This post was written by freelance contributor A. Rochaun Meadows-Fernandez through our Daily Kos freelance program.
When a college schoolmate of mine posted that her twins were born almost two months earlier than anticipated, we all swooned and welcomed them into the world. There were jokes about their determination to make it here and compliments about their beauty, but nothing more deep than that. Through the years, I’ve known many babies who were born two and even four or more weeks ahead of their due dates, like my best friend’s niece and nephew, twins who made an entrance long before the third trimester. I’d never really given the long-term implications of early birth much thought. I’d been taught that babies have a mind of their own, and we wait for them to reveal their plans.
Early arrival has been deeply normalized for me and many from my hometown. It’s so normal that if I weren’t forced to battle the “what ifs” of a suddenly high-risk pregnancy, I’d have never known November is Prematurity Awareness Month—or that the acknowledgment was necessary at all.
Being pregnant a second time with the elevated horror of an intrauterine growth restriction and several other possible health issues caused me to look into the risk factors of an early birth. It was the first time I saw a connection between my best friend’s niece passing away and the fact that she was born so early—and I was scared for myself. My child is already up against so much. She can’t afford to be born before her organs are fully developed.
It was also the first time I noticed that so many of my friends’ and former classmates’ children came into the world early. I’d been unknowingly watching as a health crisis made its way through the black community.
To commemorate Prematurity Awareness Month, The March of Dimes released its 2018 annual premature birth report card. The results indicated the significant racial/ethnic and geographic disparities of babies that have a higher chance of a preterm birth, based simply on race and ZIP code. What they found was disheartening, though not surprising. With a premature birth rate of 13.4 percent, black babies are 50 percent more likely than white babies to be born before 37 weeks.
It’s terrifying to think my daughter could come at any moment. Sadly, my risks for preterm labor are multiplied two-fold. My identity as a black woman puts me at an elevated chance of early delivery, and having a baby with a small size and health issues increases the likelihood that if my body doesn’t expel her, a medical team might make the decision for me. My awareness of these circumstances leaves me in a constant state of anxiety and stress. Unsurprisingly, stress is another risk factor for premature birth. It feels like an early delivery is a looming expectation, and I have no chance of escape.
Racism’s impact on life quality is visible in infancy. And there is research, like that on disparities in IVF outcomes across racial lines, that suggests the lack of equity in reproductive health begins during conception.
Early birth comes with many risks including but not limited to underdeveloped brains, partially functioning lungs, and an increased chance of developmental delays. It’s also a critical factor in infant mortality, an epidemic that already affects the black community in disproportionate ways.
The National Institutes of Health note ethnicity as a risk factor for premature birth. But the method of phrasing fails to make an important clarification: it is racism, not race, that has left black women and infants with an increased risk of birth-related death.
Other listed factors include violence/abuse; stress; long working hours with long periods of standing; and exposure to certain environmental pollutants. Again, there is no mention of the ways social customs have left black women dually marginalized (at a minimum) and more likely to experience interpersonal violence, overrepresentation in low-paying jobs due to hiring bias and wage discrimination, and more likely to live in areas with subpar regulations on water (like Flint, Michigan). All these conditions exist thanks to legislation and practices that effectively limit black progress. And sadly, even education and class mobility aren’t enough to eradicate the risk of maternal and infant mortality in the black community.
Trauma has become one of many traditions passed down through our genetic code.
At the same time, I worry that many of my fellow black community members overlook the role of environmental, institutional, and interpersonal racism in our reproductive health outcomes. Through the centuries, black Americans have continually been put through circumstances that threaten our physical and mental safety, and each of these impacts the safety of our unborn children.
My life and research make me hyper-aware of this data. I know that I face higher risks of birth trauma as well as death. I’ve already mourned my chance of having an “ideal pregnancy.” My first birth took a dramatic turn when my son was diagnosed with hydronephrosis, the swelling of a kidney due to a build-up of urine, during my third trimester. Sadly, my second pregnancy involves a growth restriction and a looming possibility of anorectal malformations.
As much as I would like to spend all of my time curled in a fetal position on the floor as the future of unknowns torments my thoughts, I can’t. My baby and I are already up against too much. My body can’t handle the weight of another stressor.
Now that I understand no amount of research, income, or education can prevent me from having a high-risk pregnancy, I feel a ton of uncertainty. My sudden shift from normal to high-risk makes me doubt I’ll ever have another child. I’m unsure how we will adjust if our unborn daughter requires corrective surgeries during her first 24 hours of life. And I can’t form a sentence to coherently describe how it feels knowing so much of my reproductive potential feels predetermined.
At the same time, none of that matters right now. The only goal I have is to make it to full-term.
A. Rochaun Meadows-Fernandez is a diversity content specialist whose work can be seen in The Washington Post, InStyle, The Guardian, and other places. Follow her on Facebook and Twitter.