Texas can do more to prevent mothers from dying in and around childbirth, according to a statewide study of maternal mortality and morbidity released Monday. The study’s recommendations coincide with the Texas Medical Association’s eight-point plan to end maternal deaths in the state.
Almost 40 percent of Texas women who died while pregnant or within a year of giving birth in 2012 did so for causes related to their pregnancy, the Maternal Mortality and Morbidity Task Force and Department of State Health Services (DSHS) Joint Biennial Report says. Most of those deaths were preventable and were caused by cardiovascular and coronary conditions, obstetric hemorrhage, infection/sepsis, and cardiomyopathy.
State law requires that the Task Force and DSHS submit a report to lawmakers every two years to study and review trends, rates, and disparities in pregnancy-related deaths and to make recommendations for reducing maternal deaths.
“Any death is a tragedy, but it is truly heartbreaking when a mother dies while her child is in infancy,” TMA President Douglas Curran, MD, said. “The TMA applauds the work of the Task Force and DSHS in shining a light that will help Texas lawmakers, health care organizations, and physicians find a path to ending maternal death in Texas.”
The report’s 10 recommendations to state lawmakers and health officials include:
- Increase access to health services during the year after pregnancy and throughout the interconception period to improve the health of women, facilitate continuity of care, enable effective care transitions, and promote safe birth spacing;
- Enhance screening and appropriate referral for maternal risk conditions;
- Improve postpartum care management and discharge education for patients and families; and
- Increase maternal health programming to target high-risk populations, especially black women.
The report reviewed maternal deaths that occurred in 2012, a year in which it was originally — and incorrectly — reported that 147 Texas women died from pregnancy-related causes. That report was based on data entered on the women’s death certificates.
By reviewing the medical records for all women who died within 365 days of giving birth, the report’s authors identified 89 maternal deaths in 2012. The group classified 34 of those cases as “pregnancy-related.”
The majority of those “pregnancy-related” cases, 80 percent, were potentially preventable, and 68.5 percent were women enrolled in Medicaid at the time of delivery, researchers found. The mortality rate for black women in 2012 was 13.9 deaths per 100,000 live births, 2.3 times higher than that of white women and 5 points higher than the state’s overall rate of 8.9.
The cause of death in 50 of the cases reviewed (56 percent) was pregnancy-associated, but not directly related to the pregnancy, the report says. In other words, the death occurred during or within one year of the end of the pregnancy, but was not caused by the pregnancy.
Researchers also identified and reviewed 382 maternal deaths (women who died while pregnant or within 365 days postpartum) from 2012 to 2015 to better understand long-term trends in Texas.
Of those deaths:
- 215 (or 56 percent) occurred more than 60 days postpartum;
- Drug overdose was the leading cause of death, accounting for 17 percent of all maternal deaths and for almost 80 percent of those that occurred more than 60 days postpartum;
- 80 women died while pregnant or within seven days of birth;
- Hemorrhage and cardiac events accounted for 36 percent of deaths for women who were pregnant or seven days postpartum; and
- Black women continued to be at the greatest risk of maternal death, regardless of income, education, marital status, or other health factors.
More information on maternal mortality, including ways physicians can help curb maternal deaths in Texas, can be found on the TMA website.