The premature birth rate in the United States has been persistently high among Black women for many decades. While most research on the topic of premature birth involves poor and low-income women, this book focuses on the experiences of more affluent women to show that race is as much a common denominator as class in adverse birth outcomes. Using the afterlife of slavery framework, the book argues that racism shapes professional and college-educated Black women’s prenatal and birthing medical encounters, which have precedents that emanate from slavery. The book weaves in historic examples of medical racism, offering analytical context for understanding contemporary Black women’s interpretations of medical encounters of prenatal care, labor, birthing, and the admission of their premature child to the neonatal intensive care unit. Based on ethnographic observations, archival research, and nearly fifty interviews with parents, medical professionals, public health administrators, and birth workers, including midwives, doulas and reproductive justice advocates, the book is divided into two parts. Part I offers definitions of prematurity, outlines some of its causes, and describes what it is like to have a premature child. This part also explores the everyday forms of racism, such as diagnostic lapses or being dismissed by medical personnel, and links those experiences to past ideologies and practices of medical racism. Part II uses a critical racial lens to explore three strategies to address prematurity: technological intervention, public health intervention, and the preventionist approach taken up by birth workers. The conclusion gestures toward ideas to address medical racism.