This week I had the pleasure of interviewing Dr. Ann Kellams. Dr. Kellams is a pediatrician and lactation consultant at UVA Children’s Hospital. She has served as the Medical Director of the Well Newborn service since 2006, and served as the Breastfeeding Committee Co-coordinator for the American Academy of Pediatrics, Virginia Chapter for the past ten years.
This is the first part of a two-part interview series, in which Dr. Kellams speaks on her background, what bioethics means to her and her practice, and how she works with families to navigate the birthing process.
How did you get to where you are today?
My parents tell me that I was walking around in diapers saying that I was going to be a baby doctor. I don’t know if that was my innate sensibility, or I was brainwashed by my father, who is also a doctor. It’s just something I’ve always been interested in. I’ve always been drawn to people in need, from trying to care for little toads that had been attacked by my cat, to just anything serving life.
What is it about mothers and babies in particular that interests you?
I’m really fascinated by the whole circle of life, and the maternal instincts and innate behaviors that we, and the rest of the mammalian species, all have in common. Birth is a time of celebration, but also a really vulnerable time. My mother is a role model for me, because she was always drawn to babies and also very focused on family. So I think I got some of that from her as well.
How do you define bioethics, and how does it relate to your practice?
For my work, because we work with families in a very personal, intimate space, it’s important that they feel empowered, autonomous, and respected. In my current role, I deal with people having babies; a shared common event from every walk of life that you can imagine. From an ethical standpoint, I think bioethics is related to healthcare in areas where all sorts of competing values and morals meet. And a little of what I do every day is navigating that.
Given that birth is such an emotional experience, you must work with people in emotional highs and lows on a daily basis. How do you find your own balance in this environment?
My challenge is to come into patient space with no judgments, expectations, or assumptions. Every room I walk into, I want to find out what meaning this event has for the patient. People come from all sorts of backgrounds, with concerns ranging from family situations to past births and infertility. So the challenge is trying to meet them where they are.
Part of your job is in the breastfeeding clinic, giving mothers the resources they need to breastfeed. What would you say to a mother who would like to breastfeed, but feels like she isn’t able to, or is maybe coming from an underprivileged background?
I bring to this situation a lot of knowledge and expertise, so my job is to figure out what the mom knows about breastfeeding, so that every decision she makes is an informed one. Then, my job is to completely support her in whatever decision she makes. So I might ask her why she’s interested in breastfeeding, or what she thinks would be difficult about it. And then depending on what she does or doesn’t know, and her specific areas of concern, I can give her more information. So the only real failure is not people deciding to feed their baby a specific way, because there’s lots of reasons to make that decision, but the failure would be if they made a decision without having all the information, or if they made the decision to breastfeed but didn’t receive the best support they could have. It’s not about telling mothers how to feed their babies, because I think that’s ethically problematic, but 100% supporting them in whatever their truly informed choice is.
As a doctor, you advocate for newborns who can’t advocate for themselves. How do you navigate situations where the family’s decisions deviate from what you believe to be in the best interest of the baby?
If I think that there’s imminent or potential harm to the baby, then by law and by ethics, we’re required to take it to the next level. In pediatrics we can go so far as to get court orders and involve child protective services. That’s a rare occurrence, though. Most of the time, it’s a conversation and negotiation. I try to meet the family where they are, and make sure that they understand how serious (or not serious) the potential consequences of their choices could be. A minor example could be a family that doesn’t want their child to receive the Hepatitis B vaccine at birth, which is recommended by the CDC. If we think the baby is at risk of infection, then there could be very serious consequences- it could be fatal. So we try to help families make an informed decision based on potential harm, and negotiate with them to come to the safest choice that respects their values.
This interview has been lightly edited for length and clarity.