Now that we have examined how the baby arrives in the world, let’s focus on that tiny arrival. What happens after the baby is born? What dangers do babies face after birth?

The first step after the newborn enters the world is to evaluate its health in the delivery room with a checklist called the Apgar scale. The child’s heart rate, muscle tone, respiration, reflex response, and color are rated on a scale of 0 to 2 at one minute and then again at five minutes after birth. Newborns with five-minute Apgar scores over 7 are usually in excellent shape. However, if the score stays below 7, the child must be monitored or resuscitated and kept in the hospital for a while.

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After their babies have been checked out medically, most mothers and fathers eagerly take their robust, full-term baby home. But other parents hover at the hospital and anxiously wait. The reason, most often, is that their child has arrived in the world too small and/or too soon.

Born Too Small and Too Soon

In 2010, about 15 million babies were born preterm, or premature—they entered the world more than three weeks early (Chang and others, 2013). In the United States, about 1 in every 11 babies are categorized as low birth weight. They arrive in the world weighing less than 5 1/2 pounds. Babies can be designated low birth weight because they either arrived before their due date or did not grow sufficiently in the womb.

Earlier in this chapter, I highlighted smoking and maternal stress as risk factors for going into labor early and/or having a low birth weight baby. But, uncontrollable influences—such as an infection that prematurely ruptures the amniotic sac, or a cervix that cannot withstand the pressure of the growing fetus’s weight—also can cause this too-early or excessively small arrival into life.

You might assume that prematurity has declined in tandem with our pregnancy medical advances. Not so! Ironically, the same cutting-edge procedures discussed earlier, such as c-sections on demand and ART, boost the probability of a baby leaving the womb early and being more frail (Chang and others, 2013).

Many early arrivals are fine. The vulnerable newborns are the 1.4 percent classified as very low birth weight, babies weighing less than 3 1/4 pounds. When these infants are delivered, often very prematurely, they are immediately rushed to a major medical center to enter a special hospital unit for frail newborns—the neonatal intensive care unit.

At 24 weeks my water broke, and I was put in the hospital and given drugs. I hung on, and then, at week 26, gave birth. Peter was sent by ambulance to Children’s Hospital. When I first saw my son, he had needles in every point of his body and was wrapped in plastic to keep his skin from drying out. Peter’s intestines had a hole in them, and the doctor had to perform an emergency operation. But Peter made it! . . . Now it’s four months later, and my husband and I are about to bring our miracle baby home.

Peter was lucky. He escaped the fate of the more than 1 million babies who die each year as a consequence of being very premature (Chang and others, 2013). Is this survival story purchased at the price of a life of pain? Enduring health problems are a serious risk with newborns such as Peter, born too soon and excessively small. Study after study suggests low birth weight can compromise brain development (Rose and others, 2014; Yang and others, 2014). It may impair preschoolers’ growth and motor abilities (Raz and others, 2014). It can limit intellectual and social skills throughout childhood (Murray and others, 2014) and the adolescent years (Healy and others, 2013; Yang and others, 2014)—in addition, as you know, to possibly promoting overweight and early age-related disease. And what about the costs? Astronomical sums are required to keep frail babies such as Peter alive—expenses that can bankrupt families and are often borne by society as a whole (Caplan, Blank, & Merrick, 1992).

When a child is born at the cusp of viability—at around 22 weeks—doctors, not infrequently, refuse to vigorously intervene (Duffy & Reynolds, 2011; Ramsay & Santella, 2011). But survival rates vary, depending on the individual baby—and very important—that child’s access to high-quality care (Sjörs, 2010). Plus, due to dramatic neonatal advances occurring during the l980s, many more small babies are now living to adulthood unimpaired (Baron & Rey-Casserly, 2010). I have vividly seen these statistics in operation when, in recent years, a student proudly informed our class: “I weighed less than 2 pounds at birth” or “I was born at the twenty-sixth week of life.”

Even when they do have disabilities, these tiny babies can have a full life. Listen to my former student Marcia, whose 15-ounce body at birth would have easily fit in the palm of your hand—and whom no doctor believed was capable of surviving. Marcia, as the Experiencing the Lifespan box describes, is partially deaf, blind in one eye, and suffers from the disorder cerebral palsy. But rarely have I met someone so upbeat, joyous, and fully engaged in the world.

The Unthinkable: Infant Mortality

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In the developed world, prematurity is the primary cause of infant mortality—the term for deaths occurring within the first year of life. The good news is that in affluent nations, infant mortality is at an historic low (see Figure 2.12). The bad news is the dismal standing of the United States compared to many other industrialized countries. Why does the United States rank a humiliating forty-sixth in this basic marker of a society’s health? (Central Intelligence Agency [CIA], 2014.) The main cause lies in income inequalities, stress, poor health practices, and limited access to high-quality prenatal care.

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The socioeconomic link to pregnancy and birth problems is particularly troubling. In every affluent nation—but especially the United States—poverty puts women at higher risk of delivering prematurely or having their baby die before age 1. So, sadly, I must end this chapter on a downbeat note. At this moment in history, our wealthiest nations are falling short of “cherishing” each woman during this landmark journey of life.

But I also can’t leave you with the downbeat impression that what happens during pregnancy is destiny. Yes, researchers now believe events “in-utero” play a role in how we develop. But a basic message of this book is that human beings are resilient. A quality environment matters greatly in shaping our life path (and even can change our biology) well into old age.

Now that we are on the topic of biology, I feel compelled to highlight a personal point, as an adoptive mom. In this chapter, you learned about the feelings of attachment (or mother-child bond) that often begin before birth. But I can assure you that to bond with a baby, you don’t need to personally carry that child inside or share the same set of genes. So, just a reminder for later chapters when we scan the beautiful mosaic of families on our landscape today: The bottom-line blessing is being a parent, not being pregnant. Parenting is far different from personally giving birth!

The next two chapters turn directly to the joys of babyhood, as we catch up with Kim and her daughter Elissa, and track development during the first two years of life.

Question 2.22

Baby David is in excellent health.

Question 2.23

Rates of premature births have risen due to ART; and low birth weight can produce problems in later development.

Question 2.24

• Bill, because worldwide maternal mortality is now very low.

• George, because birth is still unsafe around the world.

• Both are partly correct: Birth is typically very safe in the developed world, but maternal and infant mortality remains unacceptably high in the poorest regions of the globe.

c. While birth is very safe in the developed world, maternal and infant mortality remain serious problems in the least-developed countries.

Question 2.25

Sally: The United States—like other developed countries—has made tremendous strides in conquering infant mortality. Samantha: The fact that the United States has higher infant mortality rates than many other developed countries is incredibly distressing.

Question 2.26

You can come up with your own suggestions. Here are a few of mine: Increase the number of nurse-practitioners and obstetrician-gynecologists in poor urban and rural areas. Provide special monetary incentives to health-care providers to treat low-income women. Offer special “healthy baby” educational programs at schools, community centers, and local churches in low-income neighborhoods targeted for female teens. Make it easier for low-wage workers to actually see a health-care provider by providing incentives to employers. Set up volunteer programs to visit isolated pregnant single moms and provide social support. Target nutrition programs to low-income mothers-to-be (actually, this is the goal of the WIC program, described in the next chapter).