Born Early, Born Small

MILLIONS of couples the world over are expecting a certain precious “package.” Most of them know the approximate date that their baby is due to arrive. Some, however, are quite surprised when theirs is delivered early and is much smaller than anticipated.

On March 22, 1980, a baby was born to a couple near Middletown, New York, more than three months sooner than expected. She weighed 1 pound 12 ounces [794 g] and was a mere 13 3/4 inches [35 cm] long, about the span of these two pages.

The parents named their little one Kelly. She was born early, born small. Kelly arrived after only 26 weeks of gestation, instead of after the normal 40 weeks. Gestation is counted from the first day of the mother’s last normal menstrual period.

Premature and Underweight Babies

An infant is premature if born more than three weeks early, or prior to the 37th week of pregnancy. Previously, a baby was called a preemie if it weighed less than 5 1/2 pounds [2,500 g]. But the definition was changed, since some full-term babies also weigh less than 5 1/2 pounds [2,500 g]. Significantly, the epidemic of births among teenagers, and even preteens, has resulted in more and more underweight babies.

In the United States, about 10 percent of all live births are premature. Indeed, up to 300,000 of such babies are born in the United States each year! These are thrust from the womb into an environment for which they are not yet fully suited. They can be compared to Arctic explorers who have been deprived of their tents and sleeping bags.

True, these premature babies have all the organs of the body, although these are in an immature state. In fact, by the 15th week of pregnancy, a baby’s heart, brain, kidneys, and digestive system are formed and recognizable. Why, at three weeks the partly developed heart even starts beating!

But, of course, a baby cannot survive outside its mother’s womb during the very early weeks of pregnancy. Yet, because of advances in medical science, even preemies born during the 22nd week of gestation are now being saved. This, however, has resulted in a dilemma, and a very costly one at that. Consider how this has come about.

Recent Medical Developments

In the early 1960’s, more than half of all preemies weighing from about two to three pounds [900 to 1,400 g] died. In 1963 the nation’s finest doctors could not save Patrick, the three-pound [1,400 g] newborn son of U.S. president John F. Kennedy.

The fact is, until very recently there was a hands-off approach in the treatment of preemies. Those who were too underdeveloped or sick were allowed to die naturally. Of course, they were fed and cared for, but no aggressive treatment was initiated. Then, zealous medical personnel decided to make a career of trying to save these newborns.

In 1975 the new medical specialty called neonatology (a branch of medicine concerned with the care, development, and diseases of newborn infants) was formed by the American Academy of Pediatrics. Modern NICUs (neonatal intensive care units) were created to simulate some of the functions of the womb. Now about 90 percent of the infants weighing from about two to three pounds [900 to 1,400 g] survive!

The treatment, however, is neither pleasant nor pretty. A preemie may have half a dozen tubes inserted into his body, and his skin may be mottled purple from being stuck with needles. The science magazine Discover describes a modern NICU:

“Most of the infants lie naked on padded, electrically warmed tables, hooked up to an array of bottles and machines. Each one usually has his or her own nurse. . . . Their chests heave tremendously; their ribs and breastbones are so soft that they bow inward with each breath. According to their monitoring devices, most of their hearts beat 150 times a minute, and they take anywhere from 30 to 90 breaths in that time.”

A Real Dilemma

According to a survey, some 17,000 preemies weighing less than about two pounds [900 g] are annually admitted to the hundreds of special infant care units now operating in the United States. Now, even these very tiny ones are said to have about a 70-percent chance of survival! But at what price?

The estimates for severe mental and physical handicaps for preemies range from 5 to 20 percent, which is much higher than for full-term babies. And, of course, the smaller the baby, the greater the risks. The major risks include mental retardation, visual and hearing problems, and cerebral palsy. But that is not all. The author of The Premature Baby Book says: “I’ve seen a lot of kids born under 1500 grams [3 pounds 5 ounces] who have dyslexia, behavior problems, eye problems, or other problems the doctors call ‘minor.’”

Even preemies that doctors say are normal have difficulties. Dr. Forest C. Bennett, director of the high-risk infant follow-up program at the University of Washington in Seattle, observes: “Our tests of premature babies were all coming up normal. But parents kept telling us these babies were different from their brothers and sisters. They tended to smile less, to communicate with their mothers less, to pay less attention to light or sounds, and to be more fussy than other children. And when they grew up and went off to school, they didn’t do very well.”

