How soon after this experience did you think it would be something you wanted to write about?
It was so traumatic that, at the beginning, I wasn’t thinking about writing about it at all. And yet, like any writer, in the back of your mind you know that any emotionally complex experience, any profoundly moving time in your life, is going to find its way into your work. I thought at first that it would come out in fiction somehow. At the beginning, I just didn’t know how to tell it. It was so emotional that to commit words to paper seemed impossible. It really took a long time for me to think it through, to allow the experience to become rational. But after my second child was born, how to tell this story started to jell for me.

Did you ever try fictionalizing it?
No, but characters in short stories I’ve written have had babies prematurely. I read a book after Ben was born that my editor at Random House, Anne Collins, [Curtis’s book, Into the Blue: Family Secrets and the Search for a Great Lakes Shipwreck was published by Random House in 2003 and won the Edna Staebler Award for Creative Nonfiction] had recommended. It was called Saul, by Rosemary Kay, who had a premature baby. It’s a novel written in the voice of a premature child. The baby dies. It’s an incredible book. To take the voice of a premature child and to make it feel true is extraordinary. The beauty of this book is that she’s able to portray the perceptions of a child who’s so much on the outside, watching this whole catastrophe unfold. It’s interesting to me because women talk to each other all the time about their birth stories. It comes up in all sorts of ways. I think there’s a kind of script that we all expect to adhere to: it all goes nicely, and you have this perfect birth, maybe it’s a natural birth at home with your midwife, or it’s in the hospital and you feel no pain because you have an epidural or whatever. But I think the truth is—and I hear this all the time from other women—especially after having a second premature child—that this script is just not the reality for most people. There are all sorts of traumas. Ours was astonishing to us but certainly not unique. And that’s something I thought a lot about when I was writing this story. How do I tell our story and be true to it and evoke the enormous pain and sadness and grief that we experienced while also acknowledging people whose babies are much smaller, whose time in hospital is much longer, and whose prognosis as the child grows up, if he or she survives at all, is much more dire.

I was surprised to read that, despite the immense increase in premature babies, there are relatively limited facilities in the city to deal with them. You mention the building of a new facility at Sunnybrook in 2009, but you also mention women being sent to Buffalo to deliver their babies. Shouldn’t this be more of a priority for Canadian hospitals?
In the article, I talk about women being sent to Buffalo to deliver their babies, but that was only due to another Level III NICU at Mount Sinai closing because of an infection outbreak. That’s relatively rare, I believe. I think the facilities in Toronto are mostly adequate for the demand. But the doctors, nurses, nurse practitioners, neonatologists—the whole raft of experts at Women’s College—are unbelievable. They’re highly skilled, extremely caring; we’re very luck in the city. But it’s definitely cramped at at the Women’s College NICU.

Is that common to other hospitals?
Women’s College NICU facilities are the oldest in the city. At the other hospitals, as I understand it, there’s space for families; they provide facilities so parents can stay with their kids all the time. Women’s College is an anomaly. But because it has such a renowned staff and top-notch research coming out of it, it has been able to manage for quite a long time. And people are wedded to the downtown site. That’s not the only reason they’re still there; they’re there because they haven’t had the money to build a new NICU. But somehow they’ve managed to retain a world class staff of nurses and doctors. These people are dealing with questions of life and death; to be able to process that, to help people, to be caring, is an extraordinary feat.

You write that “doctors must make recommendations to families with the knowledge that what is true and wise today may change tomorrow or next week or next year.” What types of things are changing exactly?
Everything is changing—from the technology they use, the drugs they administer and the training of the people who deal with the babies to the more soft stuff, like how you deal with the parents, how you allow them to be involved in the care of their babies. That’s been a real change in the past 30 years—getting parents involved at the very beginning. I talk in the piece about Kangaroo Care, which is this theory developed in Colombia in the ’80s: they’ve found that preemies actually grow better when they have skin contact with the caregiver. That’s amazing! To a layperson, it sounds like some sort of magic. And yet it’s been proven over and over and is now used widely in NICUs. When our parents were having kids, if you had a premature child (or any child for that matter), the baby was in the nursery and you were in the maternity ward, and you looked at the baby through the glass. It’s a very different place now. And, of course, things are changing in terms of the babies themselves. The extreme of viability, as I talk about in the piece, has been getting lower and lower. The doctors who I spoke to at Women’s College say they can’t imagine it getting much lower than 23 weeks. But they couldn’t have imagined 23 weeks 20 years ago! In the ’60s and ’70s, you could still abort a 28-week fetus in Britain. Nowadays we consider 28 weeks basically good to go. That’s just a seismic change in the way we think about what kinds of infants can survive. And there’s also long-term impact. That’s only really becoming clear as children who were born at the extreme end of viability in the ’80s and ’90s hit school age. We’re coming to understand about the kinds of learning disabilities they sometimes have, the long-term impact of prematurity.