A Tale of Two Births: Differences in Prenatal Care

...Picking up where I left off...

Doulas are already seeing a self-selected group who can afford good care. So the preterm births they encounter don't tend to come as a result of a societally wrought malaise. We think.

But here's a clincher I did not anticipate. University of Washington Social Welfare Professor Amelia Gavin, among whose "professional interests" lie "racial disparaties in birth outcomes," explained many academics now maintain that women who grew up with significant stresses face a higher risk of frought pregnancy and premature birth.

That is, those growing up poor are more likely to go into labor early. The only thing that may really be surpising about this, though, is that the studies Gavin alluded to showed that even those who were no longer poor, who kept a healthy diet, who received thorough prenatal care, still sustained a higher risk for premature births.

What we know: African American women are more likely to give birth prematurely.

So Gavin discussed the many theories she and her colleagues held about that grouping. She said she wished to debunk what she felt was a myth that African American give birth earlier because they are genetically predisposed to do so. Calling such an explanation an excuse for apathy or lack of policy change, she pointed to studies (of which I have yet to comb through) conducted by a Chicago-based scholar (more tk) concerning analogous birth rates among Africans and Caucasians and how those rates began to differ after Black women had lived in the States for a couple of generations.

She cited what she felt was the likelihood that the stresses of racial discrimination lay a groundwork for future corporeal weakness. I.e. difficult [rife with hunger or malnutrition as well as racial discrimination] childhood/formative years-->possibility of pregnancy with "adverse" outcome.

But would not that response also generate an unwillingness to examine the differences in prenatal care among the Los Angeles Haves and Have Nots? If you can pin future pregnancy problems on childhood, why bother with attending to the pregnancy itself, as it would be, "too late" to do any good?

Common sense would likely suggest that stress of any kind is bad for pregnancy (and health in general), but wouldn't concentrating on past stress alleviate care-givers or even those expecting of accepting the responsibility that dealing with present stress would require?

Moreover, how does this theory speak to studies Gavin mentioned, ones that show Hispanic women do not tend to suffer the same level of preterm births African American women do?

South L.A. houses majority Black and Hispanic populations. But both often face racial discrimination as well as poverty--in childhood and into adulthood. So that study would support either the "it's a genetic thing" theory (and I have to say, getting into racial genetics/tendencies is almost always a very slippery slope) or, more likely, one that would show there are other factors at play here.

(So perhaps it would be interesting to speak to those doulas who donate their services to those who would otherwise be unable to afford them. I had been in contact with Doula Nora Oppenheimer, Doula trainer/Doula Association rep Ana Paula Markel and Doula/Volunteer/Birth Educator/Midwife Cordelia Hanna-Cheruiyot.)

Would this care lead to a greater number of healthy births among even the poor and those living freeway-and-pollution-adjacent?

But how do such doulas choose their clients? Who, among the underserved, gets the benefit of a doula, and who simply tries her hand at care [with or without insurance?] the old-fashioned way?

[See next post as the reporting process continues to unfold]