Maternal mortality may not be something you’d think of as a crisis in 2020, but it is in Texas. Women are dying. Texas is home to one of the highest maternal mortality rates in the country, and black mothers are dying during childbirth at double the rate white mothers do, PBS reported.
“It is absolutely clear that maternal mortality remains a pervasive problem in Texas, with 382 mothers reported to have died in Texas from 2012 to 2015 from various causes,” Rep. Donna Howard (D-Austin) wrote in an email to Reform Austin.
Just last spring, the PBS Newshour dedicated a segment to Texas’ high maternal mortality rate.
Hemorrhaging is the top cause of maternal death during pregnancy or within seven days postpartum, accounting for 19 percent of the deaths, according to the Texas Health and Human Services’ Regional Analysis of Maternal and Infant Health.
Hemorrhages are a big focus of the Texas Alliance for Innovation on Maternal Health (TexasAIM) initiative, a program which started in 2018 and is used by hospitals and communities. The goal is to end preventable maternal death and severe maternal morbidity.
In 2017, the Texas Legislature passed Senate Bill 17, which requires DSHS to implement a maternal health and safety initiative like AIM. This past session, lawmakers added $2.7 million in the state budget to help DSHS expand its TexasAIM partnership with hospitals statewide, fully funding the DSHS’s legislative appropriation request.
Hospital care is a large part of the mission.
Making Hospitals – Big and Small – Safer With the 4 Rs
Obstetric hemorrhage is the leading cause of maternal morbidity and the most preventable, according to a report from the Texas Department of State Health Services.
In a phone call to Reform Austin, Associate Commissioner of Community Health Improvement at the Texas Department of State Health Services Manda Hall, MD, discussed the maternal safety bundles Texas AIM implements to help hospital staff respond to complications in pregnancy and prevent them.
The Obstetric Hemorrhage Bundle involves hospitals incorporating the four Rs.
Readiness includes establishing a response team and whom to call when help is needed such as (a blood bank or advanced gynecologic surgery). Having a hemorrhage cart (yes, an actual cart) with supplies and checklist, keeping hemorrhage medications easily accessible and establishing emergency release transfusion protocols and unit education on protocols.
KUT.org reported on one hospital in Austin and their lavender colored “hemorrhage cart” ready to be accessed in an emergency. There’s a scale that measures blood loss, a fridge with hemorrhage medication inside for an emergency situation and other emergency supplies to save a life.
“What do you need to have in place?” Dr. Hall said on the phone. It’s a question to have nailed down when it comes to saving lives and ending the maternal mortality rate in Texas.
“Having all the supplies right there” can make a big difference, Dr Hall said.
Recognition and Prevention involves assessing the risk of a hemorrhage upon admission of every patient and outlining key strategies for active management of the third stage of labor.
Response: Each hospital defines a management plan and a unit standard for responses to obstetric hemorrhage emergencies with checklists. It also involves providing a support program for patients and families for all significant hemorrhages.
Reporting and Systems Learning: Post-event debriefs can demonstrate successes and review multidisciplinary quality to improve outcomes.
For the evaluation of women with severe hypertension in pregnancy, there’s the hypertension bundle. High blood pressure during pregnancy can lead to preeclampsia, which can begin in pregnancy and continue after delivery and cause major health concerns for the mother.
“Texas hospitals are doing everything they can to improve health care for pregnant women and new mothers. This is a top priority, and our hospitals are working in lockstep with the state health department on this,” Carrie Williams, vice president of communications at the Texas Hospital Association, wrote in an email to Reform Austin.
Through a partnership with the Texas Department of State Health Services, THA is working with hospitals across Texas to implement best practices to understand maternal mortality data, initiate collaboration, standardize processes, empower providers, and prevent death.
“Some 97 percent of Texas hospitals are participating in Texas AIM, which is a clear testament to our commitment to patient safety and quality care,” Williams said.
A Communication Network for Hospitals
When a hospital agrees to be a part of the AIM Plus network, it opts into another important piece of the program, the communication network.
Before the program existed, smaller hospitals across Texas may have struggled to connect with larger hospitals to receive support, solve daily issues or receive insight and solutions for the problems they encounter, but now communication is more immediate.
Now they receive resources and guided support from experts in maternal safety either through the network or with in-person learning sessions.
Hospital staffers and doctors meeting together in person doesn’t mean sitting quietly in a lecture, and Dr. Hall at the Texas Department of State Health Services said, “these in-person learning sessions are an opportunity to learn from each other, and the willingness to share this knowledge is key.”
There also are what Dr. Hall calls “harvest meetings,” in which hospitals come together and gather everything they have learned together. It’s an opportunity to highlight different successes as well, she said.
With the next legislative session in mind, however, Rep. Howard is still concerned.
“The state’s Maternal Mortality and Morbidity Review Committee has been recommending since 2016 that the Texas Legislature expand postpartum medical coverage for mothers from two months to twelve months,” she wrote in an email. “It is crucial that we pass this policy to ensure that our health professionals can provide intervention during the period of time in which most maternal deaths in Texas occur.”