Early: An Intimate History of Premature Birth and What It Teaches Us About Being Human

by Sarah DiGregorio

Inspired by Sarah DiGregorio’s harrowing experience giving birth to her premature daughter, Early is a compelling and empathetic blend of memoir and rigorous reporting that tells the story of neonatology – and explores the questions raised by premature birth.

The heart of many hospitals is the Neonatal Intensive Care Unit (NICU). It is a place where humanity, ethics, and science collide in dramatic and deeply personal ways as parents, doctors, and nurses grapple with sometimes unanswerable questions: When does life begin? When and how should life end? And what does it mean to be human?

The NICU is a place made of stories – the stories of mothers and babies who spend days, weeks and even months waiting to go home, and the dedicated clinicians who care for these tiny, developing humans. Early explores these stories, as well as the evolution of neonatology and its breakthroughs – how modern medicine can be successful at saving infants at five and a half months gestation who weigh less than a pound, when only a few decades ago there were essentially no treatments for premature babies.

For the first time, Sarah DiGregorio tells the complete story of this science – and the many people it has touched. Weaving her own experiences, those of other parents, and NICU clinicians with deeply researched reporting, Early delves deep into the history and future of neonatology, one of the most boundary pushing medical disciplines: how it came to be, how it is evolving, and the political, cultural, and ethical issues that continue to arise in the face of dramatic scientific developments.

Eye-opening and vital, Early uses premature birth as a lens to view our own humanity, and the humanity of those around us.

Genres: Nonfiction, Science, Medicine, Memoir, Medical, Parenting, Health

368 pages, Hardcover

First published January 28, 2020

About the author

Sarah DiGregorio is the critically acclaimed author of EARLY: An Intimate History of Premature Birth and What It Teaches Us About Being Human and TAKING CARE: The Story of Nursing and Its Power to Change Our World. She is a journalist who has written on health care and other topics for the New York Times, the Washington Post, the Wall Street Journal, Slate, Insider, and Catapult. She lives in Brooklyn, New York, with her daughter and husband. She welcomes invitations to book clubs and other gatherings. For more information and to contact her, please visit her website: sarahdigregorio.com

Reviews

[Priyanka · Rating 5 out of 5]

"Everyone realizes eventually that they can't protect their children from suffering. A premature birth is a particularly crushing introduction to that concept.'

When Sarah DiGregorio came face to face with the premature birth of her daughter, she realised how common preterm births were, how devastating they were to the health of women and yet how invisible. She was amongst the lucky ones to go back home as a parent with a child. Not everyone did.

She writes 'NICU is both futuristic and primal. Sometimes it is a place where parents hold their babies for the first time only when it's been decided to let them die. It's a place where we, the mothers, sit next to the pods that are doing the work our bodies should have done: breathing for, warming, and feeding our babies.'

Through extensive research she has traced the history of neonatal care in the US. She explains about an array of topics related to preterm birth - what was/is considered a 'viable birth', how the dedication of doctors and advances in technology pushed the boundaries of what viable meant, how incubators were developed, how machines for respiratory distress were developed, how the death of JFKs baby led to the recognition and funding of neonatal research, the moral dilemmas faced even in developed countries about resuscitating extremely premature babies, of knowing when to stop, of accepting the truth about disabilities preterm birth cause and how tough choices and decisions are made by both doctors and parents, and also how racism permeates the walls of the NICU.

Sarah brings to us stories of childbirths and the conflicts and triumphs of neonatology is facinating detail. Every chapter has accounts of the lived realities of parents. I wonder how such a huge world has been so cut off from the rest of us for so long!

She writes in her prologue- 'And sometimes, the project of treating premature babies reflects what is best and most beautiful in all of us: that we will go so far for a single human life; that some people dedicate their lives to the children of others; that love of all kinds can burn so bright.'

[Allie Schmitt · Rating 3 out of 5]

As a NICU RN for over 14 years, I found this book to be thought provoking and contained accurate NICU information. However, some chapters were so full of personal opinion and liberal bias, that it made it very difficult to want to continue to read at times. Good on the facts, bad on the politics.

