GUEST POST: Two babies, two years

I met Craig at Webstock. We sat in the corner and showed each other photos of our babies – the great past time of saddo parents everywhere (no offence Craig). Seriously, I LOVE proud parents. I love no-chill look at photos of my family mums and dads. I am definitely that parent. Imagine having to deal with me every day? I literally write about my kids all day, tweet about my kids all day, and talk about them ALL DAY. I am insufferable. I’m not suggesting Craig is insufferable, he might be, we don’t know each other that well….But he struck me as a parent who is like me. Therefore, since I’m a narcissist, I liked Craig straight away. I meet so many people through this blog, and a lot of them are dads. I am really pleased to be able to finally share a guest post from a dad on this blog. I’ve hoped I’d get a dad post eventually – it might finally shut up those “what about the dads!” comments I get. But probably not. I love dads, and I have a lot of good friends who are dads, some of them I met through this blog. But I’m a mum, so I don’t bother to do “dad perspective” stuff. That’s why I’m so happy Craig wrote this post. I think it’s lovely. Delightful. It’s all about his first two years with his two gorgeous babies! Thanks for sharing with us Craig!

Just over two years ago I donned a pair of white overalls and was led into an operating theatre at 5am. My wife had a green sheet stretched out like a volleyball net across the bump where two children had been percolating for the past thirty-five weeks. I couldn’t see past the sheet from my position near her head, but if I had I would have had a front-row seat for the insicion-and-viscera show that was an emergency ceaserean.

The doctor – our doctor – a brisk man who joked in a way that you were never quite sure about was now an image of intense concentration. His work was swift and methodical as he sliced into my wife’s abdomen, and removed both twins in rapid succession (Gwen Stefani’s It’s my life was playing softly on the theatre stereo and both babies were on this side of the womb by the time it had finished… even at this life-changing moment I thought ‘well, this is a lame choice for the kid’s first ever exposure to music’).

And with that our identical twin girls – Lillian and Ruth – were no longer black-and-white blobs on an ultrasound screen, they were flesh-and-blood, skin-and-hair, poop-and-vomit humans. I won’t subject you to the traumatic experience of our post-birth care (that’s a story for another, particularly bleak day) but over the past few weeks as we slowly got more and more used to our tiny, fragile babies we started defining time in relation to how long it was until the next feed or when the next relative was coming to stay. Another twin dad gave me the single best piece of advice I’d ever received when he told me that devising a routine, and sticking steadfastly to it was absolutely paramount. While I often waver with healthy eating and exercise goals, I had the regimented discipline of the drill sergeant from Full Metal Jacket when it came to the girl’s feeding-and-sleeping routine.

The first month was hard. As was the next couple, and the rest of that year. It never stopped being hard in one way or another, and the challenges just kind of changed without really decreasing (“yes! they’re finally sleeping through the night.. oh cool, now they’re ornery as hell all the time because teething…”).

And it wasn’t just hard either. Having twins came with a wide range of things that were unexpected – stuff that didn’t fit with anything I’d read about or thought I’d have to deal with.

The first is the questioning – at least half the time I take the girls anywhere public I’ll have to field questions like I’m that guy from Back to the Future.

“Are they twins?” a doe-eyed stranger will ask after catching my gaze, and my answer will oscillate between either a polite affirmation and a chat or a curt “yup” depending on how tired I am at the time. 90% of the time this question is followed up by the same supplementary question; “Do you have twins in the family?” Well, yeah lady, I have cousins that are twins but identical twins like these aren’t really a genetic thing. Now if you’ll excuse me, I’m trying to finish the grocery shopping and WHY ARE THERE SO MANY DAMN TOILET PAPER OPTIONS??

The other unexpected thing I came to realise was how much flip-flopping a pair of babies would do. I was under no illusions that I’d often be dealing with one cranky baby and one that was calm and chill, but what I wasnt counting on was the rate or consistency of how they switch from one role to the other. It was disconcerting to see one twin screaming her vocal cords out while the other would sit still wearing a goofy contented grin, only to have them swap dispositions completely and instantaneously two days later. This trend has leveled out as the girls have grown, but still reemerges like the bloated corpse of Rod Stewart’s career every so often and is still annoying to deal with (like Rod Stewart – probably).

And if you want to see a tableau of pure, chrystalised panic; peek through the curtains of a room where one relaxed baby is sleeping near where the parents are desperately trying to stop the non-sleeping one from howling like a banshee. Its a tense scene.

Over the past two years of tantrums, turmoil and Teletubbies Lillian and Ruth have gone from tiny, needy balls of screaming and excretions to larger, less needy, sweet bundles of babbling energy. We decided long ago that we wouldn’t have any more children, but reflecting back on the first two years, I don’t think there is much we would have done differently. For all the grumbling I’ve done over the course of this post, I love being a dad.