In addition, it is very hard on families to have a preemie in an NICU perhaps many miles away and to make frequent trips to visit​—only to see the baby suffering so. And when the little one is finally taken home, it can be especially trialsome. Sandy E. Garrand, president of a network known as Parent Care, notes:

“It’s unbelievable that hospitals will spend $300,000 to keep a baby in intensive care for two or three months, but when the baby goes home, the parents are left totally on their own without even knowing if the child will be disabled. That creates a tremendous feeling of isolation. Families are stressed. Marriages are stressed.”

One father of a tiny preemie was moved to say: “There was a time when we were afraid she would die. Now there are times when we’re afraid she’ll live. Without this technology, she would have died naturally, and we wouldn’t have had to ask ourselves these questions. Maybe that would have been better.”

Dr. Constance Battle, as medical director of the Hospital for Sick Children in Washington, D.C., says she is “immersed in the tragic outcomes of well-intentioned treatment.” Her advice to neonatologists? “I say give it some thought when you whip something into life you never see again. You don’t understand the limbo the child lives in.”

With the physical and mental outcome for many preemies so uncertain and the cost of care so high, you can understand why one magazine calls preemies “A $2 Billion Dilemma.”

Another Facet of the Dilemma

When is a baby considered a person? Some babies are legally aborted at up to 24 weeks of gestation, about the same age at which others are being saved. Thus, Omni magazine says: “The line between abortion and lifesaving care is becoming increasingly slim​—so slim that many hospitals abort fetuses in one wing while saving preemies just a couple of weeks older in another.”

The magazine pointed to what would heighten the dilemma, noting: “Lungs are the only organs unable to function in preemies 16 to 20 weeks of age. Thus, with either high-pressure chambers or ECMO [extra corporeal membrane oxygenation], the plateau of viability would take another step down,” so that even younger babies would be saved. Indeed, on July 27, 1985, a 12-ounce [340 g] baby was delivered to a mother 22 weeks pregnant, and it is still alive!

When the heart of an aborted baby continues to beat for more than a few minutes, in some hospitals the baby is taken over to the NICU, where it is kept warm and comfortable until it dies. Yet, Dr. Elizabeth Brown of Boston City Hospital explains that one such aborted baby survived and was later adopted. Dr. Brown said regarding the mother who gave birth: “She was very happy that the child lived.”

Indeed, life is precious. And nothing is so heartwarming, especially to a mother and a father, as seeing their baby live and become a happy, healthy child. This is true whether the baby is full-term or premature. But what happened in the case of Kelly, mentioned in the introduction? How can parents of preemies be helped to cope? Is there anything a prospective mother can do so that she does not give birth prematurely? What is the source of the problem of premature births, and is there a truly satisfactory solution?

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Saving the Very Premature

“Parents didn’t cry out saying they wanted this. Physicians, I among them, were the ones who wanted to go ahead. Doctors have their own agendas, their own academic ladders to climb. If you talk to parents, you find they’re much more fearful of having malformed, handicapped children than they are of stillbirths.”​—Dr. William Silverman, retired professor of pediatrics at the College of Physicians and Surgeons at Columbia University.

Premature Babies​—Meeting the Challenge

KELLY is eight years old now, and the accompanying picture shows that she is a happy, healthy child. Truly, this is remarkable when you consider that she was born 14 weeks premature and weighed only 1 pound 12 ounces [794 g]! Prior to the mid-1960’s, rarely, if ever, did an infant born so early and so small survive.

But in what ways does a premature baby differ from a full-term infant? The tiny size is the most obvious difference. Also, the baby’s delicate skin may appear pink and sort of thin; minute veins may even be visible. And depending on how early this little one came, it may have some very fine hair on its face or body. This will soon disappear.

Further, the baby’s head may seem a trifle large in proportion to the rest of the body, but this is nothing to be alarmed about. As the baby approaches its full-term-delivery date, it will acquire more fat and begin manifesting the more symmetrical appearance of a full-term babe.

As to any special needs that the tiny tot may have, these range from few to many. Each case is different. But milestones have been reached. Modern technology along with devoted hospital personnel and a superabundance of TLC from parents have resulted in a remarkable survival rate.

