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Michelle Butler was 21 weeks pregnant with twins, a boy and a girl, when she felt the contractions.

Butler prayed for them to stop as her sister took her to the hospital.

But the contractions continued and around 1:00 pm on July 5, 2020, babies C’Asya Zy-Nell and Curtis Zy-Keith Means were born. Babies weighing less than a pound each have a less than 1 percent chance of surviving, they said. They were quickly placed on ventilators.

C’Asia died less than a day later. Ms. Butler, 35, said she took him in his arms, prayed for her and said she loved him.

But Curtis couldn’t stand it. He was trying to breathe on his own and his heart rate was improving, showing some flexibility. Shocked longtime nurses and doctors at the University of Alabama at Birmingham.

Dr., a neonatologist at the hospital caring for Curtis. “Even on the first breath it was stunning,” Brian Sims said. From Day 1, he showed that he would be a strong and strong man.”

Curtis was released in April after 275 days in the neonatal intensive care unit. Wednesday, Named Curtis in the Guinness Book of RecordsBorn 132 days premature, she is the world’s most premature baby to live to her first birthday. He is now 16 months old.

Dr. Babies born prematurely rarely live more than a day, Sims said.

“The truth is, no baby survived at this age,” she said. “We say less than 1 percent, but it’s really close to zero.”

Curtis’s preterm birth reflects the consistently high frequency of preterm births in the United States, where annual preterm birth rates are high. hovering at about 10 percent, according to the March of Dimes. In Alabama, the rate was 12.5 percent in 2019, according to the organization.

Curtis was born a month after the previous record holder. Richard HutchinsonBorn in Minneapolis after just 21 weeks and two days of gestation.

The risk of preterm birth is even higher for Black women, who are over 50 percent more likely to give birth prematurely than for white women. According to the Population Reference Bureau.

Numerous factors can contribute to preterm births, including a mother’s age and income, health, and access to prenatal care. Access to birth control may play a role. Bruce Bekkar, a gynecologist and obstetrician who serves as the chair of the Public Health Advisory Council at the Climate Action Campaign in San Diego, said that women with consecutive pregnancies are also at risk of giving birth prematurely.

Climate change can make the problem worse, According to a 2020 study examining It gave birth to more than 32 million births in the United States and found that pregnant women exposed to high temperatures or air pollution were more likely to have children who were premature, underweight, or stillborn.

One of the authors of the study, Dr. It’s too early to judge how big a role climate change plays in low birth weights and preterm births, Bekkar said. 2020 study. However, stating that the evidence that this is an important factor is convincing, noting that the number of preterm births is increasing, he said: Dropped at least 20 percent in California in areas where fossil fuel plants were shut down.

Other events, at least in part caused by climate change, have been associated with preterm births, such as the increasing number of wildfires in the western part of the United States and the increased frequency and intensity of heat waves.

“It will get worse,” said Dr. Single. Climate change will “continue to put increasing pressure on preterm birth rates.”

Dr. Sims said it was unclear why Ms. Butler gave birth prematurely. She said she has access to newborn care and sees a doctor regularly.

Ms. Butler said her cervix began to open shortly before giving birth. He had surgery at UAB Hospital to close it and was discharged from the hospital on July 4th. Ms. Butler said her sister was driving home on seriously bumpy roads when she began to feel the contractions.

She said that when her daughter died, Curtis had little time to grieve knowing she was still trying to survive.

“I needed to pull myself together and be strong for him,” said Ms. Butler. The doctors told him they would have to “take it day by day, hour by hour” with a baby born this early.

“It was a roller coaster,” said Miss Butler. “He’s definitely had good days and bad days.”

Ms. Butler, who also has a 7-year-old daughter and a 14-year-old son, drove 90 minutes from her home in Greene County, Ala., several days a week to visit Curtis at the hospital.

The nurses showed him how to feed and change him and keep the feeding tube clean.

Sumita Gray, a nurse at the hospital, said she was placed on her mother’s chest for skin-to-skin contact when stable enough. regional neonatal intensive care unit.

Ms. Butler balanced her visits to the hospital with her job at the catfish processing plant. Two weeks before Curtis was discharged, Miss Butler quit her job knowing she needed to spend more time with the baby.

Ms. Gray said she was thrilled to see him recently, when the doctors and nurses caring for Curtis reunited with him and Ms. Butler to present the Guinness World Records plaque.

“It looked great,” he said. “He was very playful.”

Curtis still relies on a feeding tube and a ventilator to supplement his oxygen. Ms. Butler said she needed speech and physical therapy. Doctors, however, said they were pleased with his progress.

Dr. “It’s very interactive,” Sims said. “She laughs, takes a stand. He does everything you’d ever expect from a baby.”

Ms. Butler said Curtis, who now weighs 18 pounds 9 ounces, slept all night and rarely whined.

“A happy baby,” he said. “He’s not a crying baby.”