A note: This story discusses mental health and suicide. For resources and support, call 988 to reach the , text HOME to 741741 to connect to the , or call 1-833-943-5746 for the .
A few months after Si'Mone Scott gave birth to her daughter, she knew something was off.
This was her third pregnancy, and her toughest. The Dallas resident had been put on bed rest early on in her first trimester because she was at high risk of a miscarriage.
鈥淚've never experienced a miscarriage before and I didn't want to,鈥� Scott said. 鈥淚 was already going through a lot at home, and then to basically have to stop working, I couldn't even clean.鈥�
When Scott gave birth to her daughter via C-section, she started bleeding, losing more than 1,300 mL of blood. Postpartum hemorrhage is categorized as losing more than 1,000 mL of blood within 24 hours to 12 weeks after delivery, according to the .
鈥淚 basically almost died on the operating table,鈥� Scott said.
She said not being able to get up and move during her pregnancy and after giving birth impacted her mental health. It was like she had the 鈥渄arkest cloud over my head,鈥� Scott said.
鈥淚 called the 988 suicide line, because I was needing their help,鈥� she said. 鈥淚 was searching for it. I just wasn't getting it. And I felt like I exhausted all of my resources of trying to find it.鈥�
The health issues Scott experienced are some of the most common reasons Texans die in pregnancy. Texas is , and Black Texans die at higher rates than their white counterparts from pregnancy-related causes.
Scott got connected with , a Black-led organization in Dallas providing postpartum doula support to new parents. The organization's aim is to reduce maternal mortality rates.
Scott said she felt calm and relaxed immediately after coming to the office and meeting her doula.
鈥淓verything just started coming out of me,鈥� Scott said. 鈥淚 was speaking for hours, uninterrupted. She just listened. She just listened. And I know I was going on and on and on. But it was just being heard.鈥�
Over the next few months, Scott said she came to Delighted to Doula every week as part of her 鈥渟elf-care routine.鈥� She started to notice changes in her mood. She felt happier and had more energy to play with her daughters.
鈥淭hey never treated me like I was overstaying my welcome or anything, I was always welcomed,鈥� Scott said. 鈥淭hat helped me to realize that I do matter and that all my feelings are valid.鈥�
What is maternal mortality?
Maternal mortality is the death of someone during pregnancy or within a year of the end of their pregnancy, according to the . Causes can include pre-existing health issues like hypertension and heart disease; birth-related incidents like bleeding, sepsis or blood clots; or health issues after giving birth, like postpartum depression or intimate partner violence.
In Texas, obstetric hemorrhage (bleeding) was the most common cause of pregnancy-related death, followed by mental health conditions and non-cerebral thrombotic embolism (stroke), according to the .
In Texas, Black pregnant people die from pregnancy-related causes at two to three times the rate of their white counterparts. The MMMRC鈥檚 most recent report found these disparities , when the committee was first formed.
People without private health insurance and people over 35 were also more likely to die from a pregnancy-related cause. A 鈥渢he rate for women aged 40 and over was 6.8 times higher than the rate for women under age 25.鈥�
Jai Fields, a full spectrum doula and the childcare director for the , provides support to parents from the prenatal to the postpartum period. She said people often don鈥檛 know the warning signs for health problems.
鈥淲e鈥檙e trying to regulate the body, but not educate about the body,鈥� Fields said. 鈥淚 think that needs to happen more so that people can be informed and know what鈥檚 normal, what鈥檚 not, what should be a red flag.鈥�
She said health issues that happen after giving birth can often start small, with minor pain or swelling. These issues can be easy for people to ignore as they鈥檙e caring for a newborn and managing a household.
鈥淭his is a vulnerable time,鈥� she said. 鈥淲e know Black folks are dying, babies are dying, it鈥檚 really vulnerable.鈥�
Fields said her work in the MHEC helps give parents 鈥渢he space to rest, to breathe, to eat, to take care of their basic needs, so they are able to heal and able to be aware of their bodies.鈥�
鈥淸It鈥檚] being proactive versus reactive to, 鈥極h, now there鈥檚 a problem,鈥� and we鈥檙e in crisis mode,鈥� she said.
She said part of her work as a doula is helping people to advocate for their health needs, because 鈥測ou are an expert in your body.鈥�
鈥淣o matter what these books or statistics say, when something is off in your body, you know,鈥� Fields said, 鈥渁nd so your voice is extremely important.鈥�
Racism鈥檚 impact on pregnancy
Black pregnant people鈥檚 experiences are also according to a 2019 article in the Journal of Racial and Ethnic Health Disparities. That can include a lack of health insurance, less access to health care services, and health provider mistreatment.
It鈥檚 something Fields has seen firsthand working with her clients.
鈥淲hen it comes to birth trauma, what we鈥檙e seeing is it鈥檚 not always the actions of what happened in the birth per se, but how the person felt about their birth,鈥� she said. 鈥淚f they felt they weren鈥檛 heard, if they felt they didn鈥檛 know what was going on, if they felt they weren鈥檛 believed about their pain, which can all stem from providers being racist, if we鈥檙e being real.鈥�
According to a , Black, Hispanic, Asian and Indigenous women are twice as likely as white women to 鈥渢o report that a health care provider ignored them, refused their request for help, or failed to respond to requests for help in a reasonable amount of time.鈥�
is a clinical assistant professor at the University of Texas at Arlington who researches maternal and child health.