When the girls were about six months old a buddy of mine with a pregnant wife asked what the hardest part of being a dad was – I answered “well, you’d think it would be the stress associated with the financial burden, or the guilt that you constantly feel about how you’re going to inevitablely mess this kid up, or the anxiety of local and world events that suddenly impact you much more severely than they did before, but it’s not.

“It’s not even the physical exhaustion that the sleep deprivation batters you with, or the emotional turmoil, or the toll on the mental health of your family, or the dumb arguments, or any of that. The hardest thing about being a dad… is trying to use those stupid fucking domes sewn into every piece of baby clothing on the planet.”

I often feel like I’ve aged about four decades in the past twenty-five months and although I’ve grown a LOT, I still struggle (especially with those damn domes).

Should you get your child immunised?

I am grateful to share a post today by the incredible Dr Jess Berentson-Shaw who is a researcher and writer at the Morgan Foundation. This post was originally published on the Morgan Foundation website.  I’m publishing this post because I can’t write it. If I were to write a post under the title of “Should you get your child immunised” I’d just say “yes”. If I were to flesh it out I’d say: “Please, please immunise. I beg you”. I am the parent of a child whose trachea collapsed when he contracted a cold because the respiratory condition he was born with meant he couldn’t breathe most of the time. That day, he went into emergency surgery – it was one of the worst days of my life. He was just a baby. If he’d caught whooping cough – he’d be dead. That’s it. I have written about it – kind of – it’s so hard to write about. I have written about the agony of seeing your child unable to breathe on their own, and I’ve published a guest post by a dear friend who wrote with beautiful honesty about a day in the life of the ordinary heartbreak of parenting a child with severe health issues. I can speak from my own experiences. And I’ve been asked many times to write about vaccination. But I am, shall we say, compromised. I am a vocal supporter of immunisation because I want and need to protect my child, and I want and need to protect all of the children around me. It’s deeply personal for me. So I can’t write this post. But someone who really knows their shit and can approach it from a non-emotional place, based on scientific fact and logic and reason, can. I have closed comments on this post because vaccination isn’t a debate in my mind and I find vaccination debates exhausting and demoralising and deeply, deeply upsetting to me. So I’ll just say this:  Thank you for taking the time to read this and if you vaccinate your child – THANK YOU. From the bottom of my heart, thank you. From my whole whānau and all of my loved ones: Thank you! Thank you a million times over. Thank you to the moon and back and thank you to the stars. Thank you. Just thank you.

Should you get your child immunised?

Widespread immunisation helps everyone

A vaccination prevents an individual getting a disease, that much is pretty straightforward . However, widespread immunisation also has benefits. If enough people are vaccinated it eventually eliminates a communicable disease (a disease you can catch from someone else who has the virus) in a community, a society and eventually worldwide. Smallpox for example is eradicated worldwide.

This is known as “herd immunity”: when enough people are fully immunised (for most vaccines this is near 95% of the population), the risk of someone catching the disease and passing it to someone else not immunised is very low. Eventually the disease cannot continue to live as it cannot find enough hosts for it to breed in, and it becomes extinct. If only we could do that with rats and possums so effectively!

But a vaccination comes with risks

No medical treatment is without risks. Having an ingrown toenail removed has a risk of toe amputation, having a general anaesthetic has a risk of brain damage.

But with most interventions the likelihood of the most severe side effect is much smaller than the risks associated with not doing the thing. So there are some risks when a child is immunised, for example inflammation at the site of the injection or fever. There are even smaller risks of some more serious side effects like an allergic reaction called anaphylaxis. However, such severe side effects occur much less often with the vaccine than they would if a person caught the disease itself.

The figure below compares the risks of having the MMR (Measles Mumps Rubella) vaccine vs taking your risks with measles. If a million children had the vaccine, and another million caught the disease, then we would expect to see the numbers of complications in the table below.

 Figure 1. Severe complications due to MMR vaccine and measles among 1 million children aged under 5 years. Source:  The Australian Academy of Science.

What we can say is that there is NO risk whatsoever that you will get autism from a vaccine.

This creates a prisoner’s dilemma

This combination of factors gives rise to a prisoner’s dilemma. A what? You can find out more about the classic prisoner’s dilemma (and why it involves prisoners) here. For now we will stick with the immunisation theme.

As as immunisation rates grow in a society (as they are currently in New Zealand), the risks of contracting a disease lessen,  as do the overall risks in a population of being hospitalised or dying from that disease. So if enough other people are immunised, then it might be rational for some people to take the risk and and choose not to vaccinate their child. In other words, if the chances of their child contracting the disease are low, the parents might choose to avoid the (also low) risks associated with getting the vaccination.

