The cramping came on quickly. Then the bleeding.
Samantha Bradley was only six months pregnant. She had already miscarried once. She knew she needed to get to an emergency room.
"I was in tears," she said. "The only thing I could think was 'Get me to a hospital.'"
On vacation in Palm Springs, Bradley and her sister rushed to a nearby hospital. About 30 minutes later, Bradley gave birth to her son.
The baby weighed just 1 pound, 8 ounces — a little more than a bag of coffee.
She got only a quick glance before doctors whisked him away. She saw his rib cage protruding from his tiny frame. He didn't make a sound.
Black women like Bradley are 11/2 times as likely as white women to give birth prematurely, and their babies are more than twice as likely to die before their first birthday.
Researchers once blamed a lack of prenatal care for the disparity. Now, research shows that the explanation is much more complex, rooted in the years before the women even get pregnant. Black women are more likely to be poor, have less education, lack health insurance and have chronic conditions such as diabetes and obesity.
"They are coming into the pregnancy at higher risk," said Kay Johnson, who chairs the advisory committee on infant mortality for the U.S. Health and Human Services Department. "By the time they see a doctor, seven months is too short to repair long-term adverse health."
The leading causes of infant mortality are preterm birth and low birth weight. Even if premature children survive, they can face lifelong health or developmental problems.
The nation's healthcare overhaul is expected to help close the racial gaps by increasing access to preventive care, health insurance and family planning, Johnson said. The government is also investing in projects to reduce preterm birth and infant mortality.
Programs in Los Angeles County, including L.A. Best Babies Network and Great Beginnings for Black Babies, take steps such as screening women for depression and substance abuse and helping get them into stable housing and out of abusive relationships, often before they get pregnant.
"While there are all these medical risk factors, there are a whole bunch of other social risks," said Erin Saleeby, director of women's health programs for the county Department of Health Services. "The medical side of it will never be enough."
Samantha and Antoine Bradley met during a summer program for college-bound high school students. She went on to graduate from Cal State Dominguez Hills and started working with homeless people on skid row. He got a job cleaning up hazardous materials. They married in 2010.
Both had a rough start in life. Antoine had been born prematurely. Samantha Bradley's biological mother used drugs, so Bradley had been placed in foster care and later adopted. Both want a big family.
Three months into her first pregnancy, Bradley, who is now 27, miscarried. The loss was overwhelming. Getting pregnant again less than a year later made her excited but nervous. She attended her prenatal appointments diligently, and doctors assured her the pregnancy was going well. They decided to name the baby Adris.
Every time she heard the heartbeat in her belly, Bradley felt relieved. But on the day her son was born, she just felt scared.
He lay in an incubator, seemingly tangled in a web of tubes and cords. To lessen the environmental stimulation, his eyes and ears were covered. Machines helped him breathe. His skin was translucent, clearly showing his miniature veins.