Fighting For Their Lives
A baby dies every 43 hours in Shelby County. What are we doing about it?
On this late-winter day, in a South Memphis apartment, Terria Taylor recalls the darkest evening of her life — when her two-week-old baby died. "They told me she wasn't going to make it." says Terria, her pretty face shadowed with sorrow. "They told me they'd done all they could do."
Looking back on the six months she carried Miracle, the 20-year-old mother remembers being disappointed, because she'd really wanted a son. Gradually, though, she could envision the daughter. "My dream was that she would finish high school, because I never did," says Terria. >>
The oldest of eight children, Terria was raised by a single mother who worked several jobs. "Sometimes we might wonder where a meal was coming from," says Terria, "but we always had one." She attended Booker T. Washington High but dropped out during her senior year to take a job — exotic dancing — partly to help her mom pay the bills.
Sexually active by age 17, Terria went to a local health clinic for Depo-Provera birth control shots. When she started gaining weight, she stopped taking the shots "just for a few weeks." In March 2008 she learned she was pregnant. As the news sank in, her spirits sank too: "I was depressed and worried."
She gave up dancing, but couldn't shake some bad habits — smoking, nightclubbing, and eating what she craved. She did take vitamins, however, and was checked regularly at a clinic. The last time she went, they told her the fetus was fine.
Then in mid-September she suffered sudden pains. Her mother told her to go to The Med, where she delivered by C-section a wisp of a human — one-pound, five-ounce Miracle. "I've never seen anything so small in my life," says Terria. She lifts from her coffee table a stuffed animal about six inches long, and says, "She was as small as this. I was scared to touch her. I couldn't do nothing but cry. I'd look at her and think, 'Is this her?'"
Over the next two weeks Terria would visit The Med' s Neonatal Intensive Care Unit at the Sheldon B. Korones Newborn Center, spending hours each day with Miracle. Hooked to tubes and housed in an incubator, the infant was too small to be held. But Terria would slip her fingers inside the incubator and touch Miracle's tiny form. "I would talk to her as she lay there, and she'd curl onto my hand. When I talked, she'd get to moving so much that sometimes her heart rate would shoot up and the nurses would tell me to let her go for a little while. Her eyes were covered to protect them from the lights. But I think she knew I was there."
Terria got to see Miracle's eyes on the last day of the infant's life. Hospital staff called on the morning of September 23rd to say she wasn't doing well. When Terria arrived, Miracle didn't curl toward her mother's touch. "This time her eyes were uncovered, just barely open," says Terria. "I knew then things weren't right. But I still didn't want to believe she'd leave me."
Only after Miracle died could her mother hold her close. "They left me alone with her. It was almost evening time," she says. "I had nobody there with me. The father was at school in Arkansas and it would take hours for him to get there. Finally my mother came. Miracle was her first grandchild."
The infant is buried at New Park Cemetery on Horn Lake Road. "I think about how old she'd be now" — three months in April — "but I can only see her at the graveyard," says Terria, her voice breaking. "I'm glad I didn't buy her any clothes, I couldn't stand to look at them."
Currently 16 weeks along with another pregnancy by the same young man who fathered Miracle, Terria says, "I'll be more careful this time. And since I lost one, [the doctor at the clinic] is going to keep a closer eye on me. I know about raising babies. I raised all my mama's kids," she adds, gesturing at a wall where her siblings' photos hang. "I will take care of this one."
"You educate one group of women, and another group is getting pregnant as we speak." Y
Terria's story reflects a tragedy that's been playing out for too many years in Memphis and Shelby County. We claim the highest number of infant deaths — 193 in 2007 — among the nation's 60 largest cities, and one of the highest death rates. That rate — i.e. deaths per 1,000 persons — is 12.7, nearly twice the national average of 6.8. The majority of the babies dying are African American. In Memphis, a black mother is three times more likely to lose an infant than a white mother.
The leading causes of infant death are prematurity and its resulting low birth weights, along with birth defects and sudden infant death syndrome (SIDS). Tied closely to teen mothers and women who don't finish high school, the mortality rate is higher in certain Zip codes. For several years, 38108 in the Hollywood-Chelsea area had more infant deaths than any other Zip code in the nation. While the rate there has dropped some, others are on the rise, specifically 38127, Frayser; 38106 (where Terria lives) and 38109, which encompass large areas of South Memphis; and 38118, the Airport area.
Solutions to the problem have been scattered, including home visits by nurses through several organizations. But in 2005, a three-part series in The Commercial Appeal and, more recently, a 20/20 television segment drew glaring national attention to the large number of dying babies. As a result, infant mortality has taken a higher priority.
In April 2006, Governor Phil Bredesen held an Infant Mortality Summit that brought together legislators, local officials, health providers, and community leaders to study the problem. A $5 million grant was approved to fund several new programs with the goal of reaching more women and saving more infants, and Shelby County Mayor A C Wharton hired a coordinator to oversee an Infant Mortality Reduction Initiative.
