A newborn killed leads into a murky legal swamp of prosecution and juror ambivalence, and psychiatrists and psychologists are being trotted into court to explain something they never see in their clinical practices. But science only occasionally peeks through the mist of more viscerally important considerations, like who belongs in jail, a woman's fight to choose, or the callousness of some of the fact patterns.
This past year, the death of Amy Grossberg's newborn at a nondescript Comfort Inn in Delaware, with sweetheart Brian Peterson close by, prompted a more concerted search for legal direction. And the banality of Melissa Drexler's disposing her newborn during a bathroom break at a New Jersey high school prom jarred others to ask what happened, and why.
Who's That Girl?
One oft-cited demographic of the mother who kills her newborn was published in 1970 by Phil Resnick, M.D. Dr. Resnick reviewed data from international medical literature spanning 216 years and thirteen countries to coin the catchy "neonaticide," which distinguished the killing of a child less than 24 hours old from other child murder (Am Jl Psychiatry 126:10 1414-1420). In all, records of 35 cases of such death were reviewed; neonaticide differed from the killing of other children (filicide) by the relative youth of the mother (89 percent under 25), the frequency of an unwanted pregnancy (83 percent), and unmarried status (81 percent). Later research did not demonstrate a particular race, cultural, or socioeconomic association with neonaticide (Oberman, M. American Criminal Law Review 34:1 p 71 1996)
Case write-ups in psychiatry, gynecology, and pediatrics literature have distinguished two groups of mothers who kill their newborn: those who carry out a premeditated killing, and those who suddenly end the baby's life. More common are the impulsive, typically younger, unmarried women, never before pregnant and sexually naive. Communication about sexuality in the home is restrained. These defendants often present a history of being a passive party to the sexual relationship with the baby's father, who may ultimately have abandoned the relationship. Some may have religious or personal objections to abortion, or are ignorant that it is available to them. Those less conflicted about the morality of abortion may simply be passive in their response to crisis (Gummersbach IC Wieh Med Schr 88: 1151-55 (1938)). Very frequently, these young women live in traditional and socially isolated homes with disciplining, harsh parents whom they are nevertheless quite close to (Green, CM; Manohar, SV Canadian Journal of Psychiatry 156: 121-3 (1990)). In such families, it is unthinkable to become pregnant. One neonaticide defendant recalled her own mother told her, "If she got pregnant she would kick her ass and throw her out and send her and the baby to live with her boyfriend" (American Criminal Law Review 34:1 p.55 1996).
Dr. Laura Miller of the University of Illinois at Chicago Department of Psychiatry believes that all teens who deny their pregnancy are socially isolated. But Dr. Miller adds, "The isolation may be obvious or subtle. She may appear to be surrounded by people, but nobody really knows her at all." This anonymity makes it easier for the teen's pregnancy to escape the attention of family, friends, and teachers.
Deception or Denial . . . to Death
The signs are there, with missed periods, nausea, an expanding abdomen. The expectant young woman believes that her weight gain is the result of an increase in appetite or lack of exercise (Finnegan P, Canadian Jl of Psychiatry 27: 672 (1982)). She may never regard queasiness as morning sickness. Perhaps a visit to the doctor confirms pregnancy. But she doesn't return for follow up. There are no trips to the toy store, no baby clothes purchased, no daydreaming of, "maybe I'll call him Bart, or LaShawn, or Andre."
Two mothers kill their newborn; the premeditated and the impulsive.
The denial of pregnancy often extends to others. Parents and teachers attribute mood changes to the ups and downs of adolescence. Observes Dr. Jona Eth, a professor of Criminal Justice from Rutgers University in Camden, New Jersey, "Parents don't want to think their daughter is pregnant. They have to be distrustful of her in the first place to even think that." Oberman reports on a case of a teen aware of her pregnancy, but passively awaiting acknowledgment from others (American Criminal Law Review 34:1 p55 1996).
That denial is powerful enough to survive the rigors of labor and delivery. Dr. Miller continued, "When her water breaks, she thinks she urinated. Labor pains are thought to be cramps and she'll take a warm bath for relief. Intense labor pains are experienced as a bowel movement. She'll sit on the toilet and deliver there." Indeed, the majority of neonaticide births occur in toilets and bathtubs.
