Reproductive Justice
The Season of NICU

The Season of NICU

Megan Spencer

We spent all of winter in the NICU. When I was 25 weeks pregnant, I went into preterm labor and gave birth to my daughter. She weighed just one pound 13 ounces and was barely one foot long. Having a micropreemie in the NICU feels like an alternate reality. Time stops working the way one is accustomed. There is a near-constant cacophony of alarms and beeping. A new vocabulary and calculus emerge: types of respiratory support, umbilical lines and PICC lines, blood gas readings, chest x-rays, oxygen pressure requirements, and the ranges and measurements for so many things happening in my daughter’s small body. There was a long list of things to be afraid of: brain bleeds, an often-fatal intestinal infection, sepsis, heart defects, and respiratory distress. I was thrown into a version of new motherhood I did not anticipate.

I had heard stories about Black women’s experiences during pregnancy and birth–stories of not being believed or listened to, of racist aggression from medical staff, of dying from largely preventable complications at much higher rates than other women. Somehow I thought my knowledge of these issues would protect me from experiencing them. I wanted a Black healthcare provider, but there were no Black midwives or obstetricians in Santa Barbara, California. While I met with an OB early on in my pregnancy, I ultimately sought care with a local midwifery practice. Although all of the midwives in the practice were white women, I thought this option would give me the best chance at having the home birth I wanted and avoiding an environment I knew could be deadly for Black women and babies. My own mother birthed me at home, and I always imagined myself doing the same. I envisioned my daughter’s birth as a ceremony to celebrate and welcome her. While I did not think that it would be easy or blissful, I was not prepared for the precarity of giving birth at 25 weeks.

Before my daughter was born, I felt like something was wrong. I explained my symptoms to my midwives and tried to advocate for myself, but I was told over and over again that everything was fine. One morning I woke up with dull back pain and cramping that came in waves. It quickly intensified, so my partner drove me to the hospital. The nurse who cared for me was an older white woman. She seemed irritated by my presence, and I knew that she didn’t believe my pain was as severe as I described. My partner, tracking the contractions with an app, showed the nurse that they were increasing in frequency and intensity. She examined me and insisted things were fine, that this was normal second-trimester pain and that the contractions would be more intense if I was actually in labor. My doctor came in briefly to talk to me but did not examine me. She did not treat me with antibiotics, despite my lab work from that morning indicating infection, a common cause of preterm birth. Instead, she sent me home and instructed me to take ibuprofen.

The medication gave me relief for several hours, but I woke up in the middle of the night in agony, with almost constant contractions. We rushed back to the hospital, where I waited in the lobby for nearly 20 minutes, bending over in the worst pain I have ever felt, before an impatient labor and delivery nurse finally came down to get me. Although I could barely walk to the elevator, I was not offered a wheelchair or assistance. Aside from my partner, I don’t think anyone believed I was actually in labor. When I was finally examined in the labor and delivery unit, my daughter’s foot was coming out of my vagina. Suddenly the room was full of people crowding around my exposed body, reaching inside me to confirm my baby’s position. The pain became too intense to speak or to even know who was speaking to me. I was rushed to the operating room for an emergency C-section and given a spinal block that sent a sharp jolt down my legs. Then the pain was gone. I felt pressure and stretching. My rounding body was suddenly empty, and then she was here. Her heart rate was very low, and she wasn’t breathing, but thankfully she was resuscitated quickly. I saw her for several seconds before they took her to the NICU.

In the NICU, the days of the week lost their significance. Leaving the hospital for the first time without my baby was devastating. I spent as much time as possible at the hospital, taking turns with my partner. We were not allowed to visit our child at the same time or visit more than once a day due to COVID-19 restrictions. I was enraged that there were rules dictating when I could see my own baby. I worried that something would happen to her when I was away, and I wouldn’t be able to get to the hospital fast enough. I worried that I would be exposed to COVID and unable to visit her for weeks. I worried that she missed me and wondered where I was. I worried that we would be less bonded because of the time I had to spend away from her.