Example of a Prisoners Dilemma

For simplicity, let us pretend a community has two undecided and unrelated parents, Andrew and Brian. They have herd immunity explained to them, alongside the risks of the vaccination for measles, the risks of contracting the disease and the risks of hospitalisation or death if their child gets the disease.  Each are then asked to decide whether to vaccinate their child against measles. The risks and rewards for them are as follows:

• If Andrew and Brian both don’t vaccinate, each child has a higher risk of contracting the disease and of experiencing serious health effects of the illness, but they avoid the risk of vaccination side effects.
• If Andrew does not vaccinate but Brian does, Andrew’s child will have a lower risk of catching the disease, low risk of experiencing serious health effects of the illness and no risk of vaccination side effects. Brian’s child will have a low risk of the disease, low risk of experiencing serious health effects of the illness and some risk of vaccination side effects (and vice versa). In short, Andrew is taking a ‘free ride’, benefitting from Brian’s choice to immunise his child.
• If Andrew and Brian both vaccinated, both children will have the lowest risk (becoming no risk) of the disease and experiencing serious health effects of the illness, while both children have a risk of vaccination side effects.

Assuming Brian vaccinates his child, it might make sense for Andrew to choose not to. And this applies in the real world – in a mathematical sense the truly rational parent (when understanding the real scientific risks, we are not talking myths here) may choose not to vaccinate, provided that enough of society has been vaccinated to provide herd immunity. In this situation, a rational parent could view the risks of vaccinating their child as much greater than the risk of their child contracting the disease.

Why the ‘Free-Riders’ are hurting their kids (and others) in the long term.

You can probably see the problems in this ‘rational’ but ultimately selfish decision process, and not just for the wider community as a whole. In taking this ‘free ride’, parents who chose not to vaccinate could be harming their child in the longer term. As the vaccination rates decline (as more people choose not to vaccinate believing the risk to be low) the actual risks of contracting the disease then rise. So every child is now exposed to a greater level of risk, BUT especially those that are unvaccinated.

How do we know this? Because in countries with low vaccination rates, their rate of disease is at epidemic proportions. This interactive map shows where measles is at an epidemic rate worldwide – the majority of deaths from measles are in children under 5. Afghanistan which has an immunisation rate of less than 40% had 6000 cases in 2012 (likely to be more due to poor reporting mechanisms).

And just in case you think this is a developing world problem, in New Zealand in 1991 our immunisation coverage rate at 2 years was less than 60% overall, and only 42% In Maori and 45% Pacific children . In 1997 we had a large scale measles outbreak, there were 2169 cases notified, near 100 people hospitalised and 7 people died, four of those who died were children who were not immunised(Ministry of Health Immunisation Handbook, 2014). As we will see tomorrow, even now we don’t have the levels of immunisation we need for herd immunity – so any parent not immunising their child is rolling the dice with disease.

If an unimmunised child does come in contact with measles for example, there is a 90% chance they will get it, and if they do get it there is a 1 in 5 chance they will be hospitalised for serious complications and a 1 in 1000 chance they will die. So if increasing numbers of parents choose not to immunise due to a low risk of disease and a comparatively higher risk of vaccination side-effects they are actually, ironically, increasing the risk of their child becoming seriously ill during outbreaks. What is almost worse is that they are putting some already really vulnerable kids at greater risk.

Free-Riders risk making sick & vulnerable kids sicker

For children with compromised immunity, and in New Zealand this is mainly kids receiving chemotherapy treatment for cancer, if they contract measles they have a 1 in 2 chance of dying from it. Young babies, who have undeveloped immune systems and are too young to get a vaccination, are at high risk of contraction and hospitalisation during an outbreak of a disease. Kids in poverty who already suffer an additional disease burden compared to their better off counter parts, are more vulnerable also due to their lower vaccination rates (an issue we will go into in the next blog).  So as the rate of a disease increases due to a decline in vaccination rates, the kids that suffer from this decline are those that are least able to cope.

Only a few of us can have a free-ride and it needs to be based on need.

If herd immunity is achieved when 90-95% of the population are fully immunised (depending on the disease) and this rate is maintained for a period of time,  then the 5-10% we can carry unimmunized in our society needs to be reserved for those with the greatest need, not those who want to opt out due to illogical perceptions of risk. It helps if information about the risks and benefits, both individual and population based, are communicated effectively and people are given the opportunity to understand that their personal decision affects everyone.

Summary

In summary, having your child vaccinated helps not only your child but everyone in society. It is theoretically plausible that if enough people have their child vaccinated, it might be rational to not have your child vaccinated, given the low risk of side effects. But the more people that make that decision, the greater the risk of an outbreak becomes. And that can potentially hurt anyone that isn’t immunised. The next blog will look at the situation in New Zealand, and will expand on why the poor and sick are the ones that lose out when people choose not to be immunised.