3 Infancy, Toddlerhood, and Preschool 79Melanie had severe postpartum depression after her pregnancy with
Lina. Melanie attended therapy for 2 years and was treated with a mild
antidepressant. She weaned off the antidepressant with the advice of a physi-
cian 1 year prior to the current pregnancy. Melanie struggled with emotional
and physical trauma resulting from Lina’s preterm birth. Lina was born at
32 weeks gestational age following an emergency caesarian section due to low
fetal heart rate. Lina was a patient in the neonatal intensive care unit (NICU)
for 8 weeks where she was treated for central apnea, difficulty controlling her
body temperature, and low birth weight. Melanie was slow to recover from the
caesarian section and developed an abscess at the incision site that required
further medical treatment and was very painful. Melanie was discharged
from the hospital without Lina after treatment for her caesarian section. She
describes that as the most challenging and unnatural event of her life. Seven
weeks later, Lina was discharged from the NICU on an apnea monitor and a
medically supplemented dietary regimen of high-calorie formula that Melanie
fed to Lina in addition to a challenged breast-feeding relationship. These chal-
lenges contributed to emotional and physical pain that left Melanie in a state
of shock and depression for which she sought treatment after Lina had been
home for 6 months.
Melanie had a vaginal delivery with her second child, a son, Nathan,
at 28 weeks gestational age after an increase in gestational hypertension and
decreased fetal movement. Nathan was immediately transferred to the NICU
due to prematurity and respiratory difficulty. This was a comfort to Melanie
as she felt that he would be like Lina and just need some time to grow and
develop as a result of prematurity. During her initial visit to the NICU Melanie
noticed that Nathan had a twitch in his hands. She told the nurses, the twitch-
ing was noted in his medical chart, and Nathan was seen as scheduled by the
neonatologist. Twenty hours later, again while Melanie was visiting alone, she
witnessed Nathan having a seizure. The nurses reacted very quickly and sur-
rounded Nathan; no one spoke directly to Melanie, who immediately called
Frank. A pediatric neurologist was consulted and immediate MRI (magnetic
resonance imaging) of the brain and cranial ultrasound were performed. It
was later explained to Melanie and Frank that there were several conditions
being “ruled out” and that MRI would assist with determining Nathan’s prog-
nosis and possible treatment for a diagnosis such as stroke (see Van der Aa,
Benders, Groenendaal, & de Vries, 2014 and Murias, Brooks, Kirton, & Iaria,
2014 for treatment protocols). Upon hearing the word “stroke” Melanie felt
devastated. She felt physically and emotionally detached as she went through
the motions of caring for herself, thinking of her son and what this news might
mean for his life.
While waiting for conclusive results, the physicians ordered blood work to
investigate other potential causes of the seizures such as infection. The official diag-
nosis came 1 day later. Nathan had suffered a Neonatal Arterial Ischemic Stroke
(NAIS). According to Kirton and deVeber (2013), NAIS is the most common type of
stroke that occurs in the first days and weeks following birth. The stroke affected the
left side of Nathan’s brain causing the seizures and breathing challenges. Melanie
and Frank were informed that the stroke had likely caused hemiparetic cerebral
palsy, which would cause Nathan to have life-long motor, cognitive, and behavioral
deficits.