Charles Johnson walked into a California hospital expecting joy – hours later, his wife, Kira, was gone after preventable delays and inaction. Charles shares how that devastating loss sparked the creation of 4Kira4Moms, a nonprofit dedicated to improving maternal health outcomes, advancing policy reform and supporting families impacted by maternal mortality. The U.S. is facing a maternal health crisis, with Black women most at risk. 4Kira4Moms works to close these gaps and make childbirth safe, empowering and free of fear for every mother.
Guest: Charles Johnson IV, Founder and President, 4Kira4Moms
Host/Producer: Carol Vassar
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast, produced by Nemours Children’s Health. Subscribe on any platform at Nemourswellbeyond.org, or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week, we’ll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you are here, let’s go.
The US is facing a maternal health crisis. According to the CDC, the maternal mortality rate in 2023 stood at 18.6 deaths per 100,000 live births. While that marks a decline from the pandemic years, it remains one of the highest rates among the world’s wealthiest and best-resourced nations.
Behind each maternal death is a family and a community forever changed, underscoring the urgent need for systemic change, better access to care, and stronger support for maternal health nationwide, and no one knows this better than Charles Johnson, founder and president of 4Kira4Moms.
In 2016, he and his pregnant wife, Kira, entered the hospital for the birth of their second child. Charles left that hospital with his healthy infant son, Langston, but without Kira. This is their story, and for Charles, it’s about grief, community, single fatherhood, and the emergence of a tireless advocate for improved maternal health for anyone giving birth in the US, all in the name of the woman he loves. Here’s Charles Johnson.
Charles Johnson IV, Founder/President, 4Kira4Moms:
I often say that I didn’t choose this work; this work chose me, unfortunately. And so my journey on an advocacy kind of started out of the absolute worst day of my life. I was fortunate enough to meet a woman that absolutely changed my life, and I know you’ve probably heard me say that time to time again. And so when we talk about my wife, Kira, we’re talking about a woman that raced cars and had her pilot’s license and was a skydiver, ran marathons, and we just planned to have this beautiful full life raising these two boys, and unfortunately, she was taken from us.
We went into the hospital on April 12th, 2016, what we thought would be the happiest day of our lives, and walked straight into a nightmare. I know that you have a lot of clinicians and people that are familiar with medicine that are part of your audience, and so it’s important for me to say that throughout Kira’s entire pregnancy, she wasn’t just in good healthcare, she was in great health, and all signs pointed to both her and our new baby being extremely healthy.
As we went over, it was supposed to be a routine cesarean section. Langston, our new baby, was born perfectly healthy. And shortly after that, she’s back in recovery. As she’s there resting, I noticed blood in her catheter. This is around four o’clock in the afternoon. I bring it to the attention of the doctors and the nurses. They come in, they order a series of tests, they examine her physically, they order blood work, but importantly, they also order a CT scan that’s supposed to be performed STAT.
And so STAT, what does that mean, right? Immediately. So at this point, I’m concerned, but I’m thinking my wife is healthy, and at what’s supposed to be a great hospital. Her blood work came back. It was showing that all her blood levels were low. She’s sensitive to the touch, and so very early on, there were significant signs that she was hemorrhaging significantly internally,
This is at four o’clock, five o’clock comes, still no CT scan, right? And I’m asking, where does the CT scan? They’re saying, sir, it’s coming at six o’clock, no CT scan, still begging. I’m like, “Hey, what’s going on, guys?” They’re saying, “Oh, sir, it’s coming at seven o’clock now.” By seven o’clock, she’s shivering uncontrollably, and she’s complaining of intense pain in her abdomen; still no CT scan. I keep more adamant and I’m saying, “Hey, what’s going on?” And they begin to say, “Well, maybe we’ll take her back to surgery.”
And this game of denial and dismissal just continued to spiral and escalate. Eight o’clock, no CT scan. Nine o’clock, and now nine o’clock comes, she’s still there. The only thing they’ve done to this time, up to this point, Carol is given her IV fluids. And around nine o’clock, a nurse came in to change her fluids, and I walked outside the room and I pulled her to the side.
I said, “Look, my wife isn’t doing well. They said they would take her for a CT scan. Nobody’s come. They said that they might take her back for surgery. They’re not doing anything.” And I just grabbed this woman by both of her hands. I looked her deep in her eyes and said, “Please, can you just help us?” At which point she said back to me words that I was still, still [inaudible 00:04:32]. She said, “Sir, your wife just isn’t a priority right now. Your wife just isn’t a priority.”