[Ben · Rating 5 out of 5]

"An intimate history of premature birth and what it teaches us about being human"

I learnt a lot and some of my knowledge and beliefs have meaningfully shifted

[Gretchen · Rating 5 out of 5]

This stupid goodreads app that looks like it hasn’t been updated since 2014 keeps crashing on me while I write this review but this book is soooo good, everyone should read it, and no one should have kids unless they’re fully prepared to have a child with a disability 🫡

[Katie G. · Rating 3 out of 5]

I liked about two-thirds of this book. From a medical perspective, the content is presented in a readable, engaging manner, highlighting the enormous progression of neonatology over the last 50 years. The story of the author’s daughter’s premature birth struck a chord, as it resembles my own precarious beginning at life - tiny, narrowly escaping death, and trapped in a clear box that consisted of more tubes and wires than actual human baby. Parts of this book were emotionally difficult to read. While I found the objective content of the book to be mostly accurate, the subjective beliefs and decidedly liberal bias woven throughout (mostly in the second half) detract from the overall narrative, in my opinion. The author presents a fairly clear stance of being “pro-choice”, which is both disheartening and disappointing, especially given the sensitive subject matter at hand. As a Christian, I believe that every life is sacred and bears the image of God. This book would certainly benefit from addressing that viewpoint.

[Richard I Porter · Rating 3 out of 5]

Worth reading/listening to by parents of preemies as long as it’s been enough time since your baby’s birth.

Not before. Good to hear the history and all the efforts of people who have worked to make preemies viable and survivable in the modern era.

3 Star reviews mean this was a solid book. I probably won’t read it again but I could. I may recommend it to people interested in this sort of topic. No argument from me if you love this book.

[Amanda · Rating 4 out of 5]

I read this book just after completing 6 weeks of NICU and healthy newborn nursery. I wish I would have read the book prior to my rotations. It started with the author's own experience as a NICU mom and then described the history of supporting premature babies. Other topics included ethical considerations surrounding comfort care in the NICU, how social determinants of health influence prematurity rates, and long term outcomes for premature infants.

[Anna · Rating 5 out of 5]

This book is really, really good. I learned a lot about the science and history of caring for premature babies. I also had to stop reading every ten or fifteen minutes to cry my eyes out. This would be a great read for anyone who has any interest in reproductive/health science, as well as possible future parents with the caveat that there is a LOT of potentially upsetting content so if you’re already pregnant take caution in reading. Still, though, as difficult as parts were to read, I wish I had had this knowledge already in my pregnancy as it might have alleviated some of the fear of the unknown around my daughter’s birth.

[k8 conroy · Rating 5 out of 5]

i’m so happy this book exists. i was looking for some kind of deeper understanding both socially/emotionally and technically/medically while my son was admitted back in the hospital less than 2 weeks after discharging from the NICU. despite being surrounded by his village, it’s hard not to feel alone at the same time. you’re the only one in your head after all. EARLY made me feel like i had another circle of support around me, one that stretches across the country. so many of my own thoughts were echoed across the pages. like… it’s really not just me.

anyway, BIG shout out to them young female doctors (especially in philly ayy period) who were like, i have an idea so crazy it just might work, and sometimes it did, and that’s why my son is still breathing.

[Cheryl Crotty · Rating 5 out of 5]

So interesting. My grandson was born at 28 weeks so when I saw this book it really piqued my curiosity. I saw him and my daughter on so many pages. It was heartbreaking and uplifting all at the same time. So much information and history in this book. Even if you don’t have a preemie in your family you would still learn so much and enjoy this. I highly recommend this book. These babies are champions of how we should all live our lives. So brave and beautiful. I can not imagine our lives without “little sprout.” Jaxson is joy personified every single day.

[Marsha · Rating 4 out of 5]

Libby 🎧
Very informative.

[Liz · Rating 5 out of 5]

Thank you, Sarah DiGregorio, for writing this book. The historical context behind the modern day NICU was fascinating. The research on prematurity in current society is presented in a nuanced way. There is not nearly enough written about the NICU experience in general, so to have it written about so clearly and thoughtfully is just really great. I wanted to highlight every sentence.

[Casey · Rating 5 out of 5]

Part memoir. Part history of medicine. Part a look to the future. As a mother of 28 week twins, this book took me back to a terrifying time. It also showed me what miracles are possible. If you love a premie, work with premies, or just want to learn something new, I recommend.

[Christina DeFelice · Rating 4 out of 5]

NICU physician assistant here 🙋🏻‍♀️: a solid 4.5 stars. I was hesitant to read this book. I cannot imagine the emotional toll having a NICU baby takes on parents, especially moms, and was worried it would be a very personal emotionally charged story rather than well rounded book. I was delighted to be wrong.
I was so impressed by how well written and well researched this book was, sprinkling in personal accounts only when it would help support the writing. The author did a great job painting a picture of what the NICU environment is like if a reader isn’t already aware. Some reviewers mention it was too liberal and political. I was happy that there was actually only one section that included the heavier politics of preterm birth. Unfortunately, it does need to be discussed because not doing so, would make the book incomplete. Whether we like it or not, there are a lot of politics when it comes to women’s reproductive rights and preterm babies and I think the author did an excellent job including enough to make the story complete without including too much politics that I didn’t want to read anymore.
Especially for a NICU mom, this was a fairly nonbiased book that gave me a ton of insight into how far we’ve come in neonatology and how we’ve gotten here today.

