I know the day I’m going to retire from my pediatric practice. It’ll be the morning that I walk into our local hospital, examine a newborn, behold her wispy hair, listen to her heart, look into her bleary eyes, and not feel a sense of awe. When I think, Aw, it’s just another kid, no big deal, nothing special, I’ll be done. When I cease to marvel at the miracle of a new life, I know that this will have to be my final day. I’ll hang up my stethoscope and move on out into the sunset.
So far, this hasn’t happened. I’m still practicing, because with every newborn that I examine, I continue to feel a thrill. A new person has arrived in our world replete with all of life’s potential and wonder.
For me, a big part of the excitement of taking care of children is simply the wonder of it all. I have been a pediatrician for more than thirty years, but I haven’t yet been able to wrap my head around the idea that the baby who is crying, breastfeeding, pooing, and peeing in front of me was developing and growing in her mommy’s tummy just the day before!
How can this be?
I have never gotten over the profundity of the process. Human beings begin their lives inside another human being. When you stand back and think about it, it’s a bit of an insane notion!
I’m not alone in this wonder. I frequently ask new moms, “Can you believe that this child was in your tummy yesterday?” And even though these women have felt bouncing and kicking for months—not to mention the pain and process of delivery—their nonverbal response is always the same: it’s a smile and look of wonderment and disbelief.
And dads? When I observe that these babies were in their partners’ bellies yesterday, they look at me equally perplexed. Like me, they’re incoherent and totally baffled by what just happened to their partners and to them.
My fascination with children—and newborns in particular—began when I was a young boy. My best friend’s mother delivered twin boys. When these preterm babies finally came home, I was part of the group who gathered at their home to greet them. That day provided me with one of my first memories of being near newborns and gave me a heretofore unavailable opportunity to study them close at hand. I particularly remember being fascinated with their tiny fingers and delicate fingernails.
As a frequent visitor to their home, I recall staring at them frequently, sometimes for minutes on end (which was a long time for a young boy), scrutinizing the features of their faces, seeing them respond to the sounds in the room, and ultimately watching them mature over the months and years that I was part of their lives. That experience implanted in me an appreciation for newborns that never changed.
So much of what is amazing about newborns—from fertilization to the formation of a mature infant, fully formed with two eyes, two ears, a beating heart, and a functioning brain—occurs inside the womb, before we even lay our eyes on these freshly minted wee ones. So let’s take a step back for a moment and review how each unique, miraculous human newborn comes into existence. Pregnancy is the biological equivalent of the big bang, but it progresses quietly and ever so elegantly, day by day, without fanfare in the darkness of the womb.
For you created my inmost being; you knit me together in my mother’s womb. I praise you because I am fearfully and wonderfully made.
—PSALMS 139:13,14
It Begins in the Womb
The in utero development of human life is one of the most fascinating events that happens in the universe. The 266 days that it takes to construct a new human being in the womb of a woman is an unparalleled feat of nature.
With the advent of high-resolution ultrasound, MRI, and sophisticated microscopes, the mysteries of human fetal development life have now been more fully revealed. The big questions of embryology, however, continue to remain a mystery. Questions like, how does the newly formed zygote know when to begin the process of cell division, how does it tumble its way down the fallopian tube and know where to implant itself in the uterus? Finally, where is the instruction manual to direct this cluster of cells to form a new human? These questions still defy explanation. These are the ponderings for theologians and philosophers as much as they continue to puzzle biologists.
There are other questions too. Why do some lucky developing embryo cells get to become neurons, destined to spend their cellular lives struggling with Einstein’s tangled theories of relativity or remembering that first goofy smile of your newborn, while others are assigned to become heart cells? And why still other cells are given the nasty job of bumping and clunking along in life as sphincter muscles in the anus?
I also wonder about the how. How is it that these primitive pluripotent cells (cells that have the potential to form any tissue in the body) know which tissue to become? Where’s the choreographer telling these talented cells where to go and what to do?
The answers to some of these questions are magically and mystically tucked into our DNA. All cells of the body (except for red blood cells) have strands of DNA in them that tell the cells what to do. They direct liver cells how to function as liver cells and kidney cells how to be good kidney cells. The glory of human life is that, more often than not, the cells of the body perform their tasks flawlessly. But before the process gets under way, an egg from the mother must be ejected from one of her ovaries.
There are only two ways to live your life.
One is as though nothing is a miracle.
The other is as though everything is a miracle.