So, eight o’clock, nine o’clock, 12 o’clock, it wasn’t until after midnight that they finally took her back for surgery. Keep in mind, we went in for Langston’s delivery at 2:00 PM that afternoon. So she’s been allowed to bleed and suffer needlessly for more than 10 hours.
When they took Kira back to surgery and they opened her up, there were three liters of blood in her abdomen, from where she’d been allowed to suffer needlessly for all those hours, and her heart stopped immediately. They worked on it for some time, but they were unable to save her. And so when my wife, when those double doors closed to that operating room, that was the last time I saw my wife alive.
And so I’ve always been transparent about the fact because I eat, sleep, and breathe this now, but I’m always transparent about the fact that when I walked into that hospital that afternoon, the thought that my wife would not walk out to raise our sons. It never crossed my mind. I thought that this was going to be a walk in the park. My wife is healthy. We have great insurance. I thought that I had done everything right. I went on every visit. I never missed a prenatal visit for either one of my sons. And still, it wasn’t enough. It wasn’t enough to ensure that she walked out to live the full, healthy life that she deserved.
It wasn’t enough to ensure that my sons got to be raised by the most amazing mother in the world. When this happened, I honestly thought that what happened was an anomaly. I thought that this is a freak occurrence. This doesn’t happen to women in 2016 who are healthy, who have access to good care. But as the days went by and the days turned into weeks and weeks turned into months, I began to hear these other stories and these other whisperings of other women who had had horrific birthing experiences and other women who had experienced obstetric violence, and then other stories of mothers that had made that ultimate sacrifice just trying to give the gift of life.
And at first, I thought this was honestly just people’s way of trying to support me in my grief, just sharing the stories. But the more I listened, the more I was like, hold on. Something’s not right. And that’s when I began to do the research for myself, and I came to understand what you and a lot of people are, I hope in your audience understand, is that we are in the midst of an internal mortality crisis right in the United States. And that the reality is the very harsh reality is that the United States is the most dangerous place in the industrialized world to give birth.
And what’s even more troubling is that when we take a look at the racial disparities within that, Black mothers are dying four times as often as Caucasian mothers. And so I didn’t know what to do. I didn’t know how I could be impactful, but I felt like I had to do something. And so that’s what’s brought me to this place in this space.
Carol Vassar, podcast host/producer:
Well, Charles, first and foremost, I’m so sorry. It sounds like Kira was a wonderful woman.
Charles Johnson IV, Founder/President, 4Kira4Moms:
Absolutely.
Carol Vassar, podcast host/producer:
And I can see the hurt in your eyes, and I’m starting to tear up. Thankfully, I have glasses on. Nobody can see me, but how did you start to process that grief, especially since you had an infant and a one or two-year-old at that point?
Charles Johnson IV, Founder/President, 4Kira4Moms:
Yeah, two kids under, two boys under, two babies under two. And I’m always transferring, honestly, my kids saved my life, right? Because there were so many things that I was uncertain about, that I was confused about, that I had heard about. But the one thing I was clear about was the type of life that Kira expected her boys to have.
And so, really my first thing was just really just pouring myself into caring for them, even probably to a fault. My family had to have an intervention with me because I literally wouldn’t let anybody else help, because of how I was processing my grief, that this is what Kira would want me to do. It was my way of perpetually keeping up with every feeding, every bottle, every diaper change. That was my way of keeping my mind occupied.
Carol Vassar, podcast host/producer:
Yeah, that’s hard when you have two little ones.
Charles Johnson IV, Founder/President, 4Kira4Moms:
It is. It is. It is. But it was better than the alternative, which is being left with some very, very, very dark thoughts. And so, my boys really are very much the catalyst for this work because, as I began to learn about this there were two things…there were a couple of things I was struck by, Carol. It was one, how is this happening? Two, how is it that not everybody is outraged about this? There were people that were doing stuff, but there were a lot of people that were working very hard, but this was still very much in 2016, one of America’s dirty little secrets.
I didn’t know what I could do. I didn’t know how I could be impactful, but I felt like I owed it to Kira, and I felt like I owed it to my boys to try and do something. And not only to seek accountability for injustice for Kira, but to do whatever I could to make sure that this never happens to any other family.
Carol Vassar, podcast host/producer:
At what point in your grieving, in your mourning, which I’m guessing continues to this day, did you decide that you wanted to speak out, to be public about this, and to pursue advocacy as part of your life?
Charles Johnson IV, Founder/President, 4Kira4Moms:
Yeah, so I really struggled with it, but I shared Kira’s story the first time publicly, the Friday before Mother’s Day in 2017. So, a little bit over a year after she passed away. She passed away April 12th.
