Ashley’s Preterm Birth Story: The Psychological Effects of Premature Birth

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

References

1. 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
2. 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
3. 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