What Parents Can Do

Parents, you especially can do much for your premature newborn. Naming the child soon after birth is encouraged, as this draws parents and infant close together in a relationship that actually enhances the progress of the “earlycomer.” After the baby’s condition is stabilized, a foremost concern is to establish physical contact with the infant.

Caressing, gently stroking, and lightly massaging the baby’s skin may be appropriate, particularly if the baby cannot be held as yet. And what could be more reassuring to the little one than to hear mom and dad’s voices expressed in soft humming, sweet lullabies, or whispered words of endearment? On the other hand, when the baby is very premature, there is reason for caution. “They’re easily overwhelmed, and they crash,” says Dr. Peter A. Gorski, who spent two years recording preemie behavior. “I’ve had babies so overtaxed by the social interaction of eye contact that they go limp. What seems kindly to us may not always be best.”

Visiting the baby as often as possible will certainly help to strengthen your relationship with him. If, because of circumstances, you are not able to visit your little one physically, tape recordings of family members talking and other home sounds can be sent to the hospital for your baby to hear. An article of clothing from mother, which even though laundered still retains her unique scent, might be placed in the incubator, or isolette. Some have set a picture of mom, dad, or brothers and sisters about ten inches [25 cm] from the baby.

Consider the situation of Elise, who, in 1971, arrived ten weeks earlier than had been expected. She weighed 3 pounds 5 ounces [1,500 g]. Her parents were permitted to visit her only twice a week. Her mother, Betty, observes: “I did not have the closeness with Elise that I had with my first baby and the three children born after her.” Yet, Betty explains: “Through the years we have grown close, and Elise has turned out to be one of the most helpful and pleasant of the children.”

Mother can provide the perfect food for the premature baby, her breast milk. Canadian scientists in Toronto found that milk of mothers of preemies is different in composition from milk of mothers of full-term infants, and prematures fare better with it. According to The Journal of the American Medical Association, “the premature infant [is] better able to use the protein and other nutrients of breast milk for growth.”

What Others Can Do

Are you a friend or a relative of a preemie’s parents? If so, there is much you can do. There are groceries to be bought, meals to be cooked, housework to be done, clothing to be laundered, and perhaps other children to be cared for. Your support in these mundane matters can be most helpful to parents who must make frequent and often long trips to visit their baby in a neonatal intensive care unit.

Christy, the mother of an infant born over five weeks early, said that her Christian brothers and sisters supplied all of the above. “They were a constant source of joy and strength to us in those first few weeks,” she said.

Support can also be given by sending cards and gifts. The gifts may include anything you would obtain for a full-term infant. The size of the infant must be taken into consideration, of course. Preemie-size disposable or cloth diapers are available, as well as preemie patterns and clothing.

Emotional support cannot be overemphasized. Be positive and optimistic. Kelly’s mom, Mary, said: “I needed people to be encouraging and say upbuilding things. I hated it when some would say, ‘Don’t get too attached.’ I thrived on hope.” One Scriptural thought that sustained her is found at Isaiah 41:13: “For I, Jehovah your God, am grasping your right hand, the One saying to you, ‘Do not be afraid. I myself will help you.’”

Visits by Christian elders from Mary’s congregation were most uplifting. Both mothers, Christy and Mary, said that the support they received from their husbands was immeasurable and that the experience drew them closer together.

Prevention​—The Wise Course

There is wisdom in expending more effort in trying to prevent premature births rather than in simply caring for preemies afterward. According to one study made in the United States, for every hour a pregnancy between 24 and 28 weeks is prolonged, $150 is saved in hospital care. So it would be beneficial to include information on premature births in your “prenatal library” and to have a plan of action ready in case a premature birth occurs. But more importantly, a prospective mother should try to prevent having a premature birth.

First, a pregnant woman should not smoke. Smoking during pregnancy evidently damages fetal arteries, according to a report in Medical World News. A Cornell University professor commented: “That fetal vessels are injured, I think, goes along with what we know about the low birthweights and high incidence of congenital malformations and premature separations among babies of women who smoke.”

Second, if you are pregnant, you should steer clear of overly strenuous activities, such as heavy lifting. Third, avoid situations that may cause physical or emotional trauma. The Bible tells how a physical injury or devastating news can precipitate a birth.​—Exodus 21:22; 1 Samuel 4:19.