So I made the decision to share her story publicly, not knowing what to expect and not knowing what to expect, not knowing how it would be received. But my hope was that if I helped to raise awareness just a little bit, that would do something, that somebody might be aware. It may cause somebody to approach their childbirth journey differently. It may cause somebody to take an action or to be aware that this was even a problem. Not knowing, and I really honestly just really, I’m being as transparent as possible. I really thought naively that I would share the story and I would go back to being a soccer dad in obscurity.
We were very private people. We didn’t really have social media. Not knowing that Kira’s story, along with the stories of hundreds of other mothers, would become the catalyst for what I call the maternal health revolution, and really just be a real critical part of what I believe is sweeping change across the country.
Carol Vassar, podcast host/producer:
From 2016/2017 to today. You’ve become this very public, national advocate. Lay out the issue. You did a little bit at the start, but lay out the issue from your perspective, and maybe some of the key systemic issues in healthcare that we’re facing that need to change so that we can improve these outcomes.
Charles Johnson IV, Founder/President, 4Kira4Moms:
I love the way you set that question up. So let’s eat this elephant this way, right?
Carol Vassar, podcast host/producer:
Okay.
Charles Johnson IV, Founder/President, 4Kira4Moms:
So this is a huge problem, and it’s a complex issue, and it’s going to take a complex set of solutions.
So we talk about maternal healthcare across the board. How I anchor the conversation is twofold. It is one, our healthcare system. It’s about greed. And fundamentally, it is profits over patients. And so when we look at birthing in the United States, there has been a gross industrialization of birthing, right, movement away from midwifery movement, away from dual care, which is what was the backbone of our society for centuries, towards medicalized, hospitalized birth.
What has happened is that hospitals are incentivizing or prioritizing interventions that go they’re contrary what the human body does naturally. Now, with that being said, before people come at me and attack me for this, I’m very clear that some interventions, we talk about interventions, we talk about Cesareans, we talk about pitocin, and we talk about episiotomy, right?
Sometimes they’re necessary, and I’m all for them if they’re necessary and in the best interest of the mother and/or the child. But what we are seeing is that if you take a look here at the explosion in cesarean rates over the past 40 years, and you put that graph right next to the maternal mortality rate, they’re almost identical.
And so what has happened is, and this is just one issue, is that these interventions oftentimes lead to a domino effect of complications. But we have to go back to what’s initiating the interventions because ultimately, all those interventions become a line item on your bill. So with the cesarean birth in the United States, a doctor, a hospital system can birth a baby in a fraction of the time and oftentimes charge a family up to four times as much. So they’re turning over beds quicker, and with a much higher profit margin, with less time.
So that’s one. The other thing that we’ve seen is fundamentally what I call the Great American Compassion Deficit is there is an inability of providers to be able to connect with families and see them and prioritize them and care for them in the way that they would their sister, their mother, their uncles. Some part of that is systemic because there’re quotas and a lot of things that the system is designed for there not to be the optimal patient-doctor relationship. They may not just have the time.
But then some of those are things that we have to address and have real grown-up conversations about bias and racism that are contributing to these. I want to be clear, we talk aboutthe maternal mortality crisis. It is something that is affecting all families, all birthing people, from all walks of life. With that being said, we can’t have a substantial conversation about it without discussing the manner in which it is disproportionately affecting Black women and women of color.
And the reality of this situation is, people would lead you to believe that Black women are dying because there is something inherently wrong with them because they’re Black. And the reality of the situation is that race is not a biological condition. It’s a social construct.
And when we look at it and we peel back the layers, it would also lead you to believe there’s a narrative that the women are losing them because they don’t have access to quality care, they are under-resourced, may have complications.
But what we’re finding is that a large majority of the women of color that we’re losing defy all of those narratives. And in fact, there are studies that show that African-American women with graduate and postgraduate degrees are dying at rates higher than white women living below the poverty line. Right?
Carol Vassar, podcast host/producer:
That’s shocking.
Charles Johnson IV, Founder/President, 4Kira4Moms:
Additionally, yeah. And additionally, there is research done by Dr. Wendy Post, who’s at Georgetown, and what she found is that the average household income of Black women suffering from maternal mortality and extreme morbidity is $123,000 a year. So these are women that are having access to care, and when they’re showing up to these birthing experiences, the greatest risk factor is not their race, it’s racism. And so we have to work towards addressing these issues.
