Black women in the U.S. are one to three times more likely than white women to die from pregnancy-related complications. And Black women in Texas have almost double the chances of white women of receiving a life-threatening diagnosis or undergoing a critical procedure close to giving birth. This “severe maternal morbidity” (SMM), as it’s called, puts the mother’s life at risk. And a complicated delivery can impact the baby as well.
Memorial Hermann is committed to reducing and ultimately eliminating these racial and ethnic disparities. Each year, Memorial Hermann Health System cares for more than 25,000 laboring mothers from every ethnic, economic and racial background. Sixty percent live at or below poverty level. Forty percent are eligible for Medicaid.
In April 2021, the Memorial Hermann Maternal Equity, Diversity and Inclusion (EDI) Council was formed to fully understand the SMM problem and to identify and begin to address the underlying causes. The Council began by looking at the morbidities—the underlying health conditions—that lead to pregnancy complications for these laboring moms. The Council is one of several Memorial Hermann EDI councils which identify and undertake key initiatives designed to make a real difference in the lives of underserved communities across Greater Houston.
“We know that addressing the problem at the time of labor and delivery is not the answer,” says pediatrician Vicki Regan, MD, vice president of Memorial Hermann Women’s and Children’s Service Line. “We are working with and in the communities we serve to understand and address the underlying causes of pregnancy-related complications, including the social determinants of health, which begin long before a woman becomes pregnant.”
Kendra Folh, Memorial Hermann Women’s and Children’s Service Line program director, says, “everybody is talking about this, but not everybody is acting on it. Even while the Council is gathering and validating information and identifying opportunities, Memorial Hermann has several initiatives underway. In addition to our own programs, we collaborate with government agencies and our community partners to support all women, with an emphasis on women of color, and their babies—before, during and after delivery.”
Memorial Hermann operates two Community Resource Centers in the Houston area, each staffed by Memorial Hermann community health workers who are equipped to help women navigate concerns impacting their health, including care access, food insecurity, safe housing and transportation. The Centers help connect uninsured and underinsured individuals with vitally important access to primary and preventive care by working closely with federally qualified health centers, private not-for-profit clinics and Harris Health System.
The Memorial Hermann Community Resource centers are just one of many programs of the Memorial Hermann Community Benefit Corporation (CBC). To advance Memorial Hermann’s vision of creating healthier communities, the CBC implements initiatives in cooperation with other healthcare providers, government agencies, business leaders and community stakeholders. These programs are designed to improve the overall quality of life in our communities, including among women and children.
The CBC’s work is built on the foundation of four intersecting pillars: Access to Health Care, Emotional Wellbeing, Food as Health and Exercise is Medicine. These pillars are designed to provide care for uninsured and underinsured; to reach residents of the Greater Houston area needing low-cost care; to support the existing infrastructure of non-profit clinics and federally qualified health centers; to address mental and behavioral care services through innovative access points; to work against food insecurity and physical inactivity; and to educate individuals and their families on how to access the services needed by and available to them.
“We will never change the status of our community by focusing on health care alone,” says Carol Paret, senior vice president and chief community health officer for Memorial Hermann Healthcare System and CEO of Memorial Hermann Community Benefit Corporation. “You have to move upstream. You have to get at the issues that really drive health.”
Memorial Hermann participates in Healthy Women Houston, a citywide collaborative project to help women in underserved communities get the prenatal care they need. “Many of these women need help with transportation to doctor visits,” says Dr. Regan. “Some need mental health or substance abuse support. Others lack food or health insurance. These are all social determinants of women’s and babies’ health. The goal of the program is to connect women in need with these resources in a hospitable way.”
Harris County has one of the highest rates of maternal morbidity among metropolitan areas in the U.S. and is growing at a faster rate than the national average. Dr. Regan, Paret and maternal fetal medicine specialist Sean Blackwell, MD, Chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) serve on the steering committee of Improving Maternal Health Houston, an initiative that endeavors to make Harris County a place where every woman’s pregnancy, delivery and postpartum experience is successful and safe.