Holding that position is Antionette Holman, who brings a background in social work and organizational management to the job. Recalling the summit, she says, "We had 250 people attending from so many disciplines, wanting to help." Several programs have been launched as a result of the summit, and Holman speaks to organizations all over the area, trying to reach the women who need the information most — those who have already lost an infant. Yvonne Madlock, who heads the city and county Health Department, sees infant mortality "so connected to poverty it's not funny. We know that babies don't die just because of what happened in the womb," she says. "The reasons are rooted in life conditions of the mother, the environment she lived in all her life. The problem requires a long-term, intensive approach."
Both Holman and Madlock caution against a quick fix. "You educate one group," says Holman, "and another group is getting pregnant as we speak. Education and awareness have to be ongoing."
"It's not uncommon for a mother to show up at The Med, ready to deliver, never having seen a doctor."
Dr. Ramasubbareddy Dhanireddy moves among incubators at the Newborn Center's NICU, where 50 to 60 premature infants struggle for life. They make no audible sounds "because they're so small," says Dhanireddy. "But they do whine; we can see their faces."
Looking at one child, who has a prong in his nose to keep his lungs inflated, the doctor says, "This is a baby who 30 years ago we'd have just put in a corner and called in a priest." Passing other beds, Dhanireddy ticks off problems each child has — severe lung disease, bleeding in the brain, infections they can't fight, digestive systems that fail. A few will require "a tremendous amount of help," says Dhanireddy, as he looks at a twin who, like his brother, "is very sick. They're going to be high-maintenance babies and their mom, a teenager, is not equipped to handle them."
Dhanireddy is medical director of the Newborn Center, a position from which Dr. Sheldon Korones recently retired after founding the facility 41 years ago. During that time, a least 50,000 babies have been treated here, and the death rate has dropped dramatically. Yet as Korones points out, "We still have too many customers."
"These mothers bring so many things to the pregnancy," Korones continues. "Violence, bad nutrition, lack of medical care, everything that doesn't affect you is affecting them and making it hard."
Another problem? Too many babies having babies. "We need to empower these young moms, give them the confidence to say no to boys who seem to father children with no remorse or sense of obligation," says Dhanireddy. But once the women are pregnant, he adds, the community needs to make every effort to get them prenatal care. "I'm saddened by the situations I see. It's not uncommon for a mother to show up at the Med out of the blue, ready to deliver, not having seen a doctor."
He credits county Mayor A C Wharton for taking a stand to reduce infant mortality and developing intervention programs. "They cost money," he acknowledges, "and we don't have a bottomless supply." But these costs pale next to those of caring for premature infants — an average of $75,000 for a three-week stay according to the American Academy of Pediatrics. Some in NICU have been there far longer than three weeks, including one who arrived last July. Looking at the child in his incubator, Dhanireddy says, "This is a million-dollar baby right here. Think what that money would provide in prenatal care."
Korones blames racism and apathy for the relentlessly high infant mortality rate among African-American babies. And he believes having access to a doctor, not just a clinic, would help the mother carry the child full term. Beyond that, he adds, "These mothers want a friend. They may not tell you that, but if you could round them up and hold their hand, not just tell them what to do, but help them do it, I think we'd see a difference."
When Korones makes that statement, he doesn't have Centering Pregnancy in mind. But over the past two years, several Memphis clinics have started offering this program of prenatal education and group care. Not only do the mothers learn what's happening to their bodies, they have several hands to hold.
"This will move them along the path to making better choices."
At the faith-based Christ Community Health Services clinic on Broad Street, Margaret Taylor conducts Centering sessions with women in various stages of pregnancy. With 30 years' experience as a nurse and midwife, she knows the faces and frustrations of infant mortality. "We all know it's worse here in Memphis and even more so in African-American populations. That's been stated repeatedly. We have made prenatal care available, provided transportation, got people insurance. . . Those are all correct things to do. But we have to say to ourselves, 'If you keep doing the same thing and expect different results, you're crazy. Something needs to change.'"
Centering Pregnancy was started in the early 1990s in the Northwest but has only been tried in Memphis since 2007, with help from a $3 million state grant. The idea, says Taylor, is "for the woman to center herself in a sense of community. She gets personal attention from the caregiver, and interaction and support from other pregnant women."
Taylor is working today with a group in their last trimester. Each woman weighs herself, checks her blood pressure, and consults privately with Taylor behind a screen where each baby's heartbeat is monitored. Soft music plays as women aged 15 to 24 look through notebooks they've kept since starting the sessions, which cover topics from abdominal pain to domestic violence.
Today, in one assignment, women are asked how they'll feel once the baby comes. One circles both "playful" and "depressed." They're also asked how they will feel about sex after delivery. A married mother of five declares, "Get away from me, that's how I'll feel," and laughter erupts.
Taylor often encourages women to talk about family situations: What was it like growing up? What would they keep, what would they change? She learns about abuse, homelessness, and drug addiction. "The way the women respond to each other when they hear these stories is encouraging. No one is shunned, everyone shares."
