Social Birth: Rites of Passage for the Newborn

Spiritual care in neonatology: analysis of emergency baptisms in an Irish neonatal unit over 15 years

BACKGROUND

Emergency baptism remains an important emotional and spiritual element for many parents of critically ill infants in the neonatal unit. There is no published data available as to which neonates are baptised and their outcomes.

OBJECTIVES

To evaluate trends, outcomes and characteristics of newborn infants baptised over a 15-year period in an Irish maternity hospital.

METHODS

Retrospective study of infants baptised in University Maternity Hospital Limerick (UMHL) over a 15-year period. Patients were identified from the 'register of baptisms' for the years 2002-2016.

RESULTS

A total of 354 neonates were identified and further information was available for 341. We observed a gradual decline of emergency baptisms over the 15-year period. A total of 114 (32.2%) infants were term and 199 (56.2%) preterm. A total of 288 infants (81.5%) were baptised by Catholic priest, 61 (17.3%) by staff member, 1 (0.3%) by family member and in 3 cases (0.9%) the person baptising was unrecorded. Day of baptism varied from 1 to 88 with a mean age of 4.6 days. A total of 113 (31.9%) neonates died after baptism. Majority of infants baptised were preterm and low birth weight, with predominance of extremely low birth weight (ELBW) who also had proportionately higher mortality 47 (47.5%) following the baptism.

CONCLUSION

Emergency baptism remains an important element in the spiritual care of the critically ill newborn infants and their families. Maternity hospitals and neonatal units should have access to emergency baptism service or other equivalent 'spiritual blessings' as appropriate to the faiths followed by the family, especially in an emerging multi-faith population.

Revived for Paradise: A History of Respite Sanctuaries

Infant baptism originated when St. Augustine proclaimed the doctrine of original sin in 412 CE. Neonates stillborn or deceased before baptism were declared to go down to Hell and were buried outside of sacred ground. From the 15th century, parents carried these infants to "respite sanctuaries" in remote mountain chapels, where miraculous images were believed to revive the infant in order to allow baptism and a Christian burial. Monasteries made fortunes out of the parents' anguish. In 1528, the abuse of the Oberbüren image ignited iconoclasm and heralded the beginning of the Reformation. From 1740, Pope Benedict XIV opposed the sanctuaries, especially Ursberg in Swabia, declaring as invalid any apparent signs of life, e.g., changes in skin color, a change from rigidity to flexibility, blood flowing from the nose, sweat on the skin, cessation of a cadaveric smell, and the movement of a feather held at the infant's mouth. Only crying and sounds of respiration remained valid signs of revivification. The debate ran for centuries, highlighting the difficulty of distinguishing a stillborn from a liveborn baby before the stethoscope became available. The existence of respite sanctuaries is an illustration of the failure of the doctrine of original sin, which was never accepted by the pious.

Cot Death: History of an Iatrogenic Disaster

Since antiquity, cot death has been explained as accidental suffocation, overlaying, or smothering. Parents were blamed for neglect or drunkenness. A cage called arcuccio was invented around 1570 to protect the sleeping infant. Up to the 19th century, accidents were registered as natural causes of death. From 1830, accidental suffocation became unacceptable for physicians and legislators, and "natural" explanations for the catastrophe were sought, with parents being consoled rather than blamed. Two assumed causes had serious consequences: thymus hyperplasia was irradiated, causing thyroid cancer, and the concept of central apnea was widely accepted, which led to home monitors and distracted from epidemiological evidence. Prone sleeping originated in the 1930s and from 1944, it was associated with cot death. However, from the 1960s, many authors recommended prone sleeping for infants, and many countries adopted the advice. A worldwide epidemic followed, peaking at 2‰ in England and Wales and 5‰ in New Zealand in the 1980s. Although epidemiological evidence was available by 1970, the first intervention was initiated in the Netherlands in 1989. Cot death disappeared almost entirely wherever prone sleeping was avoided. This strongly supports the assumption that prone sleeping has the greatest influence on the disorder, and that the epidemic resulted from wrong advice.