Texas Post-partum deaths: What The Health Is Going On?

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Texas Post-partum deaths: What The Health Is Going On?

Postby sunglasses » Tue Jan 16, 2018 8:44 pm

I do not have the maternal death rates for other countries, so if you've got the rates for you country, feel free to drop them in for comparison.

The US has a problem. But Texas, specifically, has it the worst in the states.

The problem? Keep new moms alive.

Across the United States, maternal mortality — when a mother dies from pregnancy-related complications while pregnant or within 42 days of giving birth — jumped by 27 percent between 2000 and 2014, according to a 2016 study published in the medical journal Obstetrics and Gynecology.

But researchers were stunned by Texas, where the maternal mortality rate had apparently doubled between 2010 and 2012. That year, 148 women died as the state’s mortality rate hit its highest level since the Centers for Disease Control and Prevention started recordkeeping with its current disease codes in 1999.


So what is going on!?

Well, nation-wide, we fail at recognizing symptoms of HELLP and educating mothers about signs and symptoms. There seems to be more of a focus on the infant vs the mother.

But Texas? Texas declined to expand Medicaid under the ACA, which certainly has hurt lower income persons who don't normally qualify for Medicaid to follow up with pre and post natal appointments. But there's more to it then that.

The Texas Tribune has heard harrowing tales of mothers enduring medical nightmares: They bled out, had strokes and heart attacks, lost babies during delivery. Dozens of experts and advocates say maternal deaths are a symptom of a bigger problem: Too many Texas women — particularly low-income women — don’t have access to health insurance, birth control, mental health care, substance abuse treatment and other services that could help them become healthier before and after pregnancy.


Texas also cut Planned Parenthood services and claimed that other community resources would be available to do healthy women check ups and offer family planning services. Those other resources are thin or not available.

Statistically, they've found that black woman are the most likely to die. And with the data available, they aren't sure why.

Overall, black mothers are at the highest risk of dying as a result of pregnancy, according to the task force report: While they delivered only 11 percent of the babies in Texas from 2012 to 2015, they made up 20 percent of maternal deaths. White women delivered 34 percent of the state’s babies over the same period and accounted for 39 percent of deaths, while Hispanic women accounted for nearly 48 percent of the state’s births and 38 percent of deaths.

Even though Hispanic and black women have similar rates of chronic health issues like obesity, diabetes and heart disease, task force members and researchers say they can’t explain why Hispanic mothers are more likely to survive pregnancy complications.


There seems to be multiple issues and not a "single solution." I'm bitter, but I still feel if we had a NHS-like program we would have less maternal deaths.

One of the cases:

Spoiler: show
Swallow had high blood pressure after giving birth — a condition known as postpartum pre-eclampsia. She said she repeatedly told nurses she had a terrible headache but they discharged her anyway.


Interjection here: If the doctor tells us to discharge someone we have to discharge them. HOWEVER if her symptoms were that worrying the nurse really should have called the doctor and argued about it informed them of the symptoms in hopes of getting a new order for monitoring.

Swallow had been released from a McAllen hospital just 30 minutes earlier, and her husband had gone inside the pharmacy to pick up her prescriptions. On the way there, she told him something didn’t feel right. By the time he came back to the car, Swallow couldn’t talk and her right side was numb.

“It was bizarre,” Swallow said. “I could feel my heart beating into my head.”

n the end, she navigated a patchwork state system to help cover her hefty medical bills.

When Swallow found out she was pregnant, she was uninsured and working as a server in a McAllen restaurant. “There was no way I could afford health insurance,” she said.

She was told by a state worker to apply for Medicaid, the joint federal-state health insurance program for the poor and disabled. She qualified for Medicaid for Pregnant Women, which covers doctor visits, lab tests, drugs and delivery. More than half of Texas births are covered by Medicaid, according to the Texas Health and Human Services Commission, the state’s health agency.

Swallow said she had to apply for the program twice before she got in at four months pregnant. When her Medicaid coverage ended two months after she gave birth, she and her husband were able to get health insurance through the federal health exchange at Healthcare.gov.

Swallow was lucky compared with other pregnant Texas women who have to pay out of pocket for prenatal care and other health needs before giving birth — or forgo care until they deliver.

Texas has the highest uninsured rate for women ages 19-64 in the country at 19 percent


Other states have lowered their maternal mortality rates-like California. So what did Cali do right and will Texas follow?

California lowered its maternal mortality rate by 55 percent between 2006 and 2013.

California is one of 15 states that have adopted a national model for improving care for pregnant women through 10 “bundles” — collections of proven strategies hospitals use to prevent and manage pregnancy complications such as hemorrhaging and high blood pressure.

