Capturing the delicate first day of a newborn baby lying down in an incubator, experiencing the care...
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I Thought Fat Was The Enemy, Until I Had My Preemie

Every gram he gained felt like a triumph. Every back roll was a victory.

by Emily Lackey

The story of my son’s body begins with my body. I was 38 when he was born. Swollen. Heavier than I had ever been. My hands in the last picture of my pregnant body look like latex gloves that someone overinflated. The swelling was the first sign that something was wrong.

The second was my weight. “That doesn’t make sense,” I said to the nurse at my 26-week appointment. According to the scale, I’d gained 10 pounds in two weeks.

I tried to remain calm. I was already overweight when I became pregnant, and I was terrified of what the books said that predisposed me to: gestational diabetes, preeclampsia, high blood pressure — the list goes on. I had worked hard to eat well and exercise often and was perversely proud that I hadn’t gained much weight. A pound here. Two pounds there. But 10 pounds? That was too many pounds.

The nurse led me into an exam room and took my blood pressure, the cuff squeezing so tightly, it left a mark.

“That can’t be right,” she said, letting the cuff deflate all the way. She tightened it again, waited, and then tried to not look alarmed. “180/110,” she said softly, hurrying the cuff into a loop. She reached for the door. “I have to see what the doctor wants to do,” she said, and then she was gone.

Two months later, at my first postpartum appointment, that same nurse would lead me into that same exam room and take my blood pressure again.

“120/78,” she said. She draped the blood pressure cuff over the machine and started to leave. Then she stopped. “I heard what happened to you.” She shook her head. “That must have been so scary.”

At birth, humans are the fattest species in the world. A full-term baby can be born with up to 15% body fat. It’s not entirely clear why we need this much fat when we are born, but some speculate it’s a way for babies to store energy for the days between when they are born and when their mother’s milk comes in. It’s pretty simple evolutionary math: A fat baby is one that is more likely to survive.

The first thing I asked my husband after our son was born three months early was “How much does he weigh?”

My husband had followed our son to the NICU after the doctors revived his frail body, readjusted his airway, and rubbed his back to get him to breathe. But he didn’t tell me any of this at the time. I read it months later in the notes in my son’s chart.

“He’s doing great,” my husband said. “He looks great.”

“Great,” I said. “But how much does he weigh?” At 26 weeks and five days, I knew my son’s ability to survive hinged on his weight. The pregnancy app I read every day said a 26-week-old baby could be anywhere from 1.5 to 2 pounds, and I wanted him to be 2 pounds. I needed him to be 2 pounds. Anything less than that was too terrifying to imagine.

“He’s 2 pounds,” my husband said.

I laid my head back on the hospital bed and felt so relieved.

“Do you want to see him?” he asked. He took his phone from his pocket.

I nodded and smiled and didn’t say what I was thinking, which was that he did not look like a thing that was alive.

I have always wanted my body to be smaller. There are long stretches of my life where it seemed like the only thing that mattered. There was the year in high school I ate only vegetables for lunch. A semester in college I only drank diet soda for breakfast. The weeklong trip to Italy, during which I ate green salads dressed with vinegar for days, until I caved and binged on bowls of homemade pasta.

Like so many people, I believed that a thin body was a healthy body. The so-called obesity epidemic had taught me that: to remain fat was a choice, a symptom of laziness, of my lack of restraint. I conflated thinness with health and beauty, with goodness and virtue, but in the first pictures of my son, he is thinner than anything I have ever seen before. There is no fat on him. Instead, he is bright red, his skin so fine that the blood vessels show through. His legs butterfly open; his arms stretch out straight on either side. The skin on his elbows hangs off his bones like a shirt that’s too big.

“He’s perfect, isn’t he?” my husband said.

And I nodded and smiled and didn’t say what I was thinking, which was that he did not look like a thing that was alive.

The most important thing my son needed to do after he was born was gain weight, but feeding a premature infant is one of the most dangerous things you can do. Their intestines are fragile and unable to handle food. One of the biggest risks to a baby my son’s size is necrotizing enterocolitis (NEC), a serious gastrointestinal condition that happens when a hole forms in the immature intestine and leaks bacteria into the belly and bloodstream. NEC is the leading cause of death in premature infants. Affecting 5 to 8% of babies born too soon, it carries with it a mortality rate of 50%.

For two days, the doctors didn’t feed my son anything. Every night they weighed him, and every night he lost weight. His nurse wrote his weight on the white board above his incubator, and in the pictures from his first week of life, I can see it dropping. I tried not to look at the number while we were there. One pound, 15 ounces. One pound, 14 ounces. By the time the doctors deemed him stable enough to try breast milk, he weighed one pound and 13 ounces.

Finally, on his third day of life, his nurse filled a syringe with 1 milliliter of milk. It was barely anything, just a drop, but we watched as the yellow colostrum followed gravity through his feeding tube and into his tiny stomach.

