Prayers in the NICU – Thoughts on Child Mortality & Parenthood

It’s 2003 and there’s a baby in the NICU, the neonatal intensive care unit, at Children’s Hospital in Vancouver. He is very small and there are sensors attached to his tiny foot and chest, there are tubes going into his body to feed him, to give him oxygen, to keep him alive and I am standing there, stitched together after an emergency c-section, looking at him inside that plastic box. I don’t really believe in any gods, but I’m praying anyway. Or maybe not really praying, but rather trying to make a deal with the who or what or nothing that might be listening to the words I am not speaking out loud. If he lives, then I won’t ever… If he lives, then I will always…

How many parents, through how many millennia of human history, and under much worse circumstances, have bargained in similar ways with whatever powers they imagined might listen and tilt the universe in their child’s favor? Burning incense, offering sacrifices, saying prayers, chanting spells, clasping amulets. How many parents are doing the same today, in all the countries of the world, in the rubble of villages and towns, at bedsides, in waiting rooms and hospital wards? Surely, if there were such a thing as demons in the world, looking for people to sign a contract with the devil, to trade their human souls for a boon or favor, those demons would be hanging out in pediatric hospitals, in war zones, or any other place where children are injured, sick, dying, because there they would find a ready supply of parents willing, eager, to trade their souls for the lives of their kids.

It’s unnatural for children to die. That’s what we tell ourselves and each other. And yet, for most of human history, it was common. Some studies show that about half of all children died before reaching adulthood until recent times. Even in 1950, one in four children globally died in childhood. I can glimpse the way it was even in my own family: my paternal grandmother gave birth to eight children. Six lived. Two died at or soon after birth. That was less than a hundred years ago in Sweden.

Vaccines, better healthcare, improved hygiene, safer drinking water, antibiotics, and so on, have changed the equation. The global death rate of children has declined from around 50% in the early 19^th century to 4%. Even so, war, disease, accidents, famine, bombs and rockets, guns and neglect still claim the lives of kids everywhere. In 2020 an estimated 5 million children under the age of 5 died, mostly from preventable and treatable causes. 5 million. The leading causes of death for kids under 5 are complications from premature births, infectious diseases, diarrhea and malaria, asphyxiation or trauma at birth, and congenital anomalies.

In many countries, the death rate for children up to age 15 has declined to 0.3%. Still, that declining mortality rate is not evenly distributed. A child born in sub-Saharan Africa is 11 times more likely to die in the first month of life compared to a child born in Australia and New Zealand. Even within countries, there are differences. In Canada, for example, the infant mortality rate is higher in First Nations and Inuit communities. Meaning, even if the system gets better overall, it doesn’t protect all children equally. Poverty, racism, war, inequality, still claim the lives of newborns every day.

When I was pregnant, no one ever spoke to me about the possibility of my child dying for any reason. I went to prenatal classes for months where I learned all sorts of things about what could happen when I was giving birth, but no one talked about the neonatal intensive care unit until my kid was brought there and placed in an incubator. It’s unnatural for children to die, and so very rare. Why talk about something that almost never happens? Besides, even if you’re not superstitious, talking about child mortality, or what might go wrong at birth, with someone who is pregnant seems like it would be bad luck, right?

What I remember most about the 10 days my firstborn spent in the NICU is the feeling of utter helplessness. There was nothing I could do for my child except occasionally hold him, touch him, watch him, talk to him. The nurses told me what I was doing was important, but it felt terribly inadequate. Doctors and nurses would draw blood, do x-rays, poke and prod his little body, and I would stand there telling myself what the nurses told me: that he would get better, that he would come home with us eventually, that he would be OK, because anything else was impossible, unthinkable, and yet the impossible and unthinkable weighed me down every single day.

I recently sat in a local pediatric emergency room for a few hours (nothing to worry about in my case, everyone is fine), and the place was filled with babies and toddlers suffering from respiratory illnesses, fever, diarrhea, vomiting. So many babies. So many parents looking harrowed and sleep deprived. It’s unnatural for children to die, and yet, in the last few months here in British Columbia where I live, three children have died due to complications linked to influenza.

A few weeks ago, I watched the TV-images of babies being removed from the pediatric intensive care unit of a hospital in Gaza. Some of those children were evacuated and lived. Others died. Others keep dying. I can’t tell you what I thought when I watched the footage. What can you think? What can you say when all you want to do is scream? It’s unnatural for children to die, and yet it continues to happen, every day. Even when we know what to do, even when we live in a world overflowing with resources that can help, so many children are not safe in this world.

It should be unnatural for children to die, and yet they do. Too often. Too many.

It’s been almost exactly 21 years since my oldest child was in the NICU. He’s an adult now. He lived. I’ve forgotten the details of most of the prayers and bargains that went through my head in that NICU. Whatever words I spoke or recited in my mind were a way, however futile, to make me feel like I was doing something when there was nothing I could do. Those words were a way to try to tilt the universe just a little bit in my child’s favor, and a way to wring some hope from my own despair. I don’t think anything I thought or said back then made a bit of difference. I was just lucky. Lucky to be in a place and a time where there the resources existed to help my child. No gods or demons needed. Just doctors and nurses and a functioning health care system.

I don’t think there are any gods or demons in this world, none except us, the people in it who are capable of so much empathy and kindness, and so much cruelty and neglect. I think this world is terrible and beautiful, full of goodness and miracles, injustice and pain. It’s a world where children can live and thrive, or suffer and die, and where helpless parents pray and bargain every day, silently, or screaming until their lungs give out, whether anyone is listening or not, trying to tilt the universe in their children’s favor, trying to wring a drop of hope, maybe even salvation, from the black shroud of their own despair.