—ALBERT EINSTEIN
Ovulation
The process of reproduction begins with ovulation. Nestled in the mother’s ovaries, one of the eggs—eggs that have been present and waiting since her infancy—must mature and be released. This is yet another complex process that requires precise hormonal timing. It begins in the brain in a structure called the hypothalamus, an almond-sized powerhouse that has many functions, including regulating thirst, normalizing the body’s temperature, and even controlling sleep.
When it comes to ovulation, the hypothalamus sends a chemical message to the pituitary gland, the “master gland” of the body, and tells it to release two other hormone messengers: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These two molecular ambassadors circulate through the bloodstream and ultimately find the ovaries. The first hormone, FSH, tells the ovaries to make yet another hormone (I told you this was complicated!) called estrogen, which will go to the uterus and tell it to get ready for a fresh egg. The second hormone messenger, LH, tells the ovaries to release one their eggs.
Once released from the ovary, our fresh, newly matured egg (or ovum) floats briefly in the mother’s peritoneal cavity before slender and seductive, come-hither fimbrial fingers—located at the ends of the fallopian tubes—coax the fresh, just-released, extruded egg into the fallopian tube’s opening. Soft peristaltic contractions then push the egg down the tube toward the body of the uterus.
SURPRISE: The Time It Takes
Ovulation (the release of the oocyte, or egg, from the ovary) and fertilization (the fusing of the oocyte and sperm that occurs in the fallopian tube) are separated by only twelve hours. An unfertilized egg dies within twelve to twenty-four hours after ovulation.
Fertilization
One-third of its way down the fallopian tube, the ovum encounters a swarm of chaotically flagellating sperm cells, a small fraction of the millions of sperm cells that were released after intercourse and ejaculation. These are the lucky ones who have squirmed their way through the opening of the mother’s cervix, across the uterus, and into the correct fallopian tube to find our virginal egg.
Of the hundreds of sperm candidates that now surround the much larger ovum, only one will succeed in penetrating the two outer layers of the egg. To make it through this protective barrier, the head of the sperm releases a digesting enzyme that clears a path through the egg’s thick outer barrier to gain entry. In American football terms, the agile halfback sperm carefully following his blocking-tackle enzyme scores the ultimate Hail Mary touchdown by making it into the inner-sanctum end zone of the egg.
After the sperm cell muscles its way through the egg’s protective layers, the scene is set for egg and sperm to embrace in the epic event called fertilization. The coalesced egg and sperm form a zygote, and at that very instant, a totally new, unique human being—unlike anyone living now in the world or anyone who has ever lived—has been conceived.
Somewhere in the universe, there’s a band playing with fireworks overhead!
SURPRISE: A Bright Burst of Light
Fertility researchers Teresa Woodruff and Tom O’Halloran, a husband-and-wife team from Northwestern University in Chicago, have shown that, at the moment of conception, when the sperm fuses with the ovum, a bright burst of light occurs. This spectacle provides an exclamation point for the formation of new life.
This bright incandescent flash is due to a rapid influx of calcium ions into the fertilized cell, which then induces a brisk release of zinc ions from the zygote. Binding to small molecules, this zinc burst results in a fluorescence that can be seen with a microscope. Dr. Woodruff said that “to see the zinc radiate out in a burst [of light] from each human egg was breathtaking” and gave her goose bumps.
In a personal conversation, Dr. Woodruff explained to me that the brighter the burst, the healthier the zygote is. Or in other words, the brighter the flash, the better the chance that this newly formed zygote is going to make it.
The Three Stages of Pregnancy
Fertilization is the green flag that marks the beginning of pregnancy or gestation. Historically, pregnancy has been divided into three periods of equal length called trimesters. Since full gestation is approximately nine calendar months (or ten lunar months), each trimester is about three calendar months in length.
These time segments are a useful planning tool for doctors caring for mothers, but scientists, who look closer at the embryology of the unborn child, have refined the stages of gestation into three periods of varying length.
• Stage one is called the germinal stage, which lasts for only two weeks.
• Stage two is called the embryonic stage, which lasts for six weeks.
• The third and longest stage of pregnancy is the fetal stage, which lasts from the eighth week after fertilization until the delivery of the baby.
The Germinal Stage
The germinal stage of pregnancy runs from conception to full implantation of the fertilized egg on the back wall of the uterus. This takes between ten and fourteen days.
A few hours after fertilization, the newly formed zygote undergoes cell division in a process called cleavage, which yields two daughter cells. This is the first step in the development of an infinitely complex new human being.
Further division of these daughter cells, over the course of three days, results in a ball of 16 cells, called a morula, which then tumbles from the fallopian tube into the body of the uterus. The morula then fills with fluid and further divides to become a structure of 150 cells. At this point, the larger and more mature morula is renamed by scientists as a blastocyst. This blastocyst, over the next ten days, is the structure that attaches itself to the back wall of the uterus in the process called implantation.
