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"Sometimes, babies go home with an apnea monitor to make sure that they are not stopping breathing at particular instances. Some babies have retinopathy of prematurity, which is an eye disease, which then probably needs more ongoing care and attention. They have chronic lung disease, which then means more doctors' visits and perhaps oxygen," said Bryant. All of the complications of prematurity "are going to be borne more heavily in the communities that are more affected by preterm birth."
Early birth can also lead to developmental or learning issues later in childhood. "Babies who are preterm, or babies who are born very low birth weight," Bryant said, "are less likely to gain a high school diploma or a GED, [and] they have more behavioral issues."
Though overall rates of infant mortality, preterm births, and low-birth-weight births declined in Alameda County between 2000 and 2014, the racial inequities persist. Local groups like the Preterm Birth Initiative and Black Women Birthing Justice are working to learn more about the risks and challenges women of color face within the health system and to educate women about their options and rights. But because these problems don't have just one cause, many feel that changes to improve the health of women and infants will be incremental.
"There's no smoking gun. There's no one thing that you could fix that would then drive the preterm birth rates down by half," said Bryant. "Every little bit helps."
These inequities are a problem for all Americans, said Monica McLemore, a registered nurse in Oakland, "because we are robbed of the brilliance of everyone's children and the perspectives of those children and the gifts and talents of both them and their parents."
Sommer Davis wanted to be a labor and delivery nurse since she was 7 years old. She never dreamed of a fancy wedding, only of giving birth and being involved in others' births. "I was trying to describe to my daughter the other day, what it's like," Davis said. "She says she wants to be a nurse, too. So, I said, 'If you help the mamas with their babies, you get to be a part of the most overwhelming experience of love in a stranger's life every single day.'"
Lean and tall, Davis is warm and attentive to the comfort of those around her. This quality has probably only become stronger during her 15 years as a labor and delivery nurse, the last two and a half spent at a hospital in Alameda County. (Davis declined to name the hospital where she works because, she said, employees aren't allowed to represent the organization's views.)
Davis said she sees one to three cases of either preterm birth, low birth weight birth, or infant mortality on a daily basis.
Depending on the "gestational age and overall well-being" of the baby, Davis said, there are a variety of ways the nursing staff can care for a preterm infant. "Often, extreme premature babies will not eat for several weeks and their nourishment is taken care of via IV," Davis said.
Hospitals use warming pads for extremely premature babies, because they don't yet have adipose tissue — connective tissue made up mostly of fat — under their skin that would regulate their temperature. Breathing machines are used for babies whose respiratory systems aren't yet adequate or who have some other breathing issue.
For babies born too early or too small, Davis said, "breastfeeding issues are common." She added that these situations "could possibly delay healing of the mother due to stress and also place her at higher risk for postpartum depression."
In some cases, preterm births happen through induction, but Davis said that doctors would only elect to induce labor before 37 weeks if the baby or mother were facing a serious illness or complications, as in Tanisha Fuller's experience.
The induction process can take days to cause active labor, as physicians run through what Davis calls their "induction toolbox." It can be long, exhausting, and painful for the woman. She might need to wear an external fetal heart rate monitor — a strap that goes around her belly and monitors the baby's heart rate — or in some cases an internal monitor that's placed through the vagina. She may have a Cook Balloon placed in her cervix to manually dilate it. ("It's these two water balloons that go in the cervix and sort of squash the cervix," Davis said, "and you can leave it in for up to twelve hours.") She may receive Misoprostol, a drug that can cause minor uterine contractions, or Pitocin, a synthetic version of the hormone oxytocin — which, Davis said, is essential for causing contractions — or both of these.
By the time a woman has to push her baby out, she's often sleep-deprived and dealing with a lot of pain while in that state. Then more interventions — intravenous pain meds, epidurals — can happen to get her through the birth.
While Davis is glad to help mothers through all of these situations, she wishes she could do more. "I often think about what it's going to be like for them when they're discharged home. The physical recovery, I think, is challenging," Davis said, "but it's always the emotional scars that take a longer-lasting toll."