‘Death at your toes’: A look inside a Mississippi maternity care desert

by Kate Royals, Mississippi Today
November 3, 2022

YAZOO CITY — Jamara Johnson knew something was wrong when she went into labor with her third baby early in the morning of Aug. 30. 

She was 38 weeks pregnant and had been in pain the night before. She attributed it to overextending herself while cleaning her apartment in Yazoo City – “nesting,” she said. When her water broke around 5 a.m. – a greenish color she’d never seen with her first two babies – she realized she needed to get to a hospital as quickly as possible. 

Johnson lives in a county defined in a new report as a “maternity care desert” — there have not been any labor and delivery services in Yazoo County since the early 1990s, and there are no practicing OB-GYNs. Many women go to the Federally Qualified Health Center about a half hour away in Canton, while others, like Johnson, see the doctors at an OB-GYN group in Flowood, more than an hour away from her home.

More than half the counties in Mississippi are considered maternity care deserts, according to the new report from the March of Dimes. These counties have no hospitals providing obstetric care, no OB-GYNs and no certified nurse midwives. 

Discontinued labor and delivery services and shuttered neonatal intensive care units have dominated headlines in the state in recent months, painting a bleak picture for mothers and babies’ access to care. Greenwood Leflore Hospital closed Leflore County’s only labor and delivery unit on Oct. 15. Over the summer, Ochsner Medical Center in Hancock County did the same. 

The Mississippi Delta’s only neonatal intensive care unit closed in July. A few months ago, the NICU at Merit Health Central in south Jackson also shut down, raising concerns about disruptions in care for high-risk moms and babies.

The trend of reduced access and care for mothers and babies — on the heels of the Dobbs decision that overturned Roe v. Wade and is expected to result in 5,000 additional babies in Mississippi alone — does not bode well for a state already plagued by high infant and maternal mortality rates and poor health outcomes.

Dr. Rachael Morris, assistant professor of maternal fetal medicine at the University of Mississippi Medical Center, travels the state training emergency responders, nurses and providers in small, rural hospitals in obstetric emergencies and caring for pregnant and recently delivered mothers who may have complications or life-threatening problems. 

The state’s problems did not happen overnight, she said. 

“But it’s really only getting worse. The nature of this problem, it’s additive at this point,” she said. “We have a very complex, medically diverse, underserved population with a lot of high-risk patients, whether it’s diabetes, obesity, hypertension — this is a lot of our mothers in Mississippi. So when you have that baseline complexity, that creates a very high-risk population for pregnancy.”

The unhealthy population in Mississippi, a leader nationally in chronic disease, means women of childbearing age are already behind the starting line. When emergencies come up – as they will do in high-risk pregnancies – access to nearby care is critical.  

“When you’re talking about a baby and a pregnancy and a delivery, minutes matter for that mom’s health and that baby’s health,” said Dr. Anita Henderson, president of the Mississippi chapter of the American Academy of Pediatrics. 

Minutes mattered for another Yazoo City woman with eerily similar circumstances as Johnson: Tamara Stuckey was also pregnant with her third child and was a patient at the same OB/GYN group in Flowood as Johnson. On Aug. 28, 2019, the 32-year-old Stuckey was 35 weeks pregnant and taken by ambulance from her home in Yazoo City to St. Dominic Hospital, according to a lawsuit filed by her fiance and the father of her other two children. 

She was complaining of constant and sharp abdominal pains, and her medical records indicated Stuckey, who had given birth by cesarean section for both previous babies, was at high risk for postpartum hemorrhage. Her OB-GYN ordered a fetal ultrasound but did not investigate her complaints of “uterine irritability,” or mild contractions, and pain in her right shoulder, according to the complaint. She was discharged that evening and sent back home — an hour away.

That same night, her fiance called emergency medical services again. Stuckey reported a pain level of 10 on a scale of 1 to 10, the complaint states, and was again transported to St. Dominic. She arrived at the hospital around 1:18 a.m. Her baby, a little boy they planned to name Daxton, was already dead. The complaint says medical records indicate the last fetal heart tones detected were at 1:01 and 1:02 a.m. 

Within 30 minutes of arriving at the hospital, Stuckey went into cardiopulmonary arrest. Her baby was delivered stillborn early that morning, and the next day, Stuckey died.

“The maternal autopsy report revealed massive intrapartum hemorrhage, with the abdominal cavity containing four liters of free blood,” the lawsuit complaint states. 

Stuckey’s fiance Damien Sanders and his attorneys declined to be interviewed for this story.

In their response to the complaint, Women’s Health Associates and Dr. David Waddell, Stuckey’s OB-GYN, denied the allegations and agreed only to the basic facts listed in the document. St. Dominic Memorial Hospital and St. Dominic Health Services both said in their responses that the injuries and damages to Stuckey “resulted from medical conditions, events or the acts or omissions of persons or entities other than St. Dominic.” 

Johnson didn’t want to risk her baby’s life by waiting. 

She called her doctor’s office immediately when her water broke, and a nurse said to get to St. Dominic as quickly as possible. The discoloration meant the baby was at risk for meconium aspiration, which can occur when the baby passes his first stool (meconium) while in the womb. Aspiration can occur when the newborn breathes in a mixture of meconium and amniotic fluid (the liquid that surrounds the baby in the womb). 

The condition can cause difficulty breathing, pneumonia, and at worst, death. 

In the bathroom early that morning, Johnson weighed her options: she could wait for who knows how long for an ambulance to come to her apartment, or she could go to Baptist Memorial Hospital-Yazoo, where she would then be transferred via ambulance to Jackson. 