When Do You Know You Are Pregnant?
Amazingly, pregnancy can be detected as early as eight to ten days after conception. The test is based on the presence of human chorionic gonadotropin (or hCG) in the mother’s blood (by day eight) or urine (by day ten). hCG is a hormone that stimulates the mother’s ovary to produce another hormone called progesterone. Progesterone then “talks” to the mother’s uterine wall, telling it to get thicker and make ready to receive a fertilized ovum.
THE UTERUS GETS PREPARED
While the fertilized egg is being gently guided through the fallopian tube by the actions of cilia and fallopian tube peristalsis, another remarkable event is likewise occurring on the membranes that line the uterus.
Like hostesses preparing for guests, the lining of the uterus prepares itself for the arrival of the blastocyst. Epithelial cell microvilli, which are tiny projections from the uterine wall, coalesce into flowerlike structures that project from the lining of the uterus in small mounds. These uterine hillocks are called pinopods and represent landing sites for the now “sticky” blastocyst to latch on to. They form one week after ovulation and regress within two days. One of these uterine mounds becomes the site that receives the blastocyst and facilitates implantation. If pinopods fail to form and none are present on the uterine lining at the exact time for the searching blastocyst to land on, implantation fails to occur and no baby is formed.
The timing for a new life to form is precise and perfect.
When implantation does successfully happen, however, the first phase of pregnancy is over and the next phase, the embryonic stage, begins.
The Embryonic Stage
The embryonic stage of pregnancy represents the third to eighth weeks after fertilization. This is the time when the cells of the blastocyst, now securely implanted into the back wall of the uterus, come out of their fuzzy huddle, decide which pluripotent cell is going to where, and begin the process scientists call differentiation.
By the time the embryonic stage begins, the implanted blastocyst quickly differentiates into a three-layer primitive embryo. These three layers—the endoderm, mesoderm, and ectoderm—are destined to become the various tissues of the body.
Just three weeks after conception, eyes begin to appear on the proto-head of the embryo. Three days after that, the cells that make up the heart begin to coalesce, and by four weeks after fertilization—just twenty-eight short days—a faint heartbeat is present!
At the end of the embryonic stage, six weeks after implantation and eight weeks after conception, this little future baby is now officially called a human fetus. In this astonishingly short period, virtually all the organs and essential structures of a human have been formed. This newly christened fetus measures one inch in length—a veritable wee, baby inchworm—and now weighs one-thirtieth of an ounce. Eyes and eyelids, fingers and toes, a nose, a mouth, ears, and every organ in its body is present and accounted for—and if you look very, very closely, you can even tell if it’s a boy or a girl.
Baby Boy or Baby Girl?
The egg doesn’t have any say in whether your baby is a boy or a girl. Eggs only carry X sex chromosomes. So it’s the sperm, which carries either X or Y sex chromosomes, that makes the call. If the sperm cell has a female X sex chromosome, the zygote will be XX and the baby will be a girl. If the sperm carries a male Y sex chromosome, the fertilized egg will have XY sex chromosomes and the baby will be a boy.
Fetal Stage of Pregnancy
The third and final period of gestation is the fetal stage. By far the longest stage, it lasts from eight weeks postconception to the delivery of the baby. The fetal stage of gestation is all about maturation and is as dramatic and wonder-filled as the germinal and the embryonic stages.
By the end of the third month after conception, the growing fetus is beginning to assume clear human form, with moving arms and legs and a mouth that opens and closes. The face is distinguishable, with forehead, eyelids, nose, and chin.
During this stage, the fetus grows from a one-inch-long fragile wisp, weighing a fraction of an ounce, into a twenty-inch-long sturdy baby weighing an average of seven pounds and who is now ready for extrauterine life.
Our Remarkable Brains
The growth of every organ of the body is remarkable, but the growth of the brain is truly astounding and worthy of a brief description. By the sixth month of gestation, nearly all the billions of neurons in the brain have been formed. At the peak of fetal brain development, over 250,000 new neurons are forming every minute. This breathless multiplication happens quietly, day in and day out, as our pregnant mother is going about the routines of life, anticipating the third and final trimester of her pregnancy.
SURPRISE: For the most part, neurons are only capable of dividing and making new neurons, a process called neurogenesis, during fetal life. Neurons will grow in size until the teen years, but no new neurons are formed after birth. The one exception where neurogenesis does occur is in an area of the brain called the hippocampus, the structure of the brain where memory is stored.