If you are at high risk of delivering a preemie, you should consult with a person, such as an obstetrician, who has had experience in caring for pregnant women. Women at high risk include those who previously have given birth to a premature child, those who are carrying more than one child, those who are over 40 years of age or are teenagers, and those who use alcoholic beverages immoderately. Among other things that put a woman in the high-risk category are high blood pressure, diabetes, and abnormalities of the placenta. Such women need to have their pregnancy monitored more closely. Be sure to observe a proper prenatal diet to ensure the best possible health for you and your baby.

Yet, even though a prospective mother does everything possible to ensure a normal delivery, there are no guarantees. Premature births are all too common, and they appear to be increasing in number. But what about the future? Is there any prospect for correcting this defect in the human reproductive system?

When All Infants Will Be Healthy

IT WOULD be a crime to drive a person from his tent and sleeping bag on a cold Arctic night, making him endure the elements in his skimpy underwear. Similarly, it is a crime that an infant is prematurely thrust from his warm, protective place in the womb before he is ready to face the outside world. But who or what is responsible for this heinous crime?

The parents surely would not intentionally work such a hardship on their young one. Actually, the mother is unable to stop her labor when it begins, whether it occurs at a baby’s full term or before. Even medical experts do not understand exactly what starts labor, whether prematurely or at full term. What is known, however, is that something goes terribly wrong on occasion, and a baby is thrust out into a world in which it is not equipped to live.

Why this occurs is explained in the Bible. The inspired psalmist wrote: “Look! With error I was brought forth with birth pains, and in sin my mother conceived me.” (Psalm 51:5) A rebellious spirit creature induced the first human pair to rebel against God, and they thereby became sinners. They missed the mark of proper obedience to their Creator. Thus, all their offspring were conceived in sin, or imperfection. (Romans 5:12) The consequences are sickness and death, as well as various malfunctions of the body, including a reproductive system that sometimes thrusts its precious fruitage out prematurely.

A World Without Preemies

If humans had maintained their perfection, no infants would have been born before their time to face the calamities that confront so many preemies today. And the time will soon come when a mother never again will give birth prematurely. The inspired prophet Isaiah wrote about that time, providing us the promise of our loving Creator: “I create new heavens and a new earth, and the past will not be remembered, and will come no more to men’s minds.”​—Isaiah 65:17, The Jerusalem Bible.

The Bible prophecy in Isaiah goes on to tell of the heartwarming conditions that will prevail in God’s new world, saying: “No more will the sound of weeping or the sound of cries be heard in her; in her, no more will be found the infant living a few days only . . . They will not toil in vain or beget children to their own ruin, for they will be a race blessed by Yahweh, and their children with them.”​—Isaiah 65:19-24, JB.

How grand that will be when all human suffering and distress will be a distant memory, when there will never again be the need for extreme medical measures and intensive care units to try to keep alive infants born prematurely! Because human imperfection will then be eliminated by means of the grand ransom provision of our great God, never again will an infant be thrust from the womb before it is perfectly equipped to enjoy life to its fullest.​—Revelation 21:3, 4.

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You Can Realize True Comfort

◆ If your child dies, try to accept help and encouragement from friends and relatives. Perhaps those who have lost children can help comfort you.

◆ You may believe in the hope of the resurrection, but do not be alarmed if that belief does not bring you immediate comfort. As time begins to heal those wounds, you will, no doubt, come to appreciate the hope of seeing your loved one again.​—Isaiah 25:8; 65:23; John 5:28, 29; 1 Corinthians 15:25, 26.

◆ Try to rely on Jehovah, “the God of all comfort.” (2 Corinthians 1:3) He is the One who has provided a way to “bring to nothing the one having the means to cause death, that is, the Devil.”​—Hebrews 2:14.

◆ If you are a friend of the grieving parents, it might be best not to say that they can have another child. At the moment, nothing could replace that baby. It would be best in this case to “weep with people who weep.” (Romans 12:15) Your acknowledging the parents’ loss and grieving with them can bring comfort to them, as sharing grief can lessen it.

◆ It is proper and helpful to express grief, so give yourself time to resolve feelings of grief and loss. (See “Awake!” of April 22, 1985, “When Someone You Love Dies,” and of August 8, 1987, “Facing the Loss of a Child.”)