Though she knows Centering Pregnancy can't wipe away social ills, Taylor believes it can help women to take charge of their lives: "It will move them along the path to making better choices."
Centering Pregnancy sessions are also offered at some of The Med's 10 neighborhood clinics, including the Hollywood Health Loop. Leading this group of ten women ages 16 to 31 — one accompanied by her children's father, another by her mother — is nurse practitioner Meris Marshall, who conducts a question-and-answer session. Among the questions: What should you do if you don't feel the baby move? One mother says she'll eat something sweet and that will stir up a kick or two. Marshall approves, then adds, "Don't overdo sugar or caffeine, but some is helpful."
The group plays charades, acting out different ways to help the mothers relax, from drinking hot tea or listening to music, to praying, resting, and even crying. One participant turns his back and moves his hands sensually along his sides. "Making love," guesses one woman. And another shouts, "Sex! Whoo hoo!" and shoves her fist in the air.
It's too early to tell what effects Centering Pregnancy is having on local infant mortality rates, but UT researchers are compiling and studying the data. One national study published in American College of Obstetricians and Gynecologists showed centering clients had more prenatal care knowledge, longer gestations, and higher birth rates.
"Multiple miscarriages: not always her fault."
Another new program is Community Voice, funded by a state grant and administered by the March of Dimes. In the past year it has trained lay people in a 10-hour curriculum on infant mortality.
According to program coordinator Eskededra Holmes, some participants champion a specific fact and spread the word. "For instance," she explains, " multiple miscarriages may not be the woman's fault. If a man is exposed to chemicals or other substances, that can affect his sperm."
Among the trainees are two men who ride the bus each day and have seen the same girls grow up, get pregnant, and lose babies. "These gentlemen talk to the teens," says Holmes. "They're receptive to the men because they have come to know them over the years."
Elsie Holmes (no relation to Eskedra) talks to church groups. One was composed of elderly women who first told her, "We don't need to know about infant mortality." But when she reminded them that they have children, grandkids, and young neighbors to share the information with, they changed their minds. She also talked to a group of teen boys. "We had booklets for them on the role they played in babies' health," says Holmes. "Not one boy left his book behind."
"They're buying into the idea, 'I need to do my part.'"
Dr. Linda Moses delivers babies at The Med and sees patients at the Hollywood Health Loop. One patient is 20-year-old LaPorche, who's awaiting the insertion of an intrauterine device. She had a full-term first child in October, and for now, one is enough.
As Dr. Moses strides into the room, a towering yet gentle presence, she asks LaPorche if she watched the DVD about the device she'll be inserting.
"What did you learn?"
"I won't get pregnant for five years,"
After the procedure, Dr. Moses asks about her plans:
"I'm going to college."
"Have you applied?"
"I'm taking my ACT test in April."
Dr. Moses grew up in this area, Zip code 38108, which several years ago had the highest infant mortality rate in the nation. She was bused to Kingsbury High, where she graduated in 1979. Flipping open her annual, she points to her photo, and next to it, her "future ambition": Become a medical doctor so I can help all of mankind.
After graduating from medical school and a stint in Chicago, she convinced her husband they should be living in Memphis. Here she launched the Moses Community Coalition, in partnership with other organizations, that offers a GED program in the Hollywood area, and Girl Talk, which encourages candid sexual discussions between mothers and daughters.
One-on-one with teen mothers in the clinic, she fires questions at them about AIDS and condoms, schools and careers. She also feeds them if they're hungry. She knows why she's able to motivate these girls. "I look similar to them," she says. "They think if Dr. Moses says they need to go to school, she really means it."
She applauds "the many Memphians who are trying to make a difference," but adds, "The biggest difference is in the patients themselves. They've buying in to the idea that 'I need to do my part.'"
Antionette Holman estimates that with all the programs offered by various clinics and partnerships, more women are learning what behaviors to embrace — and avoid. "But we can't have the programs for two years and move on," she emphasizes. Like poverty, "the demand is always there."
"I just want this baby to make it."
Terria Taylor has made several lifestyle changes. She says she quit the nightclub scene, doesn't smoke, and tries to eat a healthy diet, but adds, "I'm not a vegetable-type person." She realizes stress is bad for both herself and the baby, but she can't help but worry about not having a job. She recently had interviews at two clothing stores, but so far neither place has hired her. Meanwhile Terria is working on her GED at Southwest Community College. The child's father is still in trade school. "Him being here with me is good," she says. She believes that with help from her family, she'll be able to care for the child.
Terria learned a lot about babies from helping raise her siblings. "I know to lie them on their backs, not their stomachs," she says. "I know not to put pillows and stuff in the bed with them so they don't suffocate."
Her infant is due in September, the same month she lost Miracle. "I will be happy no matter what the sex is," says Terria, as her eyes fill with tears. "I just want this baby to make it. If it happens again, I really don't know what I'll do."