Ab Initio International | NBO and the Power of Apology

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Kriss Rivera, MSN, RN, IBCLC

As a Maternal Child Public Health Nurse, I have the opportunity to visit families at home and use the NBO during many of these visits. I work with a great group of nurses who can share and reflect on their own experiences in the field and how the parent and child experience this new world together.

A colleague described a home visit with a mom who was unaware of her pregnancy until she delivered in the emergency room. Over the past several months the mother had noticed she was gaining weight and had tried hard to lose it. She had run around the track, dieted and used non prescription diet medications. Several months ago the father of this child had left the relationship and could not be located. My colleague reported concern over her observation of a very-difficult-to-soothe infant and the mother’s report that her one-week-old infant cried all of the time. Because we work in an atmosphere of collaboration, I was invited to visit with this mother and baby and to help the mom identify ways to calm her infant.

This mother lived with her brother, sister-in-law and their own two-year-old child. She reported that she had left her parents and nine siblings in China and had come here with her brother three years ago. She had worked as a security guard and was a tall, larger framed woman. She shared with me that she never dreamed of having a child. She was always the auntie to her siblings’ kids. She had never been around a newborn baby and she found the crying and her inability to soothe her son, Michael, to be extremely difficult. I tried to help her identify patterns associated with Michael’s cry, but even together we could not identify times of day or experiences that related to his crying. She showed me how she stopped the crying and it seemed to work for a short minute or two and then he began to cry with more intensity. As she went through her list of soothing actions, we talked about some of the reasons babies cry and the strong intense communication delivered by Michael’s cry. She handed Michael to me much like a gift is offered to a friend. He seemed to calm when his forehead and head were stroked, and I continued to try to illicit a calm alert state from Michael as the mother told me the story of his unexpected birth and her own fears about parenting. As he settled into a quiet alert state I gave Michael back to her and asked a simple question about crying. Why did she think he was crying and what did it mean? She told me that when he was born she had had the nurses take him away. Because she had not wanted to be with him, his cry was an angry cry. She said “I never should have sent him away. I love him very much, but he was a big surprise,” Michael was calm and looking for her face, and I described Michael’s desire to see her face and get to know all about her and her love for him. I began to go through the NBO items. I showed her his strong grasp, his visual acuity and coordination to follow the red ball and his ability to habituate to sound and light. I showed her how he was listening to her and looking for her face. I casually mentioned she could always apologize to Michael and as parents we learn often through trial and error. She very softly stroked his head and apologized to Michael for not being ready for him when he was born. She told him how much she loved him and how strong he was. Michael remained quiet in her arms and looked at her face as he fell asleep. I scheduled a visit for the next week and left her with a sleeping baby. When I went back to visit Michael his mother was able to associate his crying with his needs, he calmed in her arms with her voice, and she showed me just how he liked his head stroked. I had the opportunity to visit them for the next 18 months and I saw him develop into a confident toddler who knew how to communicate his needs. Michael had a mother who listened to him with an intensity and reverence for him as an individual. From time to time during our visits she would marvel at the great love and joy this unbelievable child brought to her life.

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944

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