CHARLESTON, S.C. — Janell Green Smith had attended hundreds of births as a midwife. Now, it was her turn.
As she and her husband prepared to welcome their first child, Green Smith set up a pink and rose gold nursery in their Spartanburg,South Carolina, home. She labeled each dresser drawer for the tiny clothes her daughter would soon wear. She shared ultrasound images with relatives, growing more excited as her February due date drew closer.
But Green Smith, 31, was also nervous, according to her sister. She had devoted much of her career to improving health outcomes for women in her position: Black mothers-to-be, who face disproportionate risks.
"Black women are three times more likely to die in pregnancy and in childbirth than any other race. In hearing these alarming statistics, I wanted to do something about it," Green Smith said in a 2024Instagram postexplaining why she became a certified nurse-midwife. "I wanted to be a part of the solution."
Friends and colleagues say she achieved her goal, fiercely advocating for safer, more respectful Black maternal health care in her community and beyond. That made it all the more heartbreaking when Green Smith died on New Year's Day — less than a week after giving birth to her daughter.
"Her worst fear has come to pass," her older sister, Selina Green, told NBC News.
Green Smith had developed pre-eclampsia while pregnant,a condition characterized by high blood pressurethat can be fatal. Because of the risks, doctors often recommend early delivery. On Dec. 26, eight weeks ahead of her due date, Green Smith gave birth via cesarean section at Prisma Health Greenville Memorial Hospital, according to Nichole Wardlaw, her husband's aunt, who is acting as a spokesperson for the family as they grieve.
The baby girl, named Eden, is currently in the neonatal intensive care unit.
Green Smith initially seemed to recover from the C-section. But in the days afterward, her incision site ruptured, Wardlaw said. Doctors tried repairing it at her bedside but later rushed her into emergency surgery. As the operation ended, there were complications, Wardlaw said. Green Smith went into cardiac arrest and died days later. (NBC News has not reviewed Green Smith's medical records.)
"An unimaginable loss," her husband, Daiquan Smith,wrote on Instagram, alongside a photo of the couple on their wedding day, holding hands and beaming. "Janell was deeply loved, and her presence will always be felt."
Smith declined to be interviewed; Wardlaw said he is juggling his grief with the joy of meeting his newborn.
"This is not the life that he imagined," Wardlaw said.
Prisma Health, which owns the hospital where Green Smith died as well as the Greenville midwifery clinic where she worked, did not respond to questions about her death. President and CEO Mark O'Halla described her as "not only a trusted colleague in women's health but also a cherished friend to many here at Prisma Health."
Green Smith was born and raised in Charleston. Her mother was a home health nurse, and Green Smith said from a young age that she wanted to be a nurse, too. She tried on her mother's scrubs, and she pretended to operate on her Barbie dolls, her sister said.
Dozens of mourners gathered at a vigil Wednesday evening at Forest Park Playground, in the neighborhood where Green Smith grew up, and released pink balloons into the sky. Propped up near a pool where she and her sister once swam as children were photos capturing Green Smith's recent milestones: proud graduate, confident professional and radiant mom-to-be.
Frederica Bailey, a longtime nurse, recalled Green Smith as a teenager, full of questions about the profession. Bailey warned her that if she worked as a nurse-midwife, her hours wouldn't be her own. But the thought of working weekends and holidays was no deterrent.
"She walked into her calling," Bailey said. "So many of us go through life not knowing what our purpose is."
Green Smith earned an undergraduate degree in nursing from the University of South Carolina in 2016 and briefly worked in a neurology department, but it wasn't a fit. In a TikTokshe posted three months ago, Green Smith said she decided that "women empowerment was my thing" and took a job in a high-risk labor and delivery unit.
Kyndall Beach, a former co-worker, said Green Smith was a good listener.
"She treated everybody like humans," Beach said.
Green Smith then went for a master's degree in nurse-midwifery, followed by a doctorate in nursing, both from Frontier Nursing University in Kentucky.
On Instagram, Green Smith proudly called herself the "loc'd midwife" — a reference to the twists she styled her hair in. She was bubbly and energetic, quick to earn the trust of the women she supported through their births.
Isabella Hollowell said Green Smith stayed by her side for roughly 10 hours as she labored before giving birth to her daughter in 2022. After Green Smith cut the umbilical cord, she held up Hollowell's infant and said, "Look what you made, Mama. Look what you did."
"She didn't rush me. She made me feel safe. She listened to me," Hollowell said.
On social media, Green Smith said that when she started working as a nurse in labor and delivery units, she saw shortcomings in the way pregnant women were treated.
"I wanted to be the change," she said in her recent TikTok.
The United States is an outlier amonghigh-income nations in its rate of maternal deaths, and numbers for Black women are particularly abysmal. While the overall U.S. maternal mortality rate hasdecreased in recent years, the rate for Black women remains stubbornly high. In 2023, Black women died at a rate of 50.3 deaths per 100,000 live births, compared to 14.5 deaths per 100,000 live births for white women, according tothe Centers for Disease Control and Prevention.
The higher mortality rates for Black mothers persistregardless of their level of education or income. Experts say systemic racism and implicit bias from health care providers are among the factors that exacerbate this disparity, contributing to delays in care or symptoms being dismissed.
Green Smith's goal as a midwife, she said in a 2023Instagram video, was to hear how women envision their birth experiences and to "figure out how to individualize that care to empower them and help them have the birth of their dreams."
The American College of Nurse-Midwives praised Green Smith's advocacy for equitable health care.
"That a Black midwife and maternal health expert died after giving birth in the United States is both heartbreaking and unacceptable," the group said in a statement.
Many at Wednesday night's vigil agreed.
"This isn't a new problem," said Bailey, the nurse. "But because it happened to her, it's going to shed some light."
Wardlaw said Green Smith's baby, Eden, is getting stronger every day, and the family hopes she won't be in the NICU for too long.
"She is a feisty little fighter," Wardlaw said. "She has her mother's personality."
Green said she will tell Eden about how her mother, down-to-earth and determined, was fighting to change the world.
"I just want her to know who her mom was, the legacy she left," Green said. "She was so excited for her."
Bracey Harris reported from Charleston and Elizabeth Chuck from New York.
CHARLESTON, S.C. — Janell Green Smith had attended hundreds of births as a midwife. Now, it was her turn. As she and her husband prepared ...
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