Maternal deaths are still too high in Texas

Despite the adjustment in a study’s numbers, hospitals and legislators can do more to save mothers’ lives

Last year, a woman I was caring for in Labor & Delivery almost died.

She was suffering from an embolism characterized by sudden cardiorespiratory collapse and acute hemorrhage. In the simplest terms, she nearly died from an allergic reaction to amniotic micro-substances in her bloodstream that can cause severe bleeding and inability to provide oxygen to the organs in her body.

Luckily, a collaborative team of health care workers immediately jumped in to save her life. Our team worked for hours to deliver her baby, stop the bleeding and stabilize her. To our great joy, she and her newborn survived.

I was thinking about my patient when I saw the news stories about the recalculation of maternal mortality data in Texas. Indeed, it is very good news that after the data were correctly adjusted, Texas’ 2012 maternal mortality rate was corrected from 38.4 deaths per 100,000 live births to 14.6 per 100,000 live births for 2012.

But this is hardly cause for celebration. A maternal mortality rate of 14.6 percent is unacceptably high — especially when some of these deaths are possibly preventable. Some major causes of maternal mortality in our state and across the nation include complications from high blood pressure, hemorrhage and opiates.

Although not all maternal deaths can be prevented, even one death that could have been prevented is unacceptable. Policymakers and healthcare leaders must not rest until the rate is decreased.

We must first ask why these deaths are occurring at such high rates. I suggest there are a few reasons. First, physicians and midwives aren’t always recognizing when their patients are at medical risk. Second, health care systems aren’t always prepared to react quickly enough once the risk is identified. And finally, unconscious biases are obfuscating the ability of health care teams to recognize and react to risk in the first place.

Overcoming these factors takes three steps:

• The state of Texas must continue its focus on maternal mortality issues, despite data changes. Texas policymakers should be applauded for forming and activating the Task Force on Maternal Mortality and Morbidity; members of the Task Force authored the study that identified errors in coding. The task force continues to work diligently to reduce preventable pregnancy complications from hemorrhaging, high blood pressure, drug overdoses and other causes.

• Hospitals must prioritize a culture of maternal and fetal safety. Many Texas hospitals are implementing safety protocols that were developed through the Alliance for Innovation on Maternal Health, a national data-driven maternal safety and quality improvement initiative based on proven implementation approaches to improving maternal safety and outcomes in the U.S.

All Texas hospitals should participate in the AIM program, which can be scaled up or down depending on the acuity level of the participating facility. The AIM program features patient safety bundles and tools proven to save lives and reduce maternal morbidity by ensuring that the hospital and clinical team are prepared to act quickly and effectively when an emergency happens.

Hospitals should also consider proven quality and safety initiatives such as implementation of OB hospitalist programs, in which Labor & Delivery departments are staffed with obstetricians on a 24/7 basis. Having an obstetric hospitalist oat all times helps to eliminate the delay in care that can make the difference between life or death in Labor & Delivery.

• Physicians must address how their unconscious bias affects their clinical actions. Most maternal deaths are the result of hypertension/cardiac events, bleeding, or more recently, opiate misuse. Physicians can unknowingly make assumptions about whether or not their patient has had access to prenatal care; has private insurance, Medicaid, or no insurance; or is or is not vulnerable to addictive behaviors that may result from anxiety or depression during pregnancy.

We also must critically examine the factors behind Texas’ higher rates of maternal mortality for women of color, particularly for black women. It is disingenuous to deny that there is some degree of systemic racism in the healthcare system. However uncomfortable, we must ask: Do we listen to all patients equally and provide unbiased care? Physicians may not have a complete understanding of how cultural factors may influence whether a patient tolerates pain or warning signs stoically or calls her physician to report them immediately. Overcoming these biases starts early, back in medical school, with training students to be conscious of their own personal biases that affect how they care for patients.

On Sunday, mothers across the U.S. are marching to demonstrate the critical need to address the maternal health of families in our country. I’ll be there with them, speaking up for the women for whom I have the privilege of caring, the patients our healthcare system has failed, and the actions we must prioritize in order to save lives in the future.