[Katelyn · Rating 4 out of 5]

4.5 stars. Wow. I could read DiGregorio write about cereal boxes. I started this book intending just to read her personal story of delivering a preemie, but I quickly found myself devouring this entire book. DiGregorio's investigation of preemie care past, present and future is fascinating. She clearly has a stake in the game, and her interest and personal story propel this well researched book.

A fascinating, can't stop turning the pages account of how we've handled premature birth in the past, how hospitals handle it today (this varies widely), the various reasons premature birth happens (including the stress of systemic racism) and where experts want to go with preemie care in the near future. If you have the slightest interest in any of the above, pick this book up! This completely changed how I view premature babies, and makes me appreciate even more that my son held on until 39 weeks. My experience would have been very different if he'd been born when I started having contractions at 31 weeks. I would not recommend this to women who are currently pregnant.

Highly recommended. I hope she writes more books. Recommended for fans of Mary Roach.

[Danielle Janzen · Rating 3 out of 5]

My husband and I read this book together. He is a neonatologist and this book was recommended to him by a colleague of his. I read it because I wanted a better understanding of what he does on a daily basis, as well as a mother with my own baby who was born premature. We both found a lot of this book very interesting. This is a book written by a mother of a once premature baby, so it reads like an accessible novel or memoir at times. That said, she did her research and gave a really fascinating synopsis of the history of premature births. She delves into every aspect -- everything from early birth babies on display at Coney Island in the early 1900's (yes it was a thing!) to the womb like technology of today. The reason I gave it only a 3 is I did not like how much the author wove her own opinions and political persuasions into much of the last chapters of the book. It would have been a more round reporting if both sides had been discussed. Besides that, the examples and history were interesting to read, and definitely gave my husband more to think about as he practices.

[LibraryLaur · Rating 5 out of 5]

I have a personal interest in this topic (my second child was born at 30 weeks), and I found this book fascinating. Well-written and engaging, it covered a lot of ground, from the history of neonatology to its future. It also included the author's personal story of having a premature baby, as well as other parents' stories, and a lot of thought-provoking statistics.

*Thanks to the publisher for making an e-galley available for review through edelweiss!

[Isabella · Rating 4 out of 5]

Early: An Intimate History of Premature Birth and What It Teaches Us About Being Human written by journalist Sarah DiGregorio was a beautifully illustrated book that talks about the challenges that premature babies face and their parents, especially their mothers in the NICU. She discusses the history of premature birth and of early ways to treat babies born prematurely, such as the infamous iron lung. Prematurity is so common now that we have developed newer treatments and ways of saving preemies. There are parts that our slightly controversial and political, but then again, premature births are controversial and unfortunately political. It is important to address those topics as well, which DiGregorio does in a sensitive way that also gets her point across, using statistics and factual evidence to back up her opinions. She addresses abortion and the controversial question of, “when is a fetus viable?” How do we determine that? How do we know whether or not to end a pregnancy? Neonatal medicine has come a long way, to the point where babies born at 22 weeks are able to survive. However, will they truly have a quality of life? If those babies survive, they often don’t thrive. They have high chances of developing cerebral palsy and other developmental and cognitive delays. She also discusses how racism has an effect on preterm labor. Black women are more likely to give birth early than white women are. Why is this? It’s not the genetics of black women. It’s because of the environmental stressors that black women are faced with on a daily basis. This was a phenomenal book and accurately portrays the cause and effect sequence of prematurity. My only critique is that there were a few small grammatical errors scattered throughout, but it still made sense and it still was comprehensible. This book is great to read for someone who is pregnant, has had premature births, anyone in the medical field, or just people who are interested in prematurity. Overall, ⭐️⭐️⭐️⭐️

[Kimber Burt · Rating 5 out of 5]

This was a brilliant mix of personal stories, neonatology history, current practice, and where the field is headed. The author begins with a story of her own experience going into labor at 28 weeks—a story that held many parallels to my own. I especially appreciated her description of her experience in the NICU. Seeing the infants that straddle the line between fetus and baby, not quite living in either world, allowing us all to see the development that we were never meant to see. Each day seeing them become more like a real baby as they lay in their space age looking giraffe beds. It’s a beautiful thing that is difficult to explain, but I feel that she spoke to a universal experience among most NICU parents.

