The tragic death of midwife and maternal health advocate Janell Green Smith has raised urgent concerns regarding Black maternal health in the United States. Green Smith, 31, who had dedicated her career to improving birth outcomes for Black women, died on January 1, 2024, shortly after giving birth to her daughter, Eden. Her passing highlights the ongoing crisis in maternal health, particularly for Black mothers facing disproportionately high mortality rates.
Green Smith, a certified nurse-midwife and doctor of nursing practice in South Carolina, was thrilled to announce her pregnancy in the summer of 2023. Her family celebrated the impending arrival of their newest member, with her due date on February 25, coinciding with the birthday of her husband’s late great-grandmother. However, complications arose on Christmas Eve when Green Smith was admitted to the hospital due to severe preeclampsia, a potentially fatal condition. Although baby Eden was delivered safely two days later, Green Smith’s health deteriorated, leading to emergency surgery. Tragically, she succumbed to complications less than a week after giving birth.
Black women face a staggering maternal mortality rate of 47.4 deaths per 100,000 live births, compared to the national average of 18.3. This disparity has been attributed to systemic racism, implicit biases, and disparities in healthcare access. In contrast, countries like Norway, with comparable income levels, report a maternal mortality rate of just 1 death per 100,000 live births. Green Smith was acutely aware of these alarming statistics, as her home state ranked among the highest for maternal mortality in the country.
Green Smith’s death has reverberated throughout the healthcare community and beyond, igniting renewed calls for action. “Janell was fighting with all of the rest of us who are tired of, day in and day out, looking at these numbers,” said her husband’s aunt, Nichole Wardlaw, a fellow nurse-midwife. “She was my comrade in this fight. And now she is gone.”
A Commitment to Change
Green Smith entered the field of midwifery motivated by the urgent need for change in Black maternal health. In an Instagram video posted in April 2024, she expressed her desire to be part of the solution, stating, “I wanted to do something about it. I wanted to be a part of the solution and step into a role as the provider that would listen to my patients when they said they were in pain.”
Wardlaw, who trained in South Carolina, had long heard of Green Smith’s dedication. “It was like having a homegrown midwife that was coming to serve the community,” she recalled. Colleagues noted that Green Smith’s warmth and kindness made her a beloved figure among her patients and their families. Penelope Bowman, a veteran midwife at Charleston Birth Place, emphasized that the role of a midwife extends beyond the birthing process, requiring emotional engagement with families and communities.
Despite her professional knowledge, Green Smith did not have a midwife during her own pregnancy, a situation that highlights a troubling aspect of midwifery. Wardlaw explained that Green Smith would have needed to use the same practice that employed her, which is often avoided to prevent conflicts of interest.
After her admission to the hospital on Christmas Eve, doctors determined that Green Smith required an emergency C-section. Although baby Eden was delivered successfully, complications arose shortly thereafter. On December 29, Green Smith experienced a rupture at her incision site, necessitating urgent surgery. Despite the initial success of the procedure, she faced severe complications during recovery, leading to her untimely death on January 1.
Calls for Accountability
Green Smith’s death has prompted widespread outrage and sorrow. Mark O’Halla, President and CEO of Prisma Health, where Green Smith worked, referred to her as a “trusted colleague” and “cherished friend” in a social media statement. He acknowledged her dedication to her patients and colleagues, asserting that her legacy would continue to inspire.
In South Carolina, vigils were held in her honor, bringing together fellow midwives, former patients, and family members. National organizations like the American College of Nurse-Midwives have condemned the systemic issues contributing to high maternal mortality rates for Black mothers. “That a Black midwife and maternal health expert died after giving birth in the United States is both heartbreaking and unacceptable,” the organization stated. The National Black Nurses Association echoed this sentiment, emphasizing that Green Smith’s professional qualifications did not shield her from the dangers faced by Black women in childbirth.
Recent incidents, including viral accounts of Black mothers facing dismissal at hospitals, underscore the urgent need for systemic change. Dr. Chris T. Pernell, director of the NAACP’s Center for Health Equity, noted that over 80% of maternal deaths are preventable, yet the will to address this crisis remains insufficient.
As the community mourns the loss of Green Smith, her family and colleagues continue to advocate for change. Wardlaw expressed a mix of grief and frustration, lamenting, “We cannot continue to lose our women.” Green Smith’s legacy serves as a reminder of the vital work that remains in ensuring the safety and health of Black mothers during pregnancy and childbirth.
