Black, Hispanic And Asian Babies Born Very Early Are Less Likely To Receive Lifesaving Measures
Mya Morenzoni is a nurse, and she knew the odds. Because of structural racism, Black pregnant people in the United States are three times as likely as non-Hispanic white pregnant people to die in childbirth, and the neonatal mortality rate for Black babies is more than twice as high as it is for non-Hispanic white babies. Black babies are four times as likely as white babies to die from complications related to low birthweight.
Preeclampsia, a life-threatening condition characterized by high blood pressure in pregnancy, takes the lives of Black pregnant people at five times the rate of their white counterparts.
So Morenzoni did everything in her power to stack the odds in favor of her life and her baby’s. She found a Black female obstetrician to care for her during her pregnancy, and a Black doula to support her throughout the process.
“I did a lot of working out and clean eating and all,” Morenzoni told HuffPost.
Then, at 27 weeks, and without any warning, her blood pressure spiked dramatically. With her medical training, Morenzoni understood the danger that she and her baby were in.
“You can’t have the blood pressure going up and down like that,” Morenzoni said. She remembers thinking, “I want to be here for my daughter to support her, raise her, to help my husband.”
Pivoting from the birth plan she was writing with her doula, Morenzoni says she went into “clinical mindset.”
“I was like, whatever we got to do, just do it. And they went into action.”
One solace in the midst of this frightening experience was that the Black woman neonatologist who came into Morenzoni’s room to speak with her before baby Aria was delivered via emergency C-section had been a NICU baby herself.
“Her example and her encouragement, that just really resonated,” Morenzoni remembered.
After 110 days in the NICU, with Morenzoni by her side, diligently pumping breast milk every couple of hours, baby Aria finally went home to her parents. Today, she is a joyful, babbling 14-month-old toddler who meets all of the developmental milestones for her age.
While Morenzoni and her daughter survived the threats of preeclampsia and preterm birth, not all families’ stories end happily. To add to the litany of threats that Black pregnant people and their babies face in the U.S., we now have another heartbreaking data point.
Very early-born white babies are significantly more likely to receive potentially lifesaving interventions than very early-born Black, Hispanic and Asian babies, according to researchers at Ohio State University who examined the birth records of 61,908 early pre-term births between 2014 and 2020.
Babies born in what is known as this “periviable” period, which is between 22 weeks and 25 weeks 6 days, comprised only 0.4% of births in 2015, but accounted for 40% of neonatal deaths.
Viability, or a baby’s ability to survive outside of the womb, is not guaranteed at a specific date in pregnancy. A baby’s odds of survival depend upon multiple factors, plus a sizable quantity of unknowns. When a baby arrives this early, doctors and families must make life-altering choices under intense pressure and tight time constraints, based on clinical information as well as the families’ beliefs and preferences. The earlier an infant is born, the less likely they are to survive, and, when they do, the more likely they are to face complications.
A 22-week preemie, for example, runs a 70-80% risk of physical, neurological or neurodevelopmental disability, according to Dr. Kartik K. Venkatesh, a high-risk obstetrician, perinatal epidemiologist and lead researcher on the study.
“It’s a gray zone,” Venkatesh told HuffPost. It’s also a moving target. Just five years ago, said Venkatesh, he and his colleagues would not offer life-saving interventions to babies born before 23 weeks, as it wasn’t considered possible that they would survive. But with advances in care, some of these babies are now able to live.
“When viewed alongside the existing data about Black infant mortality and Black maternal mortality, the inescapable conclusion is that some of these babies were killed by racism.”
The question is, which ones? Who decides which early preterm infants receive interventions that make survival a possibility?
Ideally, the decision-making is individualized for each baby’s prognosis, and is a shared process between doctors and the family.
But when Venkatesh and his colleagues examined the rates at which periviable infants were given assisted ventilation, antibiotics and surfactants to mature the lungs and other organs — the most common efforts doctors deploy to sustain and potentially save these babies’ lives — the data revealed a cruel trend.
“Overall,” said Venkatesh, “Black, Hispanic and Asian infants were about 20% less likely to receive intervention.”
Many factors are at play in these fraught situations, from a family’s religious beliefs to the technology available at a given hospital. But when viewed alongside the existing data about Black infant mortality and Black maternal mortality, the inescapable conclusion is that some of these babies were killed by racism.
“We adjusted for the kind of traditional kind of epidemiologic factors you’d think about, like education and insurance status and age, and we still saw these disparities,” said Venkatesh.
“‘Oh, they’ll just have another one.’ I work in health care. I’ve heard statements like that before.”
– Mya Morenzoni
Birth records show which interventions doctors used, but don’t explain why certain treatments were pursued or not. Venkatesh hopes that the study points the way forward for more research that will illuminate how this is happening.
“Is it implicit bias? Is it patient preferences? Is it because minority women are receiving care at hospitals where maybe clinical services aren’t the best?” said Venkatesh. “We need to understand all that.”
Dr. Melinda Elliot, a neonatologist and chief medical officer of Prolacta Bioscience, which produces a human milk-based fortifier for premature infants, believes some of the discrepancy is related to cost. “Many premature infants of color are born at inner-city or safety net hospitals,” she said. “There are exceptions, but these hospitals are often less well funded than those in suburban areas.”
“There is a lot of work that needs to be done to reduce bias and improve the standard of care for infants and women of color, and this starts with accepting that bias exists,” said Elliot.
“Individual health care providers need to continually look for both internal and external bias, recognize it for what it is, and work to reduce it,” she added.
Another critical component of rectifying this disparity is “shared decision-making in an environment where patients are given respect and autonomy,” said Venkatesh.
Morenzoni feels that she and her daughter received excellent care from a diverse team of doctors and nurses, but after spending all those days in the NICU observing other families’ stories play out, she says that the findings of this study don’t surprise her.
“I advocated for myself,” she explained. “Other mothers that were younger than me, that were not as knowledgeable or just completely fear-stricken,” she said, got “ran over, in a way, with the decision-making.”
Instead of being asked what they wanted, she said, she saw parents being told by doctors what would be done for their babies.
“And sometimes, [people don’t receive the same care] just by the issue of our lives not being important enough,” Morenzoni continued. “There’s this stigma, especially for Black people, if they feel that we live in poverty, or we have other children. ‘Oh, they’ll just have another one.’ I work in health care. I’ve heard statements like that before.”
Morenzoni is positioning herself to support and advocate for other new parents. Empowered by her ability to provide Aria with breastmilk during her NICU stay, she has become a certified breastfeeding peer counselor and is in the process of becoming a certified lactation specialist.
“This whole experience really opened my eyes,” she said.
“What I can personally do, as one woman, is to help strengthen and encourage other moms to know that they do not have to feel like they are just another number.”
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