After their formation, neurons migrate to various parts of the brain and begin to further differentiate and specialize. When they arrive at their designated spots, they also begin to communicate with other neurons through synapse formation. Synapses are the points of communication between neurons, and they continue to develop through childhood.
Shortly before birth and continuing after birth, a rising crescendo of synapses forms. During the first weeks after a child is born, the brain is forming an astronomical one million synapses each second! From a neurological perspective, it appears as if all the neurons in the brain want to communicate with all the other neurons in the brain. This synaptic bloom that begins before birth and continues after birth lasts only for a short time, but it ultimately produces trillions of neuronal interconnections, twice the number of synapses required for healthy brain function.
Out of necessity, this overabundance of synapses will later be pruned: unused neuronal communications wither, while the essential connections—those that are used again and again—are retained and strengthened. Even at this early in life, the principle of “use it or lose it” is at work within the human body.
But synaptic activity is far from over once we are born. Our brains show remarkable levels of plasticity throughout life with different areas of the brain going through the process of maturation at different times.
Comparing Baby’s Brain to the Adult Brain
An infant’s brain at birth is a quarter the size of an adult brain. The difference in size is due to the number of interconnections (called the white matter) that occur between neurons (called the gray matter). The size of the brain will double in size the first year of life.
From Mommy and Daddy’s Perspective
For the mother, the first couple of months of pregnancy can be times of strange cravings, morning sickness, and excessive tiredness. By three months, the top of the growing uterus (called the fundus) can be felt at the level of the mother’s pubic bone. The recently pregnant mother is now beginning to “show.”
By the end of the fourth month after conception, the fetus is six inches in length and weighs between four and seven ounces. The growing fetus is now kicking strongly against the walls of the uterus, and for the first time, a pregnant mom will feel fluttering and evanescent movements, a phenomenon called quickening.
At this time, the mother’s ob-gyn can feel the top of the uterus midway between the pubic bone and the umbilicus. Now there is no doubt to anyone that she is pregnant.
At the end of the fifth month after fertilization, the parents can clearly see the external genitalia of their baby in a fetal ultrasound and will know if they are expecting a boy or a girl.
By the end of the sixth month after conception—the end of the second traditional trimester—fetuses start to respond to sounds they hear from beyond the womb, and your child begins learning about the world around them, a world that they will soon enter and experience.
Also by the sixth month, the lungs of the fetus begin to mature; however, if a child is prematurely born at this point in gestation, he or she will require extensive respiratory support, but as a general rule, with the advent of modern neonatal intensive care units, your baby is considered viable, which means they are capable of living outside the uterus.
By the end of the seventh month of gestation, the fetus weighs about two pounds, and if light is shined into its eyes, the pupils respond. For the next two months, your baby is going to be maturing and storing fat. The average fetus triples its weight during the final two months of pregnancy in preparation for the biggest challenge of its short existence: birth!
How Long Is a Full-Term Pregnancy?
Gestation—the time that it takes from conception to delivery—is generally said to be a period of nine months, but it depends on how you count it. The actual time from fertilization to full-term gestation and birth is 266 days, or 8¾ calendar months. If we use a lunar calendar (28-day interval), gestation takes 9½ lunar months from the last menstrual period (or LMP).
Obstetricians today, however, use 40 weeks as being the length of gestation and will relate a mother’s progress in terms of weeks of gestation, despite the fact that 266 days divided by 7 days/week is 38 weeks, not 40 weeks!
A Day You Will Never Forget
There are days, and then there are days! Giving birth as a woman or watching your partner give birth as a man is one of the most surreal and exhilarating experiences of life. It is a true slam-bang moment that will be indelibly etched into the memories of mommies and daddies forever.
The process of birth is initiated by the fetus. Space begins to get tight in the womb, which causes stress to the child. The resulting hormonal changes in the infant’s hypothalamus stimulate the mother’s pituitary gland to release cortisol, which, in turn, prompts the mother’s uterus to contract. The process begins slowly and with irregular contractions. Over a few hours, however, these uterine contractions become more regular and intense. The time has come to have a baby! It’s also time to call the doctor and head for the hospital.
Most couples anticipate and plan for their delivery for months. They attend birth classes and read all the books, but one of the truths of life is no one is ever truly ready to be a parent. Despite our efforts, we’re not really prepared until it happens. And then another miracle happens. At the exact moment your child is born, you’re ready! The planning and reading and thinking through the process help, but the delivery experience is what makes it all come together.
Seven Recommendations for a Great Delivery
1. Get some rest before your anticipated delivery date. If you can take time off from work before your delivery, take it. Preparing, resting, and calming yourself before your delivery are keys to a successful delivery.