The medical professionals on the front lines may have a different perspective. "Come on," said Sandra Lee, M.D., an obstetrician from Pittsburgh. "They buy the baggy clothes, they sneak up the stairs after dinner so their parents don't see them." Dr. Lee views the denial as an explanation after the fact. "The only woman I ever delivered who truly didn't know she was pregnant was a thirty-seven year old from the inner city. They called me from the medical clinic after she came in saying she ate ice cream that didn't agree with her. Her gas pains were ten minutes apart.
Dr. Phelan concedes, "most of the women I deliver who had denied pregnancy later admit they were aware of the fetus, but were just too scared of the social consequences to deal with it."
Fatal Impulse
According to Dr. Everett Lee, a demographer from the University of Georgia at Athens, 46% of killed infants die in the first hour of life. What happens in that hour is open to enormous debate.
One theory proposes that the penetration of denial by the birth of the baby creates such an enormous stress for the mother that she enters a transiently psychotic state where she does not know what she is doing is wrong.
Psychosis at the time of killing, while supportive of legal insanity, is more the exception than the rule, according to the findings of numerous examiners who have documented neonaticide cases they examined. Indeed, the Resnick data contrasted neonaticide mothers from those who kill their infants and very young children by the relative infrequency (17 percent) of psychosis (loss of a sense of reality) or depression (9 percent) in the neonaticide mother. None of the neonaticides were followed by a mother's suicide attempt—in contrast with one third of the infanticides. All this reflects a striking difference in makeup—and motive.
Postpartum psychosis develops gradually, escalating to a syndrome of dramatic behavior and gross confusion. Moreover, research of psychosis in the peripartum period demonstrates that maternal psychosis seldom begin before 48 to 72 hours after birth (Kaplan LI, Saddock B Comp Text of Psychiatry, NY Williams & Wilkins p.495 (1996)). The mother's preoccupation reflects attachment to the infant (Harding JJ Comprehensive Psychiatry 30: 109 1989). in contrast with the denial of the neonaticide mother. The motivation of the mother with postpartum depression or psychosis for killing her newborn is often altruistic (Sadoff RL Psychiatric Annals 25:10601-5 (1995)) (to protect the child from a hard life, poverty; abuse, isolation, or even demonic possession). When these illnesses are absent, the unforeseen pressures of new motherhood may propel an impulsive and often alcohol abusing and already physically abusive mother to kill.
Dr. Miller is a proponent of a dissociation hypothesis. At the moment of birth, the girl may have memories of surrounding events,. but can experience almost an out-of-body experience when the baby is born. According to Dr. Miller, "it is not a psychosis in the strict sense of the word."
Even after birth, the neonaticide mother with strong denial is unable to attribute a motive for the killing. Emergency room personnel are sometimes the first to discover the death, after a mother presents with abnormal uterine bleeding that turns out to be afterbirth—with no sign or history of a baby. The mother asserts she remembers little of the actual event.
"Did you go to his funeral?" I asked. "Whose funeral?" she replied.
Clearing Misconceptions by Analogy
The implications for criminal responsibility give neonaticide mothers who denied pregnancy reason for caution before disclosure of their emotions or feelings. Perhaps this is why non-forensic populations may provide particularly useful insights into the mind of the mother who kills her newborn.
Emergency room staff sometimes discover the death—with no sign of the baby.
Some studies of young women who chose adoption yield a psychological profile startlingly similar to the new mothers who kill. A French researcher who interviewed 22 women "based on psychoanalytic methodology" (Bonnet, C. Child Abuse and Neglect, 17: 501 (1993)) reported that adoption is motivated in the majority of cases by psychological, not socioeconomic causes.
A number of these women described living in homes where communication about sexuality was strongly discouraged. Most of the women discovered their pregnancy after the first trimester, often during the fifth month, The mothers denied their pregnancies and explained away the symptoms they were having. Upon learning of their pregnancy, they did not seek prenatal care, and continued to believe they were not even capable of becoming pregnant. (Ibid. p. 505 ). Often, they found the realization of pregnancy triggered memories of traumatic sexuality or guilt of revealing sexual pleasure. As time made denial less possible, violent fantasies toward the unknown child began to emerge. Conflicted about these feelings, they would withdraw from others (Ibid. p. 506).
