Over the last several years, many states have begun to look at their maternal morbidity and mortality rates and have had similar findings. In 2013, the Texas Maternal Mortality and Morbidity Task Force was created and began analyzing maternal deaths in Texas. What the task force’s second report indicates is what other states also see:
- Access to care is an issue.
- Health disparities (particularly for black women) are significant, with higher numbers of maternal deaths and morbidity associated with pregnancy. The reasons for this are not clear.
- Cardiac disease, hypertensive disorders, and hemorrhage are leading causes of maternal deaths.
- Substance abuse and behavioral health issues are contributing to overdoses, the second leading cause of maternal deaths.
What the task force has also unveiled are missed opportunities for the screening of chronic conditions—both physical and behavioral—and the need to enhance access and continuity of care, before and in between pregnancies. ACOG has consistently supported programs to enhance interconception care, including our work with the Health and Human Services Commission and its new Healthy Texas Women and Family Planning programs.
So what is being done?
For five years, the American College of Obstetricians and Gynecologists (ACOG) has worked with the National Council on Patient Safety in Women’s Health to develop protocols and checklists to help providers recognize and prepare for urgent situations like hemorrhage. The use of “massive blood transfusion” protocols has helped institutions better prepare for patients at higher risks for significant bleeding episodes and specialized centers are being developed to care for these very high risk patients.
In Texas, many organizations and state agencies have been working together to identify and address health disparities and on how to improve access to care. The state is making efforts to increase availability of long acting reversible contraception (LARC), like implants and IUDs.
While massive cuts to women’s healthcare in 2011 by the Texas Legislature hindered some advances in care, the underlying conditions for our current maternal morbidity and mortality rates were already at play. The task force’s recommended course of action includes improving the reporting and recording of maternal deaths, and increased funding needed to provide other necessary programs.
- Prolonging Medicaid services is critical. Only 40% of patients return for their “six-week postpartum” exam. Over 60% of the maternal deaths analyzed occurred more than 42 days after the delivery and most Medicaid benefits stop at 60 days.
- Mental health issues are a significant contributor to the maternal mortality rate. Texas is sorely lacking in mental health facilities and providers at all levels.
- How our state approaches care for uninsured or under-insured patients must be addressed in a more comprehensive fashion. Poor Medicaid provider reimbursement rates are a significant contributor to the lack of healthcare access.
- Eligibility requirements are another area of concern. We must be able to provide continuous care for women if we intend to lower the morbidity and mortality rates for all pregnant women.
ACOG and Me & My OBG are committed to providing the highest level of care for the women of Texas. We will continue to advocate for our patients and for the resources needed to provide the best care for our patients. This report is the first step for all Texans to better understand our plight and provides an opportunity for patients, providers, and lawmakers to work together to provide better outcomes for Texas mothers.
Dr. Moss Hampton is ACOG-District XI Chair. Dr. Hampton is the regional chair of the Department of Obstetrics and Gynecology at the Texas Tech University Health Sciences Center, Permian Basin.