In 2020, Memorial Hermann began utilizing the Maternal Early Warning System (MEWS), an initiative of the Texas Collaborative for Healthy Mothers and Babies (TCHMB). MEWS is a tool medical practitioners use to facilitate timely recognition, diagnosis and treatment of critical illness, including hypertension hemorrhage and sepsis, in pregnant and postpartum women. “We know that African American women have a higher rate of maternal morbidity and mortality, and we’re using this tool to prevent complications before they occur and to expedite treatment when they do occur,” says Dr. Regan.
Memorial Hermann is an active participant in the TexasAIM initiative, a collaboration between Department of State Health Services (DSHS), the Alliance for Innovation on Maternal Health (AIM) and the Texas Hospital Association (THA). AIM is a program used by hospitals and communities across the country to improve maternal safety through implementing best-practices, with the goal of ending preventable maternal death and SMM. TexasAIM is partnering with TCHMB to provide TexasAIM participants with additional information and expertise in MEWS.
In 2018, TexasAIM implemented an Obstetric Hemorrhage Bundle to reduce SMM due to maternal hemorrhage. In 2019, the effort resulted in the prevention of SMM in 237 women. TexasAIM is currently working on its next bundle, its Severe Hypertension in Pregnancy Bundle.
“Implicit bias” is a term used to describe a bias or prejudice that is present but not consciously held or recognized. In 2020, over 200 Memorial Hermann affiliated pediatricians and other physician groups completed a course designed to help them define implicit bias, understand the relationship between health inequity and implicit bias, and develop strategies to reduce implicit bias. In addition, Memorial Hermann is utilizing the March of Dimes “Breaking Through Bias in Maternity Care” implicit bias training course to help obstetricians recognize and remedy implicit bias in maternity care settings.
Giving birth can be stressful, especially if there are underlying health conditions that can increase a woman’s risk of complications. To help ensure safe deliveries and to minimize stress, Memorial Hermann is expanding its Delivery Nurse Navigator program and hopes to incorporate community-based doulas into its labor and delivery program. As defined by DONA International, a doula is “a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.”
According to the U. S. Census, in 2020, 21 percent of children in the U.S. lived with their mothers only and nearly half of Black children lived with their mothers only.
“Living without their fathers in their lives increases a child’s risk of developing social, emotional and physical problems, especially between the ages of 0 and 5 years,” says Barre Morris, a certified Project Management Professional (PMP) in Memorial Hermann’ ISD, who leads Memorial Hermann’s Fatherhood Initiative. “Even if a child’s parents aren’t married, having the father stay involved in the child’s life is essential.”
Morris says the aim of Memorial Hermann’s Fatherhood Initiative is to reduce the risk of adverse maternal and child health outcomes through family-focused parent education. The 12-week course includes separate education classes for mothers and fathers. The fathers’ classes are designed to help each father be the best parent he can be. “Paternal healthcare gets overlooked, and it’s a huge factor,” says Morris. “When dad is in the picture, he thinks he matters, and he wants to be included.”
The mothers’ education classes are designed to increase the mother’s knowledge, positive attitudes (e.g., toward the father’s involvement) and communication skills to help her improve her relationship with the father(s) of her child(ren). “It is especially important to help increase a mother’s understanding of the importance of the father’s involvement in the lives of her children and to help increase positive interactions between these moms and dads,” says Morris.
After giving birth, many women focus on the health of their baby but at the expense of their own health. “They will make every pediatrician visit but might neglect their own check-ups,” says Dr. Regan. “For this reason, we’re encouraging our affiliated pediatricians to screen new moms for hypertension (high blood pressure) and postpartum depression when they bring their infants in for checkups.”
To learn more about all of Memorial Hermann’s equity, diversity and inclusion initiatives, please click here.