OWhen it’s my turn to be a pediatrician at my hospital’s nursery, my job is to counsel new parents on healthy newborn behaviors and assure them that their baby is capable of surviving. Breathing. While eating. Poo. The pace and routine of newborn assessment is rote: look, listen, feel. Healthy babies have commonalities that help doctors like me decipher sickness from health. When I look, I notice that each child has one mouth, two eyes, four wriggling limbs. I place my stethoscope on each tiny chest, listening to clear, crisp breaths between rapid, steady heartbeats. I feel the bones of each baby as I run my fingers over the collarbones, along the spines, on top of the skulls. I identify with the pure affection that manifests when mothers hug their children to their chests.
My pediatrician colleagues and I apply this same rhythm and routine daily to analyze the implications of poverty. I work at a security hospital in Philadelphia. The median household income in the neighborhood outside of our hospital’s manicured lawns is $36,572. Most of our insured patients are eligible for Medicaid. We have always listened to the insecurities associated with poverty. Some went down last year when the child tax credit was in effect. Since its expiration in January, however, these constraints have crept in again.
The essential is again unrealizable. Parents in our clinics are increasingly in need of help with obtaining diapers. Parents in our Neonatal Intensive Care Unit (NICU) are increasingly asking for referrals for cribs, food, bus passes. Requests for car seats come in at the clinic, nursery and NICU. We replenish the pile of newborn clothes in our hospital’s donation closet whenever the pile runs low, the bins labeled not by what’s in them, but by the names of the churches that donated their contents. I still hear from parents telling me about taking three buses each way, every day, to visit their hospitalized premature babies because they can’t afford an Uber. This is all on top of the nationwide formula shortage, which has the NICU nurse in charge constantly calling our formula rep, hoping she can source scarce formulas for our patients. the most fragile.
Read more: 5 Parents Stressed About Trying To Feed Their Babies Amid National Formula Shortage
We are supported by the village of agencies, policies, public programs, donors, non-profit organizations and community members, but it is tempting to feel devastated by the scale of the needs. That our social worker can provide temporary breast pumps and that our nurse manager can find funding for insane transportation. We can find these and other solutions because the rhythms and routines we hear are predictable. But for a while we didn’t have to. For months, I haven’t come across a single new mother pumping breast milk, drop by drop, with her own hands while waiting for her health insurance to deliver an electric breast pump.
As I walk from room to room, the bodies of my patients appear indistinct. But a study published in April taught me that if I looked deeper, with more sensitive tools than my own eyes, I could see the effects of poverty imprinted inside these bodies. These researchers examined newborn brains with magnetic resonance imaging and found alterations in how brains form and develop in the face of maternal social disadvantage. In other words, poverty has an impact on the growth of the brain of the fetus. Overcoming these effects is certainly possible. Examples abound. But I don’t believe a baby should have to try.
Discussing research that differentiates fetuses based on the lived experiences of pregnant women can be problematic. Many may be tempted to blame pregnant mothers for the adverse consequences suffered by their children. Mother blaming is not a new concept. The idea that women should be virtuous vessels, capable of perfect pregnancies in the face of societal stressors and systemic racism is a mistake. No one chooses to live in poverty. Neither pregnant women nor children. Nobody.
Read more: How I got lost in the maternity ward
And these new data are not surprising. The link between adverse health outcomes and poverty during pregnancy, infancy and early childhood is irrefutable. The seminal report “From Neurons to Neighborhoods” provided compelling and consistent content on the effect of poverty on newborns and young children in 2000. What is surprising is that, over the 22 years Since that report, and in all the years since the reports that preceded it, the pace of progress has been slow.
Slow progress is not progress. The moral imperative to help all citizens give birth to healthy babies and raise healthy children is also a financial imperative to ensure healthy adults, healthy citizens. Healthy workers. Pilot funding programs for pregnant women are underway in California. The Child Tax Credit was a cost-effective federal policy that was successful in reducing child poverty and improving the lives of mothers raising children during pregnancy.
I am not a poverty specialist. I have lived all my life fed and housed. I don’t do research on the effects of poverty like the authors of the study in St. Louis, nor am I an expert on early childhood development like those who wrote “From Neurons to Neighborhoods.” . But I’ve spent my career as a pediatrician listening to my patients’ parents share their stories after I took my stethoscope out of my ears. Their stories have taught me to see beyond what my own eyes can capture, to do all I can to support those I serve.
Read more: The child tax credit was a lifeline for my sons with special needs. Congress must extend it.
Not everything has improved as a result of the child tax credit. The early morning ritual in our postpartum unit of fathers, anxious to disrupt their partner’s sleep, leaving for jobs in warehouses, factories, retail stores, then returning each evening to participate in the newborn bond that they missed during their work, never stopped. My colleagues who work in our pediatric and adolescent clinic serve patients who are increasingly victims of gun violence. But looking back, we spent less time last year getting our families’ necessities and were able to care for our patients in other ways. For a time, the families of our patients spent less energy sorting out the poverty.
Near the end of each newborn assessment, I discuss the common reflexes babies need to survive. A start, a suck, a hold. When I press my index finger against a newborn’s palm, it grabs my finger, as you would expect. If I don’t withdraw my hand, its hold remains. Babies, people, are resilient. Our bodies are predestined to grab, grab and hold whatever is offered to us. I only wish our nation would place more in every palm.
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