By Jennifer Porter Gore

(WIB) – The state of South Carolina ranks among the highest in the nation for maternal mortality. And just like nationwide, the burden falls most heavily on Black women. 

But a recent gathering of healthcare leaders, birth workers, and families in the state vowed not to take the situation lying down. 

The group convened to honor Dr. Janell Green Smith, an esteemed nurse-midwife and doctor of nursing practice who died on New Year’s Day, not long after her daughter was born prematurely. The gathering also included a panel discussion on community-based care, mental health support, and policy changes to improve maternal health.

“We also had a mental health therapist there who could talk about how we process when things like this happen,” says Simone Lee, co-founder and reproductive justice director of the Charleston-based BEE Collective. “But he was also a dad, so he could speak about how partners can show up for moms during labor.” 

Losing One of Their Own

The death of a physician can have aftershocks far beyond hospital walls. For many local birth workers, Green Smith’s loss has been deeply personal, affecting hundreds of patients and scores of colleagues. 

Lee, a veteran doula who had worked with Green Smith, says everyone at the event felt the weight of her absence.

“We had a community conversation, both honoring Janelle’s legacy, but also talking about ways as a community that we can pitch in to make sure that these types of tragedies don’t happen to any other moms,” she says.

The event also focused on healing.

“It has been a grief process for a lot of us,” Lee says. In January, “my organization actually hosted a grief circle in Janelle’s honor for birth workers, and we had over 60 people piled into our space wanting to process and grieve together.”

The event took place last month at The EpiCenter, a woman-owned and operated practice that offers a wide range of medical services including obstetrics and gynecological care. It’s one of a handful of Black-owned and operated practices in the state.

Efforts to improve maternal health in South Carolina have increasingly focused on expanding Medicaid support services for pregnant and postpartum patients. Dr. Annie Andrews, a board-certified pediatrician who was one of the panelists, said Medicaid currently funds half of all births and six out of 10 nursing home beds in South Carolina. 

In 2022, the state extended Medicaid coverage for new mothers from just 60 days after birth to a full 12 months. State health officials said the change would help reduce pregnancy-related deaths while improving care for mothers with conditions like hypertension, diabetes, and depression. 

Since then, health advocates and others have sought to add reforms, such as reimbursing community doulas and more support for Medicaid patients, particularly those in rural communities, where many low-income Black residents have seen maternity services decline. 

Andrews says that in South Carolina, “there’s a huge and, most concerningly, to me, widening racial health disparity when it comes to maternal mortality.”

Recent data shows that Black women in the state “are four times more likely to die as a result of complications related to childbirth,” she says. “And that is maddening in and of itself, because there’s no biological reason for that.” 

Even more frustrating, Andrews says, is the “failure to address this issue by our state lawmakers, and now, of course, by lawmakers in Washington DC, who really just couldn’t care less about addressing this problem.”

Andrews is running in the state’s Democratic Senate primary to determine who will take on  Sen. Lindsay Graham, a Republican who has represented the state on Capitol Hill since 2002. If elected, Andrews says she will immediately call for the impeachment of Health and Human Services Secretary Robert F. Kennedy, Jr. 

A Doula’s Journey

Lee’s path into birth work began with her own experiences. A mother of three, she says two of her children’s births were difficult — and one was traumatic. 

“The third time around, I said, ‘There must be something that I’m missing,’” she says. During her research, Lee kept encountering a word — doula — she did not yet understand. Not long afterward, she began training to become one. 

After realizing that many of the families she wanted to help could not afford her services, Lee co-founded the BEE Collective in 2018 with three other Black women. The acronym stands for the Beloved Early Education, and features a network of community-based doulas in South Carolina’s Lowcountry.

The group also operates what Lee describes as South Carolina’s first grassroots perinatal “safe spot,” offering services including childbirth education classes and a breastfeeding support group. 

A major part of their service area is Berkeley County, Lee says, which is the state’s largest county by area but has just one hospital.

“For a lot of families, that means they have to drive 45 minutes or more to get there,” Lee says. “And it’s hard to get OB-GYNs to work in rural populations that are predominantly Medicaid patients because there’s not a lot of money there.” 

Andrews agrees.

 “It’s really easy for lawmakers to be very deeply disconnected from their communities, but as a physician in a children’s hospital, it’s really hard to look away,” she says. While women are advised to get physical and mental health checkups after delivery, Andrews says, the recommendations “often do not take into account the socioeconomic barriers and challenges these parents face if you just delivered your third or fourth child and you’re struggling to make ends meet, and you don’t have reliable transportation.”

Janell Green Smith’s Legacy

When she thinks about Green Smith, her late colleague, “the first word that comes to mind is ‘intentional,” Lee says.

Green Smith “was very intentional about the way she cared for people, the way she spoke to people, and the way she conducted business,” Lee says. “She could command every room she walked into with an assertiveness that let you know she was an expert in her field.”

Lee said Green Smith also encouraged others to join her in the health care field.

“One of the last things she told me was, ‘Simone, you’re needed in these spaces,’ Lee says. “I had been talking to her about going back to nursing school and worrying about the cost and time away from my children. She told me, ‘Do whatever you have to do. Take loans out. You’re needed.’”

Although Lee says Green Smith’s influence lives on.

“I think she’s impacting more people than she probably even realized,” Lee says.