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Black Maternal Health: How to Reduce the Risk of Prematurity and Strategies for a Healthy Birth
Black Maternal Health: How to Reduce the Risk of Prematurity and Strategies for a Healthy Birth Christine Ivery, MPH, CHES Project Director Prematurity Prevention Initiative Family Health Initiatives In New Jersey, Black birthing people are seven times more likely to die from pregnancy-related complications when compared to their white counterparts. The Maternal Experience Survey (MES), is New Jersey’s first tool to improve the way birthing people receive care and address biases. The survey, developed by the NAACP Atlantic City Black Infant and Maternal Mortality (BIMM) task force and Family Health Initiative’s Prematurity Prevention Initiative, amplifies voices that have been unheard or silenced and empowers sustainable change. With the American College of Obstetricians and Gynecologists proclaiming January 23 as Maternal Health Awareness Day, it is important to highlight strategies that advance Black maternal health and prevent prematurity as an act of awareness. What’s Preterm Birth? Preterm birth is the delivery of a baby before 37 weeks or more than three weeks before a designated due date. In the United States, babies who are born early have an increased risk of critical complications and death within the first month of life. Babies that are born prematurely require time to develop their lungs, liver, brain, and other vital organs to survive (March of Dimes, 2019). At birth, preterm babies are more likely to require treatment in the NICU, have an increased likelihood of being on life support, have a higher risk of being readmitted to the hospital after going home, and increased risk of Sudden Infant Death Syndrome (SIDS). Early birth can also cause long-term impacts such as behavioral and social-emotional issues, learning difficulties, increase risk of Attention Deficit- Hyperactivity Disorder (ADHD), and a greater likelihood of chronic diseases such as hypertension or high blood pressure, diabetes, and heart disease. Preterm Birth and Racial Disparities in New Jersey New Jersey mirrors the national preterm average where one in ten babies are born early. Preterm infants within the state are seven times more likely to die in their first year of life. These risks increase significantly for Black babies. In New Jersey, Black infants are twice as likely to be born preterm than their white counterparts (NJ SHAD, 2020). Why Does Preterm Birth Happen? Early birth is not completely preventable, however, efforts such as improving lifestyle factors, seeking preconception care, and receiving early and consistent prenatal care can help to limit risks. Several risk factors can increase the risk of preterm birth. This includes being pregnant with multiples (e.g. twins, triplets), pregnancy complications (shortened cervix, history of uterus or cervical surgery), stress, late or absence of prenatal care, tobacco and substance use, short time (less than 18 months) between pregnancies, and a prior history of previous preterm births. In many cases, women who deliver preterm have no risk factors at all. It is important to also recognize barriers of disparities and systemic racism when addressing preterm birth. Birthing parents require and deserve the dismantling of obstacles such as transportation, insurance, food insecurity, education, racism, discrimination, and additional issues, particularly for Black birthing people who experience higher rates of preterm birth and infant mortality. Through the Maternal Experience Survey, we hope to hear from Black birthing people about their maternal journey. The survey will advocate and develop sustainable solutions to birthing inequities within the state. How to Reduce the Risk? While a solution is not present to prevent all preterm births, strategies exist to avoid early birth and to have a healthy pregnancy. Prevention
Birth spacing: Birth spacing describes the time from one child's birth until the next. It is recommended to wait at least 18 months to allow the body to heal before the next pregnancy.
Lifestyle Changes: There are several ways to maintain or improve health for positive birth outcomes:
Pre-pregnancy Weight Achieving a healthy weight prior to pregnancy can help to improve birth outcomes. Underweight birthing people have an increased risk of preterm birth. Birthing people who are obese or have an excess amount of body fat can face preterm birth risk complications such as preeclampsia (high blood pressure condition). Avoiding Alcohol and Substance Abuse Alcohol and substance abuse during pregnancy can significantly increase the risk of early birth. Smoke-free Environment Tobacco smoke and related uses are among the top five causes of preterm birth. Smoke from tobacco contains over 7,000 chemicals and breathing in small amounts of smoke can be harmful. Prevent and Manage Chronic Disease Diabetes- Diabetes occurs when the body has too much sugar (glucose) in the blood Gestational diabetes is a type of diabetes that is only present during pregnancy. If diabetes goes untreated during pregnancy complications can occur such as premature birth and delivering a stillborn baby. High Blood Pressure- High blood pressure occurs when the force of blood in arteries becomes too high. Preeclampsia, a high blood pressure condition increases the risk of preterm birth during pregnancy. Limit Stress Stress is directly related to early birth. Black birthing people can experience physical “weathering,” meaning their bodies age faster than white counterparts due to experiences of long-term stress linked to disadvantages and discrimination over time. Stress can be limited with activities like meditation and yoga, and seeking help from a healthcare provider and mental health specialist if needed.
Early Prenatal Care: Receiving early and consistent prenatal care reduces the risk of preterm birth.
Interventions Healthcare providers may recommend the following intervention options for birthing people at risk of early birth.
Progesterone: Progesterone is a hormone made by the placenta during pregnancy. Studies have shown some decreased risk of preterm birth in women who have had a previous early birth when given 17P progesterone weekly injections starting at 16 weeks.
The Prematurity Prevention Initiative offers funding for birthing people in need of 17P and nurse assistance. To find out more visit: www.njpreterm.org/providers
Cerclage: A cervical cerclage is a stitch that is placed in the cervix to help keep it closed.
This has been shown to help birthing parents carry their baby to a later gestational age with healthier outcomes.
Low Dose Aspirin: For birthing people with high blood pressure or preeclampsia prior to preterm birth, healthcare providers may prescribe a low-dose aspirin. Low-dose aspirin (81 mg daily) can lower the risk of preeclampsia in birthing parents with risk factors.
Your Role in Preventing Preterm Birth Whether a parent, community member, birth worker, or healthcare provider, everyone has a role in preventing early birth.
Collaborate with organizations to address communities impacted by maternal and child health disparities
Advocate and evaluate policies involving maternal and child health (e.g: Doulas, Mental Health, Lactation Resources)
Educate parents, community members, and colleagues. Share prematurity and maternal child health messaging through social media, toolkits, podcasts, and related readings.
Know the resources in your community. Find resources for birthing people and families through New Jersey maternal health consortiums:
Northern – The Partnership for Maternal and Child Health of Northern NJ PMCH.org Central – Central Jersey Family Health Consortium CJFHC.org Southern – Southern New Jersey Perinatal Cooperative SNJPC.org For additional resources in your area call NJ 2-1-1 or visit nj211.org.
Share and/or complete the Maternal Experience Survey. The Maternal Experience Survey(MES) is New Jersey’s first community tool designed to improve care and reduce childbirth-related disparities for Black birthing people. With the support of the NAACP Atlantic City BIMM task force and the Prematurity Prevention Initiative, this tool allows birthing people to share their experience in a safe manner embedded with identity acceptance and respect.
The MES is available for all New Jersey parents in English and Spanish. The survey features 3 unique breakouts: 1. Currently Pregnant 2. Recently Delivered and 3. Full MES (where birthing people share their entire pregnancy journey. To prevent preterm birth and maternal health complications, it is essential for parents to share their experiences and perspectives. The Maternal Experience Survey magnifies the voices of birthing people and implements strategies to improve the crises around Black maternal and child health in the state. To access the Maternal Experience Survey visit https://www.njpreterm.org/mes. The Prematurity Prevention Initiative is a program of Family Health Initiatives (FHI) supported by funding from the NJ Department of Health. FHI is a subsidiary agency of the Southern New Jersey Perinatal Cooperative 2022.