Texas doctors frustrated by delayed maternal mortality report, say it won’t stop current improvement strategies | Don’t Miss This

AUSTIN — A delay in Texas maternal mortality and morbidity numbers has some doctors frustrated as they say the information could help address issues in a more timely manner.

In mid-September, Dr. John Hellerstedt, the Texas Department of State Health Services commissioner, informed members of the Texas Maternal Mortality and Morbidity Review Committee that its biennial report on maternal mortality and morbidity data would be delayed until mid-next year.

That decision could have negative impacts, said Dr. Carla Ortique, chair of the review committee.

State lawmakers will be returning to Austin for the 88th legislative session from January to May. Without an updated report, funding for resources and education may be diverted to other issues perceived to be more pressing based on available information, Ortique said.

“If we are not able to release this data until mid-2023, that essentially means that any legislative action that might be necessary would be unlikely to be taken,” Ortique said.

Hellerstedt told committee members that DSHS decided to withhold the report – originally due on Aug. 31 – in order to offer a more complete document later. Hellerstedt said a report released on deadline would be preliminary, still missing data from 2019. This would lead to the numbers being updated, which could be perceived as the department changing data.

He added that other states with committees that do the same work release reports with data of complete calendar years. Texas however has reports with a partially completed final year that is later updated. Hellerstedt said this also makes comparisons difficult.

“It leads to a level of questioning, potentially, that is ultimately detrimental to the work of this committee,” Hellerstedt said during the meeting.

Hellerstedt, who is set to retire at the end of the month, said the delay was due to the work it takes to compile and verify the data, compounded by limited resources.

He said while he knows the committee members and anyone who follows the data may be disappointed in the postponement, it could be an opportunity to prove to legislators that additional resources and time are needed in order to have a full analysis by calendar year.

Weeks after Hellerstedt’s announcement, the federal Centers for Disease Control and Prevention released a report that found that four in five pregnancy-related deaths in the U.S. were preventable, a trend doctors say they see happening in Texas.

The report, compiled by the CDC’s Maternal Mortality Review Committees, looked at pregnancy-related deaths between 2017 and 2019 in 36 states, including Texas. It found that 22% of deaths occurred during pregnancy, 25% occurred on the day of delivery or within seven days, and 53% occurred between seven days to one year after pregnancy.

While the leading cause of death varied by race and ethnicity, the report found that 23% of deaths were due to mental health conditions, such as deaths by suicide and overdose- or poisoning-related to substance-use disorder.

Another 14% were due to excessive bleeding, 13% were due to cardiac and coronary condition, and 9% each were due to infection, cardiomyopathy and blood clots. About 7% were due to high blood pressure. Of those, 80% were preventable, experts say.

“The majority of pregnancy-related deaths were preventable, highlighting the need for quality improvement initiatives in states, hospitals, and communities that ensure all people who are pregnant or postpartum get the right care at the right time,” said Dr. Wanda Barfield, director of CDC’s Division of Reproductive Health, in a statement.

According to data from the Kaiser Family Foundation, Texas has a maternal mortality rate higher than the national average.

The latest report compiled by the Texas Maternal Mortality and Morbidity Review Committee found that in 2015, the maternal morbidity rate in Texas was 18.4 per 1,000 deliveries. 

Dr. Kimberly Pilkinton, president elect of the Texas Association of Obstetricians and Gynecologists, expressed shock that the report would be delayed, adding that she was disappointed as the data also brings attention to persistent issues in the American healthcare system.

For example, she said, many patients do not know they have chronic hypertension or undiagnosed diabetes until they are pregnant, and push off going to the doctor due to lack of health insurance coverage.

“Access to care can affect the preconception care, or lack thereof, of patients that leads to higher risk pregnancies and therefore higher likelihood of complications either during a pregnancy or after a pregnancy,” Pilkinton said.

Pilkinton added that she feels that without the data, it will be difficult to make strong cases for more money and resources to improve maternal health care overall.

“Knowledge is power in a lot of ways and definitely related to this,” she said.

Ortique said the data could also help make a strong case as to why the state should expand medicare coverage for mothers up to 12 months after birth, a bill that was chopped down to six months by last session’s senate chamber. She said the data could also help support the need for greater funding in rural Texas, for a more diverse healthcare workforce or even greater investments in graduate medical education in Texas.

“The data certainly supports the development of medical help for women,” Ortique said.

Even so, Ortique said not having data will not delay the work that is already being done in the state to address the issue.

As an educator, Pilkinton said she uses the data in her classes to emphasize the importance of good communication, listening to patients but also providing them information to have successful postpartum recoveries. While she said she may have to revert back to 2020 data in her class, it will not prevent her from highlighting the importance of the issue.

She added that the delay in data will also not slow down the push her organization is making on educating all parties involved in a new birth, from the medical team to the patients and the broader community.

“In Texas, we’re not the worst in the United States, but we’re definitely on the wrong side of the statistics,” Pilkinton said. “We’re definitely on the lower half of the maternal mortality data compared to some states in the U.S. which is not where I know Texas wants to be.”

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