new breastfeeding infant with multiple allergies and colic. We had a lot to focus on. I diagnosed her with Postpartum Depression. She did not want antidepressants. She agreed to meet with me and do cognitive dyadic Infant Mental Health treatment.
In the next few months, we met regularly. We talked about her much wished for babies who were miscarried for reasons unknown. One had been a girl whom she named. Amanda mourned and grieved. I empathized with her, normalized her grief and encouraged her mourning while still trying to hold the joy of having a newborn.
We did not talk much about her early history. Since she had been through our Intake Department, I already had some of this. When she was 16, she had come to this country and found work as an au pair. After 10 years she became a U.S. citizen. She did not have family here but kept in touch via Skype. She had one girlfriend she was close to. She was very articulate and intelligent, with four years of community college under her belt and in much demand as a professional nanny. She worked hard to help those children in her care. She had married and divorced. Soon after her divorce she met her current boyfriend, who became the father of this baby. Amanda said he drank a lot. She denied drinking herself. When she became pregnant, she did everything possible to have a healthy baby.
We talked about her pregnancy with Sammie and the long difficult labor and delivery. Her boyfriend was there, cut the cord and held his son first. After a time, Amanda held him and named him. She said she was “in a state of shock” that he survived and she did not feel like a mom.
She was determined to breastfeed Sammie and followed a special diet because of his many allergies. At 5 months, Sammie was still waking every two hours and breastfeeding. He was also teething. Her boyfriend was not helping. Instead he was demanding, drinking nightly. He frequently told her to get a job. When they didn’t get along, he threatened to make her “disappear”. Still she stayed. In our sessions we talked about her feelings in this relationship. I provided information and handouts on alcoholism. We talked about what a healthy partnership should look like. I referred her to the local shelter for women, LACASA, and to group treatment there. She did not go.
By 6 months, Sammie’s two teeth were through. He began to sleep better. He was laughing out loud and a month later beginning to show signs of stranger anxiety. At times Amanda said she felt like a mom. With encouragement, she now got out regularly to walk with him.
But by 8 months, his sleep difficulties had returned. At night he woke frequently and slept no more than ½ to 1 hour during the day. During our sessions, he was fussy. Amanda would bounce and jiggle him. He was now receiving Early On services for Torticollis, a condition that causes tight muscles, tilted head and difficulty in head turning. It can be congenital or acquired. Occupational therapist Lisa came out twice a month and provided exercises and emotional support.
Meanwhile, our sessions ebbed and flowed. In one session Amanda would be happy. Sammie was better. He didn’t fuss during our session and sometimes fell asleep in her arms. Both Amanda and Sammie were getting more sleep. She was feeling more attached. In other sessions, she would take that back and say she no longer felt any attachment. She was exhausted and overwhelmed. No one seemed to know how demanding it was to take care of Sammie.
At times, I too felt frustrated and exhausted. I knew the parallel process was occurring as I felt these emotions strongly and frequently. In our agency, parents often can get respite care to give them a break from the 24/7 care of their child. I thought this might help. I requested authorizations. My supervisor approved them but no respite person could be found who was trained to deal with an infant. We focused on finding someone, a friend or a community person, to provide respite care for Sammie. That effort met with little success.
I brought out Ages and Stages Questionnaires for her to do with her partner so that he might become more involved. It’s a method that sometimes works, but his alcoholism seemed to get in the way. I provided information and resources on infant development such as articles from Zero to Three, again hoping that might draw him in.
When Sammie was 8 months old, he and Amanda went back home overseas to her family for a month long visit. It had been a great vacation and she had caught up on rest. However, this return signaled the beginning of months of cancelled, rescheduled and no show appointments. I was not sure what had happened. I called from time to time.
During long spans of no contact I sent letters notifying Amanda that her case would be closed unless she let me know that she wanted to keep seeing me and continue treatment. Each and every time she called. Sometimes it was to reschedule only to not show. Sometimes she was in crisis and needed to talk. I validated her feelings and supported self-care. One day she called after a very emotional fight with her boyfriend. Again he had threatened to make her “disappear” and to take the baby.
