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Texas

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The Texas Maternal Mortality and Morbidity Review Committee (MMMRC) was legislatively established in 2013 and convened in 2014. The 17-member multidisciplinary review committee meets quarterly and reviews all pregnancy-associated deaths occuring in a calendar year among Texas residents with an indication of pregnancy within up to one year of the end of pregnancy except for motor vehicle crashes not involving vehicular homicide or suicide. In 2013, Texas had 387,110 live births and 175 confirmed pregnancy-associated deaths subject to review. Texas Health and Safety Code Chapter 34 directs the MMMRC to study and review: cases of pregnancy-related deaths; trends, rates or disparities in pregnancy-related deaths and severe maternal morbidity; health conditions and factors that disproportionately affect the most at-risk populations; and best practices and programs operating in other states that have reduced rates of pregnancy-related deaths. Through this process, the MMMRC develops recommendations to help reduce the incidence of preventable pregnancy-related deaths and severe maternal morbidity.

VISIT THIS MMRC's WEBSITE
Contacts
Primary
Name
Allison Waage
Credentials
MSN, RN
Title
Maternal Health and Safety Nurse Coordinator
Affiliation
Texas Department of State Health Services
MMRC Role
Coordinator
Email
Allison.Waage@dshs.texas.gov
Phone
512-776-2907
Secondary
Name
Lisa Hollier
Credentials
MD, MPH
Title
Chair, Texas Maternal Mortality and Morbidity Review Committee
Affiliation
Baylor College of Medicine; Texas Children's Health Plan
MMRC Role
Chair or Co-Chair
Email
lmhollie@texaschildrens.org
Phone
832-828-1256
Secondary
Name
Sarah Beard
Credentials
BSN
Title
Program Specialist
Affiliation
Texas Department of State Health Services
MMRC Role
Coordinator
Email
Sarah.Beard@dshs.texas.gov
Sources of Funding
ERASE MM
Yes
STATE MATERNAL HEALTH INNOVATION
No
TITLE V MCH SERVICES BLOCK GRANT
Yes
STATE BUDGET
No
Scope of cases reviewed
All pregnancy-associated deaths occuring in a calendar year among Texas residents with an indication of pregnancy within up to one year of the end of pregnancy except for motor vehicle crashes not involving vehicular homicide or suicide are reviewed to determine pregnancy-relatedness. The scope of the Texas MMMRC review is all pregnancy-related deaths.
Individuals, Disciplines, and Organizations Represented on Review
Organizations Core Disciplines Specialty Disciplines
Academic Institutions
FIMR/CDR Programs
Healthy Start Agencies
Hospitals/Hospital Association
Professional Assoc. State Chapters
State Medical Society
State Title V Program
Community Advocates
Family Medicine
Forensic Pathology
Maternal Fetal Medicine/Perinatology
Nurse Midwifery
Obstetrics and Gynecology
Perinatal Nursing
Psychiatry
Public Health
Social Work
Community Leadership
Critical Care Medicine
Epidemiology
Mental Health Provider

Success Stories

Incorporating a Health Equity Framework


The Texas Maternal Mortality and Morbidity Review Committee (MMMRC) established a Subcommittee on Maternal Health Disparities (Subcommittee) following release of the Maternal Mortality and Morbidity Task Force and Department of State Health Services Joint Biennial Report, September 2018 to support application of a health equity framework to MMMRC case review.

The Subcommittee’s work reflects the MMMRC’s commitment to comprehensive case review.  The Committee is developing, testing, and refining the Discrimination Assessment and Social Determinants of Health Facilitated Discussion Tool (DASH Tool) to facilitate a standardized process for the MMMRC to consider non-clinical drivers of maternal mortality during case review.  

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Policy Impact


Policymakers, researchers, stakeholders, and the public have focused considerable attention toward the issues of maternal mortality and severe maternal morbidity (MM/SMM) in Texas. The Texas Maternal Mortality and Morbidity Review Committee (MMMRC) and Texas Department of State Health Services (DSHS) are committed to improving maternal health and preventing MMM in Texas.

