In Texas, mothers are dying — and lawmakers and public health officials are trying to figure out why.
Maternal mortality is defined when a mother dies from pregnancy-related complications while pregnant or within 42 days of giving birth, according to the Texas Tribune. Nationwide, the rate rose by 27 percent between 2000 and 2014, according to a 2016 study published in “Obstetrics and Gynecology.”
In Texas, the maternal mortality rate had doubled between 2010 and 2012, shocking researchers. The state’s mortality rate hit its highest level in 2012 when 148 women died.
As the Texas Tribune reported: “A new study says the rates from 2011 to 2015 were likely inflated because of misreporting on death certificates. The Texas Department of State Health Services has begun using a new methodology for 2012 onward, which it says produces a more accurate rate.”
On KERA’s “Think,” Marissa Evans, a reporter with the Tribune, provided context to the numbers, which show among other things that black women are disproportionately at risk.
Why it’s hard to quantify maternal mortality
The definition of maternal mortality differs at the state and federal level.
“When you have these two very important agencies, in our case, the Texas Department of State Health Services and the federal Centers for Disease Control [and Prevention], saying ‘We’re counting it in these different ways and we have these different numbers to show for it.’ That’s where we come into having a problem,” Evans said.
But everyone that Evans spoke to in her reporting agrees that regardless of what the numbers are, they are rising in Texas.
“No matter how you look at the definitions, people still need to be paying attention to this issue and we still need to figure out what we can do to protect mothers as they prepare for childbirth,” she said.
Texas, however, is not the only state struggling with maternal mortality. Mississippi also has a high rate. And California once had a high rate, but is starting to lower it.
The rate is rising across the country, but Texas is still considered a “top 10 place” for the issue.
What kinds of problems women can have after giving birth
It's still rare for a woman to die during or after childbirth; however, a lot of these deaths are unnecessary and preventable.
“The problem is that it’s so rare that people are still just realizing that this is still a thing that happens in the United States,” Evans said.
These deaths happen quickly after birth, within a matter of hours, days or weeks. Hemorrhaging and issues with C-sections are more immediate causes of deaths, but in the weeks after a woman gives birth, blood clots, strokes and postpartum preeclampsia can threaten her life.
“When you’re about to take care of a newborn, you might not even be thinking about your own health and your own safety,” Evans said. “You’re thinking about keeping your newborn alive. You’re thinking about, ‘What does he or she need as they come into this world?’”
Evans said discussions about postpartum depression are improving, but doctors are still having trouble educating their patients about stroke, heart attacks and other serious conditions after childbirth.
On maternal mortality and black women
The state’s task force on maternal mortality has found that black women are the most at risk of dying after childbirth or having complications, Evans said.
“We really can’t talk about black women and black maternal health unless we’re talking about systemic racism in the health care system," she said. "You have women who do not feel like they can talk to their doctors. You have unconscious bias against black women when they’re trying to ask questions, or perceptions about ‘if they’ll follow their doctor’s orders when it comes to their health plans.’”
This is @SerenaWilliams like you’ve never seen her before. Our February cover star opens up about her recent health scare, the first couple months of motherhood, and how she’s not slowing down anytime soon. https://t.co/bhT541QpLD
— Vogue Magazine (@voguemagazine) January 11, 2018
All of that factors into how black women are welcomed into the health care system, Evans said. She points to Serena Williams’ recent disclosure of her own pregnancy complications and fighting her doctors to get the care she needed.
Evans said Williams' experience will help people think about how they perceive black women and black mothers and mothers in general in their postpartum period.
“Mothers after giving birth know their bodies better than anybody else,” Evans said.
- Dangerous Deliveries: Is Texas Doing Enough to Stop Moms from Dying [The Texas Tribune]
- Lost Mothers: Maternal Mortality in the U.S. [NPR]
- The Last Person You’d Expect to Die in Childbirth [ProPublica and NPR]
- The quiet crisis among African Americans: Pregnancy and childbirth are killing women at inexplicable rates [Los Angeles Times]