She said an example of how stereotypes and systemic racism show up for pregnant people is 鈥渁 Black woman might say that she's in pain, but the stereotype surrounding that is that Black women are stronger, they can take more pain.鈥�
how this myth about pain tolerance, which began in the United States to justify inhumane treatment of Black enslaved people, leads to
Even as a public health professional, Green said there are things she needed to know about pregnancy that she couldn鈥檛 find answers to. She said it made her feel hopeless and scared.
鈥淵ou don鈥檛 want to die,鈥� Green said. 鈥淵ou work with maternal mortality all day, and when you get pregnant, the first thing is not like, 鈥極h, my goodness, I'm so excited.鈥� It's, 鈥業 don't want to end up like a lot of these women that I'm studying on a daily basis.鈥欌��
But she鈥檚 hopeful her research will underline the importance of cultural competency and equity training for doctors to better serve Black and other pregnant patients of color.
鈥淚 want women when they go into pregnancy to feel the joy of pregnancy and not the fear or the anger,鈥� Green said. 鈥淏lack women should not be dying in pregnancy or after pregnancy.鈥�
Maternal mortality data and programs
Recent research has challenged some of the statistics about maternal mortality in the United States, but disparities still exist.
Cande Ananth is a . He recently that said data errors, not worsening outcomes, contributed to the United States鈥� high maternal mortality rate.
A CDC spokesperson told NPR in March that the organization and thinks the method underestimates the number of deaths. But Ananth said regardless of the percentages, there are still disparities.
鈥淲e generally think it's structural racism that's affecting why we see such a big disparity across race [and] ethnicities in this country,鈥� he said. 鈥淎nd that's another very, very important area that we need to start focusing a lot more on.鈥�
Ananth said these issues have been around for a long time but hopes there鈥檚 more of a research focus on what鈥檚 driving the different pregnancy outcomes based on race.
鈥淭he progress to shorten or reduce the gap between Blacks and whites hasn't met with much success,鈥� he said. 鈥淲e need to do a better job of figuring out how to reduce or shorten that gap.鈥�
Maternal health and mortality have been a large focus of the Biden-Harris Administration. The administration put out a , which started by proposing a 12-month postpartum extension for Medicaid.
Advocates, birth workers and researchers have said this extended coverage will lower the rates of maternal mortality and morbidity. In March, Texas extended coverage to a year, , which Gov. Greg Abbott said is projected to impact about .
The blueprint also calls for more funding. The Health Resources and Services Administration (HRSA) in 2023 to health clinics and programs.
鈥淲e need to center our work around what women know they need,鈥� said . 鈥淎nd when they say something's wrong, that the system responds to it. The burden isn't on women. No, the burden should be on the system and the policy environment to get the best possible outcome for all families.鈥�
This also includes the maternal mental health hotline launched in May 2022, . In its first year in operation, the hotline received more than , primarily around depression, anxiety and feeling overwhelmed.
鈥淲hat we wanted to do is give people a safe space 24/7 to call or text and have a conversation with a mental health professional,鈥� Johnson said. 鈥淭hat allows you to鈥alk about your concerns and talk about what you're feeling and experiencing.鈥�
In Texas, HRSA has provided funding to the , health centers in places like Houston and San Antonio, five Healthy Start programs, including in Dallas and Fort Worth, and training for health professionals.
鈥淭here are far too many women who face structural, systemic issues that make it harder to trust the health care system,鈥� Johnson said. 鈥淭hat is why we have made this such an important line of work for us in this administration, because those things need to change.鈥�
鈥榊ou never know when someone is going through that what can really happen.鈥�
Nowadays, Si'Mone Scott works for Delighted to Doula, speaking to clients and doing member outreach.
鈥淚 found a passion that I didn't even know existed,鈥� she said.
She said along with the importance of listening, one of the biggest lessons she鈥檚 learned is prioritizing rest, especially after giving birth.
鈥淚鈥檝e become a better person, a better mother,鈥� Scott said. 鈥淏ecause I'm no longer pouring from an empty vessel, I'm learning to pour into myself first. I can't say it enough how thankful I am and how honored I am to even be able to help other mothers who were either currently or previously in my previous position.鈥�
Scott encourages other new parents to reach out for support before health issues become crises.
鈥淭his literally saved my life,鈥� she said. 鈥淚 literally was having suicidal thoughts, even though I didn't want to go through with them. That dark cloud鈥ou never know when someone is going through that what could really happen. And so whether suicide, or complications, don't just put it off.鈥�
For resources and support, call 988 to reach the , text HOME to 741741 to connect to the , or call 1-833-943-5746 for the .
Elena Rivera is 四虎影院鈥檚 health reporter. Got a tip? Email Elena at erivera@kera.org
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