The University of Texas Medical Branch is positioning itself as a leader in the fight against maternal mortality by joining a group of Texas hospitals working to reduce the number of mothers who die during or soon after child birth, officials said.
The Texas Department of State Health Services announced in May that medical branch campuses in Galveston and League City were among 166 Texas hospitals to join a best-practices program called TexasAIM.
The state’s focus on maternal mortality was sharpened by a 2017 academic report that concluded Texas had the worst maternal mortality rate in the developed world. The state of Texas later challenged that study, saying the numbers it cited were based on faulty reporting.
Still, in Texas, there were 14.6 deaths per 100,000 live births in 2012, the most recent number available. That rate is far higher than other states. In the same timeframe in California, for example, there were 6.2 deaths per 100,000 births.
Texas’ numbers also are far worse for African-American women and for women age 35 and older.
The program aims to give hospitals both information and physical assets to reduce deaths among mothers in the days and months after they give birth.
The local hospitals were some of the first to join the program, Dr. George Saade, chief of obstetrics and maternal-fetal medicine at the medical branch, said.
“We’ve led most of this stuff that’s coming down,” Saade said.
The program provides “bundles” — lists of best practices — that improve the chances a woman will survive a high-risk pregnancy.
The program’s first bundle is a plan to reduce maternal hemorrhages, which is when a woman suffers heavy bleeding after giving birth.
The recommendations through the AIM program are for hospitals to have carts ready with supplies and blood in case a hemorrhage occurs, and, more importantly, to have a plan and an individual assessment in place in order to be ready for a problem.
The medical branch already does some of those things, although it doesn’t have hemorrhage kits in place yet, Saade said. But it has long had a system in place to treat high-risk pregnancies with a higher level of caution, as is being suggested by the AIM program.
The medical branch’s Galveston facilities already are experienced at managing high-risk pregnancies for women from across the state, Saade said. The medical branch also operates 13 low-cost regional clinics, where doctors are trained to identify high-risk patients early in their pregnancies, he said.
“We need to be caring for them early,” Saade said. “The outcome of the babies depends on the outcome of the mother.”
The AIM program also is developing methods to address opioid drug use during pregnancy, and on ways to reduce complications from high blood pressure, he said.
The AIM program has been implemented in 16 other states — and has been successful in other places. The first five states that implemented the AIM program saw between an 8 percent and 22 percent decrease in maternal mortality, according to the Texas Medical Association.
In May, the association’s House of Delegates unanimously approved a plan to reduce the number of mothers who die during or soon after pregnancy to zero.
The association said it would ask the state to create a benefits program for uninsured women of childbearing age to keep them healthy before, during and after a pregnancy. The association also said it supported increased training for doctors and nurses, and increased access to effective contraceptive devices.
One aspect of maternal mortality that Texas’ initial plan does not address is mental health.
Sherry Duson, the founder and director of Houston’s Center for Postpartum Family Health, said the state should develop best practices to help doctors be as highly prepared to treat postpartum depression as they are for other medical crises.
As many as 20 percent of new mothers suffer from postpartum depression, she said.
“Their mental health is impacted by that physical event,” Duson said. That was particularly true if women experienced trauma during the birth or had to have a procedure such as an emergency cesarean section, she said.
“They may spend the first year with some PTSD,” Duson said. “We see moms coming in for six or eight months after a birth. It still does have an impact.”
Advocates have been pushing for universal mental health screening of new and expecting mothers, but that effort hasn’t received much support from the state, she said.
“We’re always at the bottom of the list in terms of public services,” she said of mental health services. “It does need to be advocated for.”