2. Go light on birth plans. It’s normal and understandable to want to have as much control over your labor and delivery as possible. Requests like skin-to-skin time and delaying the application of antibiotics in your baby’s eyes are reasonable. No labor and delivery nurse will deny new parents these requests.
But I caution parents that every labor and delivery is unique, and thus, doctors, nurses, and parents cannot be fully anticipate what will be. There are simply too many variables at play. With this in mind, my observation, over the years, has been that birth plans never quite measure up to what ultimately ends up happening. But the nurses and doctors who care for you during your delivery are your advocates. They are pros in delivering babies because they do it every day. They understand the process, and they are excellent in caring for laboring mothers and newborn babies. They also understand why you desire and have composed a birth plan, and almost without exception, they will do their best to accommodate and respect your wishes, but let them do their job and don’t let your birth plan interfere with what is best for Mommy and child.
3. Be kind to the staff. Having a baby is one of the most stressful events young couples will ever experience, and in the midst of the process, it’s easy to forget your manners. That said, it’s important that couples realize that the people you meet in the labor-and-delivery unit and who are about to assist you in having your baby have helped thousands of other women deliver babies too. They are highly trained professionals, so respect them, show them your kindness, and engage their expertise. I mention this because I have seen couples who, amid the drama of delivery, have lost it. Big time! This is never a good idea.
To quote Mary Poppins, “A spoonful of sugar helps the medicine go down.” It works that way with people too.
4. Fathers, keep a low profile. Giving birth is a deeply feminine event. You are in the delivery suite as a visitor. A wise father is one who quietly asks only relevant questions, renders few opinions, and keeps himself generally invisible. Dads, you have two simple jobs in the delivery suite: love and support your partner and let the nurses and doctors do their jobs.
Hold your partner’s hand, massage her back, respond to her requests, and tell her—quietly—that you love her dearly and respect her eternally. Done!
5. Fathers, take fewer photographs and movies. The delivery of your child is not a Broadway show. And it’s hardly the most elegant moment in a woman’s life. Childbirth is a basic, unvarnished, and intense human event that often doesn’t follow a script. Yes, having photographs of the first moments in your baby’s life is important, but I’ve observed that some dads are so bloody busy snapping pictures that they miss the human earthquake that is happening live and in front of their very eyes! Later on, they have to rewind the video to see and remember what actually happened at their child’s delivery.
Don’t let this be your story. If you are forced to make a choice, childbirth is an event to experience, not photograph.
And if you really want to have the event recorded with all the right angles and perfect lighting, have someone else do the job.
6. Have your baby in the hospital. There are options when it comes to giving birth, but one of the responsibilities you have as a parent is to optimize the safety of both Mom and baby. Where is the best location to give birth to a baby? Given the experience of the nurses and doctors at your local hospital’s labor-and-delivery units and the resources that are there—like real-time fetal monitoring and a readily available operating room—there is virtually no question that having a baby in a hospital is the optimal choice for baby and Mommy.
Maybe the ambiance of a hospital is not what you want, or perhaps you worry about feeling like a number, or possibly you are looking for a totally “natural” childbirth, unhindered by cumbersome protocols. I understand these desires, but when it comes to the delivery of your baby, play it safe.
An easy and ideal birth certainly can happen anywhere, but birth complications are common. An umbilical cord can get wrapped around the neck of your child, for example, and thus compromise the oxygen delivery to the baby each time the uterus contracts. Or a mother may experience an excess amount of blood loss after or during a delivery, which may lead to hypovolemia and circulatory collapse. I could go on, but the goal for every delivery is a healthy mommy and a healthy child who start life out on the right foot.
7. Don’t have your baby under water. Water births are a fad. They may be fancied to be more “natural” to some, but they are fraught with serious consequences if everything doesn’t go perfectly right. It’s natural for babies to take a big breath the second they are born. Make sure they’re breathing in air, not the contaminated water their mothers have been laboring in for the past several hours.
Furthermore, it’s been recently reported by the Centers for Disease Control and Prevention that water births are linked to the development of Legionnaires’ disease in infants. The Legionella bacteria thrives in warm water and can cause severe, life-threatening pneumonia in individuals with immune compromise—like newborn babies—when they are exposed to the bacteria. (“Legionnaires’ Outbreaks,” Washington Post, June 8, 2017)
You Have Your Baby
I have been to hundreds of deliveries, and there is no more sublime scene in life than seeing parents behold their babies for the first time. It’s a wonder-filled, utterly joyous, and overwhelmingly rapturous moment. You did it, Mommy and Daddy! You just had your baby!