Mrs. Randolph has had a long-standing relationship with CPQCC, providing her critical insight into a wide range of projects which focuses on advancing anti-racism in the NICU through teamwork and family-centeredness.
She began her two-year term as Chair of the “Within the NICU” Subcommittee of the Health Equity Taskforce in January 2022 as the first African-American as Chair.
Tell us about your pregnancy experience(s) from your first trimester through to when you gave birth to your preterm babies.
I am the mother of 3 children born premature. In my senior year of college in 2010 in New Orleans, Louisiana, I found myself pregnant, suffering from severe hyperemesis garvadarium, and at a far distance from any close relatives or friends. My sickness from hyperemises garvadium was so severe that I was told only 1% of pregnant women ever get that sick. I had to drop out of both prestigious colleges I was attending at the same time as they did not have family housing and I needed to support myself financially. I applied for food stamps and was told that I had to choose between being in school or feeding my baby. I chose to feed my growing baby. I was two semesters away from graduating with my bachelor’s in biology and public health with a minor in chemistry and the goals of becoming an OB/GYN and working for the World Health Organization (WHO).
At 5 months pregnant I started getting blood draws for my pregnancy. The doctor called and told me that my lab results showed that my child would be born with abnormalities, and I should have a late term abortion because I couldn’t go to school to be a doctor with a sick child. This took an emotional toll on my mental health. I was determined to have my child despite the consequences and a few weeks later I began having preterm contractions.
I moved back to California at 32 weeks gestation and had my son, Aiden, 2 weeks later. Due to his premature birth, he had to stay in the NICU for 2½ weeks with jaundice. Today we manage his mild ADHD and vision problems.
I had my second child 4 years later while living in Houston, Texas. Once again, I suffered from severe HG and was constantly hospitalized. I researched and advocated for the progesterone shot to help with preterm contractions at 4½ months. My doctor filled out the request and within two weeks I was denied the progesterone shot from Medicaid even though I checked every box on the questionnaire form. I again had to move back home to California and received the shot a week after my arrival. I had my daughter at 34 weeks gestation. London stayed in the NICU for 2 weeks for low birth weight and to monitor other potential premature birth effects .
One year later, after I had moved back to Houston, I became pregnant. I suffered the same severe HG and immediately left Texas at 6 weeks pregnant before the nausea became unbearable. I drove from Houston to Sacramento, CA, with my 2 small children and applied for medical care the next day of my arrival. I was let go from the doctor at 4 months in the receptionist area. Medi-Cal couldn’t find me a replacement doctor, so I was then seen by an ultrasound doctor weekly until delivery at 36 weeks.
Before I went into labor, I had a psychological meltdown in my grandmother’s backyard at 35 weeks because I had horrible thoughts that my baby had passed the week prior, and my body was just carrying a baby. It was not normal for me and I was not seeing a doctor. While I was shedding tears from depression and anxiety, my husband rubbed my back and reminded me that a normal pregnancy lasts 40 weeks and that he was happy I passed 34 weeks. She was born at 36 weeks, which is still considered a premature baby. She was my smallest baby and was in the hospital for 3 weeks for low birth weight until she reached 5 lbs.
I lost 30 pounds with each pregnancy. I lost my family support and they have never fully understood what I went through with severe morning sickness and the NICU stays. I was never educated on premature birth or the NICU experience. I was never given anything to take home from the NICU from all 3 experiences. I have been a victim of having CPS ask me questions about why my baby was born prematurely even though the doctor said I was healthy. It was a very dark time. Premature birth affects your mental health. Moms of premature babies experience significantly higher levels of stress and depression and not everyone understands that.
I know what it feels like to be Black, pregnant, and shamed. From those experiences I got a tubal ligation after my third child so that I would never feel helpless in the arms of the healthcare system. I created my non-profit, GLO Preemies, in 2014 so that no other Black families will feel alone with their premature babies from the time of pregnancy through to when the child is 18 years old.
What did your obstetrician tell you with each pregnancy challenge? Were you warned about the potential for preterm birth risk for your babies? Were you given resources or sent to a high-risk pregnancy doctor (Maternal Fetal Medicine doctor, also known as an MFM)?
For all pregnancies I was not offered to see a high-risk pregnancy doctor
- Premature Birth 1: I was told at 5½ months pregnant that my blood draw results showed that my son may have too many chromosomes, cleft lip, and more. I was not advised to see a specialist but instead given the option to have a late term abortion due to my career aspirations and the implications of having a child with special needs. I was given no education on premature birth or even told the definition. No one offered information on how to care for preterm babies even after I made my decision.
- Premature Birth 2: My doctor and I started talking about premature birth when I had to advocate for medicine to help with my preterm contractions that were just beginning. She told me I had a high chance of a second premature birth. I was not given any resources or education for premature birth. No one checked on my mental health.
