Why Does Texas Have the Highest Maternal Mortality Rate in Developed World?

Texas State Representative Shawn Thierry and her daughter Klaire. Thierry was put under full anesthesia for a C-section after suffering a life-threatening complication following an epidural shot. Courtesy Representative Shawn Thierry

"We've got to look at the group that's being most affected and solve it for that group," Thierry said. "Then I feel like everyone will benefit."

The task force has identified some contributing factors on why women of all races are dying after childbirth — including having babies later in life, or having health problems such as obesity, chronic high blood pressure, and diabetes.

The rise in cesarean sections and related complications, plus delaying prenatal care until late in pregnancy, were also found to be factors, said Dr. Lisa Hollier, chair of the task force and president-elect of the American Congress of Obstetricians and Gynecologists.

"The next step that we took was we looked at these chronic problems, like obesity, high blood pressure, and diabetes, and found that the frequency of those conditions has also been increasing in Texas over time," Hollier said.

Other theories haven't panned out.

After abortion rights advocates pointed to the closure of dozens of women's health clinics throughout the state as a result of a2013 law requiring them to meet the same medical standards as standalone surgery centers, the task force looked for a correlation. But the biggest spike in maternal mortality rates in Texas happened between 2010 and 2012 — before the clinics were shuttered.

"It would be easy to say [that's a cause] and a knee-jerk reaction is to say yes," Thierry said. "But the task force and others haven't provided me the data for that."

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While Texas has the worst maternal mortality rate in the nation, America as a whole struggles, too. In every other wealthy country around the world, rates have been decreasing but, in the U.S., theyincreased from 2000 to 2014.

In reaction, certain regions have adopted practices to reduce maternal mortality. California is leading the way with the California Maternal Quality Care Collaborative, a decade-old model that gives doctors and nurses specific tools for specific obstetric emergencies — hemorrhage carts for storing supplies in the event of bleeding, protocols for preeclampsia and other serious conditions during pregnancy, for example.

The tools have worked: Maternal deaths in California fell to around 7 per 100,000 births by 2013, according to arecent Propublica story exposing weaknesses in America's postpartum healthcare.

Texas launched a similar collaborative last year in the hopes of emulating the results.

"California has done an excellent job," Hollier, the chair of the Texas task force, said. "Our collaborative is new, but we are looking forward to being able to implement these same kinds of programs that have proven effectiveness to reduce maternal mortality."

For Zavala, the Texas father whose wife Michelle died last month, those programs came too late. He's left with just 8 days of memories of Michelle basking as a new mother.

"She spent a lot of time with Clara sleeping on her chest, which Clara loved, and Michelle loved, too," he said.

Their first weekend home, however, Michelle noticed that one of her feet was swollen, a sign of a possible blood clot. By Monday, the swelling was gone, but Michelle called her doctor anyway — and was told not to worry, Zavala said.

"I don't know who she spoke with, but they made the wrong call. They said if the swelling has gone back down, then it's probably not anything to be concerned about," he said.

Doctors have not told Zavala what caused the pulmonary artery thrombo-embolism, a blood clot that had entered Michelle's lungs. Right now, Zavala is not focused on blame — he's just trying to keep it together for Clara, whose hazel eyes remind him of his wife's.

Relatives are workingto help pay for expenses for Clara, and Zavala's parents and in-laws are helping care for the baby.

Clara has already grown and developed in the several weeks since Michelle's death, Zavala said.

"She much more alert, much more awake during the day now," Zavala said of Clara. "It's just a such a shame Michelle is not here to see that."

NBC News

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