Nathaniel Van Niel was born 14.9 ounces and 10 inches long. He is smaller than a hand, small enough that his mother Maria's wedding ring fits loosely around his wrist.
Nathaniel wasn't due to arrive until today, Sept. 11, but he came 14 weeks early on June 6. He is doing well now, weighing 3 pounds, 9.5 ounces, and Maria Van Niel says he looks like a "mini baby" but cries like a big one.
Van Niel, of Carmel Valley, said she feels blessed to have Nathaniel, no matter how challenging his arrival has been.
"I was dealt a different kind of birth," Van Niel, 34, said. "You just have to enjoy the experience that you get."
Nathaniel wasn't Van Niel's first premature baby. Her oldest son Caleb, now 7, was born 1 pound, 10 ounces, and her daughter Olivia, now 2, was born 2 pounds, 11 ounces.
While it has never been easy, the experience with Caleb was the most difficult.
"I would cry every time I saw moms leaving the hospital with fat, chubby babies," Van Niel said.
The premature births were caused by a condition called intrauterine growth restriction (IUGR), which causes slow growth of the fetus or for the growth to stop altogether.
Dr. Mandhir Suri, also a Carmel Valley resident, delivered Nathaniel at Sharp-Mary Birch Hospital. He said Nathaniel is not the smallest he's ever delivered. He has delivered babies that were about 10.5 ounces, and said 400 premature babies a year are born at Mary Birch.
Suri said only 5 percent to 10 percent of prematurity is caused by IUGR, which can be prompted by maternal factors such as high blood pressure, kidney or respiratory disease, malnutrition or anemia and substance abuse.
Problems with the placenta can also be a factor. In Van Niel's case the placenta was not absorbing nutrients from the mother fast enough.
Because Nathaniel was so slow growing, they wanted Van Niel in the hospital and ultimately had to take him out via Cesarean section.
"It was so awful," Van Niel said.
Immediately after he was delivered, Nathaniel was moved to the respiratory room, and Van Niel didn't see him for five hours and didn't hear any news about his condition.
To finally see her tiny baby was "emotional to say the least," she said,
"To describe it in words would be very difficult," Van Niel said. "I didn't cry, but I just had a hard time seeing that he was so small. I thought there was no way he was going to make it."
Van Niel said his skin looked frail and dark and his legs were the size of pinkie fingers. She didn't want to get too attached because she feared the worst - when she went home from the hospital, every time the phone rang she was afraid to pick up and hear heartbreaking news.
Van Niel wasn't even able to hold her new baby until July 9, nearly a month after his birth.
The challenges with premature babies are plenty, Suri said. They have respiratory issues because their lungs are so small and they have no immune system so they are highly susceptible to illness. Nathaniel has already had two bouts with pneumonia.
Additionally, the blood pressure of their tiny hearts has to be monitored and they cannot feed. Suri said premature babies are fed initially by intravenous fluids and then given breast milk through a tube.
"It's a long, long way to survival," Suri said. "We do whatever we can do for these babies."
Chances for premature survival are much greater now, Suri said, thanks to advances in technology, medicine and education. He said nationally the survival rate is about 50 percent and is 90 percent in San Diego.
He said the risk of premature birth increases for teenage mothers and older mothers, with multiple gestation births and for babies conceived through in-vitro fertilization. The likelihood of a premature birth decreases when the mother is healthy.
Through her experience, Van Niel said she has had the support of family and friends, even though a lot of people don't know what to do in the case of a premature birth. Van Neil's advice is to make contact with the mother, a quick e-mail or phone call, no matter how awful the situation.
"Sometimes we just want people to listen, even if we're telling the same story over and over again," Van Niel said.