Premature Predicaments

This chapter examines the definitions of prematurity over time and specifically explores how racial science has been used to animate the definitions and etiology, or causes, of premature birth. This chapter focuses on the birth stories of four women, who gave birth prematurely in different centuries, between the nineteenth century and the present, to shed light on the temporality of Black women’s birth outcomes. The birth stories, including one contained in Incidents in the Life of a Slave Girl, an autobiographical narrative by Harriet Jacobs, highlight questions about the definition and etiology of prematurity. The stories also illustrate some of the clinical causes of premature birth and present the situations that women describe as evidence of medical racism.

Saving the Babies

In the nineteenth century, the United States began to address its embarrassingly high rates of infant and maternal mortality, and later premature birth rates, in earnest. Those efforts have often been racially disparate. Using a critical racial lens, this chapter explores the uneven racial outcomes of the technologies of saving, or strategies used to save infants and mothers. A number of programs, policies, and scientific advancements, including the development of NICUs, have facilitated the development of saving interventions. The exploration of saving begins with the founding of the Children’s Bureau in 1912 and the Sheppard-Towner Act of 1916 and concludes with the use of NICUs. This chapter shows that the interventions have not been as successful for Black as for white infants and mothers, once again illustrating the racial politics of reproduction. Special consideration is given to the critique of NICU technology, about which both medical and public health professionals raise questions concerning how NICUs overshadow other forms of addressing prematurity.

Pregnancy and Prematurity in the Afterlife of Slavery

This chapter illustrates the connection between racialist thinking of the past and Black women’s contemporary medical encounters. It addresses the various ways in which medical racism is asserted when the care of Black women and their children is compromised due to racist concepts such as obstetric hardiness, hardy babies, and mothers’ being viewed as menacing or potential threats. While other stories are included, Yvette Santana’s birth story is the touchstone for exploring several ways that medical racism is experienced; her account is framed around histories and ideas about Black women, their bodies, and reproduction. The organizing concept of this chapter is diagnostic lapse. A diagnostic lapse is the consequence of racialist thinking and results in a misdiagnosis.

Into the NICU

This chapter offers ethnographic insight into the neonatal intensive care unit (NICU), a space that is largely inaccessible to the general population. The chapter describes the physical space of the NICU. Parents reveal how they felt about having their newborn infants admitted to the NICU and the varying degrees of racism that saturated the experiences of some, but not all, parents. Most parents interpret their experience through the lens of medical racism. At the very least they understand that if it were not for a particular mediating factor, such as having a connection to the medical field, they likely would have been subjected to racist medical encounters. This chapter also examines how mostly white neonatologists respond to questions related to race and adverse birth outcomes and finds that, for most, class replaces race as the explanatory factor for understanding premature births.

Narrowing the Gap of Black Women’s Burden

Administrators working within the public health approach to health issues generate information used to mobilize against a particular plight. The March of Dimes, which from its founding has developed public education campaigns to address child-related health issues such as polio and German measles, is no different. This chapter chronicles the organization’s intervention approach to addressing maternal and child health issues. Interviews with key administrators document how the March of Dimes takes up the issues of racial disparity and premature birth. However, as this chapter shows, there is a difference between characterizing racial disparity for the purpose of raising awareness about premature birth rates and addressing medical racism, which are an integral part of the content of Black women’s reproductive experiences.

Introduction

The introduction sheds light on the crisis of premature birth among Black women. It lays out the theoretical terrain on which premature birth is generally understood and develops the rationale of linking the issue to past ideologies and practices of medical racism. Premature birth and medical racism are introduced through the birth story of a young African American woman who was a college student when she became pregnant and later gave birth to a daughter, born three months prematurely, who was admitted to a neonatal intensive care unit (NICU). Grounded in a Black feminist framework, which privileges Black women’s experiences as a site of knowledge production, the chapter describes the book’s theoretical foundation; its methodological approach; and its use of birth stories, interviews, ethnographic observations, and archival sources to understand Black women’s medical encounters.

Radical Black Birth Workers

The interventions used to address premature birth do not address the issue of medical racism. Moreover, interventions are not preventive. This chapter focuses on the role that radical Black birth workers, including doulas, midwives, and reproductive justice advocates, play in addressing Black women’s adverse birth outcomes. Radical birth workers attempt to prevent adverse birth outcomes by delivering comprehensive care throughout pregnancy, labor, birth, and postbirth. Often, at the same time, they also view themselves as mediators between women and the obstetric medical system founded on the exploitation of Black women’s reproduction. Birth workers have their roots in early midwifery practices, and many seek to reclaim pregnancy and birthing from the power of the medical-industrial complex. The preventive approach as an alternative to medical births and the provision of care based on compassion have been shown to produce very good outcomes for many women.

Conclusion

Having examined the history of prematurity, Black women’s experiences of pregnancy, labor, and birthing, and their assessments of medical racism, this chapter gestures toward some approaches to address Black women’s high rates of prematurity. These approaches may also be applied to rates of infant and maternal mortality, as well as to addressing the adverse birth outcomes of other groups. Presently, much emphasis is placed on stereotyping the characteristics believed to cause prematurity. The general approach is to intervene in the problem. This chapter suggests that preventive approaches to birth outcomes must be deployed with the same commitment as is done with interventions. Transforming the model of care requires viewing pregnancy as an event, not a risk. And, unless risk is well established, pregnancy care need not be medicalized. In the event that medical interventions are necessary, a team-based model of care is preferable. Medical providers should be sharing the care with the family, a midwife, and a doula. Most important, medical professionals must acknowledge the ways that they uphold racism in their practice of medicine.

Witnessing a Birth

The first part of this book has emphasized birth stories told by Black women and two Black men. These have frequently been angst-filled narratives, often soldered with histories and interpretations of racial stereotyping and the experience of racism. Up to this point the chapters have interrogated premature birthing experiences from the vantage point of Black mothers and fathers, who have been subjected to articulations of racial bias. Most mothers, but by no means all of them, described interactions with medical professionals that may be characterized as being caught up in webs of racism based on how they were treated....