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maternal mortality

It’s hard being pregnant in Harris County

We need to figure this out.

Life-threatening, pregnancy-related complications — the iceberg beneath the surface of the U.S. maternal health crisis — are on the rise in Harris County, according to a new report.

The report not only confirmed the Harris County rate is worse than that of the state and nation, it found that it increased more than 50 percent between 2008 and 2015. Texas’ rate of life-threatening, pregnancy-related complications went up 15 percent in the same time period.

“In subtle and unintentional ways, women’s health in Harris County has been subjugated to the health of babies so profoundly that the health of women of childbearing age is often not prioritized,” says the report, a project of the Houston Endowment.

Dr. Lisa Hollier, a Houston obstetrician-gynecologist and a co-chair of the task force that produced the report, said Harris County’s high rates “point to the need for greater intervention to promote safety around the time of delivery. Such complications are 50 times more common than pregnancy-related deaths, but don’t get near the amount of attention.”

Hollier and Dr. Cecilia Cazaban, the report’s principal investigator, said it is unclear why Harris County’s rate is increasing at such a high rate. They said that analysis is next on tap for the task force.

[…]

The new report focuses on severe maternal morbidity, the term for conditions that require such treatment as a respirator or blood transfusions or hysterectomy during delivery or in the immediate hours thereafter. It can lead to maternal death, but even when the patient survives, it can cause damage, such as kidney or heart failure, sometimes requiring lifelong treatment. It also is costly to the patient and health care system.

Harris County’s rate of severe maternal morbidity in 2015 was 2.4 percent, meaning there were 238 cases for every 10,000 deliveries. The 2015 rate was 1.97 in Texas and 1.46 in the United States.

See here for some background. The task force website is here, though I don’t think this report is on there. I hope there’s no need for me to say anything more than we really need to understand this problem so we can solve it.

Texas’ maternal mortality rate not as bad as previously reported

Good news, if a bit puzzling.

Several of the state’s top health experts released a report in the medical journal Obstetrics & Gynecology on Monday showing that by using the new method, the number of women who died dropped from 147 to 56.

The study uses an enhanced method of counting maternal deaths that involves cross-referencing birth certificates, death certificates, hospital discharge data and medical records to confirm that a woman who died was pregnant before she died. The state’s current method of calculating maternal deaths includes using specific medical codes and requiring officials to check a box on death certificates indicating whether a woman was pregnant before she died.

The study said the state’s 2012 maternal death numbers inflated the number of women 35 and older who were classified as a maternal death and included reporting errors in which women who had not been pregnant were reported as maternal deaths. The researchers said they also found 2012 deaths that were not included in the state’s original maternal death numbers.

The authors noted that other states have used the same methodology to calculate maternal deaths. They said they chose 2012 for the new analysis because it was the year when maternal deaths peaked in Texas.

The study’s authors said they plan to use the new method to confirm maternal deaths and calculate maternal mortality rates for additional years.

See here for the background. The story notes that even with the revision, which the authors of the new study attribute to “data error” in the initial report, the mortality rate for black women was still double what it was for white women. There are still other serious concerns as well, as expressed by Lisa Falkenberg:

“I would hate to see us lose the momentum that we’ve gained,” said Dr. Lisa Hollier, an obstetrician and gynecologist at Texas Children’s Hospital.

“We still have women dying of preventable causes,” she said. “We still have a two-fold, a doubling, in the risk of death for African-American women. Those things need to change. I don’t think we should accept where we are.”

Hollier, who co-authored this week’s report and also chairs the Texas Maternal Mortality and Morbidity Task Force, points out that deaths aren’t the only measure of the problem. For every maternal death, Hollier says there are 50 women who experience severe complications that can lead to hysterectomies, breathing problems requiring ventilator support and kidney failure, to name a few.

“If there are 50 women who die in a particular year, there are 2,500 women who had severe complications,” Hollier said. “There are so many more women who are affected than just that tiny tip of the iceberg which is mortality.”

All this happens in a state where as Falkenberg reminds us our Republican leadership has refused to expand Medicaid – something like half of all births in Texas are paid for by Medicaid – and have cut back on access to healthcare for women by gutting Planned Parenthood. The definition of “pro-life” in this state is so narrow you could slide it under a lobbyists’ door. So go ahead and be happy that things aren’t as bad as we feared, but don’t be satisfied with it.

UPDATE: Sophie Novack in the Observer makes a lot of really good points about this revised study. Go read what she says.

Maternal mortality bills pass the House

Good.

House lawmakers tentatively approved a series of bills Monday aimed at helping Texas curb its unusually high rate of women dying less than a year after childbirth.

The primary measure, House Bill 9, would direct the state’s Task Force on Maternal Mortality and Morbidity to continue studying pregnancy complications and maternal deaths until 2023. Last year, a study in the medical journal Obstetrics and Gynecology revealed that Texas’ maternal mortality rate had nearly doubled between 2010 and 2014. State task force data shows that between 2011 and 2012, 189 Texas mothers died less than a year after giving birth, mostly from heart disease, drug overdoses and high blood pressure.

State Rep. Cindy Burkett, R-Sunnyvale and the bill’s author, said giving the task force more time to make recommendations on how to prevent those types of health issues in pregnant women and new moms would help save lives and lower costs Medicaid, the joint federal-state health insurance programs for the poor and disabled.

“As in many things, prevention is better and often cheaper,” Burkett said.

