Texas made ominous headlines a few years ago when studies found that the number of maternal deaths (women dying in pregnancy, childbirth or the first few postpartum weeks) were higher than any other state or any country in the developed world.
The maternal death rate had been rising nationwide, as the Medical Journal of Obstetrics & Gynecology showed the national rate rose 26 percent from 2000 to 2014. But the journal found that Texas’ situation was especially dire. From 2011 to 2014, it said the number doubled from 18 deaths per 100,000 to 36, a rate usually reserved for “war, natural disaster or severe economic upheaval.”
A further review of the data found that those numbers were inflated, though still high, especially for African American women. Many of the maternal deaths from the study were of women who had not been pregnant. Nonetheless, the legislature began to act to reduce maternal mortality. The state created a Task Force on Maternal Mortality and Morbidity to study the issue, the Perinatal Advocacy Council to recommend the criteria for maternal care and minimum requirements for levels of maternal care just like trauma units and the NICU.
Following the studies and recommendations, the Texas legislature passed legislation listing the requirements for the four levels of maternal care, with level four being the most intense. The American College of Obstetrics and Gynecology and the Texas EMS Trauma and Acute Care Foundation are tasked with evaluating every hospital in the state between now and April 2020 to standardize the maternal care system.
Maternal care “encompasses labor and delivery through postpartum and discharge. a normal delivery that could into a complication,” says Carla Rider of TETAF. Hospitals apply for a certain designation, and surveyors like Rider come to the hospital to see if they meet the requirements.
The differences between a Level III and Level IV Maternal Unit can be the difference between life and death for mothers, and the state designation can help hospitals coordinate to make sure the women get the care they need should complications arise. The code specifies, for instance, that Level III units “have skilled personnel with documented training, competencies and annual continuing education, specific for the population served,” but Level IV units must “have a maternal fetal medicine critical care team with expertise and privileges to manage or co-manage highly complex, critically ill or unstable maternal patients.”
Prior to the rating, the hospitals self-proclaimed their ability to handle complicated maternal situations. “Maternal care can take a long time to come along with standardization,” Rider says. Physicians trained 30 years ago might be slow to adopt the latest best practices to make sure mothers stay safe. “These protocols in place ensure that this mom wont fall through the cracks.”
By September 2020, every hospital in Texas should have a standardized maternal care rating. Read about the designations for all four maternal levels here.