Carol Vassar, podcast host/producer:
What is the best approach? You talked about the elephant and taking the elephant one bite at a time. Where’s the best place to take a bite so that we can get at this really huge issue?
Charles Johnson IV, Founder/President, 4Kira4Moms:
Another wonderful question. So I think that this is something that everybody can learn from this, right? Can take their bite of the elephant, right?
One, if we’re talking about advocacy, I know we’re probably going to have a more substantive conversation about this. We’re talking about legislation. In all 50 states, there are currently statewide pieces of legislation to improve maternal health outcomes, right?
On the federal level, there are several bills, including the Black Maternal Health Momnibus, the Dads Matter Act, as well as Paid Leave for All, that we feel will grossly and dramatically improve maternal health outcomes. So that’s the first step that anybody can take, regardless of who you are. You have kids, you don’t have kids, but everybody has a mom, right? There’s only two types of people. Either you are a mama or you got one. That’s it. It’s simple.
And so you can simply go to our website 4kira4moms.com, or to the Black Maternal Health Caucus website, and take 30 seconds to sign the petition demanding that your representative support legislation.
Please do the same thing on the state level. It’s about information. It’s about empowering families with the information on how to make informed decisions about their choices and options available to them. So that’s one of the things that we do a lot at 4Kira4Moms, it’s empowering families with information.
What’s the difference between a doula, a midwife, and an OB? What are the pros, cons, and associated risk factors with both? Let me be clear once again. I feel that every birthing person in this country, and I’m very intentional about using an inclusive language, deserves the safe, birthing, dignified experience of their choice. If you want to have a baby at home in your living room, and you’re not high risk, surrounded by all your family members, you should have that. If you want to have it assisted by a midwife, you should have that.
If you want to have an OBGYN, you want every modern day, you want to be hooked up to all the modernities, you want to press the button when you feel pain, you should be able to have that. And very importantly, if you want to have an integrated model where you have your doula with your OB, you should be able to have that, and it should be paid for, right?
There is a lot of tribalism in birthing and birth work. I don’t get caught up in that. My job is to make sure that families have access to their best options that they feel are for them, and that those options are safe and respectful.
Carol Vassar, podcast host/producer:
I want to talk about dads. I just want to kind of call out dads. You’re a dad, you’re a single dad raising two young men. What do dads need to know? I mean, it seems like you were very confident going in, you’d already had a successful birth, you were anticipating a second successful birth. What would you like to have known going in, so that you could be informed, could be present, and be an active partner, to make sure that outcomes are what they should be?
Charles Johnson IV, Founder/President, 4Kira4Moms:
Absolutely. I cannot speak enough about the importance of the role of fathers, dads, and non-birthing parents, right? Access to doula care is amazing. Addressing institutional racism is amazing. Reforming care and payment models, and all these things that we’re working on, are amazing.
But a huge part of our theory of change, Carol, is that if we can empower fathers with the tools and resources they need to be active advocates in support systems, we feel that this will go a huge way to drastically improving maternal health outcomes quickly, right? Dads need to understand what questions to ask. Dads need to understand their options. Dads need to even start with their own health and how that can inform the health of a child. Dads need to understand warning signs, right? Both pre- and post-conception warning signs, right?
What does it mean if she’s having severe headaches or her feet are swelling? How can I look out and see what might be preeclampsia? How can I recognize signs of postpartum distress, and very importantly, postpartum depression? And if that happens, how do I support her in the best way possible?
So we’ve developed, and as actually as the shirt says, we’ve launched an amazing program that I’m really proud of, called 4Kira4Dads, that just it’s a first-of-its-kind curriculum, completely free, for dads to be able to plug in and have a place where they can get information on every aspect of their pregnancy journey. Not her, but their pregnancy journey.
Understanding the importance of partnership, understanding how your presence can do so many things. Not only it can improve the entire pregnancy, it can improve, it can reduce instances of preterm labor, NICU days, complications, postpartum depression, and so we’re really, really proud of that. And so people can find out more information by going to 4Kira4Dads.com. And so we really feel that by empowering fathers with the tools and resources they need to pick up part of that load and do it in a way, as an ally, as a support system. We really feel that that’s going to be a dramatic improvement. I really hope that this is why we adopted is Lamaze.
Carol Vassar, podcast host/producer:
I want to widen that lens, though, dads obviously have a very, or non-birthing partners, have a very special relationship with the birthing partner, with the mom. Let’s widen that lens to grandparents, other family members, and the community at large.
Charles Johnson IV, Founder/President, 4Kira4Moms:
Yes, absolutely.
