CLARIFICATIONS: Dr. Jerri Refuerzo is a doctor with UTHealth and sees patients at Memorial Hermann Katy. The Houston Endowment study was led by the UTHealth School of Public Health. Chris Van Deusen is the director of media relations for the Texas Department of State Health Services.
Despite Houston’s extensive number of hospitals, recent studies show Harris County is ranked higher than the state of Texas and the U.S. for severe maternal mortality and morbidity.
Maternal mortality is defined by the World Health Organization as when a mother dies from pregnancy-related complications while pregnant or within 42 days of giving birth. According to an April study from the Houston Endowment led by the UTHealth School of Public Health, severe maternal morbidity is described as unexpected complications of pregnancy or labor and delivery that result in significant, negative short- or longterm consequences to a woman’s health.
“There is a clear problem with maternal mortality and morbidity [in Harris County]that needs to be addressed on an urgent basis,” said Dr. Lisa Hollier, medical director of obstetrics & gynecology at the Texas Children’s Health Plan’s Center for Children and Women.
Hollier served as co-chair on the Houston Endowment’s Texas Maternal Mortality and Morbidity Task Force, which worked over the past year to identify risk factors and propose solutions to address the high rates in Harris County. Researchers concluded Harris County’s rate is increasing.
According to the study published in April, between 2008 and 2015 the rate of severe maternal morbidity in Harris County increased by 53 percent, greater than the overall increase across Texas of 15 percent.
The rate of severe maternal morbidity in Harris County in 2015 was 238 per 10,000 deliveries or 2.4 percent, 20 percent higher than the Texas average of 200 per 10,000 deliveries. The U.S. average is 150 per 10,000 deliveries.
Katy’s close proximity to Houston means the risk factors identified in the study are similar to Houston’s, according to local women’s physicians.
“We are aware of it in Katy, because we are so close to Houston [and]I would imagine that the causes are probably about the same,” said Dr. Jerri Refuerzo, a high-risk pregnancy specialist at UTHealth. Refuerzo sees patients at Memorial Hermann Katy.
Hollier said data from the study finds Katy also exhibits high rates.
“The Katy area that is just below I-10 [that area]is between the rate of overall Harris County and [a rate that is]almost double [the]Harris County [rate],” Hollier said. “So that [area]below I-10, out west in the Katy area, is at more risk than the average for Harris County itself.”
Hollier said the farther one travels west the more risk is identified there, but it is difficult to pinpoint the reason for this phenomenon.
“There is still more learning that we need to do about the risks specific to the Katy area, and that was part of the reason that we started doing this research,” Hollier said. “I think we should look at this as a beginning for the Harris County area and I look forward to seeing what additional follow-ups we will have from some of the organizations who work specifically in the Katy community.”
Local, state solutions
Some of the solutions outlined in the study call for increased access to health care and more education. Lynneece Rooney, a certified nurse midwife at the Katy Birth Center, said she thinks that it is not a lack of health care providers that affects Harris County’s rate, but rather a lack of education and understanding of how critical preventive and prenatal care is.
“And a lot of people don’t have insurance … [they]just walk into the hospital when it’s time to deliver and that puts them at an increased risk because they haven’t been getting any [preventive]care,” she said.
Rooney said women who do not seek preventive care can end up finding out they are anemic and experience bleeding issues after delivery or discover they have hypertension that went undiagnosed.
“And that puts their baby at risk as well as themselves,” Rooney said
The steering committee’s plan outlines nine solutions for hospital systems in Harris County to consider implementing, but these changes will take time, Hollier said.
On June 4 the Texas Department of State Health Services, the Texas Hospital Association, Texas Medical Association, Texas Academy of Family Physicians and American College of Obstetricians and Gynecologists hosted a TexasAIM leadership summit. The organizations announced new initiatives that include implementing safety bundles for best practices in hospitals across the state in an effort to decrease maternal mortality and other severe pregnancy complications.
According to the TDSHS, bundles are sets of clinical guidelines and practices developed by the Alliance for Innovation on Maternal Health, or AIM.
“We’ve had a great response and more than two-thirds of [Texas] hospitals that do maternity [services]have signed up for it,” said Chris Van Deusen, director of media relations for the Texas DSHS.
The program includes three best practice programs; the first will center around maternal hemorrhage, one of the most common causes of maternal death in the seven days following childbirth. A bundle on opioid use in pregnancy is also in the works and will be available more broadly next year. A third bundle will center on hypertension in expecting women.
Additional reporting by Tierra Smith