During her recent trip to the United Nations, New Zealand Prime Minister Jacinda Ardern used her speech to recommit the government to making New Zealand the “best place in the world to be a child”, ensuring that:
no matter where you are born in the world, your local school is the best school, there is food and a health system that you can rely on and perhaps most importantly that you are loved and that you are heard”.
Leading New Zealand paedriatrician Dr Simon Rowley would no doubt agree with those sentiments. The welfare of babies and children is at the heart of his recently published book, Mind That Child: A Medical Memoir. Few would be more qualified to provide some guidelines on how to improve on present conditions.
A major focus in his professional life has been on those tiny babies whose survival depends on technological advancement and the skills of NICU (Neonatal Intensive Care Unit) staff. The book begins by showing what this involves: alongside the euphoria of saving lives there are constant pressures, enormous costs and ethical dilemmas.
What are these dilemmas? The “amazing technology” that keeps a very premature baby alive costs approximately $3000 a day and can mean an expenditure of hundreds of thousands of dollars. When babies are suffering chronic serious pain and sickness and there is no hope of recovery, should staff use available technology to keep them alive just because they can? Dr Rowley’s answer is a definite no, and he details the case of a baby who would never be able to “see, speak, hear, eat or breathe unassisted” .
Rowley explains that any NICU sees a disproportionately large number of underprivileged parents, “because it turns out that being underprivileged is in itself a strongly causal factor for having a premature baby.” Some babies are already damaged before birth because of their mothers’ drug or alcohol addiction while pregnant and will be going home to parents “who haven’t a clue how to look after a child”, or in other instances, to violent and abusive homes. Should these babies receive as much time and attention as others? The good doctor’s response is a definite yes, and in other parts of the book, he outlines measures he would love to see implemented to improve their chances .
He repeatedly emphasises that the first 1000 days of life are crucial for normal development, “and a lot of that is built on what happens in those first few weeks”. He strongly advocates for longer hospital stays for new mothers, during which time they can be advised in basic baby care and supported to establish successful breastfeeding. This should be followed up with regular home visits for ongoing advice and reassurance by, for example, Plunket Nurses and midwives. He would like to see paid parental leave extended to 26 weeks, and quotes the Swedish example of up to two years.
Mind That Child is aptly titled: the writer very obviously does mind. He worries that these premature babies, and others born at full term, are disadvantaged by poverty before they enter the world. The stress of living in cold and inadequate housing, or trying to cope despite a lack of money for basic needs and medical care, can lead to “harsh, punitive or inconsistent parenting” and, in the worst cases, serious child abuse. The positive news is that if a baby is “held, stroked, cuddled, sung to, talked to, rocked, fed and loved” its brain will develop normally whether or not there is money. One of the many intriguing pieces of information in the book that was new to me was the correlation between brain development and head size. Rowley describes his experiences assessing Russian orphans for adoption, and how head size was affected by the amount of stimulation and care they had received. The younger the child when adopted, the more easily they “catch up neurologically and settle in emotionally”, and the more their measured head sizes “leap up through the percentile charts”. Love and attention, it seems, are nutritious food for the brain.
It is not only the chapters dealing with premature babies that readers will find thought-provoking. Dr Rowley does not disguise his views on a variety of other matters, including how often men are left out of the conversations around babies, with the majority of midwives and health workers in this field being mainly women. The issues he addresses include the importance of vaccination, the effects of bad parenting (and what society could be doing to help), false economies “rife” in the health system – such as policies that promote premature maternal discharge, and (the greatest health crisis facing the current generation) obesity. He calls for the kind of “bold political action” needed to make healthy foods more readily and cheaply available than those full of sugar and fat, and to address our “scandalously large proportion of cold, inadequate housing”.
The book raises some tough questions, among them:
- NICU units are saving previously non-saveable lives. Can we continue to finance the medical advances available to sustain these very premature babies?
- Are doctors in some instances ‘playing God’?
- We can spend an enormous sum keeping a tiny baby alive for months; couldn’t we also be spending more on improving the lives of the parents who will be looking after this child for the next 20 years?
- With the increase in children born with foetal alcohol syndrome, and the ongoing effect this has within society, what more can we do to combat this?
Being exposed to childhood trauma, Dr Rowley asserts, is so toxic it increases chances of bad outcomes in every facet of health. Therefore “strategies for breaking the cycle of family disfunction” are essential, and to this end he endorses Brainwave Trust Aotearoa. This charity provides a wide variety of expertise to promote a message of hope, insisting that “there are ways to be an effective parent even if your own childhood was blighted by trauma”. The strategies offered by Brainwave Trust Aotearoa are at the heart of all the parenting advice given by Dr Rowley in this book: loving attention, cuddles, good food, good talk … simple cost-effective remedies which, if implemented, would make an enormous difference to all aspects of New Zealand life.
Patricia Thwaites lives in Dunedin, New Zealalnd. She is a retired schoolteacher and occasional book reviewer for the Otago Daily Times. One of her children was born prematurely, at 30 weeks, in1969, hence her interest in the amazing technological advances in NICU since then.
Mind That Child: A Medical Memoir by Dr Simon Rowley (with Adam Dudding) is published by Penguin Group (NZ), 2018.