Medical Examiner

Preemies Should Not Be Props

The ad linking smoking to premature birth is so wrong in so many ways.

premature baby.
Babies can be born early because of a number of factors beyond the mother’s control: Genetic factors, infection, lack of prenatal care, and even air pollution. Above, a baby born in the 23rd week of pregnancy is pictured in Chongqing, China, on Nov. 18, 2014.

Photo by TPG/Getty Images

Extreme anti-smoking ads are maddeningly manipulative. You’ve probably seen some of the more disgusting ones, released by the Centers for Disease Control and Prevention as well as state health agencies: the poor guy who has to cover his tracheotomy hole in order to shower, the woman who’s an emaciated shell of herself because of cancer, the various close-ups of lungs and arteries made gray and fatty by cigarettes.

The CDC keeps promoting these ads despite evidence that they don’t really work, at least not for people who are trying to quit. The agency’s own study showed that after its first national ads aired in 2012, compared to before the campaign, 1.6 million more people sought help to quit. Yet, after three months, only 200,000 were smoke-free, and the agency admitted that half those people have relapsed. It’s a tough addiction to quit, and manipulating the emotions and scaring the crap out of millions just to get 100,000 people to quit is an annoyingly inefficient use of resources.

The latest set of ads, though, is one of the most manipulative yet. It’s not gross, but it depicts the “sad” tale of Amanda Brenden, a young Wisconsin mother who had a two-month-premature, 3-pound baby because she smoked a pack a day while pregnant. In the ad, released in the summer of 2014, we see a picture of her tiny daughter in a NICU incubator. In the gut-punch final shot these ads always have, Brenden looks forlornly through an access door of an incubator and says, “My tip to you is: Speak into the opening so your baby can hear you better.”

As the father of a 28-week preemie who started life three months early at 1½ pounds, I find this ad particularly galling because it implies that smoking caused Brenden’s baby to be born prematurely. That’s hogwash. Even though smoking has been connected to low birth weight, and studies have shown a strong correlation between smoking and premature birth, Brenden’s daughter could have been born early because of a number of factors beyond her control. According to the March of Dimes, genetic factors, infection, lack of prenatal care, and even air pollution could contribute to preterm labor. In fact, researchers really don’t know what causes premature birth, which is one reason why the CDC saying that “if you smoke, you will get a baby who starts life in an incubator” is mother-shaming to the worst degree.

In our case, we could only speculate about how our daughter Evy’s birth mother ended up delivering her three months prematurely. We were presented with the birth mother’s medical history when we considered having Evy placed with us; it suggested that other health issues beyond anything she ingested while pregnant could be the cause. But no one, even the pediatricians and neonatologists we talked to, could pinpoint what caused Evy to arrive early.

One thing we did learn by visiting the hospital to see Evy while she grew strong enough to leave is that the doctors and nurses involved in neonatal intensive care units are miracle workers. Advancements in NICU care have given micro preemies like Evy a much better chance to survive than even 15 years ago: There’s a 75 to 85 percent survival rate for preemies born at 28 weeks, and a 90 to 95 percent survival rate for babies like Brenden’s, who was born at 32 weeks. So, despite her daughter’s touch-and-go start to life, her baby had more than a good chance of surviving and having a normal life.

There’s no information in the ad about this baby’s outcome. It turns out that Brenden’s daughter is now 7 years old, suffering from asthma and some of the breathing problems many preemies carry with them into their lives. (Evy, thankfully, started breathing on her own a couple of weeks after she was born.) Otherwise, though, the girl is healthy, according to a Milwaukee Journal Sentinel report about Brenden.

But if you watch the ad, you’d think the girl never made it out of the NICU. The message is: “I had to see my newborn through a plastic box because I was a smoker … feel sorry for me.” This is also hogwash, at least from the evidence I saw when I was watching my baby through a plastic box.

Parents of preemies definitely feel guilty about what may have happened to cause the birth to be so early. But what they tend to do when they visit the NICU day after day is rally around that little peanut in the incubator. There isn’t much time to feel guilty when they’re there, because the nurses encourage parents to feed, change, and hold their children as much as possible, except in the case of the most sickly kids. If you want your baby to hear you, all you have to do is talk to her as she’s swaddled in your arms, though the chances she’ll be awake to hear it are pretty minuscule, as preemies sleep most of the time. (They need to sleep to start catching up to that growth curve, after all.)

Even if their child is in the NICU for months—and in extreme cases, they can be in the hospital past their first birthdays—all the parents think about when they’re visiting their kids is their health and the day they bring their little one home. And once the babies are home and start growing, the narrative turns to “look at this little battler thrive,” as my wife and I have seen in Facebook groups like Life After NICU.

Manipulative public service announcements like this risk making people less sympathetic to the cause of smoking cessation. I also wouldn’t be surprised that the millions of parents of preemies, many of whom had kids in much more perilous situations than this mother’s, have little to no sympathy for her. They just want to know what the kid is doing now. That’s the first thing I thought of after seeing the ad for the first time. Then I thought about getting Evy a new “NICU Graduate 2015” onesie in a bigger size than the original one we bought her, because we want to remind ourselves of just how great of a fighter she is.