I didn't know what was normal. I didn't know who to ask.
In Arkansas, the distance between policy progress and lived experience remains a quiet crisis — one measured not only in statistics but in the stories of mothers who left hospitals without their babies, who couldn't sleep for fear, who were dismissed until their bodies gave way. Dr. Nirvana Manning, an OB-GYN and mother at UAMS, is asking her state to close that distance by building systems worthy of the courage it takes to give birth there. Arkansas has begun to move — ranking fifth nationally for low severe maternal morbidity and passing meaningful legislation — but the question now is whether momentum can be transformed into a promise kept to every mother, regardless of zip code or insurance status.
- Mothers took the stage at a Little Rock theater and named what data alone cannot: the nurse who stayed, the doula who broke through fear, the family member who insisted on the hospital — and the systems that made those interventions necessary in the first place.
- Arkansas still struggles with maternal mortality and early prenatal access, and the postpartum period — when risk peaks and support fragments — remains the most dangerous gap in the continuum of care.
- UAMS's Proactive Postpartum Call Center has reached nearly 2,000 mothers statewide, offering check-ins, Medicaid navigation, and connection to resources that women repeatedly said they didn't know existed.
- Legislative wins like the Healthy Moms, Healthy Babies Act and doula reimbursement mark real progress, but mothers don't experience legislation — they experience a phone call answered or a concern dismissed.
- Extending Medicaid to twelve months postpartum, expanding rural care, and deepening community partnerships could move Arkansas from cautious progress to national leadership — if the political will holds.
A few weeks ago, six women stood on a stage in Little Rock and told the stories that had made them who they are as mothers. One left the hospital without her baby. Another described postpartum anxiety so severe that sleep became something to fear. Others spoke of being dismissed — repeatedly — until their bodies were in crisis. What connected every story was a pattern: systems that failed, and individuals who finally listened when it mattered most.
Those stories followed Dr. Nirvana Manning home. As chair of obstetrics and gynecology at UAMS and a mother herself, she returned to a single question: how does Arkansas build a future where these stories become rare?
The 2025 March of Dimes Report Card offers a complicated answer. The state still struggles with maternal mortality and access to early prenatal care — but it now ranks fifth nationally for low rates of severe maternal morbidity, and mortality has improved compared to the previous period. That progress is the result of two years of deliberate effort by physicians, doulas, midwives, and advocates pushing for change together.
The Healthy Moms, Healthy Babies Act expanded telehealth and Medicaid eligibility. Arkansas now certifies and reimburses doulas. These are meaningful shifts. But as the mothers at The Rep made clear, a woman does not experience legislation — she experiences a prenatal visit, a labor room, a question answered or left unanswered.
That gap is why Manning's team built the Proactive Postpartum Call Center, which has now reached nearly 2,000 mothers across the state. UAMS nurses call to check on physical and emotional well-being, help with Medicaid re-enrollment, and connect families to lactation support, safe sleep guidance, and housing resources. The center exists because mothers kept saying the same thing: they didn't know what was normal, didn't know who to ask, didn't know help was available.
The work is far from finished. Extending Medicaid coverage to twelve months postpartum, strengthening rural maternity care, expanding home-visiting and doula programs, and addressing chronic conditions early in pregnancy could prevent crises before they take hold. The Transforming Maternal Health grant offers a rare opening to build something new — rooted in prevention, early intervention, and community trust.
Arkansas does not have to accept its current standing. The stories told on that stage revealed both the urgency and the possibility of something different. The question is whether the state will answer it: What if every mother felt heard the first time she raised a concern? What if the next generation of mothers told a different story entirely?
Six women stood on the stage at Arkansas Repertory Theatre a few weeks ago and told the stories that had shaped their lives as mothers. One carried the weight of leaving the hospital without her baby. Another described postpartum anxiety so severe that sleep itself became terrifying. Others spoke of having their concerns dismissed—sometimes repeatedly—until their bodies were in crisis. What held these stories together, beyond the courage it took to speak them aloud, was a pattern: systems that failed them, and the people who finally listened when it mattered most. A nurse who stayed at a bedside. A family member who insisted on the hospital. A doula whose presence broke through fear.
Those stories have stayed with Dr. Nirvana Manning, chair of obstetrics and gynecology at the University of Arkansas for Medical Sciences, not just as a physician but as a mother herself. The question that followed her home was direct: How can Arkansas build a future where these stories become rare instead of routine?