- Premature Birth 3: As soon as I found out I was pregnant, my doctor and I discussed my third preemie child as it was almost certain that I would have another one. I received no education for premature birth. I was told that I was now an expert. At 5 months pregnant, my doctor considered my severe hyperemesis gravidarum a liability and I had to see an ultrasound tech weekly until I delivered at 36 weeks. I was given no information on new research for the disease.
What did you know about preterm birth and infant/family outcomes prior to your experience with it?
I was essentially a doula to all my friends in high school and during college. I would research pregnancy topics, the science of birth and relevant maternal questions for them to help them in their doctor appointments. I was a walking pregnancy book and decided to become an OB/GYN while in college. I was studying for the MCAT when I first got pregnant. I had tons of maternal health knowledge but had no knowledge of premature birth. Essentially, I understood what a healthy pregnancy looked like, not a pregnancy that ended too early.
Fast forward to today when Sera Prognostics has the PreTRM® Test that can determine a woman’s risk for spontaneous preterm birth. Having had that tool, how do you feel that you could have changed how your pregnancy played out in an unexpected early delivery, even if medically indicated?
I would have loved to have the test to prepare myself mentally for a premature birth as well as prepare my babies’ rooms for their arrival. Even if you have a healthy pregnancy, you are still getting ready for the moment your bundle of joy arrives either early, on time, or late. It would have eased my mental state, especially in my third pregnancy when I had a breakdown because I didn’t know if I was going to deliver early or not. This test can help a family prepare for their babies’ birth and get information on topics that may be relevant to them.
How do you look back on your pregnancy and preterm birth experience? What would you want to tell expectant mothers?
During my second pregnancy, I had to research everything on my own. I found medicine that could help with contractions, and I advocated for that treatment to try to save my baby before a problem could get worse. I want other mothers to know that getting a test for preterm birth can be scary, but not knowing that there is even a possibility is scarier. Educating yourself on your pregnancy, the effects of premature birth, and NICU rights is always a good idea. Use the education to empower yourself, and if you don’t have a preemie, you may be able to support others with premature babies in your community.
FAQs about the psychological effects of premature birth
Research suggests2 that gestational age, or the stage of pregnancy, may be associated with an increased risk of certain psychiatric disorders. However, it’s important to note that individual experiences and risk factors can vary.
Preterm Birth: Preterm birth refers to giving birth before the 37th week of pregnancy. Several studies have indicated that preterm births are associated with an increased risk of psychiatric disorders or mental health problems in both the mother and the child. Women who give birth prematurely may have an elevated risk of experiencing postpartum depression, anxiety disorders, and post-traumatic stress disorder (PTSD). In children, preterm birth has been associated with a greater risk of developing mental health and social problems that can persist well into adulthood, such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders.
Late-Term Pregnancy: Late-term pregnancy refers to pregnancies that go beyond the 41st week of gestation. While research in this specific area is more limited, some studies suggest that prolonged gestational age may be associated with an increased risk of certain psychiatric disorders or mental health difficulties in the child. For example, a study published in 20203 found that late-term birth was associated with a slightly higher risk of ADHD in children.
It’s important to note that these associations are based on observational studies, and other factors such as genetic predisposition, environmental influences, and individual circumstances can also contribute to the development of psychiatric disorders. Additionally, the relationship between gestational age and mental disorders is complex, and further research is needed to fully understand the mechanisms involved and prevalence of this association.
During pregnancy, women may experience various psychiatric disorders. The most common mental health problems observed in pregnancy include:
Depression: Depression is a common mental health condition characterized by persistent feelings of sadness, hopelessness, and a loss of interest in activities. Hormonal changes during pregnancy can contribute to the development or exacerbation of depression.1
Anxiety disorders: Anxiety disorders, such as generalized anxiety disorder (GAD), panic disorder, and obsessive-compulsive disorder (OCD), can occur or worsen during pregnancy. Anxiety disorders are characterized by excessive worry, fear, and a range of physical and psychological symptoms.
Bipolar disorder: Bipolar disorder involves extreme mood swings, ranging from depressive episodes to manic or hypomanic episodes. Pregnancy can be a challenging time for women with bipolar disorder, as hormonal changes, sleep disturbances, and stress can trigger mood episodes.
Postpartum depression: Postpartum depression is a type of depression that occurs after childbirth. While it is distinct from depression during pregnancy, it is worth mentioning as it is a prevalent psychiatric disorder associated with the perinatal period.
Perinatal anxiety: Perinatal anxiety refers to anxiety disorders that occur during pregnancy or in the postpartum period. It includes generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias.
Post-traumatic stress disorder (PTSD): Some pregnant women may have a history of trauma or may develop PTSD during pregnancy. Traumatic events such as accidents, abuse, or previous birth experiences can contribute to the development of symptoms of post-traumatic stress.
Eating disorders: Women with a history of eating disorders, such as anorexia nervosa or bulimia nervosa, may experience challenges during pregnancy. Hormonal changes and body image concerns can exacerbate these disorders or trigger a relapse.
