This story originally aired on WRAL on Wednesday, April 26, 2017. Watch
While many women have known risk factors, the cause of many preterm births is a mystery.
North Carolina is still struggling to improve its ranking for preterm births. The March of Dimes, an organization working to find the cause of preterm births, lists the state with a C grade.
Three-year-old Caroline is Brent and Renee Garber's second child. Their first pregnancy with now-5-year-old Lucy was perfectly normal.
"Caroline's was a perfectly normal pregnancy, too," Renee Garber said. "We still don't know she came so early."
The Garber's had no reason to think there would be a problem until around Christmas in 2013 while visiting friends and family in New Jersey. Renee Garber was just 25 weeks into her pregnancy.
"Renee started having problems," Brent Garber said. "We went to the hospital, were there for a few days, and then she ended up being born the day after Christmas."
This book of memories shows Caroline, born at 1 pound, 12 ounces.
The family clung to hope that she would be fine.
"Unfortunately, you're also faced with all the research that says she would have a 70 percent chance of cerebral palsy and all these (other problems)," Brent Garber said.
Caroline remained in neonatal intensive care for four months.
Currently in North Carolina, 10.2 percent of newborns face the same challenge.
"(That is) about 9,000 babies per year that are born preterm," said Duke University OB/Gyn Dr. Amy Murtha.
Murtha says identifying women at high risk with early interventions is key to reducing those numbers.
The solution goes beyond good nutrition, smoking cessation and women maintaining a healthy weight, especially in more impoverished areas of the state.
"It's access to health care, it's access to education, access to stable housing and access to food," Murtha said.
In the Garber's case, there were no known risk factors for preterm birth—Caroline showed no sign of complications.
"We like to share Caroline's story, so that others in this situation can realize that miracles do happen," Brent Garber said.
These days, many people fighting obesity are turning to weight loss surgery to help prevent a preterm birth.
The original, non-commercial weight loss support organization in the country, called TOPS, still preaches exercise, and eating sensibly.