The numbers suggest the state has work to do. The 2025 March of Dimes Report Card documents that Arkansas still struggles with maternal mortality and access to early prenatal care. Yet the same report also shows progress that deserves recognition. Arkansas now ranks fifth in the nation for low rates of severe maternal morbidity—a measure of serious complications during pregnancy and birth. Maternal mortality itself has improved compared to the previous period. That improvement is the result of deliberate effort: physicians, hospital systems, doulas, midwives, and advocates across the state have spent two years pushing for change, and the results are beginning to show.
The Healthy Moms, Healthy Babies Act expanded telehealth access and introduced presumptive eligibility for Medicaid coverage. The state now certifies and reimburses doulas. These are significant shifts toward a more equitable system. But as the mothers at The Rep made clear, policy alone does not translate into lived experience. A mother does not experience legislation. She experiences a prenatal visit, a labor room, a phone call, a question answered or left hanging.
That gap is why Manning's team at the Arkansas Center for Women and Infants' Health has focused intensely on the postpartum period—the weeks and months when risk is highest and support is most fragmented. Through the Proactive Postpartum Call Center, UAMS nurses have called nearly 2,000 mothers across the state to check on their physical and emotional well-being, help them navigate Medicaid re-enrollment, and connect them with resources for lactation support, safe sleep, and housing stability. The center has also distributed postpartum alert bracelets and supply kits and launched partnerships with hospitals statewide. These programs exist because mothers kept saying the same thing: "I didn't know what was normal. I didn't know who to ask. I didn't know help was available."
But the work is incomplete. Extending Medicaid coverage to twelve months postpartum would transform the lives of thousands of Arkansas women. Strengthening rural maternity care, expanding home-visiting and doula programs, and addressing chronic conditions early in pregnancy would prevent crises before they take hold. The state must continue listening to mothers, particularly women of color, and to providers and families in rural areas where the gaps are widest.
The Transforming Maternal Health grant and other recent investments offer an unprecedented opportunity to build a new model rooted in prevention, early intervention, and community partnership. Arkansas does not have to accept its current rankings. The stories told at The Rep revealed both the urgency and the possibility of something different. The question now is whether the state will seize it: What if every mother felt heard the first time she raised a concern? What if every family—rural or urban, insured or uninsured—had the support they needed from pregnancy through the first year of life? What if the next generation of mothers told a different story entirely?
Notable Quotes
Too many mothers told us the same thing: 'I didn't know what was normal. I didn't know who to ask. I didn't know help was available.'— Dr. Nirvana Manning, chair of obstetrics and gynecology at UAMS
The Hearth Conversation Another angle on the story
You heard six mothers tell their stories. What was the single thread that ran through all of them?
The feeling of being alone at the moment they needed someone most. One woman didn't know what was normal. Another had legitimate concerns dismissed. What struck me was that survival often came down to one person who refused to look away—a nurse, a family member, a doula. The system didn't save them. A person did.
Arkansas ranks fifth in the nation for low severe maternal morbidity. That sounds like success. Why does it feel incomplete?
Because ranking fifth means four states are doing better, and more importantly, because those statistics measure only one thing—severe complications. They don't measure the mothers who felt unheard, or the ones who didn't know help existed. The numbers don't capture the lived experience of uncertainty.
You mention the postpartum period as the critical gap. Why is that moment so fragile?
Because a mother is physically and emotionally vulnerable, her body is changing in ways she may not understand, and the medical system largely steps back. She's supposed to know what's normal. She's supposed to know who to call. But many don't. That's when postpartum anxiety takes hold, when untreated infections become dangerous, when isolation deepens.
The Proactive Postpartum Call Center has reached nearly 2,000 mothers. What does a call actually do?
It says: someone is checking on you. It connects her to resources she didn't know existed. It gives her permission to ask questions. It's not a cure, but it's presence. And presence, as the mothers on stage showed us, can be the difference between crisis and care.
You're calling for twelve-month Medicaid coverage postpartum. Why that specific change?
Because coverage ends at sixty days now, right when a mother is still vulnerable and when chronic conditions—diabetes, hypertension—are emerging. If we catch those early, we prevent emergencies. If we abandon her at sixty days, we guarantee some will fail.
What would it mean if Arkansas actually became the safest place in the country to have a baby?
It would mean that a mother's zip code, her insurance status, her race—none of it would determine whether she lived or died, whether she felt supported or abandoned. It would mean the stories we heard at The Rep would become historical, not current.