“Now we wait and see,” the nurse said. She would examine him every three hours for signs of digestive distress: abdominal swelling, changes in blood pressure, blood in his stool, green or yellow vomit.

That night, my husband and I stayed in the NICU until it was time for me to pump again, and then we returned to our room on the postpartum floor and held our collective breath.

The next morning, when we woke up and went to the NICU, the doctors told us he did great. They were increasing the milliliters in his feeds to 2.

It was Deb, my son’s night nurse, who told us what would happen. The first night that he was alive, my husband and I stood at the foot of our son’s incubator, our arms wrapped around each other. We must have looked like we needed reassurance, because Deb came up to us then. She had been a NICU nurse for 20 years, she said, and she had seen it all.

“Some days he’ll gain,” she said. “Other days he’ll lose. But once he gains that first pound…” She snapped her fingers. “He’ll start packing on the pounds.”

We clung to her confidence. After that, we made sure to be there for every weigh in. Every night, after shift change, our son’s nurse would change his diaper, gather the cords to the machines that kept him alive, and lift his tiny body into the air until the scale zeroed. Every night I stood by his bed, waiting and watching as she set him down and the day’s weight appeared on the screen.

The day I discovered he had back fat, I peeled the blanket from his naked body and took pictures of it from every angle.

It was the opposite of what stepping on the scale had been for me. The first scale I ever weighed myself on was a white scale that my mother kept in the kitchen. Stepping onto that one was a tense moment, too: watching the red needle jump to the number that I was worth that day. The math was simple: The smaller my body was, the better I had been. The smaller the number was, the better I felt.

But the number on my son’s scale meant something very different. The various scales I had weighed myself on had determined things that seemed ridiculous to me now. What did fitting into a smaller pant size matter anymore? This scale my son was set on so delicately every night determined things of real consequence: whether we would be able to bring him home, whether he would thrive, whether he would survive. Every gram he gained felt like a triumph. Every time he lost a few grams, every time a nurse lifted his wires too high and he lost a few more, it was devastating. On the drive home those nights, my husband would reach for my hand across the dark of our car.

“Remember what Deb said,” he’d say to break the silence.

It took my son nearly a month to gain a single pound. Twenty-seven days, to be exact. When he reached 3 pounds, I made him a crown out of construction paper with the number three on it. I wrapped it around his small head and secured it with a piece of surgical tape. After that, every indication of fat felt like a victory. The first roll behind his knee. The first pucker of a knuckle. The first sign of a double chin. The day I discovered he had back fat, I peeled the blanket from his naked body and took pictures of it from every angle.

A week after my son was born, a new doctor joined his team. She stood beside his incubator, looking down at his growth chart. The night before, he had finally been back above his birth weight. When the nurse weighed him, the scale read 2 pounds, 1.5 ounces. On the way home from the hospital, I texted everyone the good news.

The neonatologist looked closely at his growth chart that next morning. “Two pounds at birth,” she said. “That’s impressive for a preeclampsia baby.”

People with preeclampsia often give birth to small babies. The same flaw in the placenta that causes a person’s blood pressure to spike can also impact the amount of nutrients that reach the fetus. Thankfully — miraculously — that hadn’t happened to mine.

The neonatologist looked up from her chart. She smiled at me. “You did a really good job growing him,” she said.

My baby son has my eyes, my mouth, my hands, and my fat. I love his body, and in loving his body, I am loving mine, too.

The list of things my body had failed to do for my son seemed endless in those early days. By being born prematurely, he lost so much. Critical antibodies. Immunity. Muscle tone. Healthy lungs. Minerals to make his bones strong. Security. Attachment. Having my body fail so spectacularly during pregnancy only seemed to confirm what the world had been telling me: that my body was a failure, and every negative outcome that could happen to it was, naturally, a result of my failure to become and stay thin.

But when the doctor told me I did a good job, I realized the list of things my body has done is so much bigger. My body made this baby, and how could anything that made something so good be bad?

Now that he is home, noticing my son’s fat is my favorite thing to do. The way his toes look like sausages stuffed too full for their casings. The way his thighs develop rolls so deep I have to carefully clean the diaper cream out of them before bed every night. The way I can lift his cheeks with my finger and watch them jiggle when they fall. Now, when I put his 3-pound crown on him, it fits his head like a fascinator, tilted to one side like a joke.

It’s funny: My son’s body is a lot like my body. He has my eyes, my mouth, my hands, and my fat. I love his body, and in loving his body, I am loving mine, too.

These days, when someone asks me how my son is doing, I can’t think of anything else to say.

“He’s so fat!” I say. He is fat, meaning he is eating solids now — sweet potato puree and oatmeal mixed with breast milk. He is fat, meaning he puts everything in his mouth that is small enough for him to fit. I feel so different about fat now. Fat is a reminder. It is a prize. It’s undeniable proof that he is here, and we are, both of us, alive.

Emily Lackey’s work has been published in Glimmer Train, Prairie Schooner, Post Road, Literary Hub, The Rumpus, and Longreads among others. She lives and writes in Western Massachusetts.