Shawn Thierry can’t recall the moment she gave birth, but she does remember how she almost died.
Her medical team had just administered an epidural to numb her body for a cesarean section. But it didn’t work like it was supposed to, Thierry said. She could still feel her legs. Suddenly, it felt as if the anesthesia was traveling to her heart. She couldn’t breathe.
“I told them, I said, ‘I don’t think I’m going to be able to hold on much longer,’” she said. “‘Please, just put me under.’”
The medical team rushed to put Thierry under general anesthesia. They performed a C-section to deliver the baby girl, who Thierry planned to name Klaire. It wasn’t until after the birth that a nurse told the first-time mother that she’d experienced a life-threatening complication from the epidural that can paralyze the diaphragm, leaving patients unable to breathe.
“Here I am as a lawyer with private health care,’” she said. “As a woman of color, I thought to myself, ‘If I’m experiencing this, I can’t imagine the thousands and thousands of other women who are having even worse outcomes.’”
Eight years later, Thierry, a Democratic state representative from Houston, is fighting to improve care for mothers. She is among several lawmakers who are pushing this year to make maternal health a priority amid an uphill battle to balance a $1 billion budget deficit and mend cracks in the state’s economy that were widened by the coronavirus pandemic.
Their push comes after the federal government last month pledged to make the U.S. one of the safest countries in the world for women to give birth. Today, women in the U.S. are more likely to die from childbirth or pregnancy-related causes than those in other developed countries. The situation is the most dire for women of color: Black and Native American women are two and three times more likely to die of pregnancy-related complications than white women, according to federal data.
“Calls to action by the United States Surgeon General are a rare step, reserved for the most serious public health crises facing all Americans,” wrote Alex Azar, the Health and Human Services secretary. “Maternal morbidity and mortality is a crisis, and has been for far too long.”
‘A life or death situation’
Women in the U.S. today are 50 percent more likely to die in childbirth than their mothers were. Yet up to two-thirds of their deaths are preventable, research shows.
To stop women from dying, the federal government says states need to address widespread problems, including: racial disparities; access to care in rural areas; gaps in health insurance coverage; variation in medical practices; and the availability of current and accurate data.
More than 150 counties — home to more than 2 million Texans — have no OB-GYN, a situation largely driven by rural hospital closures and physician shortages.
“This really shouldn’t be a Democrat versus Republican issue because if you are pro-life, then it’s all the more important,” Thierry said. “No woman, in order to bring life into the world, should have to die or sacrifice her own.”
Another proposal would require medical professionals to undergo continuing education to address cultural and racial bias, aimed at improving care for women of color. Thierry also introduced a bill that would require Medicaid to cover services from doulas — trained professionals who support women before, during and after childbirth.
In Texas, a growing number of women are hiring doulas, whose presence is associated with shortened labors, fewer C-sections and decreased need for pain medication, to serve as advocates in the delivery room. The need is especially pronounced for women of color, Thierry said: “If you don’t have someone that’s really willing to listen to you, I witnessed the fact that it can become a life or death situation.”
Preventing unnecessary C-sections
Today, the U.S. has one of the highest rates of cesareans in the world. The surgeries save mothers’ and babies’ lives when things go wrong but carry increased risks of infections, blood loss, hysterectomies and complications in future pregnancies.
Medical experts warn some doctors are overusing the invasive surgery. Across the U.S., 25.9 percent of first-time mothers with uncomplicated deliveries undergo C-sections. The federal government wants to drop that to 19.4 percent.
The Express-News recently analyzed C-section rates at Texas hospitals and found that rates of mothers’ first C-sections, even if their deliveries were considered uncomplicated, ranged from 2 percent to 31 percent — a 15-fold variation.
The newspaper’s investigation focused on one Laredo hospital with the state’s highest rate in 2019, where the hospital’s overburdened doctors may have used the surgeries in part to keep up with high patient volumes and manage hectic schedules.
“It’s something that an individual hospital really can work to address,” said Dr. Lisa Hollier, chair of the Texas Maternal Mortality and Morbidity Review Committee. “It would be very important for the hospital to have a quality team that does a review and examination in cases of low-risk cesarean deliveries so that they can understand why this is happening.”
One of the suggestions Hollier — and the federal government — recommends is for hospitals to adopt evidence-based patient safety guidelines.
So far, the state health department and Texas Hospital Association have helped hospitals adopt best practices for preventing and treating hemorrhages, but they haven’t yet pushed the guidance that can help prevent unnecessary C-sections.