click to enlarge Photo by Drew Costley

After her frightening experience with the preterm birth of her son, Tanisha Fuller became a doula.

While she was carrying her third child, Tanisha Fuller had to convince her hospital caretakers that something was really wrong. It was 2003, she was six months pregnant, and she was unsure of what was happening to her. The Richmond resident had rushed to the emergency room at Alta Bates hospital in Berkeley with pain in her back, feeling like she couldn't breathe. At the hospital, she was told that it was "probably gas," she said, given a Tylenol, and told to lie down in the examination room.

She asked for an X-ray. Looking back, she isn't sure why. "It had to be God," she said.

"They did it, and came rushing out," Fuller said. Someone told her, "'Your lung collapsed. Let's get you into surgery.'" The medical staff placed a breathing tube in her chest; she ended up needing to use one until she delivered.

At the time, nobody told her that the complications from her lung meant her baby was in danger of being born "preterm" — before 37 weeks of pregnancy had been completed. She just knew that she needed to get to three different appointments each week: one with a high-risk doctor, one with a pulmonologist, and one for a stress test. Though she had two other kids at home — ages 6 and 1 — was working, and didn't have a car, Fuller didn't miss a single appointment.

At one of her weekly stress tests — during which "you go lay down for 30 minutes and they hook the baby up to a monitor that makes sure it's not in distress," she said — Fuller learned that her baby was, in fact, in distress. He wasn't "responding well to everything that was going on," she recalled. The medical staff feared that, if another complication with Fuller's lung arose, it might affect both mother and child.

Fuller's health care providers decided she needed to be induced — to have her labor started early. "I was scared. I was terrified. I was crying, because I just didn't know," she remembered. "I didn't know if that meant that my baby was not going to make it. I didn't know if it meant there was something wrong with me, and I was going to die."

After a couple of hours at Alta Bates, a nurse finally explained that Fuller's team of health care providers felt that inducing her was the safer option and told her what would happen.

A few days later, Fuller went home with a 5-pound baby — her son came just short of a month early. Everyone at home was scared to touch him because "he was so tiny," she said. "I had to kind of learn on my own how to take care of him."

For women in the United States, giving birth to a preterm baby is a fairly common experience. The Centers for Disease Control reported that, in 2016, "preterm birth affected about one out of every 10 infants born in the United States." Babies who are born too early, according to the CDC, "have higher rates of death and disability." They haven't yet fully developed, and it's harder for them to adjust from life inside their mothers to functioning on only their own bodies' systems.

As widespread as this problem is, it's more prevalent for some mothers than others. Nationally, the rate of preterm birth among African-American women, like Tanisha Fuller, was about 50 percent higher than that experienced by white women in 2016, according to the CDC. Even in the affluent Bay Area, between 2012 and 2014, African-American women were almost twice as likely to give birth to preterm babies as women of other races, according to data published by the Alameda County Public Health Department last year.

According to this same data, Black women in the East Bay are also nearly three times as likely to give birth to low birth weight babies — infants born weighing less than 5.5 pounds — than are white women. Babies born this small are "approximately 20 times more likely to die than heavier babies," according to a 2004 report by the World Health Organization.

Although African-American babies were only 9.8 percent of the total births in Alameda County between 2012 and 2014, they made up more than a quarter of the infant deaths during that time. They are also more than four times as likely as white infants to die from disorders related to being born with a low birth weight or to having a gestation that was too short, as well as from causes like Sudden Infant Death Syndrome (SIDS).





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Maternal mortality, though it affects a very small number of women in California, also disproportionately affects African-American women. In 2013, according to data compiled by the California Health Care Foundation, about 26 of every 100,000 pregnant Black women died —almost four times as many as white women, who died at a rate of seven per 100,000 that year.

"We know that African Americans are more likely to have a preterm birth, more likely to have infant mortality," said Allison Bryant, a Boston-based physician who is a member of the American Congress of Obstetricians and Gynecologists' Alliance for Innovation on Maternal Health. As a result, she said, Black families probably carry a disproportionate burden due to the health consequences of preterm birth.

Babies born too small or too early, Bryant said, often need to stay in the hospital nursery or in the Neonatal Intensive Care Unit (NICU) "for a long period of time." After leaving the hospital, they tend to have chronic health challenges, which means more provider visits, equipment, and monitoring.