When Janell Green Smith first announced her pregnancy this past summer, her family was ecstatic. After participating in more than 300 births as a certified nurse-midwife and doctor of nursing practice in South Carolina, with a particular focus on helping Black women give birth safely, she was looking forward to welcoming a child of her own, with her husband Daiquan Smith, whom she’d married in 2024.

That her due date was February 25, the same birthday as her husband’s late great-grandmother, seemed like a promising surprise. At her baby shower in the fall, friends and family came to Greenville, South Carolina from out of town to celebrate, and the couple marked the occasion with bright pink outfits.

But on Christmas Eve, Green Smith, 31, was admitted to the hospital after developing severe preeclampsia, a pregnancy-related blood pressure disorder that can be fatal for a mother and her baby. Two days later, baby Eden was born, early, but safe. Then came further complications, family told CNN, requiring an emergency surgery. Less than a week after her baby’s birth, Green Smith was dead.

CNN has not been able to confirm what Green Smith’s exact cause of death was. But Black mothers are far more likely to die from complications of childbirth than other races, a multi-causal issue attributed to systemic racism, implicit biases and care disparities.

While the most recent data on national maternal mortality shows 18.3 deaths per 100,000 live births, for Black women, that number rockets to 47.4 deaths per 100,000 live births — a stat that covers deaths up to 42 days post-birth, deaths like Green Smith’s. In Norway, a country with a similar per capita income to the US, the rate of maternal mortality is 1 death per 100,000 live births.

Green Smith knew those rates. Her home state ranked top 10 for the highest maternal mortality rate in the country.

On January 1, Green Smith became another statistic. Her death has sent ripples throughout the country, drawing renewed attention to the issues that continue to kill Black mothers.

“Janell was fighting with all of the rest of us who are tired of, day in and day out, looking at these numbers,” her husband’s aunt Nichole Wardlaw, a fellow nurse midwife, told CNN through tears. “She was my comrade in this fight. And now she is gone.”

‘An amazing human’

Green Smith came into midwifery upon hearing the “alarming statistics” about Black maternal health, she said in a video posted in April 2024 to Instagram.

“I wanted to do something about it,” Green Smith said at the time. “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.”

Before Wardlaw met Green Smith as her future niece-in-law, she had already heard about Green Smith’s work. Less than 9% of midwives nationally are Black, and Wardlaw’s own South Carolina–based midwife mentor, Penelope Bowman, kept talking about how there was this amazing Black midwife from the Lowcountry that she simply had to meet.

“It was like having a homegrown midwife that was coming to serve the community,” said Wardlaw, who lives in Virginia but trained in South Carolina. Bowman kept saying, “‘We have to get together. Come down from Virginia, you have to meet her, because you’re going to love her.’”

Bowman turned out to be prophetic: Wardlaw instantly loved her. When asked about what made Green Smith so special, her voice broke trying to respond. After a pause, she continued: Her personality; her smile; her presence, always welcoming and warm.

“She was an amazing human,” Wardlaw said. “And you don’t meet amazing humans every day.”

Bowman, a longtime nurse midwife at Charleston Birth Place, a birth center, remembers those conversations with Wardlaw about Green Smith. Midwifery isn’t an easy job, she said — the work goes beyond the person giving birth, and often involves engaging with the patient’s family, and sometimes community, all while providing care before, during and after pregnancy. Despite the long hours, Green Smith approached her role with kindness and gentleness, showing up to work on her days off and always encouraging new parents, Bowman said, though she could be tenacious when the situation called for it.

“She really got involved with a lot of different families,” Bowman said. “People gravitated to her because the enthusiasm, the love, the concern, all these different aspects came from her.”

‘Her credentials did not protect her’

Despite her own professional experience, Green Smith did not have a midwife present during her own pregnancy, though having a midwife has been shown to improve birth outcomes. To readily get a midwife where she lived, Wardlaw said, Green Smith would have needed to use the same practice that employed her, a situation that midwives prefer to avoid due to possible conflict of interest.

Upon Green Smith’s admission to the hospital on Christmas Eve, doctors decided her condition was serious enough to require an emergency C-section, said Wardlaw, recounting what other family members relayed to her.

The C-section was successful, and baby Eden was delivered on December 26, at just 32 weeks and requiring steroids to help her lungs mature. Still, Green Smith was proudly able to “pump a nice amount of milk,” Wardlaw said.

Everything changed on Monday, December 29. Green Smith felt a pop; her incision opened, there was bleeding, and she was rushed back to the operating room for emergency surgery, Wardlaw was told.

The procedure went well, but the complications came during recovery post-surgery, Wardlaw told CNN. On January 1, Green Smith’s heart stopped beating.

“We’re still trying to find out exactly what happened,” Wardlaw said.

Prisma Health, which operates the hospital where Green Smith died, and also owns the practice where Green Smith worked, did not respond to CNN’s request for comment. In a statement posted to social media, Prisma Health President and CEO Mark O’Halla called Green Smith a “trusted colleague” and “cherished friend.”

“Those who had the privilege of working alongside Dr. Green Smith speak of her bright spirit, her dedication to serving others and the compassion she brought in equal measure to her patients and her colleagues,” O’Halla wrote. “Her legacy of love and commitment will continue to inspire us all.”

In her native South Carolina, Green Smith’s death has come as a shock. Vigils were held in Greenville, where she lived, and Charleston where she was from, attracting fellow midwives, former patients and family. As news of her death has spread, national organizations have expressed outrage over the continued high 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 American College of Nurse-Midwives wrote in a public statement. “Her death underscores the persistent and well-documented reality that Black women — regardless of education, income, or professional expertise — face disproportionate risks during pregnancy and childbirth due to systemic racism and failures in care.”

“Dr. Green Smith’s knowledge did not shield her. Her credentials did not protect her,” wrote the National Black Nurses Association. “That reality demands more than reflection; it demands accountability.”

Her death comes just one month after two instances of Black mothers being dismissed or delayed at hospitals went viral — one mother gave birth on the side of the highway, another had her baby a mere 12 minutes after being admitted.

The high rate of Black maternal mortality has long been a condition in American health care, Dr. Chris T. Pernell, director of the NAACP’s Center for Health Equity, told CNN last month. More than 80% of maternal deaths are considered preventable, according to the Centers for Disease Control and Prevention.

“The will is not there to solve an issue that unfortunately has not gotten better,” Pernell said.

For Wardlaw, her grief is mixed with anger. As a midwife, she knows these deaths happen more than they should, and she feels hopeless knowing her knowledge and understanding of the system couldn’t fix this.

Green Smith, the mother of Wardlaw’s new grandniece, was not the first, and she won’t be the last. Wardlaw’s next words were careful, but firm: “We cannot continue to lose our women.” (CNN)

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