HB 9 charges task force members with finding solutions to help Texas women struggling with postpartum depression; looking at what other states are doing on maternal care; and examining health disparities and socioeconomic status among mothers dying in Texas. The measure still needs one more House vote.

The Senate passed a similar bill on July 24. Both chambers will likely head into conference committee to reconcile the two measures.

See here and here for some background. Please note that the reason that this item is on the special session agenda is because bills like these were snuffed out at the end of the regular session as a result of stalling tactics by the House Freedom Caucus, whose pique at being treated meanly by Speaker Straus overrode their ever-present concern for unborn babies. I’m sure we can all appreciate the sacrifice they had to make.

Black women face much higher risk of pregnancy-related death in Texas

Any time you’re being compared to a third world country, it’s not a good thing.

Black women bear the greatest risk for pregnancy-related death in Texas by far, according to a much-awaited new report, commissioned because the state rate resembles that of many Third World countries.

The report, which follows the publication of a national study that found Texas’ maternal mortality rate has doubled since 2011, ranked heart conditions, overdose by legal or illegal drugs and high blood pressure of pregnancy as the leading causes of such deaths.

“This confirms what we feared – that many of these deaths could be prevented,” said state Rep. Armando Walle, D-Houston, the House author of the 2013 bill that created a Department of State Health Services maternal mortality task force and charged it with producing biennial reports and recommendations. “It’s a travesty that this is happening.”

[…]

Marian MacDorman, the University of Maryland-based lead author of the Obstetrics & Gynecology study said she applauds the Texas team for “looking into the deaths in greater detail.”

“Although the Texas Department of Health study uses different methods and data sources from mine, I think we both agree that maternal mortality is a serious problem in Texas,” said MacDorman. “I especially appreciate their policy recommendations for how to reduce it.”

The Texas report found most of the state’s maternal deaths – 60 percent – occurred between 42 days and a year after delivery. MacDorman’s study identified 262 Texas deaths in the same two-year period based only on those who died within 42 days.

Walle said he is hopeful the report makes an impression on the 2017 Legislature.

“I’m not naïve to the fact we haven’t expanded Medicaid, but something needs to be done to increase access to pregnant women,” said Walle. “We can’t keeping letting federal dollars go to other states while these women are dying.”

See here for more about the previous study that showed an overall rise in maternal deaths in Texas. The story lists a number of things that could be done to help this situation, all of which involve expanding access to health care, most of which could be accomplished by expanding Medicaid. Since we know that won’t happen under the current leadership, none of whom has been quoted in a story I’ve seen so far, the question is what if anything they would propose to do about it. My guess is it would involve tort reform and high-deductible health plans, because we know those fix everything. Pro Publica has more.

Why are so many pregnant women dying in Texas?

Better yet, what are we going to do about it?

The rate of Texas women dying of pregnancy-related causes nearly doubled from 2010 to 2014, with the state seeing more than 600 such deaths in the four-year span.

In a new study, set to be published in the September issue of Obstetrics and Gynecology, researchers found that Texas experienced a dramatic increase in pregnancy-related deaths from 2010 to 2012. While the rest of the country also experienced an increase, no other state saw the rate nearly double like it did in Texas.

Some health experts complain that the state has been slow to respond to the problem. A state task force on the issue is nearly three years into its work and has released no recommendations.

“We’re really seeing this is a serious problem with maternal mortality,” said Dr. Daniel Grossman, an OB-GYN who studies the effects of recent reproductive health legislation in Texas with the Texas Policy Evaluation Project at the University of Texas at Austin. “It really seems like that’s where the state officials should be focusing on trying to improve health and safety.”

From 2006 to 2010, the rate of Texas women who died while pregnant or within 42 days of being pregnant due to causes related to their pregnancies fluctuated between 18.1 and 18.6 deaths per 100,000 live births, according to the study. In 2011, the rate jumped to 33, and by 2014, it was 35.8.

In 2012, 148 women died from such causes, up from 72 deaths two years before.

The findings stumped the national researchers and have prompted them to begin a further study into maternal mortality in Texas. Vital statistics officials on both state and national levels “did not identify” any change in the data recording processes that could have resulted in the dramatic increase, according to the study.

The Texas Legislature created a task force in 2013 to study pregnancy-related deaths and severe complications in the state. It’s set to release its first report to lawmakers on Sept. 1.

[…]

The rise in pregnancy-related deaths in 2011 coincided with the beginning of major budget cuts in Texas. In September of that year, health care providers across the state began to feel the effects of a family planning budget reduced by two-thirds.

Sarah Wheat, a spokeswoman for Planned Parenthood of Greater Texas, said many of the family planning clinics that lost funding or closed were an “entry point into the health care system” for women.

“Chances are they’re going to have a harder time finding somewhere to go to get that first appointment,” Wheat said. “They may be delayed in getting that initial pregnancy test and then a prenatal referral.”

The study mentioned changes to women’s health services and clinic closures but didn’t go so far as to suggest there was a correlation between that and the uptick in pregnancy-related deaths.

“Still, in the absence of war, natural disaster, or severe economic upheaval, the doubling of a mortality rate within a two year period in a state with almost 400,000 annual births seems unlikely,” the study said.

I’m going to wait and see what that task force finally says on September 1. It took them three years to come up with something, so one hopes it will be worth the wait. In the meantime, I wonder why we haven’t heard more from the “pro-life” forces in this state, whom we know are legion and not at all the quiet types. One would certainly think that a sharp, unexplained rise in the rate of pregnant women dying would be the sort of thing that might attract their attention and at least some of their energy. Wouldn’t one? The Current has more.