How Modern Medicine Has Changed Premature Birth Care

Jan 29, 2020
Originally published on February 18, 2020 1:05 pm

Journalist and mother Sarah DiGregorio joins us to discuss her new book, “Early,” a deeply personal study of premature birth in the United States.


Sarah DiGregorio, author of “Early: An Intimate History of Premature Birth and What It Teaches Us About Being Human.” (@SarahDiGregorio)

Dr. Charlene Collier, director of the Mississippi Perinatal Quality Collaborative. (@CHCollier)

How Modern Medicine Has Changed Premature Birth Care

Sarah DeGregorio was only 28 weeks pregnant when she gave birth to her daughter in an emergency C-section. The baby weighed 1 pound, 13 ounces — almost 6 pounds under the average birth weight.

DeGregorio watched as her child spent her first two months of life in a neonatal intensive care unit hooked up to ventilators and feeding tubes.

But she was lucky, she says, to have access to the kind of medical resources needed to keep a premature baby alive.

Still, the birth was difficult. “Being introduced to parenthood in an ICU setting is not easy,” she says.

DeGregorio’s experience led her to write a book about premature birth. Her book, “Early: An Intimate History of Premature Birth and What It Teaches Us About Being Human,” traces the history of treatment for premature births and lays out some of the major problems still facing mothers who give birth prematurely. The book also tackles issues faced by marginalized communities and under-resourced areas.

Dr. Charlene Collier is the director of the Mississippi Perinatal Quality Collaborative, which aims to improve birth outcomes across Mississippi. She says that in states like hers – where, according to 2018 data from the National Center for Health Statistics, the premature birth rate is the highest in the country – the problem can feel overwhelming.

“When I’m working clinically, it feels like there’s a wave rushing in that we’re having a really hard time stopping,” Collier says.

Collier also says the public health effects of racism impact the care certain mothers receive. Preterm birth rates for African American mothers, for example, are about 50% higher than for white mothers.

“Many people hear that statistic and begin to think there’s something inherently wrong with black women. Or inherently wrong with what black mothers do, and that is not true,” she told On Point’s Meghna Chakrabarti. “ … They do everything we ask them to do in terms of caring for themselves, and yet we still see these outcomes. And that really comes down to how racism, implicit bias and explicit biases are deeply ingrained in our health care system.”

Read more on the past and present of premature birth care in the U.S. below.

Interview Highlights

On premature birth care in previous generations

Sarah DiGregorio: “Premature birth has always happened. It hasn’t always been considered a medical problem with medical solutions. But, of course, babies have always been born early. And throughout history, midwives and parents have come up with ways to keep babies that are too small, to keep them warm. And my grandfather was one of twins. He was born in 1921 and he was very premature. My great aunt remembers that he was maybe about 1.5 pounds, they were 1.5 pounds each. And … they were born at home. My great-grandmother was an immigrant from Italy. And she wrapped them in cotton and kept them in a very low oven. And that was quite common actually, that was a solution that women had come up with. Throughout history there are lots of examples of that — different ways that people came up with to try to keep these babies alive.”

On the invention of the baby incubator

Sarah DiGregorio: “There was a doctor named Stephane Tarnier, he was a doctor at the maternity hospital in Paris in the 1880s. And the story goes that he went to the Paris Zoo one day and he had been bothered by the very high mortality rate that the most underweight babies had in his hospital. So, this was something that he had been thinking about. And apparently that day he was looking at a poultry egg warmer, which was something that has been used for thousands of years. I think the Egyptians actually came up with it. But [it was] basically a way to hatch poultry eggs. And he was looking at that and he thought to himself, ‘Well, what would happen if I put a baby inside there? That would keep them warmer than what we do normally.’ Which was really just to wrap them up in flannel. So he asked his friend, who was the head of the Paris Zoo, to come up with a prototype for him, and he started using it.

“He started using it around, I think it was 1883. And immediately survival rates jumped up. Previously, he had had something like 30% of babies born around 4 pounds, something like 30% of them survived. And then when he started using the incubator, 60% of them survived. So immediately it was obvious. And you know, his incubator at the time … the first one that he used was a hot water tank on the bottom and then an area for a baby on top. And so it wasn’t very, very different from what, you know, parents and midwives had sort of been rigging up for centuries. But what he did was really bring it into the realm of the idea of the medical. And sort of testing its effectiveness and disseminating that idea that this is something that has a really measurable effect and we should be doing more of this.”