Those who suffer strokes involving the right parietal lobe deny the stroke, and deny illness, even as they are paralyzed on their entire left side. Some with massive tumors deny their existence to the point of inoperability, or even death. Why is the denial this extreme?
Some requested late-term abortions. As birth approached, their anxiety increased; they feared confronting the child. Labor often took them by surprise; they arrived at the hospital just in time to give birth. Afterwards, they did not want to see, hear, or touch the infant; some went so far as to demand general anesthesia so as to avoid being alert for the birth. When well meaning hospital personnel placed the child on the mother's belly or encouraged physical contact or breast feeding, significant and unforeseen distress resulted. This physical contact helped immediately establish a connection, in conflict with the revulsion, even to the point of violent fantasies, for what the mother had considered an intruder up to that point (Ibid. p. 508).
There is no mother child relationship in neonaticide. This is sharp contrast with the mother who abuses her fetus, or kills her infant, or small child, or her newborn with premeditation.
The denial is accompanied by a peculiar indifference.
John Condon, reporting cases of women who abused their developing fetuses, provided a portrayal of mothers different from the neonaticide teen or mothers who sought adoption. The abusive expectant mothers did have a relationship with the fetus—one of loathing—either for the baby, or for the husband, subsequently displaced and directed at the fetus. Alcohol abuse was common. Unlike the withdrawn and repressed immaturity of the denying neonaticide mother, the fetal abuser was described as impulsive and emotive (Jl of Nervous and Mental Disease 174: 9 509-516 (1986)).
This profile more closely resembles the mother who chooses to kill her baby after its birth. The premeditated newborn killing is more likely prompted by economic circumstances, the persuasion of a manipulative father ("No Evidence for Abuse," The Forensic Echo 1(6) :16 ) or consequences from an illegitimate pregnancy. A history of antisocial personality or conduct disorder may be seen, and a family history more representative of amorality. There is less associated shame with pregnancy per se in this woman, often older, who is in contrast far less conflicted about her sexuality.
Denial protects against anxiety and conflict; it is a defense mechanism seen in the narcissistic, to protect against confronting weakness. It is also seen in the histrionic, who have more shallow, poorly developed ways of dealing with conflict. It is no coincidence that dissociative states, where individuals may disconnect for periods, without memory, are found in these more immature women. Often they have a history of significant trauma. Despite their ignorance, some are quite academically capable (Finnegan P, Canadian Jl of Psychiatry 27: 672 [1982]), which often makes our appreciation for their denial more difficult.
Denial as a defense mechanism is also at the root of Conversion Disorder. Conversion disorders involve, typically, a neurological function; perhaps paralysis of a hand, loss of vision, loss of balance, even a seizure disorder (DSM IV, Washington, American Psychiatric Press, 1994 p. 433). However, medical evidence for these illnesses is not found; all tests show the person with a hysterical conversion disorder has nothing at all wrong with his or her physical functions. The patient is not malingering; she believes she cannot move, regardless of the results of the workup. On interviewing, the patient, despite the dysfunction, displays "la belle indifference," a peculiar indifference to her infirmity. And the loss of function is later to be connected to a psychological conflict she cannot resolve.
"La belle indifference" is evocative of the neonaticide mother, who not only denies her fetus, but also is surprisingly unfazed by the physical symptoms of pregnancy. The denial most certainly serves to resolve the conflicts of enormous psychological magnitude. Is the denial of pregnancy also a hysterical loss of function? The dissociation in the moments after birth, also more frequently seen in the emotionally immature, would support this hypothesis.
Death Investigation
There is much to be learned by the method of killing as well. Common methods of neonaticide are suffocation, strangulation, head trauma (usually from dropping into a commode), and drowning (in the receptacle where the birth occurs). The detachment of the mother from her fetus is dramatically challenged by the undeniable presence of the newborn. And the cry that is for some, sure to follow birth is the undeniable confirmation that the baby lives. Suffocation stifles the cry, and the baby's death preserves the denial.
