Maternal health care experts say the needs in the rural parts of Texas are vast, but can be addressed with help

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Quality of maternal health care in Texas varies greatly depending on where you live.

World-class medical facilities and specialists are often limited to the large metro regions of the state. And Texas women are more likely to be uninsured, miss routine check-ups, and die during pregnancy and childbirth than in almost any other state.

“They need all of it,” said Lisa Dillard, director of the Maternal & Infant Health Initiative for the March of Dimes West Texas, when asked what maternal healthcare needs. ”I’ve heard over the last four years about staff turnover, staff burnout, and a need for active resources within the hospital to keep the doors open to birth a baby safely.”

Dillard, along with other medical officials, gathered on Tuesday at the University Medical Center in Lubbock for an event hosted by The Texas Tribune to discuss the successes and struggles of strengthening maternal health.

Maternal health in rural Texas has been a major issue for the state, as almost half of all counties are considered maternity care deserts, meaning there’s nowhere to give birth or access prenatal care, and more than a quarter of women live more than 30 miles from the nearest provider.

Dillard said this has led to a situation where mothers are giving birth on the roadside, sometimes in rural Texas, due to trying to get to the nearest provider.

“That affects cortisol levels every day, as they're not sure whether they're going to get the care, be in the right place at the right time, and deliver a healthy baby,” Dillard said.

Organizations like UMC Health System in Lubbock have found ways to ease the burden on patients who are far from health providers by connecting them to resources that help them with overnight stays, through partnerships with organizations like the Ronald McDonald House, whose family rooms have a kitchen, showers, laundry facilities and more.

“You want them to come to where the resources are. You want them to come to where the specialists are. You want them coming to where we have rapid access to blood products, where we have emergency surgical options, where we have a high-level neonatal ICU to treat the babies afterwards,” said Jill Shanklin, vice president for nursing excellence at UMC Health System. “And then our responsibility as a healthcare organization is also to support those families that are coming a long distance.”

Dr. Lauren Swartz, a full-spectrum family medicine physician at Covenant Health Plainview, noted that some expectant mothers also struggle with lack of transportation.

“So they don’t always have access to even a car, or they may not have Medicaid yet, so they may not have access to the Spartan bus. If a family has one car and they use it to get to work because making those hours is how they keep their family fed and alive and going, it can be a struggle to find a ride,” Swartz said.

Rural maternal health providers have become innovative in finding ways to meet expecting mothers where they are, through programs like the free-of-charge doula program at UMC.

“Last year, we had 607 of our patients utilize our doula program. We have integrated doulas into a part of our care team, and they are doing education for patients, allowing them to come beforehand and take classes and prepare for birth,” Shanklin said.

Texas lawmakers passed a law last session that now requires all pregnant women to be screened for non-medical needs, like housing, transportation, or food insecurity. The legislation also provides Medicaid reimbursement to doulas and community health workers for their work in performing these screenings.

“I do think our state is slow to move, but we do move in the direction of caring for moms and babies. I think with a little bit more funding and a bit more innovation with technology, we can do more,” Dillard said.

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