I was in a hurry when she called that day, on my way to see another client. I was tired of giving Amanda time on the phone and never seeing her in person. I didn’t get any billable productivity hours for phone calls. And, besides, I was a temporary patch. I strongly advised going to the shelter. I would see her there. She said she would go in the morning. I promised to call that evening but got busy and did not. Not calling when I promise is not typical of me. In retrospect, I realize I was angry and just wanted her to leave and pull her life together. I called in the morning both on her cell and at the shelter. She did not return my calls for a month and she had not gone to the shelter. Her parents kept telling her, via Skype, to work things out.
By now it was becoming more apparent that Sammie had problems. He still did not sleep for long periods of time. He had large and fine motor skill delays as well as communication delays. He continued to be breast fed due to allergies and did not attempt to self-feed. Sensory problems were emerging. He rejected strained foods of any kind. And, at 12 months, he was barely crawling.
When we did have a session weeks later, Sammie would make eye contact with me and smile. But his brown eyes did not light up. They were vacant. His pediatrician continued to say “Let’s wait and see.” Amanda was upset. I validated her concerns and encouraged her to find a pediatrician who would listen to her. I encouraged self-care because Amanda was so focused on fixing Sammie and doing it alone that she was physically and emotionally drained. Encouraging self-care, listening, validating concerns were often all I could do when we had sessions. Much like the parallel process, our sessions waned and waxed: we would meet for a while then not meet but communicate sporadically on the phone.
One day, after receiving my termination letter, Amanda called and said she wanted to continue. It took a bit of work but we soon began to meet regularly again and to understand the problem more. It had not just been a problem within her, but a problem within her son. At birth no one but Amanda had seen a problem but she somehow, knew all along. She said that when the doctor held her son by his feet the first seconds after birth, she knew, knew something was really wrong. She just did not know what. Not only did she have difficulty attaching, but her son did too. His recent diagnosis at 17 months bears this out: he has Global Developmental Delays, Autism Spectrum and Pervasive Sensory Disorders.
In my last visit with Amanda and Sammie, I told her I was writing about our time together and asked what she would like other professionals to know. She said this:
“It was so very important to me to have you. I knew you would be there for me, that you did not go away. You listened. Professionals don’t listen very well. I think they miss what’s being said. Dr. H… I kept telling him, showing him the footprints in the sand, but still he didn’t see. So I would tell them to listen and to be open-minded. Don’t have ‘I’m a professional’ (attitude). Just focus on this one mom and baby and try to understand.
And when they are listening, focus on the feeling part of it. I think now of how they were missing my feelings. (Those feelings are saying something very important even though you are only shown footprints).
And to give support. How very important it is for the mom not to feel alone. Be open to a mom reaching out for support so that mom does close down.”
Amanda also had words of advice for mothers to listen to their own intuition, their own ‘mom voice’, to educate themselves and to keep following up with professionals who do listen to them.
Amanda then gave me more that I think others in the field of Infant Mental Health might benefit hearing. She said:
“It meant so much, to know, to trust. There was that time when they called you (my office) and it was your day off. They called you, told you to call your client. You called. It meant so much to know, to be able to cry, to trust you would be there when I had no one and was so far from my family. To trust I could count on you.”
Amanda switched to a pediatrician who listens and who made referrals for Sammie’s evaluations. She now is close friends with other moms of toddlers with disabilities. Sometimes they have play dates. Amanda has gotten Sammie toys and physical equipment to help with his development. Soon Sammie will begin receiving ABA services in our agency. Amanda plans to leave her partner soon and has made concrete steps and connections that lead me to believe she will soon be in a better place and space for herself and her now 2 year old.
And me- I learned that the parallel process is hard to see when you are in the middle of it. It sometimes takes writing it out or using the reflective process to recognize it is taking place and to understand it. In those many missed sessions, Amanda was running from her feelings because she knew and mourned for herself and her son. Those are really hard realities.
And I was reminded again how important it is to be present and to really listen. As for those icicles, well, some melted and some are still waiting for the right time.