The immediacy of the birth is profound to the mother. The immediacy of her response in then killing the child, with efforts to avoid detection made only after the death, reflect the impulsivity of the action and the motivation of killing to preserve the denial. These are the killings which truly exemplify the dilemma to follow. Michelle Oberman, in her reported sample of 44 neonaticide mothers, reported 16 of the killings were by suffocation.
Do physiological changes of abnormal perinatal conditions, such as eclampsia, include psychological changes as well? Are these changes enough to suggest a mother did not know what she was doing was wrong? Eclampsia, which can occur before, during, or after delivery, involves extreme elevations of blood pressure, and the mother suffers seizures. Is eclampsia characterized by a change in mental status? "Only during the seizures," says Palmer Evans, M.D., an obstetrician at Tucson (AZ) Medical Center Violence during seizures is not directed, but a person may become violent toward someone very physically close. A person may also be violent between seizures (Welner M. Presented at American Psychiatric Ass'n Annual Meeting San Diego, 1997).
Delirium, a condition of an abrupt change in mental status, may occur around the time of birth. However, the behaviors associated with delirium reflect disorientation and confusion; the histories available from numerous neonaticide cases suggest the mothers were deliberate, methodical, and aware of whom they were avoiding. This diagnosis might be appropriate if the crime scene reflects gross disorganization of behavior, including only halfhearted attempts to clean blood from the scene.
Once a young mother is taken into custody, considerable uncertainty for what happened, and how to prosecute, will follow. Since the denying mother remembers little of the time around the death, physical evidence is needed to confirm that the baby was actually killed. Predictably, a key battle in suspected neonaticide cases concerns whether the baby was born alive.
The American College of Obstetrics and Gynecology has established criteria for viable births which exclude weights of less than 500 grams, or gestational age of less than 23 weeks, based on likelihood of survival. "In the absence of some dramatic congenital anomaly, there is no reason to believe the baby was not born alive," relates Cyril Wecht, M.D., the medical examiner of Allegheny County (PA) who has consulted on one of the recent hotly contested alleged neonaticides. According to Charles Hirsch, M.D., Medical Examiner of New York City, the appearance of inflated lungs and an air bubble in the digestive tract on postmortem examination confirms that the baby was born alive. Some pathologists dispute the long held notion that lungs which float on water confirm a live birth. However, "an x-ray will show air in the lungs," said Dr. Hirsch.
Even when birth is established, these investigations are further complicated by uncertain cause of death. While stabbing or head trauma might provide clearer evidence to be presented to judge and jury, suffocation in many cases leaves no identifiable markings. In cases such as these, disposal of the newborn in a garbage or a roadside container suggests the indifference of the mother. Does that make her a murderess? "In the absence of a confession, it's a lot harder to tell," concedes Dr. Wecht.
Disposal suggests indifference. Does that make her a murderess?
Statistician Eth estimates there are 6 million conceptions per year. 4 million babies are born and 1.5 million fetuses are aborted. That leaves 500,000 unaccounted for. Stillborns and babies who die in utero account for some of this number. How many? Pediatricians, occasionally reminded of the dark secret of neonaticide, wonder aloud how often the deaths they classify as sudden infant death syndrome are covert neonaticides and infanticides. And the dead newborn is not always reported even when discovered (Jason J; Carpenter, M; Tyler, C. Public Health Briefs 73:2 195-197 (1983)). How many silent deaths never reported before as stillborn are there? We could never know. How many women drink their babies to death in pregnancy? A lot more than can be accounted for. How many stillbirths result from absent or poor prenatal care? Still more. Charles Hirsch, MD., Medical Examiner of New York City, admonishes that many pathologists maintain a high suspicion for foul play in the death of a newborn. "A long time ago, someone taught me to think dirty; it's a homicide until proven otherwise" he notes. "The time to look for it is at the autopsy, not after the burial."
And if neonaticide occurs in the socially isolated, highly religious communities, then what happens in insular communities such as the Amish, ultra-orthodox Jewish, and Mormon, where influence in community institutions keeps things from the scrutiny of courts? "This is the kind of thing that is dealt with in a way that nobody hears about," acknowledges Dr. Raffle Lottner, a psychologist with the Jewish Board of Family and Children's Services in New York. Collusion or discarding may be the only way to avoid detection; but death certificates can only be issued by a medical examiner, and death certificates are required for burial.