The state also launched a “Maternal Quality Care Collaborative” that brought state agencies, hospitals and professional health care associations together to prevent pregnancy complications and deaths. It’s seen whopping success with how hospitals now handle two potentially lethal conditions: pre-eclampsia and hemorrhaging during and after labor

Texas Department of State Health Services officials say the state is implementing two bundles: one for hemorrhaging and another for hypertension. They’re also working with other states to develop another bundle for opioid abuse.


Another issue? Many women aren't having post-partum visits or having a post-partum appointment around 6 weeks after baby. This can be deadly.

Postpartum care is arguably as important as prenatal care. Federal data shows that more than half of maternal deaths happen after a woman gives birth, most often caused by cardiovascular disease, infections and hemorrhages.

But the American College of Obstetricians and Gynecologists found in 2016 that as many as 40 percent of women didn’t get postpartum care.

“So many of our patients don't take care of themselves in the postpartum period because they are taking care of their newborn,” said Sean Blackwell, president-elect for the Society for Maternal Fetal Medicine and a doctor in Houston. “Mom will commonly skip her visits to take care of her babies. Or, she's taking care of her other kids and family, and sacrificing her own health, which is going wacky.”

A baby’s first pediatric visit usually takes place three to five days after birth, but a mother typically won’t see her doctor until four to six weeks after delivery, if at all — and serious complications often emerge in the first few days and weeks after delivery.

Insurance coverage also matters. For women who gave birth and paid out of pocket for care or didn’t specify how they paid, 27.7 percent didn’t show up for their postpartum visit, versus 16.6 percent of women covered by Medicaid, according to Monitoring System data.


As a result of this news article, the Texas Tribune has released a PDF for expectant mothers.

In the course of our months-long investigation into the high number of Texas women dying or
experiencing serious complications during and after pregnancy, The Texas Tribune found that prenatal
and postpartum care are key for helping expectant mothers have the healthiest pregnancy possible.
To help Texas women know what to ask their doctors when they become pregnant, we compiled the
questions below from interviews with women's health experts.


The Tribune is asking people to share the PDF in hopes that it may help women know what questions to ask during their appointments. The end goal, of course, is to save a life.
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Re: Texas Post-partum deaths: What The Health Is Going On?

Postby DamianaRaven » Tue Jan 16, 2018 9:58 pm

As a Texan, this makes me glad my breeding days are over! At the same time, both of my daughters are of childbearing age, so I'm not altogether free of worry and outrage. I think the problem, if boiled down to its simplest element, can largely be blamed on the conservative Republican hatred of women, with particular emphasis on "sluts." Funding for reproductive health often gets shot down for fear that women will somehow end up with easier access to birth control and/or abortion. If that means more women die from childbirth, oh well. They should have thought of that before they spread their legs and got pregnant!
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Re: Texas Post-partum deaths: What The Health Is Going On?

Postby sunglasses » Tue Jan 16, 2018 10:16 pm

While I can see why you think that it's a much more nuanced issue then that. I urge you to read the articles I've linked.
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Re: Texas Post-partum deaths: What The Health Is Going On?

Postby DamianaRaven » Tue Jan 16, 2018 10:39 pm

sunglasses wrote:While I can see why you think that it's a much more nuanced issue then that.


I'm well aware, hence the part about boiling the problem down to its simplest element. Furthermore, what makes you think I didn't read any of the material you provided?
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Re: Texas Post-partum deaths: What The Health Is Going On?

Postby SandTea » Tue Jan 16, 2018 10:47 pm

It is a complicated issue. Political stances certainly play a part though. The strangling of Planned Parenthood couldn't have helped. I don't think I would argue too much if someone claimed eugenics, either. It probably has more to do with money and power, like always, but it does remind me of when sterilization of "unfit mothers" and the mentally ill was common. It's just a new way. A less attributable way.
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Re: Texas Post-partum deaths: What The Health Is Going On?

Postby cmsellers » Wed Jan 17, 2018 12:03 am

I wonder what percentage of these deaths are illegal immigrants. Texas is both a major crossing point and a major destination for Central American migrants, and the state government is constantly trying to make it as difficult as possible for anyone to live here without the proper papers, be they illegal immigrants, old black people, or merely generic poors.
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Re: Texas Post-partum deaths: What The Health Is Going On?

Postby sunglasses » Wed Jan 17, 2018 12:19 am

The largest percentage is black women, per reports.

They did not differentiate between naturalized, citizen, documented and undocumented hispanic women.
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