She weighed 1 pound, 3 ounces at birth. Weeks later, she’s still fighting for her life

Just after midnight on Mother’s Day, Samantha Hancock became a mom. And then her baby was whisked away.

Hancock’s baby was born preterm, at just 23 weeks, and little Emma Grace Hancock wouldn’t be able to make it on her own.

Doctors at Fairview Park Hospital in Dublin made plans to transport the 1-pound, 3-ounce baby to Coliseum Medical Centers for intensive care. While they waited, a nurse manually pumped air into the baby’s lungs, breath by breath. The hospital didn’t have a ventilator small enough for the tiny premature newborn.

“I started crying. I mean, it was mixed emotions,” Hancock, 29, said. “I was happy that, you know, she was here, but I was also sad, because she was going through all she went through.”

A birth is considered preterm or premature when it occurs before the 37th week of pregnancy, though pregnancies typically last 40 weeks. Babies born between the 23- and 25-week mark are considered “periviable,” right on the brink of a chance at survival.

In such situations, parents have two choices: let their baby go or watch it struggle to survive.

“It’s a very, very different animal to be born at 36 versus 23, because, at 36 weeks, your baby generally does fine, and at 23 weeks, a baby fights for its life,” said Dr. Scott Sullivan, director of maternal fetal medicine at the Medical University of South Carolina and scientific chair of the American College of Obstetricians and Gynecologists’ southern district. “So the risks really are reflected on when it actually happens.”

Preterm births, which can be dangerous for both mothers and babies, occur at a disproportionately high rate in Georgia. According to Peristats, a database produced by the March of Dimes that tracks maternal and infant health, 14,577 babies were born preterm in Georgia in 2016, or 11.2 percent of births.

The state’s preterm birth rate has hovered around 11 percent for the past decade. Between 2012 and 2015, Bibb County’s average rate was 13.3 percent, and Houston County’s was 10.1 percent. The national average is 9.8 percent.

Sullivan said that the nationwide average has been on the rise in the past few years. Sullivan attributed Georgia’s high rates of premature birth partially to factors that impact many Southern states, such as obesity, high blood pressure, diabetes and smoking, as well poverty and ethnically diverse populations that are disproportionately affected by preterm birth.

However, he said Georgia has also faced a series of hospital closures in recent years, which has forced rural moms-to-be to travel farther distances for care.

“Georgia’s not unique. South Carolina’s had the same issue. It just seems like it’s hit Georgia harder, because it’s been more numbers (of hospitals closing),” Sullivan said. “I guess that Georgia’s bigger and very rural, and it’s a real problem.

Preterm birth linked to infant mortality

When a baby is born before its due date, it can face a multitude of health risks, both in the short and long term.

Immediately after a baby is born, preterm, doctors’ first priority is to keep the newborn alive.

“The baby that’s born premature has a higher risk of dying before the first year of age,” said Dr. Misael ‘Mitch’ Rodriguez, a neonatologist at Navicent Health. “The more premature you are, the higher that risk.”

At 23 weeks, Rodriguez said, newborns have only a 15 to 20 percent chance of survival.

But even if doctors keep the baby’s heart beating, premature infants weighing less than 3.3 pounds, as Emma Hancock did, can suffer from pulmonary disease, bleeds into the brain, eye diseases and bowel inflammation, among other complications.

Once a premature baby’s condition is more or less stable, he or she still might face long-term health issues.

Preterm babies are more likely to suffer from developmental disorders or learning disabilities, Rodriguez said, and also face a higher risk of blindness and necrotizing enterocolitis, a disease that causes inflammation in the infant’s intestines so intense that doctors might need to remove parts or all of the baby’s intestines.

The later a baby is born, the better its chances. If a mother goes into labor before her due date, doctors try to stall delivery for as long as possible. But preterm labor can occur for a variety of reasons, many of them completely unpredictable.

Women might go into labor if they have an infection or a chronic health condition, like high blood pressure. But if the baby stops growing or the mother’s water spontaneously breaks, labor also can come before expected. And if doctors can’t prevent a preterm birth, the outcome can be fatal.

The large number of preterm births in Georgia also is linked to the state’s high infant mortality rate, which Rodriguez said is among the highest in the country.

Between 2003 and 2013, an average of seven babies died before their first birthday per 1,000 babies born, according to Peristats. During that same period, the national average was six deaths for every 1,000 live births.

Different groups are affected at different rates, Rodriguez said.

“If you look at the white population versus the African-American population, the infant mortality rate and also the prematurity doubles that in the African-American population,” he said.

Rodriguez said multiple factors could impact the level of risk expectant mothers face of giving birth before their due date or losing their baby in infancy. One major contributor to premature birth and infant mortality is insufficient pre-conceptual care, he said.

“In other words, identifying even before you decide to get pregnant the issues that may have increased the risk and morbidity of a pregnancy,” Rodriguez said.

Other risk factors include high body mass index, obesity, hypertension, exposure to environments where abusive behavior occurs and use of drugs, tobacco or alcohol, he said. Rodriguez added that mothers who give birth to a premature baby are more likely to go into preterm labor in subsequent pregnancies, but they can lower their chances of a repeat early birth if they wait 18 to 24 months between pregnancies.

Sullivan emphasized that all expectant mothers face the possibility of premature birth, no matter how healthy they are.

“People don’t realize that they have a one in 10 chance or more of having a preterm birth. And so many of them are shocked when they’re in that situation,” Sullivan said. “I think education is important, educating people about the importance of what we can do.”

About 12 weeks since baby Emma was born, and she’s still in the neonatal intensive care unit, now at Medical Center, Navicent Health. She spends her days inside a clear incubator, where her mom can look inside or poke her fingers through little holes on the sides to gently caress her baby’s arms. At her 11-week appointment, she weighed just 3 pounds, 8 ounces.

The room is kept dark to protect the baby’s eyes and prevent overstimulation. The main source of light comes from the bright lines and squiggles that run across the monitors, tracking the infant’s levels.

Hancock visits her daughter most days, but more than anything, she just wants to be a mom, without the help of doctors and machines.

“My biggest hope is just to get her home and be able to hold her as much as I want to,” Hancock said. “Take care of her like I should.”

Samantha Max is a Report for America corps member and reports for The Telegraph with support from the News/CoLab at Arizona State University. Follow her on Facebook at facebook.com/samantha.max.9 and on Twitter @samanthaellimax. Learn more about Report for America at www.reportforamerica.org.

This story was originally published August 2, 2018 at 10:55 AM.