So nervously, the country approaches this underreported phenomenon— and the ambivalence plays itself out in courtroom chambers located in urban, rural and somewhere in between America. Can the legislature be far behind?
Defense: The Actor
"The judge does not want..: to send this woman to jail," said the defense attorney. Doc if you find anything psychological, she'll use that . . . but do it fast, because the (high profile) case might complicate things.
The United States is the only country in the world to vigorously prosecute teenagers who kill their newborns, and just as vigorously refuse to convict them. Prosecutors are not the only group with a punitive interest. Americans United for Life are actively endorsing the Crimes Against the Unborn Child Act. Common law currently holds that unless the baby was born alive, the mother cannot be charged with homicide. The proposed statute would overturn the common law and categorize conduct causing the death of an unborn child as homicide.
Currently, 25 states classify the killing of an unborn child as homicide. Any number of criminal statutes assists the prosecution of the neonaticide mother, from unlawful disposal of a body to first degree murder. The trend toward trying juveniles as adults may include the disposition of neonaticide cases. And some states have statutes containing additional penalties for vulnerable victims.
And so it goes for female neonaticide defendants. Juries and judges may condemn the act but salvage the actress. While most teens are charged with first-degree murder, law professor Oberlin's analysis of 47 prosecuted neonaticide cases between 1988-1995 revealed convictions in only 15 case, Of those 15 convictions, some of the sentences imposed consisted of therapy and parenting class.
The best defense strategy remains a matter of the cause of death. Unborn child statutes traditionally preclude the mother from responsibility for intrauterine death. For this reason, the defense benefits from asserting the position that the baby was born dead. This is less feasible when the cause of death is clearly at the hands of the mother. For this reason, suffocation is clearly the easiest neonaticide to defend, provided there is no confession. However, a particularly brutal or bizarre action such as stabbing or burning may reflect psychosis. This may enhance an insanity defense or more easily, a dissociation defense that establishes diminished capacity.
What if there is a confession? Profound guilt, especially when depression is present, may motivate the mother to take even more mental responsibility for the killing. Emphasizing the emotional simplicity of the interrogated defendant may present the best technique for weakening videotape confession evidence.
Because of the gross confusion of delirium, defense attorneys can present a formidable argument of no criminal intent if the newborn died of exposure or passively by drowning, if there is other evidence for the mother's gross change in mental status. This is part of the reason why neonaticides that follow abandonment are easier to defend than active killings. The delicate newborn may be very quickly slain; a fact pattern that reflects the gross disorganization of the mother, with little or no effort to hide the body or clean the crime scene, would be more consistent with delirium and argue against criminal intent. This reconstruction distinguishes the approach of pathologists from many psychiatrists who emphasize psychosocial history. "We don't look at demographics," explains Dr. Hirsch.
The neonaticide mother can be portrayed as a victim as well. This is enhanced by a comprehensive life view that demonstrates a naive, perhaps previously abused woman in an oppressive household with real basis for fear of community ostracism or fracture of family relationships elemental to her life. Jurors relate to this on human terms and cannot put this little girl away, regardless of the law and whatever they believe happened. One juror described a similar response in a popular magazine (Binswanger CK Glamour 302-305 Sept. 1997).
Professor Oberman told The Forensic Echo of one surprising strategy used by a colleague: "He told the jury the story of the girl's labor and delivery. Birth is not a silent process, but this girl did it while people were sleeping around her. They denied it too. He portrayed the psychological fortitude necessary to silence yourself during birth." The jury sympathized.
Jurors cannot put her away regardless of the law
Such sympathy from the juror or judge may fuel acquittals or lenient sentences, but the defense attorney pumps the gas. And a good attorney takes no chances. Michael Dowd is a Manhattan attorney renowned for defending women by using the battered woman's defense. He has been consulted on numerous neonaticide cases, and is under no illusions about jury sympathy. "One of the hard things you have to get beyond is the notion of baby-killer, because what follows after that is... who could kill an innocent child?"