Or, since she wasn’t having contractions yet, she could get in the car and drive.

She had made this same game-time decision less than a year before when she went into labor with her second child on Sept. 20, 2021. She drove with the child’s father to the Yazoo City hospital but didn’t bother getting out of the car when they saw there was no ambulance there, so they decided to take their chances. 

Less than an hour after leaving the hospital, Johnson called 911 and they pulled over in Sullivan’s Grocery in Flora. Minutes later, Johnson gave birth in the back of an ambulance in the grocery store parking lot at 1:45 a.m. 

“If I was still in Yazoo City, I would’ve had to wait on that same ambulance (that met me in Flora) to come, so I just went on and took my chances,” Johnson said of her decision. 

With her third delivery, she felt even more pressed for time: she needed to get to a hospital capable of treating her baby in case there was something wrong. She called her aunt Summer Brokman, who lived about five minutes away, and asked her to go with her to the hospital. The two started the drive with their hazard flashers on. About 30 minutes into the hour-long drive, Johnson was stopped again — but this time, it was in Pocahontas, and it was for a different reason.

A Highway Patrol car had pulled the two over on Highway 49.  

Brokman told her to try and be calm and not make any sudden movements. But Johnson, who had been driving until that point, was starting to have contractions and was in pain.

The officer asked for Johnson’s license and registration, and Brokman pleaded with the officer.

“I was like, ‘Sir, look, she’s having a baby. She’s in labor, she delivered her last baby on the side of the road … can you follow us to the hospital?’” Brokman recalled. “And he was like, ‘License and registration.’” 

The two were shocked, but Johnson produced her driver’s license, and they sat on the side of the road while the officer ran it through the system. More than 10 minutes later, they said, he came back and issued Johnson two tickets: one for speeding and the other for not having insurance. 

“He’d asked me for insurance and I told him I couldn’t — I was in too much pain to search for it,” Johnson remembered.

Brokman looked for it but couldn’t find it, she said. 

The trooper finally let the two go, and Brokman took over driving. They made it to Jackson, and Johnson’s son was born around 9 a.m. — about two hours after the trooper had written her the ticket.

Criss Turnipseed, director of public affairs at the Mississippi Highway Patrol, said they have no official protocol as to how to handle medical emergencies, and it is “left to the Trooper’s discretion.” 

“Our first preference for those instances is always to call 911 first. There is no ‘official’ protocol for how a Trooper should proceed with someone claiming there is a medical emergency on a traffic stop other than based on his observations and the severity he is authorized to request an ambulance to the scene himself,” Turnipseed said in an emailed statement to Mississippi Today. 

Turnipseed said he had no comment on what happened to Johnson and Brokman. 

Now, more than three months later, Brokman and Johnson can’t help but think of all the things that could have gone wrong that day. They say they commonly hear stories about women in Yazoo City giving birth on the side of the road — like Johnson did in 2021 — and they were glad they made it to a hospital.

“My momma used to always tell me when I was young: ‘When you’re having a baby, you’re closer to death than you’ll ever be in your life,’” Brokman said. “Death is at your toes.”

That statement is especially true in Mississippi, which leads the nation in maternal and infant mortality. And it is even truer for Black women and babies, who are significantly more likely to die in childbirth than their white counterparts. 

The pregnancy-related mortality ratio was 33.2 deaths per 100,000 live births between 2013 and 2016 — nearly double the national average of 17.3 deaths per 100,000 births. 

The same is true for babies: the state has the highest rate of infant mortality in the nation, and the rate of death in Black infants is twice that of white babies. 

For Black women in Mississippi, the rate was about three times the rate of white women at 51.9 deaths. 

The state also has one of the highest rates of uninsured people in the country – a problem the March of Dimes report highlights when discussing the importance of quality care before having a baby, during pregnancy and after.

“Continuous high quality health care in all three time periods can lead to better health outcomes for both mom and baby,” the report states. “… Stalled progress to improve pregnancy outcomes has, in part, pointed towards inconsistent health interventions before pregnancy.” 

Greenwood Leflore Hospital, which permanently shuttered its labor and delivery unit as the hospital fights to cut costs and stay open, welcomed just over 2,000 babies into the world over the last five years. 

But now, any babies born at the hospital will be born in the emergency room, where interim CEO Gary Marchand said the hospital has relocated labor and delivery equipment. 

The closest hospital with labor and delivery services is in Grenada — a 45-minute drive or more for some in the area.

Providers and community members worry more women in Leflore County will have experiences like Johnson and Stuckey’s. Dr. Terry McMillin, an OB-GYN who has practiced in the Greenwood area for more than 20 years, said the closure of the unit is “devastating.” 

“In the short term, are you going to have potentially some bad outcomes? I can’t predict that, but certainly it only increases that likelihood,” he said.

The hospital now only has “limited obstetrical call available” — or several obstetricians who retained their privileges and can assist ER physicians if the situation warrants and they are available. 

“The March of Dimes report just illustrates that we have to find ways to provide access and health care to moms even in the midst of some of those maternity deserts, and having more and more labor and delivery units closing is just the wrong direction,” said Henderson, the head of the Mississippi pediatrician group.

The March of Dimes report ended with several policy recommendations, including expanding Medicaid for individuals who make less than 138% of the federal poverty level, or about $30,000 annually for a family of three.  

Mississippi remains one of 12 states not to expand Medicaid under the Affordable Care Act — and one of 21 states not to extend postpartum Medicaid coverage for new moms beyond 60 days to 6 months or a year, another recommendation of the report.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.