Wednesday, May 16, 2018

Maternal Deaths in Texas: Let’s Go in a New Direction

By Erika Munch, MD
San Antonio obstetrician-gynecologist, reproductive endocrinology and infertility specialist

Texas leads the country in many categories.

Friendliest people? Check!

Tallest 10-gallon Stetsons? Check!

Maternal mortality? Reality check.

Maternal deaths in Texas, defined as deaths during pregnancy or in the first six weeks after delivery, have some of the highest rates in the county and the industrialized world — close to 30 deaths per 100,000 live births. Nationally, the United States has a maternal mortality rate of about 28 deaths per 100,000 live births, which is nearly 50 percent more than in 2005 and more than double the rates of Canada and most industrialized European countries. In 2012, there were some widely publicized but erroneous numbers of Texas maternal deaths (mainly because some unrelated causes were included). But regardless of the exact number, even one preventable maternal death is one too many.

Several smart people have gotten together to serve on the Texas Department of State Health Services (DSHS) Maternal Mortality and Morbidity Task Force to best determine how to decrease these numbers, paralleling nationwide efforts to decrease maternal deaths. In a recent national study published in the professional society journal Obstetrics & Gynecology (The Green Journal), several Texas investigators examined what pregnancy factors may be linked to higher risks of maternal mortality. Most factors they identified can be sorted into three broad categories:

  1. Limited access to care — Maternal mortality was linked with unintended pregnancies and limited prenatal visits, meaning women who weren’t intending to be pregnant or could not access a doctor for prenatal or postpartum care were at higher risk of dying.
  2. Previous health problems — Diabetes, elevated blood pressure, obesity, and heart disease can make a pregnancy and the first six weeks postpartum riskier.
  3. Race — Certain groups, including Hispanics and non-Hispanic black women, are at higher risk of maternal mortality, possibly because of limited access to care or preexisting health problems.

So what’s a Texan to do? Friendliness and stylish hats are not going to get out of this one. Fortunately, the task force is developing recommendations, some already in place, to help reduce these risk factors. I’ve summarized the recommendations below.

  1. Get the facts! Provide preconception education
    This starts with providing access to family planning services like providing contraceptives and education to women who are not yet ready to be pregnant. Campaigns like Someday Starts Now aim to educate women about the risk factors THEY can change, without a doctor visit, that affect the health of the mother and infant. These include avoiding secondhand smoke, achieving a health body weight, and proper nutrition.
  2. Know before you go! Manage preexisting conditions
    If you are thinking about pregnancy, get a physical! Pregnancy is the longest cardiac stress test that most of us ever endure, much more demanding than five minutes on a treadmill. Cardiac events (like heart attacks or heart failure) were the No. 1 cause of maternal death in Texas in 2011-12. A primary care physician or obstetrician-gynecologist can help you or your loved one get on track to manage any health conditions, like diabetes and high blood pressure, as well as the “silent” conditions like heart disease, which can cause life-threatening complications in pregnancy if not well managed.
  3. Give mom a hug! Support women postpartum
    After all the weekly pregnancy visits are done and the baby is born, all eyes are on the baby! But as a society, it’s a grave mistake to ignore the changes that happen to mom in those first few weeks (and unfortunately, a mistake that most new moms make themselves). Mom’s risk of blood clots, stroke, and cardiac events generally increase in those first six weeks after she gives birth. The risk of postpartum depression exists, too, which can decrease mom’s ability to get other health matters evaluated, and can isolate new moms even further. So give that new mom the encouragement she needs … maybe it’s a hug, maybe it’s a clean and convenient place to pump milk once she returns to work. And if you’re someone who carries professional or legislative pull, consider advocating for or enacting some laws that protect moms and extend health care access well into the first year after birth. 

Together, we can all do our part to take care of Texas, especially caring for those who are growing and raising the future of Texas.

Editor’s Note: In March, physician leaders met at TMA’s Maternal Health Congress to discuss ways to reduce maternal deaths. They will present their proposals to the TMA House of Delegates (the association’s policymaking body) this weekend at TexMed, TMA’s annual conference in San Antonio.

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