Nearly half of the counties in Texas are in maternity care deserts. That means they lack a hospital or birthing center that offers obstetric care, as well as doctors and other health care professionals who are trained in obstetrics, according to UT Health San Antonio's Rogie Royce Carandang, PhD, MPH, MSc, RPh. A recent report from The Texas Advisory Committee to the U.S. Commission on Civil Rights said that lack of access to health care workers who specialize in pregnancy is one of the reasons Texas ranks 48th in the nation in maternal mortality.
Maternity care deserts often force those in rural areas of Texas to drive hours to receive care, leading to significantly reduced access to prenatal care and higher rates of preterm birth. And when they have a medical emergency, few local providers know how to care for them, which can lead to life-threatening complications.
”Because people don't have that direct experience, they actually don't know what to do,“ explained Carandang, who is an assistant professor in the Department of Health, Behavior, and Society at the Kate Marmion School of Public Health. "And what to do during that situation is crucial to keep the patient alive until they reach the hospital to receive the appropriate care needed."
There are critical changes in human physiology during pregnancy. The maternal body experiences a 50% increase in blood volume. Organs shift, and there is heightened heart and lung function. The enlarged uterus compresses major blood vessels and restricts blood return to the heart. If health care workers don't know how to adapt during a maternal health crisis, like cardiac arrest, a patient's risk of a poor outcome, including death, spikes. So Carandang has developed a training program for first responders and medical professionals in maternity care deserts called Obstetric Life Support.
"OBLS is designed to help health care professionals respond to life-threatening emergencies during pregnancy and postpartum period, including maternal cardiac arrest," Carandang said.
The program involves simulations that allow health care workers to practice treating cardiac arrest during pregnancy.
"The simulation allows people to practice team-based decision-making, communication, leadership, and some technical skills that are needed when it comes to addressing these kinds of rare but high-stakes emergencies in a safe environment," Carandang explained.
The goal of OBLS is to arm those in maternity care deserts with the kind of knowledge that will reduce preventable deaths.
"It strengthens readiness for the moments when every second counts," Carandang said. "In Texas, where geography, access, and health disparities shape maternal outcomes, emergency preparedness is not optional. It's a public health priority."
Ultimately, Carandang would like OBLS to be available across the country.
Science & Medicine is a collaboration between TPR and The University of Texas Health Science Center at San Antonio that explores how scientific discovery in San Antonio advances the way medicine is practiced everywhere.
