By Sarah Varney
Washington, March 16 (KHN via EFE). – Tamara Etienne’s second pregnancy was fraught with risk and worry from the start, exacerbated by the fact that she had already suffered a miscarriage.
As a third-grade teacher in a Miami-Dade County public school, she was on her feet all day. She was weighed down by financial worries, even having health insurance and some paid leave.
And, as a black woman, a lifetime of racism made her wary of unpredictable reactions in daily life. She was exhausted from the derogatory and unequal treatment at work. Just the kind of stress that can release cortisol, which studies show increases the risk of preterm labor.
“I experience it all the time, I don’t walk alone, or I do it with someone I have to protect. Yes, the cortisol level in my body is uncountable,” she expressed.
At two months pregnant, the relentless nausea suddenly stopped. “I started to feel like my pregnancy symptoms were going away,” she said. Then a strange back pain started.
Etienne and her husband rushed to the emergency room, where they confirmed that she was at serious risk of miscarriage. A cascade of medical interventions — progesterone injections, home fetal monitoring and bed rest — saved the girl, who was born at 37 weeks.
Women in the United States are more likely to give birth prematurely than women in most developed countries. This coincides with higher maternal and infant mortality rates, billions in intensive care spending, and often a lifetime of disability for those born prematurely.
About one in 10 live births in 2021 occurred before 37 weeks’ gestation, according to a March of Dimes report published in 2022. By comparison, recent research cites preterm birth rates of 7.4% in England and Wales, from 6% in France and 5.8% in Sweden.
In its report, the March of Dimes found that preterm birth rates increased in nearly every state from 2020 to 2021. Vermont, with a rate of 8%, ranked highest in the country:
An A-“. The bleakest results were concentrated in the southern states, which scored the equivalent of an “F” with preterm birth rates of 11.5% or higher.
Mississippi (15%), Louisiana (13.5%) and Alabama (13.1%) were the worst performing states. The report found that, in 2021, 10.9% of live births in Florida were preterm, earning it a “D” rating.
Since the Supreme Court struck down Roe v. Wade, many specialists fear that the incidence of premature births will skyrocket. Abortion is now banned in at least 13 states and strictly restricted in 12 others: States that restrict abortion have fewer maternity care providers, according to a recent Commonwealth Fund analysis.
That includes Florida, where Republican lawmakers have enacted anti-abortion laws, including a ban on abortion after 15 weeks gestation.
Florida is one of the least generous states when it comes to public health insurance.
Approximately one in 6 women of childbearing age are uninsured, making it difficult to maintain a healthy pregnancy. Florida women are twice as likely to die from causes related to pregnancy and childbirth as California women.
“It makes me sleepless,” said Dr. Elvire Jacques, a maternal-fetal medicine specialist at Memorial Hospital in Miramar, Florida.
Jacques explained that the causes of preterm births are varied. About 25% are medically induced, for conditions such as preeclampsia. But research suggests that many more may be rooted in a mysterious constellation of physiological conditions.
“It is very difficult to identify that a patient will have a preterm labor,” Jacques said. “But you can identify the stressors in her pregnancy.”
Doctors say that about half of all preterm births due to social, economic, and environmental factors, and inadequate access to prenatal care, are preventable.
At Memorial Hospital in Miramar, part of a large public health care system, Jacques receives high-risk pregnancies referred by other South Florida obstetricians.
On the first date he asks them: Who do you live with? Where you sleep? Do you have addictions? Where do you work? “If I didn’t know that they work in a factory standing still, how could I recommend that they wear compression stockings to prevent blood clots?”
Jacques urged a store manager to allow his pregnant employee to work sitting down.
He persuaded an imam to grant a mom-to-be with diabetes a reprieve from religious fasting.
Because diabetes is a major risk factor, he often talks with patients about eating healthy. He asks them, “Of the foods we are discussing, which do you think you can afford?”
Access to affordable care separates Florida from states like California and Massachusetts, which have paid family leave and low uninsured rates; and the United States from other countries, health policy experts say.
In countries with socialized health care, “women don’t have to worry about the financial cost of care,” said Dr. Delisa Skeete-Henry, chief of the department of obstetrics and gynecology at Broward Health in Fort Lauderdale. And they have paid maternity leave.
However, as preterm births rise in the United States, wealth does not guarantee better outcomes.
Surprisingly, new research reveals that at all income levels, black women and their babies experience far worse birth outcomes than their white counterparts. In other words, all the resources that wealth offers do not protect black women and their babies from premature complications, according to the study, published by the National Bureau of Economic Research.
Jamarah Amani witnesses this as executive director of the Southern Birth Justice Network and an advocate for midwifery and birth attendant care in South Florida. As she evaluates new patients, she looks for clues about birth risks in family history, lab work and ultrasounds. And she focuses on stress related to work, relationships, food, family, and racism.
“Black women who work in high-stress environments, even if they are not financially challenged, can face preterm labor,” she said.
Recently, when a patient showed signs of preterm labor, Amani discovered that her electric bill was past due, and that the company was threatening to shut off her service. Amani found an organization that paid off the debt.
Of Tamara Etienne’s six pregnancies, two ended in miscarriage and four were at risk of preterm birth. Fed up with the onslaught of medical interventions, she found a local birth attendant and midwife to help deliver her two youngest children.
“They were able to walk me through healthy, natural ways to mitigate all of those complications,” she said.
Her own experiences with the pregnancy left a profound impact on Etienne. Since then, she has become a birth attendant herself.
KHN (Kaiser Health News) is the newsroom of KFF (Kaiser Family Foundation), which produces in-depth journalism on health. It is one of the three main programs of KFF, a non-profit organization that analyzes the problems of health and public health in the nation.
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