Attorney Steven Insley of Paterson, New Jersey is equally cautious. He represents a client who admitted throwing her newborn to her death from a bathroom window. She pled to the lesser offense of aggravated manslaughter and spared herself a life sentence. His perspective? "Don't count on a sympathetic jury!"
He does plan to use her life circumstances and their emotional impact as a mitigating factor at the sentencing hearing. "The young woman was sent to this country for the sole purpose of earning money to send back to her family in Mexico." His client faces the prospect of 30 years in prison.
Is there a type of juror that is more inclined to compassion for the accused teen? Attorney Dowd vowed, "It's a mistake to make judgments about jurors. An older woman may be more likely to think, nothing ever moved me to kill my child. Sometimes, men are more willing to listen to someone else's experience, since they haven't the frame of reference," Attorney Dowd looks for jurors who can get beyond their own experience and appreciate that "bad things happen to good people."
A good defense strategy is to search for a juror who can appreciate mental illness, given the difficulties in explaining a girl's mental state. Attorney Dowd explained. "You have a young woman on the stand who seems to be just like them. When you have someone who seems collected and coherent, it's difficult to get a jury to understand what she was like when she was not coherent."
While defense attorneys emphasize the person to the jury, the prosecution maybe particularly successful emphasizing the act. In the Rebecca Hopfer case ("Juvenile as Adult a Matter of Remorse," The Forensic Echo 1(10): 16), one reporter from the Dayton Daily News recalled how the prosecutor took out a plastic trash bag before the jury and tied the opening into a knot, re-enacting the victim's disposal. He reminded them that this was purposeful, and that it showed intent. The jury returned a verdict of guilty of murder.
Despite the seeming implicit psychiatric sensitivity to the mother's conflicts, some testimony can also assist the prosecution. The question of intent to kill is raised by the defense when a baby is abandoned, and the cause of death is undetermined. This may make the difference between charges of criminally negligent homicide and manslaughter. Even when the cause of death is undetermined, prosecutors are served by emphasizing that the abandonment of a child in a trash can or in an alleyway is most peculiar maternal behavior that is likely to be reflected in continued denial of the pregnancy by the mother For this reason, it would later prove to be advantageous for the prosecution to avoid pressing charges immediately in order to emphasize the callousness of the mother, who, after tossing out her baby, is likely to continue to display "la belle indifference." Witness the public revulsion at the story of the "Prom Mom," who returned to the dance floor after killing her newborn. Read public as jury.
Prosecutors seldom have the advantage of a fact pattern so ripe for impact, but with a little patience, a post event history of behaviors may be assembled that show little psychological impact and perhaps just a little too much enjoyment. The guilt reported in neonaticide mothers grows slowly, and the denial, which worked to repress the conflict of the pregnancy, will do just fine to make the murder go away, too.
Prosecutors who feel they have a denial case on their hands but confront a defense of psychosis or dissociation should advise the psychiatrist to carefully examine the plaintiff for previous instances where the defendant employed massive denial. This negates the defense notion that the mothers response was so exceptional. Prosecutors are then able to demonstrate that the mother might respond with denial of responsibility even when the stakes are not so high as being kicked out of the home.
Denial is far more impressive when the secret is truly a secret. The presence of the father, with no discernible psychopathology (even the most brazen defense would have a hard time convincing a jury that both boyfriend and girlfriend dissociated or had a shared psychosis) supports premeditation. So does the mother's confiding in her friends her motivation to conceal the pregnancy. Dissociation and denial, like other defenses, operate at an unconscious level, with motivation unclear to the actor. Clearly articulating fears to friends establishes a true recognition of pregnancy. And a discussion of the pregnancy forces a jury to consider that the mother had to have recognized she was eventually going to give birth. This enables the prosecution to counter a history of a mother who bought no baby clothes, no toys, made no advance preparations. Was it because she denied her pregnancy? Or when she didn't, because she never planned to give birth?
The prosecution is served by not pressing charges immediately.
