Mana was born weighing only 653 grams. Photo: RNZ Pacific / Tiana Haxton
The mother of Cook Islands' miracle baby, born over four months premature, is calling for an overhaul of maternity healthcare on the island.
Louisa Castledine and her daughter, Mana, are a powerful testament to resilience in the face of adversity.
Born prematurely in September last year at just 24 weeks, Mana's survival not only marked a personal victory for the Castledine family but also uncovered critical gaps in the Cook Islands' healthcare system and the urgent need for reform.
The Castledine family recently celebrated Mana's first birthday and sat down with RNZ Pacific to share their story.
'Miracle baby' reveals critical gaps in Cooks healthcare
It was September 2023. Louisa was at home doing dishes when she realised her waters had broken.
She was only 23 weeks pregnant.
They rushed to the Rarotonga hospital only to be told, there were no available doctors.
"[The hospital] said, 'come back tomorrow', and I was like, 'I'm pretty sure this is a medical emergency'. They explained that there were no doctors and nurses up at the hospital. They were all at a conference."
"I actually said, 'No, I'm not leaving till I see a doctor'. So, they managed to contact a doctor down at the conference to assess me and came with the conclusion that my waters had broken."
The doctor confirming her fears was just the start of a nightmare roller-coaster of events for the Castledine family.
They were told by doctors the hospital was not equipped to care for a premature birth in the Cook Islands.
Her only hope was a medical evacuation to New Zealand: but there were no available hospital beds.
"I was instantly flooded with the idea that I was losing a baby," Louisa recalled.
"I actually waited in hospital here in the Cook Islands for three days before I could be medevaced to New Zealand. And so, in that time, it was really daunting because I was conscious at any point, I could go into labour and she wouldn't have the support that she needed in order to survive."
Mana underwent intensive care for months following her premature birth. Photo: RNZ Pacific / Tiana Haxton
Louisa said the hospital did not have the antibiotics or steroids needed to support her complex condition, making the three-day wait even more terrifying.
When the family finally arrived in New Zealand, the gravity of their situation overwhelmed them as they faced life-altering decisions regarding preemie care.
"It was full on," Louisa shared, adding that, "We were faced with decisions around extreme prematurity to staring at the barrel of long-term disabilities, that doctors essentially sat us down to discuss our options."
"We went with intensive care to give her every chance of survival, to do whatever it took to save her," Louisa said.
She said they took to social media to share our journey raising awareness.
"And in doing so, thousands of people rallied to our side offering their support being moved by our story and journey! It provided comfort in our greatest time of need," she said.
Just a week after arriving in Aotearoa, Mana Te Hine Toa Pearl Castledine, kicked her way into the world.
Weighing only 653 grams "Powerful Female Warrior" was a fitting name for Mark and Louisa's third child born into battle.
Mark and Louisa (Mum and Dad) dedicated hours every day to skin on skin contact. Photo: RNZ Pacific / Tiana Haxton
The months that followed were intense, battling numerous infections and complications as a result of Mana's extreme prematurity.
The family felt displaced - living in Hamilton, dedicating hours every day to skin on skin therapy with their little one as she fought to survive.
Their other two children, Zion and Niva were in Auckland, staying with extended family and attending school.
The Castledines continued to document their journey online.
After eight complication riddled months, Mana had pulled through and was cleared to return home to the Cook Islands.
Members of the NICU team that supported the family through the greuling 8 months after birth. Photo: RNZ Pacific / Tiana Haxton
However, upon returning to Rarotonga, the family were reminded of the stark differences in maternity care between the Cook Islands and New Zealand.
In New Zealand, they felt surrounded by medical support, with specialists and counsellors at the ready, and a barrage of provisions for the family.
"As soon as we hit the hospital in New Zealand, we were approached by a number of specialists, and so there was a full wraparound support from start to finish. Whereas in Rarotonga, I am aware that we are really limited in our resources, but there needs to be a overhaul and better support for our families and our mums."
While the family have a dedicated paediatric team in Rarotonga now, they did not have one for several months.
'We need to strengthen how we care for our babies' - Cook Islands health secretary
Cook Islands Ministry of Health secretary Bob Williams said they are addressing the gaps in the system and are introducing a new initiative, focusing on enhanced maternity care, and the first 1000 days after birth.
"We need to strengthen how we care for our babies in the first 1000 days, before they get into the school system. To ensure that babies get the best, healthy meals and drinks that they need to grow to be a healthier baby and young child."
He said the first few years of a baby's life sets the foundations for their future health and wellbeing.
The Ministry has recently introduced ante-natal classes for expecting mothers to better equip them for motherhood.
And local midwives are involved in the new post-natal program, visiting new mothers regularly for the first six weeks after birth.
Williams said there are also plans on the horizon to train more midwives, fully upgrade the maternity ward at the Rarotonga hospital and extend maternity leave from 3 weeks to 3 months.
"By law it is only 6 weeks, but again, to support the first 1000 days, maternity leave is important, so there's already discussions for that to be increased to at least 12 weeks."
After eight months in New Zealand, Mana was medically cleared to return home to the Cook Islands Photo: RNZ Pacific / Tiana Haxton
For the Castledine family Baby Mana is now a bubbly, thriving one year old but her parents are conscious of how different their story could have been.
"To arrive at the hospital and be told to come back the next day could have meant the difference between life and death for my daughter. Luckily for me, I was strong enough to say, No, I'm not leaving."
"Had that been a younger, first time mum who encountered that, she probably would have gone home and laboured at home and had a very different outcome to me."
Looking back at how she was initially turned away, and then had to wait three days to be medevaced to New Zealand, Louisa looks forward to change.
"I always wonder how many other situations where families of ours have been put in that position, and further sickness or death could have been easily preventable. We need to get better at putting in preventative actions and more proactive actions rather than reactive actions, it helps us with healthier communities, but it also minimizes our reliance on New Zealand."
While the health ministry's current upgrade plans do not yet equip them to handle premature births, Williams is confident they are heading in the right direction.
He said with time, resources, and funding, they will be grow to be less reliant on medical evacuations to New Zealand.
"I think 99 percent of the babies that are born, we can do it here given the resources that we have in country and the specialists available. But should there be any beyond our capacity to safely deliver them, then we will have to refer them to New Zealand."
Currently, the Ministry has a team of five in Fiji undergoing extensive midwifery training to further bolster the new maternity services in Rarotonga.
Williams said they expect the planned upgrades to the maternity ward to be complete by the end of the year.
They will also be opening a new 'family block' in the ward, where new mothers can stay and have access to medical guidance 24/7 while navigating the first few days with their new-born.