It’s important to note that each individual’s experience with mental disorders during pregnancy can vary. Pregnancy can be a time of heightened vulnerability for women, and the support and care of healthcare professionals are crucial in managing these conditions. If you or someone you know is experiencing mental health concerns during pregnancy, it is advisable to seek professional help for appropriate diagnosis and treatment.
Premature birth, which refers to the birth of a baby before 37 weeks of gestation, can have various psychological effects on both the child and the parents. Here are some common psychological effects associated with premature birth:
Parental stress and anxiety: Parents of premature babies often experience high levels of stress, anxiety, and emotional distress. The unexpected nature of a premature birth, the challenges of the neonatal intensive care unit (NICU) environment, and concerns about the baby’s health and development can contribute to parental psychological distress.
Postpartum depression and anxiety: Mothers of premature babies may be at an increased risk of developing postpartum depression and anxiety. The emotional and physical stress of having a preterm baby, coupled with hormonal changes and the disruption of typical postpartum experiences, can contribute to these mood disorders.
Trauma and post-traumatic stress disorder (PTSD): Parents may experience symptoms of trauma and develop post-traumatic stress disorder due to the traumatic nature of the premature birth experience. The fear for the baby’s health, witnessing medical interventions, and the emotional rollercoaster of the NICU can contribute to these psychological effects.
Bonding difficulties: Premature birth can sometimes disrupt the natural process of bonding between parents and their baby. Separation due to hospitalization, medical procedures, and the NICU environment can make it challenging for parents to establish a close and immediate emotional connection with their baby.
Developmental concerns: Premature birth can lead to developmental challenges in children. Parents may experience stress and anxiety related to their child’s developmental progress, milestones, and potential long-term effects on cognitive, motor, or social-emotional development.
Psychological effects on the child: Preterm infants may also be at an increased risk of certain psychological and developmental issues. These can include neurodevelopmental disorders, such as attention-deficit/hyperactivity disorder (ADHD), learning difficulties, behavioral problems, and social-emotional challenges.3
Premature babies, also known as preterm babies, can face a range of challenges and health issues due to their early birth. The most common problem among premature babies is respiratory distress syndrome (RDS). RDS occurs when a baby’s lungs are not fully developed, resulting in difficulties with breathing. This condition is more common in babies born before 34 weeks of gestation.
Besides RDS (Respiratory Distress Syndrome) other common health problems among premature babies include:
Apnea of prematurity: Preterm infants may experience pauses in breathing, known as apnea. This occurs due to an immature respiratory system and can lead to bradycardia (slowed heart rate) and cyanosis (bluish discoloration of the skin).
Intraventricular hemorrhage (IVH): IVH is bleeding that occurs in the brain’s ventricles, or fluid-filled spaces. The blood vessels in the premature baby’s brain are fragile and can rupture, leading to this condition. IVH can range from mild to severe and may have long-term neurological effects.
Necrotizing enterocolitis (NEC): NEC is a condition in which the tissues of the intestine become inflamed and may start to die. Premature babies are at a higher risk of developing NEC due to their immature digestive systems and limited blood flow to the intestines.
Retinopathy of prematurity (ROP): ROP is an eye disorder that affects the blood vessels in the retina. It primarily affects premature babies born before 31 weeks of gestation or with a birth weight of less than 1500 grams. Severe cases of ROP can lead to vision impairment or blindness if not properly managed.
Jaundice: Jaundice is a common condition characterized by yellowing of the skin and eyes due to elevated levels of bilirubin. Premature babies are more prone to developing jaundice, and they may require phototherapy or other treatments to manage it.
Low birth weight: Premature babies often have low birth weights due to their early birth. Low birth weight can contribute to various health issues and may require special care, monitoring, and support for growth and development.
- Mitchell, A. R., Gordon, H., Lindquist, A., Walker, S. P., Homer, C. S. E., Middleton, A., Cluver, C. A., Tong, S., & Hastie, R. (2023). Prevalence of perinatal depression in Low- and Middle-Income countries. JAMA Psychiatry, 80(5), 425. https://doi.org/10.1001/jamapsychiatry.2023.0069
- Grigoriadis, S., VonderPorten, E. H., Mamisashvili, L., Tomlinson, G., Dennis, C.-L., Koren, G., … & Steiner, M. (2013). The impact of maternal depression during pregnancy on perinatal outcomes: A systematic review and meta-analysis. Journal of Clinical Psychiatry, 74(4), e321-e341. doi: 10.4088/JCP.12r07968
- Marroun, H. E., Zeegers, M., Steegers, E. A., Van Der Ende, J., Schenk, J. J., Hofman, A., Jaddoe, V. W. V., Verhulst, F. C., & Tiemeier, H. (2012). Post-term birth and the risk of behavioural and emotional problems in early childhood. International Journal of Epidemiology, 41(3), 773–781. https://doi.org/10.1093/ije/dys043
Talk to your doctor today about the PreTRM Test for your individual risk assessment.