Paternal involvement in neonaticides is rare, in contrast to infanticides. The role of Brian Peterson, who was allegedly at the Comfort Inn somewhere in Delaware at the time his girlfriend Miss Grossberg's baby was delivered, is therefore intriguing. Case reports from the literature suggest a neonaticide father may perceive that the presence of a baby might alter the romantic relationship. In an especially pathological union, this might prompt a dramatic action. Also reported is paternal neonaticide motivated by recognition that the stigma of the unmated pregnancy will fracture the otherwise harmonious and accepted relationship (Resnick P Am Jl Psychiatry 126:10 1418 (1970)). Still other fathers may view the fetus as a rival, or seek to conceal extramarital paternity (Saunders, F. Public Health 104:4 368-372 (1989)). Denial is not attributed to the male; this may explain why Resnick's data reported that courts took a harsher sentencing approach to neonaticide fathers than mothers.
Life After Death?
What happens to the mother long after the disposition of the case? Because instances of neonaticide are culled from disparate locations and decades, little is known about outcomes. We attempted to follow up on the fate of seven neonaticide mothers who entered the justice system between 1987 and 1988, but they are unaccounted for, even in the prison system. Those written up in the literature have been reported to experience lingering guilt, even depression, but some mothers go on to eventually have children (Saunders, F. Public Health 104:4 368-372).
Child welfare agencies are concerned about recidivism when the mother becomes pregnant again. Dr. Miller evaluates the parental fitness of former neonaticide mothers and she has not found an automatic link. "Things go awry when there are problems with the social support network and people aren't intimately involved with her life," said Dr. Miller "If that changes, the prognosis is good."
No More Neonaticide?
Can we possibly prevent this tragedy, when everything that defines it seems far from anything that can help? Secular institutions endorse contraception. Religious institutions preach abstinence. How are women educated about adoption and abortion as alternatives? As it is, less than 3% of adolescents resolve unplanned pregnancy through adoption (Daly K. Youth & Society 25:330 (1994)). Sarah Holbrook, an adoption specialist in New York, downplays the connection between neonaticide and availability of adoption. "We're not into it," she commented. Dr. Phelan also finds adoption of limited benefit. "Women who are aware they are carrying a child for nine months are going to find it very hard to go through all that just to put the baby up for adoption."
Can we learn from Rwandan and Bosnian rape victims?
How can we learn from societies where neonaticide might not be so shocking? Victims of war, dehumanized, impoverished, and often isolated, might see their conception of rape as particularly alien. Yet, according to one Rwandan official, neonaticide is not the problem we might suspect. Christine Umutoni of the Rwanda Mission to the United States noted that many young mothers abandoned their children to orphanages following the war rapes of 1994. While some saw the babies of rape as "monsters," the government is educating the people to accept the growing toddlers as merely children.
Lydia Topic of the Bosnian Mission to the United Nations has worked with victims of rape. She related, "The society supported the girls and their babies. The Lutheran World Foundation made a house available where the girls could give birth . . . I don't know of a single case where a baby was killed."
Whether neonaticide is absent in Rwanda and Bosnia or not, the accounts link community support with better outcome. How can we apply these examples to American health care? In the case of Dr. Phelan's mother who denied pregnancy despite a confirming ultrasound, she chose to maintain the connection rather than confront the denial. "She wanted to refer to it as a mass, so I told her, 'I need to see you for this mass. . . whatever we had to do to keep her coming back.' In her experience, presenting this connection enables the mother to gradually come to terms with the pregnancy "If I sense that the mother is denying the pregnancy, or if the support system is poor, I try to refer her for social services." With such channels available, isolation is reduced and the mother can find support to resolve shame and underlying conflicts. Given the association of neonaticide with isolation, this early intervention for immature primipara mothers with obviously inadequate support systems may provide enormous preventive benefit. At the very least, prenatal care compliance is enhanced; in a precious few troubled teens, tragedy might be averted.
Primary care specialists and OB/GYN, sometimes with only one opportunity as a respected adult presence, can educate their patients who might be at risk later on for tragic outcome. Counseling at these treatment settings may provide an important opportunity for unexpected mothers to verbalize feelings about the pregnancy, and to parachute the mother from denial to a prenatal course of abstinence from alcohol, responsible medical follow up, and disposition without psychological or criminal consequences. This intervention keeps a woman's health where it belongs—out of the courtroom, and out of the legislature. Perhaps then neonaticide will truly become the rare problem we mistakenly now believe it to be.
