Experts agree that maternal deaths are a problem in the United States, but few agree on just how big the problem is. That's largely because the data that states collect on the number of maternal deaths often is not reliable.
HR 1318, a bill signed by President Donald Trump in December, is designed to help states fix some of their problems with collecting maternal death information. The Preventing Maternal Deaths Act of 2018 would help states and fund maternal mortality review committees that can evaluate, improve, and standardize maternal death data.
The bipartisan bill, sponsored by U.S. Rep. Jaime Herrera Beutler (R-Wash.) and supported by the Texas Medical Association, authorizes $12 million in grants over five years to review pregnancy-related deaths. HR 1318 also is designed to ensure that state departments of health create a plan for physician and provider education that improves the quality of maternal care, publishes finding, and carries out recommendations.
“Every one of us must do a better job ensuring quality care for mothers throughout pregnancy and during the post-partum period,” said U.S. Rep. Michael Burgess, MD (R-Lewisville), a key player in moving the bill through the House of Representatives. “As an [obstetrician-gynecologist] for nearly three decades and chairman of the Energy and Commerce Subcommittee on Health, I believe it should be a national goal to eliminate all preventable maternal deaths — a single one is too many.”
Maternal death data has been recognized as unreliable largely because state vital records-keeping needs improvement. On Jan. 1, the Texas Department of State Health Services (DSHS) will launch a new vital records system called TxEVER, in part because of inadequate data collection on maternal deaths.
At TMA's March 2018 Maternal Health Congress, DSHS Commissioner John Hellerstedt, MD, said closer investigation of death records often shows discrepancies between the information on death certificates and the information in medical records.
"There is a fundamental problem with the accuracy of death certificates," he said.
About two-thirds of all states — including Texas — already have maternal mortality review committees, but this is the first time these state committees will be able to apply for federal funds, according to Pro Publica. Texas' committee is called the Maternal Mortality and Morbidity Task Force. Under HR 1318, the task force and other review committees will submit their data to the U.S. Centers for Disease Control and Prevention (CDC).
Because of problems with data collection, CDC has not issued an official maternal mortality rate since 2007. However, CDC reports that about 700 women die each year in the United States as a result of pregnancy or delivery complications, and an estimated 60 percent of these deaths are preventable. Also, about 50,000 women suffer from severe pregnancy-related health problems each year.
The most recent verified data from Texas — collected and reviewed by the Maternal Mortality and Morbidity Task Force — shows 34 pregnancy-related, maternal deaths in 2012, of which 80 percent were judged to be preventable.
TMA’s maternal health recommendations for the 2019 Texas Legislature include these requests to improve data collection:
- Support comprehensive efforts to improve the state’s surveillance of maternal mortality and ensure Texas’ maternal death records have accurate information on all of the factors associated with maternal deaths; and
- Require improved interoperability among electronic health record systems to eliminate barriers to the exchange of health information critical to providing quality maternal and postpartum care.