On why preterm birth rates are about 50% higher for African American mothers

Dr. Charlene Collier: “There is no doubt about the history of racism in our country. And there’s never been a full response to deal with those effects on the health of women or any of our health care system. So there isn’t a biological basis for that difference. That has to be put to rest immediately because many people hear that statistic and begin to think there’s something inherently wrong with black women, or inherently wrong with what black mothers do. And that is not true. I can absolutely say that in clinical care, black women want to have their babies on time, they do everything we ask them to do in terms of caring for themselves, and yet we still see these outcomes.

“And that really comes down to how racism, implicit bias and explicit biases are deeply ingrained in our health care system. And we have not done enough to dismantle that and deal with those effects. And so we’re really seeing it come to fruition in the preterm birth rate. We can have excellent technology in our NICUs, we can provide excellent medical care, but medical care is not what’s going to fix this in our country. We really have to start looking at the woman’s entire lived experience. And that starts from birth and childhood, the neighborhood she grows up in, the type of environment she’s living in, the education she has access to. And it’s not enough to think a single pill or medical intervention is going to fix that.”

On preterm birth rates as a “window” into community health

Sarah DiGregorio: “When I first started reporting the book, Cyndi Pellegrini, who was a senior vice president for public policy at March of Dimes, said something really memorable to me. She said the premature birth rate can be understood as a canary in a coal mine. So if those numbers are going up, there is something wrong. And … the prematurity rates can be a lens and a way of understanding the health of a given community. It’s the same for individuals who have had negative birth outcomes.

“You know, in pregnancy, people who have had complications like I had, or who have had preeclampsia, are more likely to go on to have cardiovascular disease. It’s sort of a window into — it reveals something about your health that may not otherwise have been revealed until later. And for communities and for populations that can be understood the same way, it’s a window into the health of a community. And you know that if the prematurity rate in a given community is going up, it means that the people who are birthing in that community, their health is on decline. And understanding the reasons that that might be is really important. So that we can target those problems and give those communities justice — give them better care — so they can have healthier babies and healthier lives.”

Liam Knox wrote and transcribed this interview for the web. Sydney Wertheim adapted it for the web. 

From The Reading List

Excerpted from “Early: An Intimate History of Premature Birth and What It Teaches Us About Being Human” by Sarah DiGregorio. Copyright © 2020 by Sarah DiGregorio. Published by Harper, an imprint of Harper Collins Publishers.

The New York Times: “Feeding a Preemie Means Swallowing Your Pride” — “If eating is about pleasure, at least for me, cooking is about control. Knowing how to make onions sizzle gently in oil and start to go limp, then transparent, then light brown, then sweet and dark. It’s a transformation that’s entirely predictable, a product of muscle and sense memory. If I pay attention in the kitchen, if I am careful, nothing goes wrong.

“When I was pregnant, I worked at Food & Wine magazine. Editing recipes, the biggest part of my job at the time, is a meticulous and satisfying exercise in imagining all the mistakes that could be made in a kitchen and then trying to prevent them.

“It was 90 degrees out as my stomach started to swell, but in the office we were cooking and tasting crunchy escarole salads, potato gratin, roasts and gravy, butter cookies and layer cakes. Summer at a monthly cooking magazine is about Thanksgiving, and then the holidays.”

CBS Sunday Morning: “Premature births: One of the biggest public health threats facing the U.S.” — “Chances are you know someone who was born prematurely. Last year, one in ten American babies was born too soon, before 37 weeks gestation. Reportedly Albert Einstein, Charles Darwin and Stevie Wonder were all preemies. That puts me and my family in very good company.

“We’ve come a long way since my grandfather was born weighing about one-and-a-half pounds. My great-grandmother kept him alive by putting him in a very low temperature oven. I was born about two months early in 1979. And in 2014, my daughter, Mira, was born at 28 weeks weighing 1 pound 13 ounces. She spent two months in the neonatal intensive care unit. Five years later, she’s the spunkiest kindergartner in New York City.

“So, while you might know someone born prematurely, you might not know how devastating premature birth is, for families, for communities, and for our country as a whole.  Being born prematurely comes with a host of risks, ranging from death to lung disease, to neurological and learning disabilities.”

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