Data from more than 63,000 labor and delivery admissions in 23 hospitals across four health care systems—Harris Health System, HCA Healthcare, Memorial Hermann and UTMB Health—reflected a severe maternal morbidity rate of 115.3 patients per 10,000 deliveries and a maternal mortality rate of 25.1 deaths per 100,000 deliveries.
Dr. Carey Eppes, a maternal fetal medicine physician at the Baylor College of Medicine and member of the Texas Maternal Mortality and Morbidity Review Committee, said the data from the Maternal Data Registry Demonstration Project—part of the Improving Maternal Health initiative—was collected much closer to the incidents than what is typically used to calculate maternal morbidity and mortality, and with different criteria for collection.
“Most of [the data in this registry is collected] within a month or two months of the event compared to administrative data, which is usually at least an 18-month lag before it makes it to the point where we can see it and even longer before the public can see it,” Eppes said. “So hospitals can use that data to drive improvement in real time.”
Notably, Black women accounted for 27% of the severe maternal morbidity cases—ones with serious complications from pregnancy including organ damage—and 50% of the deaths, despite making up just 17% of all labor and delivery admissions to these hospitals.
Nakeenya Wilson, a community advocate on the MMMRC who experienced complications with her own pregnancies, said that while the data from the data registry report was probably not comparable to state reports because of the criteria used, the trends would be similar.
“What is likely true is that the disparity that exists that are captured into those reports are probably similar [to the MMMRC report],” Wilson said. “The Houston area [is] one of the more densely populated cities when it comes to the African American population. I think that is a good snapshot ... [of] the challenge to be a Black woman of childbearing age in Texas.”
State-level data
At the state level, the committee on which Eppes and Wilson serve was expected to release its biennial report earlier this year, with state law requiring that the committee and the Texas Department of State Health Services submit the report to the governor by Sept. 1.
Interim DSHS Commissioner Jennifer Shuford, who took the position Oct. 1, said at the Dec. 9 meeting of the MMMRC the report would be released “as early as next week.”
Wilson said during the meeting that in her and many of her colleagues’ on the 17-member committee’s opinion, there was no need for the report to be delayed.
“Suppressing and withholding data that does not make us look good is dishonorably burying those women,” Wilson said.
Dr. Manda Hall, associate commissioner of community health improvement for the DSHS and department representative for the MMMRC, reported the statewide maternal mortality ratio remained “relatively stable” from 2013-2017, fluctuating between 18.3-20.7 deaths per 100,000 live births.
Because the report’s data lags by three to four years, Dr. Patrick Ramsey, vice chair of the MMMRC and maternal fetal medicine physician, stressed the need for real-time data.
“[The data] does not help us inform anything we do today that impacts care in the next several months or the next year. We really do need real-time data access for both maternal and neonatal outcomes,” Ramsey said.
State Rep. Shawn Thierry, D-Houston, pre-filed a bill for the upcoming legislative session to create a work group to advise the creation of a maternal mortality and morbidity data registry statewide.
From work with the Houston-area registry, Eppes said she learned what it takes to support hospitals in collecting and submitting data.
“I think the biggest need is having [hospitals] be funded to support a person to collect and put this data in, in order to improve outcomes,” Eppes said.
