Krista Hayes holds her baby, Noa Hayes-Guess, one month postpartum in their home in Oakland, CA on February 18, 2021. (Photo courtesy of Krista Hayes)
Krista Hayes holds her baby, Noa Hayes-Guess, one month postpartum in their home in Oakland, CA on February 18, 2021. Credit: Courtesy of Krista Hayes

Shortly after giving birth to her first child in 2021 at an Oakland hospital, Krista Hayes began hemorrhaging due to a retained placenta. She was rushed into emergency surgery and lost nearly 3.5 liters of blood. Even though she almost died, Hayes recalled, no one took the time to explain what had happened. In the days following the surgery, she said her concerns about pain were ignored. 

When Hayes returned home, she struggled with processing her near-death experience and was consumed with wondering what life would have been like for her daughter if she had died. Hayes also struggled with allowing herself to rest, even though she had family support. But suddenly having a baby who needed her all the time was overwhelming.

“A lot of people don’t realize how much of a change it is, not only physically but also mentally,” Hayes said. “There is a shift in your hormones. So why would it not shift mentally as well?”

Though 65% of pregnancy-related deaths occur in the year after delivery, no single doctor oversees postpartum care, leaving many women unsure where to seek help and without anyone checking on their well-being. That’s concerning in light of new data from the Centers for Disease Control and Prevention showing that nearly 85% of pregnancy-related deaths are preventable. The primary causes of maternal deaths identified by the CDC are mental health conditions, hemorrhage, and cardiac and coronary conditions. 

Krista Hayes in her hospital room after giving birth and surviving surgery to stop her hemorrhaging on Jan. 26, 2021. Hayes was administered with five intravenous catheters and had blown veins, resulting in significant bruising. Credit: Courtesy of Krista Hayes

Jasmine Swinson, a midwife at Highland Hospital and Collective Birth, said issues arise during postpartum because women are left without sufficient support. In Oakland, a network of organizations is increasing the support new mothers receive by providing additional checkups, building community, and offering services that encourage health and rest. These organizations focus on Black women, given significant disparities in health outcomes by race. 

A primary reason women’s health issues slip through the cracks, Swinson said, is because America does not have standardized postpartum health care. 

The Guidelines for Perinatal Care recommends that women with uncomplicated pregnancies receive 15 checkups before birth but only one after birth, despite the alarming statistics. 

“You don’t see a doctor for six weeks after giving birth. And that’s how people die,” said Swinson. “And then even after that, there’s no care. You’re just floating around on your own.” 

Swinson also said many first-time mothers have never seen a birth or accurate portrayals of recovery, leaving women feeling alone in their postpartum experiences. 

“We hide the real thing,” Swinson said, referring to when the Oscars banned a commercial for postpartum products in 2020 for being “too graphic” in its portrayal of a recovering mother. “It’s detrimental to our health when all we see is the happy, gushy, cute side.”

Black women at higher risk

During pregnancy, Hayes joined BElovedBIRTH Black Centering, an Alameda Health System program available at AHS hospitals and wellness centers, which delivers perinatal care in a group setting. It launched in 2018 as part of Alameda County’s Perinatal Equity Initiative, which was designed by and for Black women and has served more than 100 participants. While standard postpartum care only includes one checkup, BElovedBIRTH provides approximately three. Participants join cohorts based on due dates, and the group setting allows women to bond with others going through the same experiences. 

Although Hayes received prenatal and postpartum care from BElovedBIRTH midwives and did not have any significant health complications, she said, due to her body mass index, she was required to deliver with an obstetrician. 

For Hayes, a significant benefit of the program was the community. On TV and among her friends, she did not see any Black women attending birth classes. But because of the program, she found other women she could talk to about what she was going through, whom she could call late at night. 

“I never thought that could be something for me,” Hayes said. “Now I have women that I refer to as my lifelong sisters.” 

Krista Hayes holds her baby, Noa Hayes-Guess, two months postpartum in their home in Oakland, CA on March 30, 2021. Credit: Courtesy of Krista Hayes

According to the CDC, Black women are three times more likely to die of pregnancy-related causes than white women. Another study shows the disparity between Black and white women remained high even after stratifying for education, poverty, and obesity levels.

Jyesha Wren, founder and program director of BElovedBIRTH and midwife at Highland Hospital, Alameda Health System, said she is not surprised by the new CDC data. 

“We already knew that a large, very large proportion of the deaths that were happening were preventable. But these figures are even worse than previous ones I’ve seen,” Wren said. “Then when you layer on racism in addition to just already inadequate medical health care systems, it exacerbates the problem.”

Another organization, Mothers for Mothers Postpartum Justice, is supporting Black mothers by equipping them with items for recovery. MPJ’s NOURISH! program, which launched in 2020 after receiving a surge of donations with the rise of the Black Lives Matters movement, provides free, nutritious meals to mothers for six weeks after birth. MPJ partners with restaurants that prepare the meals, and they deliver food to mothers receiving care from partner organizations — BElovedBIRTH and Roots Community Health Center in Oakland, and San Francisco General Hospital and One Love Black Community in San Francisco. 

Linda Jones, MPJ’s director of community collaborations, co-founder of Black Women Birthing Justice and a doula, said MPJ focuses on postpartum because most others don’t.

“It’s the little stepchild of the whole perinatal period. Nobody talks about it at all. Your friends don’t tell you about it. The doctor doesn’t tell you about it. You don’t learn about it in any of your classes. It’s just all about giving birth,” said Jones. “And then they send you home, and you have no idea what to do.”

MPJ has supported nearly 200 mothers and delivered more than 9,000 meals.

Another MPJ program provides products mothers need immediately after birth, such as adult diapers, herbs for sitz baths, and cooling breast pads. 

MPJ and BElovedBIRTH’s core programming concludes after around six weeks, aligning with the traditional U.S. postpartum time frame. But things are changing, Wren said, and people are starting to recognize that postpartum is much longer. 

Federal law only requires states to provide pregnancy-related Medicaid coverage for up to 60 days after birth. Last year, however, 27 states – including California – opted to extend coverage through 12 months. 

With the extension, BElovedBIRTH is exploring adding checkups for mothers during pediatric visits to ensure they receive more long-term care.

Wren also wants to begin in-depth assessments for economic wellness. Housing insecurity, she said, impacts her clients’ mental and physical health.

MPJ is also expanding by partnering with Black-owned cafes to create a space where new mothers will be able to get free coffee, meet other moms, and ask questions. The program launched on Jan. 27 and is held weekly at OakCali Cafe near Lake Merritt. 

Florence Middleton is a visual journalist based in Oakland, California. She joined The Oaklandside as a photojournalist intern through a partnership with UC Berkeley’s Graduate School of Journalism, where she is pursuing a master’s degree. Florence’s work focuses on themes of community, women, and culture, and she has covered stories both locally and globally. Florence is the recipient of the 2023 Pulitzer Center Reporting Fellowship and the 2023 Dorothea Lange Fellowship honorable mention.