My daughter’s doctors and nurses worked hard to keep her stable. She could not breathe or eat or maintain her temperature on her own. She received parenteral nutrition through a PICC line until her digestive system could handle small amounts of breast milk through a feeding tube. The list of medications keeping her alive felt endless: pulmonary surfactant to keep her lungs open, dopamine to maintain her blood pressure, phenobarbital to stop seizures, morphine and ativan to make her more comfortable and less agitated while she was intubated, caffeine to remind her to breathe, antibiotics to fight infection. I watched her through the thick plastic of the isolette, wishing desperately that she was still in my belly. Her eyes were still fused shut, and she had a perfect swirl of dark hair on her fragile head. I spoke to her quietly, read her my favorite Black feminist poems, and told her about all the people who loved her. I asked her to stay, if she could.

When she was eight days old, I held her for the first time. Her nurses and respiratory therapists carefully transferred her tiny body and the tangle of tubes, lines, and wires attached to her, to my chest. She felt impossibly small in my arms. During the almost four months that she was hospitalized, holding her was a brief reprieve from the chaos around us. I watched as other families took their babies home from the NICU – and then one day there was a mother who didn’t get to. I still think of her very often. Almost every day my daughter had episodes where she would abruptly stop breathing, resulting in her heart rate and oxygen levels dropping dangerously low. This was expected because of her prematurity. We were told she would grow out of the episodes, and she eventually did, but nothing can prepare you to watch your child stop breathing. There were constant reminders of how far we were from an ordinary newborn baby phase.

The doctor and the midwives who failed to take my concerns and symptoms seriously are revered in the community where I live. They are widely celebrated by other white women as the most progressive, feminist options for prenatal care. It has been dizzying to reflect on the medical neglect I experienced and the precarity of my daughter’s life alongside such admiration. This was supposed to be the best care I could get, and still my child almost died because my pain was dismissed. In the time since my daughter’s birth I have turned to Black and women of color feminist scholarship and writing to make sense of my experience, to find other stories of Black queer motherhood that would help me feel less alone. In the NICU I read Cherríe Moraga’s Waiting in the Wings, an account of queer, Chicana motherhood and the terrifying start to a premature baby’s life. I read Dána-Ain Davis’s research on preterm birth among Black women, from which I gained the language of obstetric racism to think about the circumstances of my daughter’s birth.[1] I read Tressie McMillan Cottom’s and Congresswoman Cori Bush’s accounts of going into preterm labor and being violently dismissed by medical staff. Though these stories horrified me, they affirmed that I was not imagining what happened to me.

Lately, I am trying to feel okay with the way my belly spills over the waist of my pants and how my stretch marks have grown around my hips, toward my belly button. I have lost sensation there, a common result of c-sections. For some people, feeling does not return. Reckoning with my postpartum body, a source of joy and a site of trauma, has been challenging. It is hard to think that if I were someone else, someone in a different body, my words may have been heard by nurses and doctors, and my daughter’s entrance into the world might have been different. It is hard to carry the intimate knowledge that I could not protect my child from having to fight so hard just to live. Underneath my folded belly the scar is barely visible: a thin brown line just a few inches long. I look at it sideways in the mirror and think of my daughter’s chubby legs and head full of dark curls. I am amazed that she grew in my body. She came into the world through this small line that was once an opening. I remind myself that my belly was a portal.

  1. Davis, Dána-Ain. Reproductive Injustice: Racism, Pregnancy, and Premature Birth. New York, USA: New York University Press, 2019.

Featured image caption: NICU. (Courtesy Flickr)

Megan Spencer is a black feminist artist, scholar, and mother. She is a PhD candidate living on Chumash land at the University of California, Santa Barbara, where she studies black feminist ecology, specifically how black women’s visual art and literature demonstrate connections between ecological crises and various forms of racial, sexual, and state violence. Her work can be found in The Feminist Wire, The New Inquiry, and Sexual and Reproductive Health Matters (SRHM).

2 thoughts on “The Season of NICU

    • Author gravatar

      Thank you, and I wish I could send a long in-person hug. It is horribly true that people with power often dismiss the words, beliefs, and needs of those with less power—and racism surely belongs in this truth. I’m hugely grateful that your daughter survived, and that you had the courage to write this for All of Us. Treasure that portal, for sure. And, Nursing Clio editors, you know I value your hard questions and insight, so I hope you don’t mind my asking in return … how about a Black woman in that NICU image??

    • Author gravatar

      Beautiful,scary, with joy and pride in you for all you endured to birth the most adored little girl.

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