The U.S. has a high rate of preterm births, and abortion bans could make that worse
A third-grade teacher at an overcrowded
And as a Black woman, experiencing a lifetime of racism had left Etienne wary of unpredictable reactions in daily life and drained by derogatory and unequal treatment at work. It's the sort of stress that can release cortisol, which studies have shown heighten the risk for premature labor.
"I'm experiencing it every day — not walking alone, walking with someone I have to protect," she said. "So the level of cortisol in my body when I'm pregnant? Immeasurable."
Two months into her pregnancy, the unrelenting nausea suddenly stopped. "I started to feel like my pregnancy symptoms were going away," she said. Then strange back pain started.
Etienne and her husband rushed to an emergency room, where a doctor confirmed she was at grave risk of having a miscarriage. A cascade of medical interventions — progesterone injections, fetal monitoring at home, and bed rest while she took months off work — saved the child, who was born at 37 weeks.
About 1 in 10 live births in the
It's a distinction that coincides with high rates of maternal and infant death, billions of dollars in intensive care costs, and often lifelong disabilities for the children who survive.
"It's very hard to identify that a patient will automatically have a preterm birth," says Dr.
Physicians say that roughly half of all preterm births are preventable, caused by social, economic and environmental factors, as well as inadequate access to prenatal health care. Risk factors include conditions such as diabetes and obesity, as well as more-hidden issues like stress or even dehydration.
In its 2022 report card, the
States that restrict abortion have fewer maternal care providers
Many maternal-fetal specialists worry that the incidence of premature birth could soon soar, with abortion now banned in at least 13 states and sharply restricted in 12 others — states that restrict abortion have fewer maternal care providers than states with abortion access, according to a recent analysis by the
That includes the state of
Social and biological stressors can interact to trigger preterm birth
The causes of premature births are varied. About 25 percent are medically induced, Jacques said, when the woman or fetus is in distress because of conditions like preeclampsia, a pregnancy-related hypertensive disorder. But research suggests that far more early births are thought to be rooted in a mysterious constellation of physiological conditions.
At
When meeting a patient for the first time she asks: Who else is in your household? Where do you sleep? Do you have substance abuse issues? Where do you work?
"If you don't know that your patient works in a factory [standing] on an assembly line," Jacques said, "then how are you going to tell her to wear compression socks because that may help her prevent blood clots?"
Jacques has urged a store manager to let her pregnant patient sit while working. She persuaded an imam to grant a mom-to-be who had diabetes a reprieve from religious fasting.
Because diabetes is a major risk factor, she often talks with patients about eating healthfully. For those who eat fast food, she asks them to try cooking at home. Instead of, "Can you pay for food?" she asks, "Of the foods we're discussing, which one do you think you can afford?"
A lack of access to affordable care separates
In countries with socialized health care, "women don't have to worry about the financial cost of care," said Dr.
Yet wealth does not ensure better pregnancy outcomes, the
Statistics on race and premature birth reveal a tragic trend
Startling new research shows that at every
To offer meaningful help, you have to ask the right questions
"I find Black women working in high-stress environments, even if they are not financially struggling, can face preterm birth," she said. She develops "wellness plans" that include breathing, meditation, stretching and walking.
Recently, when a patient showed signs of preterm labor, Amani discovered that the woman's electricity bill was overdue and the utility was threatening to cut service. Amani found an organization to pay off the woman's debt.
Of
"They were able to walk me through healthy, natural ways to mitigate all of those complications," she said.
Her own pregnancy experiences left a profound impact on Etienne. She has since become a fertility doula herself.
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