Carol Vassar, podcast host/producer:
What can they do to be supportive during the pregnancy, to make certain that the outcome is as it should be?
Charles Johnson IV, Founder/President, 4Kira4Moms:
I want to stay here forever. You asked the best question. So we talk about it takes a village to a child. That’s absolutely true, but it also takes a village to bring a baby into this world. And so the more rich that community is, the better off I feel that, the better chance there is to have a wonderful birthing experience. So I think that also to the extent that the family can understand as much as they can, because everybody’s family dynamics are different.
So sometimes that grandparent may be that point person. They’re going to appointments in the birthing room, understanding, if they’re not understanding, how they can support, how they can step in, do things like laundry, take care of meals, ask questions about the wellbeing, check for signs, understanding what the options are, understanding the rights of the patient and the family at the hospital.
These are all things that the community and the support system, not only support, making sure that you can take some of the load off, but also making sure that they’re informed about the rights, the decisions that the family has made, and what their expectations are for their birthing process.
Carol Vassar, podcast host/producer:
How are your boys and you doing today?
Charles Johnson IV, Founder/President, 4Kira4Moms:
Honestly, we’re doing good. We’re doing really well. There’s never a dull moment. Before we hopped on, I was sharing that we just had Langston’s ninth birthday, and of course, those birthdays and those milestones, just being transparent, are always bittersweet. Because, as beautiful as they are, we always, as my mom likes to say, it’s always the empty seat at the table.
And so we try and do everything. We do what I call Kira style, right? We celebrate with joy. We laugh, but I’m just very, very, very fortunate. I tell men or anybody that is listening who’s considering choosing a partner, choose wisely because they have all the best parts of their mom. They’re smart, they’re funny, they’re good at everything they do. They have a spirit of adventure. They love to travel, see new places, meet new people. And they’re just amazing kids, man. And they keep me on my toes, and so I’m really enjoying every moment of it.
There’s definitely a lot of things about my life that I wish had turned out differently, but the two things that are in my control that I really just try and pour myself into are this work and my boys. So they’re doing wonderful, and I appreciate you asking.
Carol Vassar, podcast host/producer:
It sounds like Kira would be very pleased with the path that your-
Charles Johnson IV, Founder/President, 4Kira4Moms:
I hope so.
Carol Vassar, podcast host/producer:
… Your life has taken. What do you think about that? What would Kira say about what you’re doing now and how her boys are doing?
Charles Johnson IV, Founder/President, 4Kira4Moms:
Yeah. I think that she is just tickled, man. I can’t help, but when they say certain things or do certain things, I can’t think about just how much she would enjoy and just how amazed she would be with them. Succinctly, as far as the work and stuff, when I’m asked about what Kira’s perspective is, I kind of sum it up this way. Kira would say something to me. It was just simple. Whenever she was proud of something that I was doing or accomplished, or I had a big win, and she would just say, “Go, baby, go.” And I think that that’s what she would say.
Carol Vassar, podcast host/producer:
Go, baby, go. I wish we didn’t have to go, but we’re going to finish up here on that note. Charles Johnson for Kira for Moms, this has been fabulous. Thank you for being here.
Charles Johnson IV, Founder/President, 4Kira4Moms:
It is my absolute honor. Thank you. And when we get this under control, I’m looking forward to coming back and talking about this some more.
Music:
Well Beyond Medicine.
Carol Vassar, podcast host/producer:
What an amazing story. What an amazing family. Again, thank you, Charles, for being so vulnerable and sharing your story with our podcast family. And to our podcast family., Thank you for listening.
If it happens outside the doctor’s office and it affects a child’s health and well-being, it’s a story we want to tell here on the Well Beyond Medicine Podcast.
You can contact us about story ideas in a couple of ways. You can email [email protected] and give a rundown of your idea, plus your contact info, or leave the same information on a voicemail on our website, Nemourswellbeyond.org.
That’s Podcast Central for us, so please take advantage of it to subscribe to the podcast and to our e-newsletter and leave a review. That’s Nemourswellbeyond.org.
You can also subscribe to the podcast on your favorite podcast app and on the Nemours YouTube channel.
Thanks so much to our production team for this episode: Cheryl Munn, Susan Masucci, Lauren Tata, and Alex Wall. Video production by Britt Moore, audio production by Steve Savino, and yours truly.
Join us next time as the podcast team travels to Citizens Bank Park, home of the Philadelphia Phillies, for Childhood Cancer Awareness Night. I’m Carol Vassar. Until then, remember, we can change children’s health for good. Well Beyond Medicine.