The Maternal Mortality and Morbidity Task Force and Department of State Health Services Joint Biennial Report, September 2018, included findings and recommendations to reduce MM/SMM. These findings and recommendations informed several actions of the 86th Texas Legislature, Regular Session, 2019 and is reflective of the Texas MMMRC’s success in moving recommendations into action.    

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Maternal Health and Safety Initiatives


The Texas Maternal Mortality and Morbidity Review Committee (MMMRC) proposed several recommendations to increase maternal health and safety in the Maternal Mortality and Morbidity Task Force and Department of State Health Services Joint Biennial Report, September 2018 . Recognizing the importance of addressing the recommendations of the MMMRC, the Texas legislature appropriated funding to support the work of the Texas Department of State Health Services (DSHS), Healthy Texas Mothers and Babies (HTMB) Branch and collaborative partnerships, to implement data-supported and recommendation-driven maternal health and safety initiatives.

For more information on these initiatives: Maternal Health & Safety Initiatives Legislative Report (PDF).

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State Materials
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Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report (2020)
2020
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Joint Biennial Report of the Maternal Mortality and Morbidity Task Force and the Texas Department of State Health Services (2016)
Texas Department of State Health Services
2016
Submitted July 2016, as required by Senate Bill 495, 83rd Legislature, Regular Session 2013. Explanation of processes involved and highlighted findings from evaluation of maternal deaths, and recommendations to help reduce incidence of pregnancy-related deaths and severe maternal morbidity in Texas.
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Texas Autopsy Record Request Form
Texas Department of State Health Services
2016
Autopsy Records Request letter sent to a medical examiner’s office, hospital physician, or Justice of the Peace who received custody of the decedent in question. Records requested include the autopsy, toxicology results, and any additional consultant or co-investigation reports.
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Texas Maternal Mortality and Morbidity Task Force Report
Texas Department of State Health Services
2014
DSHS report of progress in establishing the task force, submitted to the governor, lieutenant governor, speaker of the House of Representatives, and legislative committees September 2014, as required by Senate Bill 495, 83rd Legislature, Regular Session 2013. Explanation of activities and processes involved in establishing a task force and development of its operating protocols as the group began evaluating cases of pregnancy-related deaths and observed trends in severe maternal morbidity in Texas.
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Maternal Mortality in Texas: Using Precision Public Health to Improve Maternal Outcomes (with Appendix)
Texas Department of State Health Services
2016
Explanation of methodologies and sources used in various interpretations of the rates of maternal mortality and related causes and risk factors in Texas, as well as examples of activities and collaborations (planned or already in place) directly related to the recommendations made by the Maternal Mortality and Morbidity Task Force.
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Texas Medical Records Request Form – Hospital
Texas Department of State Health Services
2016
Fax Cover sheet and Records Request letter sent to hospitals in which the patient in question may have received services, including labor and delivery, postpartum, emergency department, outpatient labs or imaging, behavioral health or substance use treatment, and allied health services.
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Texas Medical Records Request Form – Provider
Texas Department of State Health Services
2016
Fax Cover sheet and Records Request letter sent to health care providers from whom the patient in question may have received services, including prenatal care, postpartum care, general or specialty medicine care, and visits to allied health services providers.
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Texas Facility Learning Module: Responding to Data Requests
Texas Department of State Health Services
2014
Texas Health and Safety Code gives the Department of State Health Services authority to access health and medical records relevant to cases of pregnancy-associated death and severe morbidity. This learning module provides facilities with an overview of Task Force authority and the facilities’ role in the record request process.
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Texas Health and Safety Code, Chapter 34: Maternal Mortality and Morbidity Task Force
Texas Department of State Health Services
2013
Statute mandating formation of Maternal Mortality and Morbidity Task Force by Senate Bill 495, 83rd Legislature, Regular Session 2013.
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ENHANCING REVIEWS AND SURVEILLANCE
TO ELIMINATE MATERNAL MORTALITY