Early: An Intimate History of Premature Birth and What It Teaches Us About Being Human.
By Sarah DiGregorio.
Moved by her daughter’s premature birth, Sarah DiGregorio wrote a thorough and thoughtful inquiry into care for premature babies. In the past hundred years, major advancements have been made. More babies and smaller babies can survive. Beyond the medical science, how we care for babies and their families speaks the most about our own capabilities as human beings.
At the turn of the 20th century, babies were only described as ‘early’ or ‘weaklings.’ They were not expected to survive. Parents options were to keep the baby warm in pot, an oven or in bed with them. Inspired by hatcheries that kept chicks warm, in 1880, Dr. Stephane Tarnier and the midwives at the Hospital Maternité in Paris promoted the use of incubators with gavage feeding. This was the beginning of advanced care for early babies.
Interestingly, incubators were available in the United States though as a sideshow at places like Coney Island. These ‘incubator babies’ were a regular feature until 1943. A good percentage of ‘incubator babies’ did survive and eventually incubators were adopted as a practice at hospitals.
Babies also needed help to breathe. Providing oxygen was one step yet this had the risks of retinal damage and blindness. And beyond getting oxygen, the lungs had to be able to expand and contract to breathe. Dr. Mildred Stahlman, in 1961, recognized the value of small ”iron lungs” to help babies breathe. These machines pulled the chest muscles to open the lungs and perform mechanical breathing action, though the infant had to remain in the iron lung. The next advancement came soon after in 1963. Dr. Maria Delivoria-Papadopoulos saw how using very small tubing and cuffs could provide oxygen instead of an iron lung.
Another advance was a better understanding of fetal lung development. Premature babies lack sufficient surfactants, a substance that keeps the lung membrane from sticking to itself. Without surfactants, the lung can not easily reopen and expand for breathing. Steroid treatments were developed and are now used to lessen breathing complications.
Among all these technical advancements, Dr. Heidi Als recognized that these babies still needed a womb environment to finish growing, especially for brain development. She saw how the infants were responding to the environment and communicating. In the mid 1980’s, she developed the NIDCAP program: (Neonatal Individual Developmental Care and Assessment Program) This enabled parents and practitioners to distinguish a baby’s signs of calm, stress, tiredness. Thus, care could be more sensitive to the infant ‘s needs. This validated the need for skin-to-skin contact, breastfeeding, and gentle touch, even for the smallest babies. Parents could engage with their baby in a more positive way, their love was a valid part of their baby’s care. This was, and is, an important need of the family that is beside the infant.
In less than one hundred years, from the work of Drs. Tarnier, Stahlman, Delivoria-Papadolous, Ahls and many others, there’s been remarkable progress in understanding fragile and preterm babies. In 1960, neonatology was an accepted term for this new medical specialty. These advances raise questions about how early is too early to treat? Can a womb-like environment be replicated to help babies grow?
There are many reasons and mysteries as to why babies are born early. The fact is, all the medical advances are undermined by unhealthy, stressful environments and disparities in health care.
The real question is… What are we doing to preserve and protect the growing environment of mothers?
How are we supporting the growing environment of families?
Even before the baby is born or even conceived, a safe place to live, clean water and complete nutrition are fundamental. Research validates these “Social Determinants of Health“: what a person needs to grow and thrive.
• Safe, affordable housing. • Living Wage. • Quality Education. • Transportation. • Availability of Food.
• Social Connection and Safety. • Job Security.
Living with daily microaggressions, disrespect and threats erodes the health of women and their families. This is living with racism, classism and gender oppression. Black women in the United States have the highest rates of of pregnancy complications and death (three to four times the rate of white women), of preterm and low birth weight babies. Sarah DiGregorio describes one woman’s experience of her two births. It is a striking example of the negative impacts of racism on pregnancy.
Dr. Crear-Perry grew up in a stable community, went to medical school and, with her husband, welcomed their first child, a healthy full term baby. During her second pregnancy, as a resident doctor, she was chronically doubted and disparaged in her skills as a physician, as a Black Woman physician in the white male hierarchy of medicine. That chronic wearing down affected her pregnancy and birth. Her second child was born at 22 weeks. Even her good health, education and family support could not protect her.
Frederick Douglass said, “It is easier to build strong children than to repair broken men” Families need safe, stable homes and access to sensitive care. Families with a fragile baby need programs that are tailored to that child’s developmental trajectory. Those therapies often need to continue for years. Sadly, and sadly predictable, the range of resources for families depends on location and financial resources. In my experience as a doula and IBCLC, I have been able to connect families with beneficial Early Intervention programs. Alas, that has been limited to specific cities. Next door in another city, I scrambled to find local, affordable (hopefully free) accessible support. In rural parts, the resources are even more scattered and scarce.
What does premature birth teach us about being human? That medical science can continue to improve therapies that help premature babies survive and thrive. But what is Science without Love? Babies and families need access to sensitive care and safe places to grow. Most importantly, how we treat each other deeply affects our well-being and the well-being of future generations.
Resources: Addressing Inequities in Health Care:
Black Women’s Health Initiave https://bwhi.org/
National Birth Equity Coalition https://birthequity.org/
Prevention Institute publications
Centers for Disease Control Healthy Communities Program