By Ivey Schofield
Troaria Sampson wanted to be a mom.
But Sampson, who weighed 360 pounds and had diabetes, said her doctors in Robeson County discouraged her from pregnancy, warning that her baby could die.
In 2015, after trying for five years with her husband, Sampson got pregnant at age 27 – a milestone that should have excited her but instead filled her with guilt and dread.
“There are people like me who don’t have insurance and are being judged by their outer appearance,” said Sampson, who is Black and worked at the time as a cashier at Food Lion. “But it didn’t lessen my want to be a mother.”
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Sampson visited doctors in the early weeks of her pregnancy, but many women in Robeson County do not receive such prenatal care that health officials say is crucial for the well-being of mothers and their babies.
Robeson is not considered a maternal care desert, according to the March of Dimes, which tracks access across the country. UNC Health Southeastern in Lumberton says it delivers about 1,200 babies each year.
But Robeson ranks last among North Carolina’s 100 counties for the percentage of pregnant women who receive early prenatal care, with 53% visiting a doctor during their first trimester, according to Healthy Communities NC.
Other counties in North Carolina’s Border Belt aren’t far behind, with about 56% in Columbus County, 58% in Scotland County and 61% in Bladen County, data shows.
The state’s goal is for 80% of pregnant women to receive health care during their first trimester by 2030.
Several organizations across southeastern North Carolina, including health departments, hospitals and pregnancy centers, are trying to increase awareness and access to prenatal care. Health officials say Medicaid expansion, which the state legislature adopted in March, will help ease the financial burden for low-income women who are pregnant.
A lack of prenatal care increases the chances for labor complications, birth defects, and hypertension and postpartum hemorrhages, said Dr. Donald McKinley, an obstetrician and gynecologist at UNC Health Southeastern.
“Prenatal care is absolutely one of the most important aspects of having a healthy pregnancy,” he said. “When pregnant, the patients need to be seen as soon as possible to change medication or start medication to survive a very important developmental stage.”
Pregnant women might be hesitant to seek care for a variety of reasons, including illegal drug use, lack of health insurance, lack of transportation to appointments and previous negative experiences with doctors, experts say.
Sampson said her interactions with medical professionals added to her skepticism during her subsequent pregnancies. She now has three children.
About 12% of married Black women report facing at least one barrier to receiving prenatal care, compared to 9.8% of white women, according to a 1997 study. Black women have the highest maternal mortality rate in the United States, with 69.9 per 100,000 dying due to their pregnancy, compared to 26.6 per 100,000 white women, according to 2021 data from the Centers for Disease Control and Prevention. Data was not available for Native American women.
Sampson said she ultimately got the support she needed from Healthy Start, a program at the University of North Carolina at Pembroke that has been funded by the federal government since 1998 to reduce the infant mortality in Robeson County.
“Every appointment,” Sampson said, “they were there.”
Megan Knight, who lives in the Bladen County town of Dublin, said early prenatal care changed her experience. She had complications during her first two pregnancies. When she got pregnant for a third time, she saw a doctor who told her she had a defect with MTHFR, a gene that tells the body to metabolize folic acid.
Knight said she started taking blood thinners and didn’t experience any complications during her third and fourth pregnancies.
“Complications occur because we’re afraid, we don’t seek help or we say, ‘I can’t get a ride, I don’t want to tell my mom or my boyfriend I’m pregnant,’” Knight said. “And that creates risk. But those risks can be easily eliminated.”
Knight, who recently opened a pro-life pregnancy center called Mercy House in Elizabethtown, wants to help pregnant women in Bladen County access prenatal care.
Bladen County is considered a maternal care desert, where there is no hospital or birth center that offers obstetric care and there are no obstetric providers, according to a recent report by March of Dimes.
Mercy House offers free medical-grade pregnancy tests, online pregnancy and parenting classes, diapers, clothes and emotional support.
“I know that when women are in crisis, their immediate response is I need to get rid of this,” Knight said. “And we want them to know they’re not without hope, they can do this and there are resources.”
Janet McPherson, who oversees Living Hope, a Christian-based pregnancy center in Columbus County, said many pregnant women don’t know about local resources.
“There’s not any one place you can go and say, ‘If you’re pregnant, this is what’s available,’” she said. “This is a real problem. There is no coordination among ministries and groups.”
Pregnant women should contact their county health department to find if they qualify for Medicaid and WIC, a nutrition program for mothers and young children, said Carlotta Rivers, maternal health coordinator at the Scotland County Health Department. Parenting and breastfeeding classes are also available.
Women with high-risk pregnancies due to substance misuse, domestic violence, homelessness or other factors can qualify for pregnancy care case management that includes monthly check-ins from social workers, said Barbie Britt, nurse supervisor at the Robeson County Health Department.
“We try to do as much as we can here,” Britt said.
Coastal Horizons, a Wilmington-based nonprofit with a pregnancy and postpartum office in Whiteville, offers specialized help for pregnant women struggling with addiction, program coordinator Gayle Beese said.
The office communicates with local medical providers to make sure patients go to their prenatal appointments and provides transportation when necessary. It also offers Suboxone, which Beese said is safe to take during pregnancy and breastfeeding.
Beese said shame often prevents pregnant women who struggle with addiction from getting prenatal care early in their pregnancy. They worry they’ll be judged by their medical provider or their baby will get taken away by the Department of Social Services.
“Recovery doesn’t get easier just because you have a baby,” Beese said. “They deserve care too.”
In Robeson County, UNC Health Southeastern has a doctor who specializes in pregnant women struggling with addiction.
One in every four pregnant patients at the hospital, which has several satellite offices across the county, has been diagnosed with an opioid use disorder, McKinley said.
Healthy Start helps connect women in Robeson County with resources across the region and provides transportation, said Erica Little, the program coordinator.
In 2019, when Sampson’s child stopped breathing and needed to be induced, a Healthy Start worker drove her to the hospital. In 2021, when Sampson got pregnant with her third child, the program connected her with a provider who prescribed anxiety medication.
“Even though I’m saying our county has a biased way of looking at people, Healthy Start is in our community,” Sampson said. “They do not treat you with the same bias our community has. They’re trying to overcome the bias in our county.”
Because of her experience with Healthy Start, Sampson has become an advocate for pregnant women.
Sampson said a pregnant 17-year-old came to her after being disowned by her mother and kicked out of her church choir. Sampson helped the girl get a job at a local boutique, where she became employee of the month. Since then, the girl has gotten engaged and found a new job.
“I was so proud of her,” Sampson said.
Sampson also encourages her sixth-grade students at Deep Branch Elementary School and her youth group at Deep Branch Missionary Baptist Church to talk about sex education. She carries around a few brochures about the free services at Healthy Start, just in case.
“Never let guilt and shame prevent you from getting the health care you need,” Sampson said.