The beginning of this book heeds warning that it’s contents may be upsetting to pregnant women or those with a child in the NICU. This warning is justified, but I will admit it kept me from reading it for about 2 years following my sons birth. However, looking back I think I would have appreciated all the valuable information, relatable personal stories, and heroic tales of crusaders paving the way in this field to make everything we do now to keep tiny babies alive possible.

So really, this book was amazing. So informative. So personal. Factual and emotional at times. My only draw back was the clear bias that overlaid the blurry ethical line between viability and the right to abortion. The author spoke of pro-choice providers providing top tier care and how laws restricting abortion makes progress in this field murky in an ethical sense. However, I felt this perspective neglected the pro-life providers that are in neonatology, whose ethical stance brought them to the field. Bringing perspective from these providers would have added so much more to this book and I felt it was the only thing missing.

Overall, bravo 👏🏻

[Kelly · Rating 5 out of 5]

This book was reallyyyyy incredible - I was sad to finish it! Besides my continual interest in women's health topics, I'm also currently taking a creative nonfiction course this semester; this book was a gorgeous example of creative nonfiction, as the author weaves her own personal experiences of prematurity with the public history and future of neonatal medicine. DiGregorio's personal experiences complimented the research included within the piece so well and made the narrative even more impactful. Overall, I feel like this is the most I've learned while reading a birth/pregnancy-related book in a while. I didn't know very much about premature birth and DiGregorio examines the entire history of neonatal medicine, cross-cultural practices, the current medical innovations occurring in the US, the ethics of these innovations, and also the political ramifications of these neonatal innovations. Discussing the topic of premature birth brings up so many medical ethics questions and made me consider how life exists in so many different forms - this type of medical advancement continues to beg the question of, who determines what constitutes life? I've hung on to this book after finishing it and would like to jot down all the pages I found most interesting/surpring at some point!

[Lauren · Rating 5 out of 5]

An informative and thought-provoking treatise that takes a deep-dive into the historical, sociocultural, and political influences on our current understanding of preterm birth. DiGregorio does not shy away from difficult or taboo conversations and dispels a number of myths surrounding this subject. I appreciated her ability to seamlessly interweave the facts with numerous moving anecdotes. I recommend this book to anyone interested or involved in maternal health care and neonatology.

[Carol Meerschaert · Rating 5 out of 5]

Never did I think I’d be reading this book at the same time my daughter-in-law read it, as we were caring for my grandchild who was born 10 weeks early. My kids were huge, my largest being 12# 4 oz so I had no idea about the world of tiny babies and premies. This book was an excellent view into that world. I am still learning a lot and am so grateful that I had this book to help me on the journey.

[Danielle Converse · Rating 5 out of 5]

I don’t typically write reviews, but this book hit so close to home that it deserves a few words.

Listening to Sarah recount her story reminded me in many ways of my daughter’s birth story - the emotions, trauma, grief, and hope. It was fascinating and heartbreaking hearing the history of neonatal intensive care units (NICU) and the stories of other families. I especially appreciated hearing about the University of Iowa Stead Family Children’s Hospital and the groundbreaking work they’ve done.

I think this book is worth a read for those who are wanting to better understand prematurity and the NICU experience.

[Francesca Branciforte · Rating 4 out of 5]

Informative, thought-evoking, and optimistic. As someone who works with parents of young children and infants, many of which were born premature or spent time in NICU, DiGregorio painted such a clear picture of families’ journey of early births. She referenced so much great scientific research and shared many anecdotes from parents of premature infants as well; this was fantastic.

[Amelia · Rating 4 out of 5]

This book couldn't have been more timely, coming out the same year my preemie was born. I recently decided I wanted to read a book about prematurity and stumbled upon this one, which turned out to be exactly what I was looking for. It addressed so many of the questions I had then and now, and it was so fascinating and thought-provoking. I kind of wish I had read it sooner, although it's probably best that I read it after leaving the NICU. It was kind of an emotional roller coaster. That being said, I feel like this is essential reading for parents of preemies.

[Lexi Karrer · Rating 5 out of 5]

As a NICU nurse this was so intriguing to learn about how we came to care for these little humans. Just wow!

[Emma · Rating 5 out of 5]

The perfect cap to my year and a half working in the NICU — smart, compassionate, thoughtful, and well-researched. A true asset.

[Josie Veal · Rating 5 out of 5]

This should be assigned reading for everyone who works in healthcare! The back half of the book was particularly compelling— such clear explanations on how the intersections of science, policy, resources, and the human spirit can dictate health outcomes.

[Marina M · Rating 5 out of 5]

An amazing book. So well written, made me cry several times, sharing such important concepts. Everyone should read this book!!

[Vanessa · Rating 4 out of 5]

My only critiques are that I wish there was more than one book like this and I also wish we talked more about racial disparity and how to battle it.