Maternal care on the south side
Marina Riojas was 25 weeks and two days pregnant when her waters broke at the end of September.
With a history of miscarriage and subchorionic bleeding that started at nine weeks, Riojas knew her pregnancy was considered high risk, but she didn’t expect it. It was too early.
Having previously worked for Women’s Health Texas in Stone Oak, Riojas had planned to travel from her South Side home to the North Side to give birth, but when her waters flowed, she and her husband knew there was no time. for it.
They drove the five minutes to Texas Vista Medical Center and went to the emergency room.
“It was scary. I didn’t know if we were going to lose her,” Riojas says.
The hospital recently received a Level III maternal care designation from the state, which means an OBGYN is on-site 24 hours a day and was there to respond to emergencies when Riojas arrived. She was assessed and admitted to the maternity ward where doctors and nurses worked to keep her daughter inside and grow her as long as possible.
At 26 weeks and two days, Riojas’ daughter was born. Named Myraclle, she weighed only 1 pound, 10 ounces and was 13 inches long.
Before Riojas could touch her, Myraclle was rushed to the hospital’s neonatal intensive care unit.
“When I came down to see her, she had a bag and all these tubes. It broke my heart, ”says Riojas.
Still, Riojas and her husband were able to touch their daughter’s hand and watch her and learn while she received care.
There was still a lot of fear in the unknown, says Riojas, but she and her husband were grateful for the care they received and to be there to see Myraclle’s little personality shine in those early days.
“She was very active in my stomach and when she came out she was also active,” she says. “She grabbed the tubes and was fighting so the nurses wouldn’t touch her. Even the doctor said she had a bit of a sassy personality.
Myraclle is just one of 12.2% of San Antonio babies born before 37 weeks gestation, the highest preterm birth rate of any major city in Texas, according to March of Dimes, a goal-oriented organization. nonprofit that campaigns for the health of mothers and babies.
When people have received antenatal care throughout pregnancy, as Riojas has done, doctors may be better prepared to treat babies if they arrive early.
But often this does not happen.
In the southern part of San Antonio, only 54 percent of women receive antenatal care during the first trimester, compared to 77 percent nationally. In downtown San Antonio and zip codes south of downtown, 14 to 21 percent of babies born in 2017 were delivered to women who had antenatal care late or not at all. That rate has fallen to 8% or less in the majority of zip codes on the north side, according to the state’s Department of Health Services.
There are many reasons why a woman does not seek care after finding out that she is pregnant. Judit Vega, director of March of Dimes’ San Antonio Maternal and Child Health Collective Impact, says rates of premature births and late or no prenatal care are higher among black or Hispanic women and babies. Some mothers stay away from doctors because they have experienced racism or prejudices implicit in health care in the past, or have friends who have experienced it. Others lack insurance or Medicaid, while still others struggle to access transportation, housing and food insecurity, all of which make it harder to seek antenatal care. “These inequalities have all been exacerbated by the pandemic,” Vega said.
Of course, the issue of maternal and child health is not an issue that will be resolved quickly. Even outside of San Antonio, Vega points out that data shows the United States to be one of the “most dangerous developed countries” for childbirth, especially for black, Hispanic or Native American women. In nine particularly dire cities, including San Antonio, March of Dimes launched Collective Maternal and Child Health Impacts that aim to help bring community stakeholders together to identify and address some of the existing issues.
The effort only started last year, but Vega says they want to improve the overall community support women receive, especially black and immigrant women. Hospitals, healthcare providers, schools and social services often work in silos, so they want to help them communicate better and focus on the overall health of pregnant women, says Vega. They also discussed the development of implicit bias training for hospitals, and at the state level, March of Dimes is advocating for doula services to be reimbursed by Medicaid, as women whose births are assisted. by a doula tend to have better results.
“It’s not just a factor that contributes to premature births and maternal mortality,” says Vega. “It’s several things.”
All the effort is made with the economic divisions that have long existed in San Antonio in mind. The south side (and parts of the west and east sides) have historically had fewer options for care, says Vega, so having more facilities like the Texas Vista Medical Center that are equipped to handle high-risk patients and patients. Premature births are needed citywide if Bexar County is going to see any improvements.
In addition to the Texas Vista Level III maternal care designation achieved last year, the Mission Trail Baptist Hospital on the south side has also opened a labor and delivery unit. Before higher care options were available at these hospitals, the nearest hospital for full-service maternal care was at least eight miles away.
Texas Vista Medical Center was renamed Southwest General Hospital last March and unveiled more than $ 2 million in upgrades, including an investment of nearly half a million dollars in its NICU, which also carries a Level III designation, said CEO Jonathan Turton.
“We are the only hospital in our geographic area to be level III,” he says. “This means that a pregnant patient can expect to be seen in any type of emergency and we will be able to help them cope safely.”
Pregnant women could still receive emergency care, but there was no guarantee that an OB was on site. Now women can be assessed immediately and if an emergency delivery is needed babies can be delivered by Caesarean section in 15 minutes, says Jennifer Perlmutter, head nurse.
Turton adds that they realize that receiving a higher standard of care and the community knowing it is available are two different things. They communicate with obstetricians, organize community events, and make an effort to travel to the surrounding neighborhood so families know what is available.
They are also working to hire in the area when possible and the hospital has partnered with Palo Alto College to develop a nursing program for students on the south side. Texas Vista is also the teaching hospital of the School of Osteopathic Medicine at the University of the Incarnate Word.
“When we talk about the South Side, we use ‘proud South Side’ and talk about it in a way that we don’t talk about other parts of the city,” he says. “We need to make sure, when we design health systems and services, that we do it in a local way that is responsive to the needs of the local community. “
Dr. Cody Henderson, medical director of the NICU at Texas Vista, says almost all parents want the best for their children, which is why providers need to communicate the importance of prenatal care.
While nutrition and avoiding certain behaviors during pregnancy go a long way in supporting the health of both mother and baby, he says modern medicine can spot problems and can often fix them or set up teams to deal with them. treat if a baby arrives before the due date. .
“When you lack this care, you can end up giving birth early when you don’t need it or be in an environment that doesn’t provide the level of care you need,” he says. “With early antenatal care, the rates of cesarean sections and everything are lower.”
Turton says they are continually working to earn the trust of the community, knowing that mothers and babies benefit when they can access care near their homes.
When patients need additional treatment, they can easily be transferred to other hospital systems, including the Children’s Hospital. The NICU cares for about 40 babies each day, 50 percent of whom have been transferred there to receive the highest level of care available from neonatologists as well as specialists and subspecialists, says Dr. Maria Pierce, a neonatologist and Director of the NICU at the San Antoine Children’s Hospital.
Myraclle was transferred there and underwent successful heart surgery in early December. Her parents and doctors hope to get her home in January, just in time to celebrate her due date. “Miracles happen,” says Riojas. “You just have to stay strong and keep the faith. “