What are we doing about Black maternal health outcome disparities? One Austin hospital shares its plan
Last week, April 11-17, was designated Black Maternal Health Week and included the reintroduction of the Black Maternal Health Momnibus Act in Congress, which offers funding to improve health outcomes through community groups, diversifying the workforce, improving data collection, investing in digital tools and focusing on some higher risk groups.
Last week also included the announcement of a $1 million grant to six local organizations working in collaboration to improve Black maternal health outcomes by providing child care to moms during pregnancy, labor and hospitalization and after birth.
In Texas, two reports, one in 2018 and one in 2020, highlighted the disparity in maternal mortality and maternal morbidity for women of color, especially Black women. In that 2018 study by the Texas Department of State Health Services, Black women in Texas had a pregnancy-related mortality rate that was 2.3 times higher than white women's rate. A 2020 study by the department showed 89% of all pregnancy-related deaths in Texas could have been prevented, and Black and Hispanic mothers had higher rates of severe maternity complications than white mothers.
Locally, what are hospitals doing to improve maternal health outcomes? We asked Dr. Jeny Ghartey, maternal medical director and maternal fetal medicine specialist at Ascension Seton Medical Center Austin and assistant professor of women’s health at the Dell Medical School, what that hospital has been working on. Their goal is to reduce the disparity in morbidity rates by 10% in the next fiscal year. Although Seton would not share those rates, officials said they have not improved in recent years.
Birth and the months before and after are risky times for all women because pregnancy involves two patients to consider, it involves some bleeding, and there's an increased risk for pregnant women to develop a blood clot, even in a healthy woman. Pregnant women today are also older and often have more preexisting hypertension, obesity and diabetes.
"All of these together make for a risky time," Ghartey said. But she reminded that "the majority of the time everything goes well."
Ghartey has been at the hospital since 2017. Since 2018, all hospitals in Texas have been classified by what level of maternal care they can provide. The highest is level IV, which Seton Medical Center has achieved, along with North Austin Medical Center and St. David's Medical Center.
That means certain cases will be sent to those hospitals instead of those with a lower designation. Such cases include women who have a high risk of stroke, who have active cancer, who have had a heart transplant in the past year or who are in any other high-risk situation. The higher designation hospitals have staffers trained in complicated care and the tools to handle those cases.
A lot of quality improvement oversights have been put in place, especially around the most common causes of maternal mortality and severe maternal morbidity (illness). These include hemorrhage, hypertension, stroke and cardiovascular complications. Seton participates in the Texas Alliance for Innovation on Maternal Health or TexasAIM, which has created best-practice guides to be followed on the most dangerous maternal health conditions.
Ghartey said these guides help standardize care, from recognizing the condition to treating it.
"All providers will feel equipped to respond, and that will help reduce health disparity here and across the state," she said.
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Seton also has created the Health Equity Rights subcommittee to look at outcomes not just through the lens of the patient's medical conditions and treatment, but also by asking questions about implicit bias and discrimination in recognizing the condition and the care given. The committee also reviews internal policies to make sure they are not inadvertently "further marginalizing women," Ghartey said.
Seton has expanded the number of Black obstetricians in its service from two when Ghartey started to five. Forty obstetricians are delivering there — half in private practice, half affiliated with Dell Medical School. Seton also has increased the number of Black labor and delivery nurses.
Ghartey said having more Black providers can help improve outcomes. She cited research on Black infant mortality rates going down when they are treated by a Black pediatrician.
Even with these steps, there are still disparities that cannot be explained by other factors.
"The disparities we are seeing cannot just be explained away by co-morbidity rates or socioeconomic status. When we account for those differences, disparities still remain," Ghartey said.
Seton has focused on learning from the Black community. It has reached out to community organizations such as Black Mamas ATX, which provides doulas and other services to Black mothers, and sought conversations with its Black patients, Ghartey said.
Even with all those steps, Ghartey saysid, the rates of severe maternal morbidity have not improved. "We are seeing a big disparity," she said, but it's consistent with what's happening nationally.
Seton Medical Center has not had a maternal death recently, Ghartey said. This past year had worse rates because pregnant women or women who had just given birth got COVID-19 and required ventilation. When removing those cases, the rates were the same as in previous years.
Seton is looking at both case by case and overall areas "where we can improve the most. That's what's driving our health equity work," she said.