Combatting Maternal Morbidity and Mortality:

How TCU’s Medical School Is Making Childbirth Safer

Maternal morbidity and mortality are a national crisis. In the Dallas-Fort Worth Metroplex in North Texas — a region that includes Dallas and Tarrant counties — more than 60,000 births take place every year. That number is greater than the number of annual births that take place in the majority of U.S. states, yet the rate at which women here experience serious complications during pregnancy and childbirth ranks among the highest in the country.

In Fort Worth’s 76104 ZIP code, where the Anne Burnett Marion School of Medicine at Texas Christian University is located, about 30 percent of residents live below the poverty line, and one in every 20 births experiences a severe obstetric complication such as hemorrhage, preeclampsia or sepsis.

“Despite all of our advances in technology, women are still dying and the majority of these deaths are potentially preventable,” says Dr. April Bleich, the medical school’s academic chair of obstetrics and gynecology. “By reducing severe obstetric complications (SOCs), we can improve maternal morbidity and mortality.”

That conviction is at the heart of the North Texas Maternal Health Accelerator (MHA) — a cross-county initiative with an ambitious goal of reducing SOCs in North Texas by 20 percent by 2028, a change that could keep 500 to 600 women in the region out of crisis each year. The effort brings together academic medical centers, hospitals, clinics, nonprofits, and other community partners across the region.

So far, the MHA has raised over $25 million, and early results are showing meaningful improvement in one of its first priorities and the most common SOC — reducing blood transfusion rates in laboring women, one of the most dangerous complications of childbirth.

The Burnett School of Medicine at Texas Christian University, located in Tarrant County, is at the center of the effort; faculty and staff are leading work to pool resources and talent, developing new approaches already reaching patients, and reshaping the standard of care for women nationwide.

TCU’s medical school is joined by accelerator partners with deep expertise in women’s health. They include the University of Texas Southwestern Medical Center in Dallas, which runs the largest OBGYN training program in the country and whose faculty write the primary textbooks on obstetrics and gynecology, as well as Parkland Health in Dallas, which is one of the largest birthing centers in the country and national leader in innovations in maternal health.

TCU’s role in the MHA didn’t emerge by chance. According to Dr. Stuart Flynn, the medical school’s founding dean and the MHA’s principal investigator, it was built on a decade of community partnerships, philanthropic relationships, and research infrastructure that TCU and its MHA partners assembled long before the accelerator launched.

“Our school has been a tremendous collaborative force, and I’m proud of that,” Flynn says. “We were in the right place at the right time with our skill set and willingness to convene the leading programs and people to collaborate and save lives.”

Stuart D. Flynn, M.D., founding dean of the Anne Burnett Marion School of Medicine at Texas Christian University.

Stuart D. Flynn, M.D., founding dean of the Anne Burnett Marion School of Medicine at Texas Christian University.

Building the bridge

Historically, Dallas and Tarrant counties have nurtured rivalries as fierce as high-school football in Texas. But old rivalries gave way a few years ago when Fort Worth’s Mayor Mattie Parker decided the region’s high rates of maternal morbidity and mortality were unacceptable and called leaders together to act.

The group quickly found that many of the resources and solutions to better support pregnant women and new moms already existed across the region, they just weren’t connected. Flynn compared it to a 1,000-piece puzzle. They had all the pieces, now they needed to put the puzzle together.

“It started with both cities, both counties, doing amazing things, but not talking to each other,” Flynn says. “And it ended up coalescing into this beautiful, collaborative effort and we anticipate that the outcomes from our work will drive positive changes in maternal health nationally and worldwide.”

It’s a model that reaches beyond maternal health. Universities have long tackled global challenges that no single sector can solve alone, collaborating with other government, philanthropic, industry, and academic partners to uncover solutions.

Now, the MHA’s participants are moving quickly to make a difference. “We have a unique opportunity to not only make a difference locally, but to build a framework that can be replicated across the country,” Bleich says.

The iron intervention

One of the first issues the MHA is tackling is the leading severe obstetric complication in North Texas and the nation — blood transfusions due to the rapid loss of blood during childbirth. While white women in the two counties experience complications near the national average, Flynn says, the rates are significantly higher for women of color.

The initiative's first major intervention targets the risk before it begins. Nearly every pregnant woman becomes anemic, a natural consequence of the body’s increased fluid demands during pregnancy. The less blood she has going into delivery, the faster a hemorrhage can spiral into an emergency that requires a blood transfusion.

The fix may be as simple as an over-the-counter iron pill. A 2023 study by UT Southwestern and Parkland Health tracked nearly 14,000 patients. Those who received iron supplements from their health care provider had meaningfully higher blood counts by the time they went into delivery and were significantly less likely to be anemic. After the program launched, postpartum blood transfusions dropped by one-third.

“That immediate impact on anemia in pregnancy is almost unheard of in any kind of study we ever do,” Flynn says.

The most difficult part, however, isn’t educating women about the importance of iron, it’s getting a bottle of the supplement into their hands. For lower-income women juggling rent, food, and childcare, the cost alone is a barrier. “It’s that handoff that is the hardest part of this whole effort,” Flynn says.

That operational challenge also led TCU to scrutinize what was in the bottle. Many over-the-counter iron supplements carry side effects, such as nausea, vomiting, and other gastrointestinal issues, making them difficult for patients to tolerate.

“Our first challenge was to find an iron supplement that could be obtained over the counter without the need for a physician prescription,” says Gregory Kearns, who holds a doctorate in pharmacy and is associate dean for research at TCU’s medical school. “There are many of those on the market but most of them are in forms that have been associated with side effects.” So, a manufacturer that offered a gentler formulation was identified.

Today, the medical school is working directly with frontline clinic staff — the people at the intake desks who distribute the bottles — at nearly 70 clinics to make sure pregnant patients leave with iron in hand.

So far, 20,000 bottles have been distributed, and early data already shows a downward trend in transfusions. Flynn is targeting a 10-percent reduction in year one as proof of concept.

Training for the worst

A second major priority is optimizing the emergency response when a patient bleeds in the delivery room, ensuring they have access to blood as soon as possible. At these moments, every second counts, Flynn says.

The simulations focus on the chain of steps — from getting blood out of the bank to the right room — so that nothing is left to chance. TCU leads these efforts in Tarrant County, implementing the training model developed by counterparts at UT Southwestern in Dallas. So far, MHA has run two large-scale simulation events and is on track to hold more than four a year.

“When you train clinical institutions how to optimize their efficiency, they want to do it — and they do,” Flynn says.

Through the MHA, TCU also is helping coordinate a broader web of support for at-risk mothers, including screening for hypertension, distributing free blood pressure cuffs and breast pumps, and promoting a local app called Parent Pass, which was developed in Tarrant County, that connects moms to community services and parenting support.

Parent Pass, Flynn says, “closes the loop” for families by giving pregnant and postpartum moms instant live support; easy access to local resources, such as food pantries and family activities; practical parenting and child-development guidance, and better personal connection to medical and mental health care across North Texas.

“Our job is the convener, streamlining processes to make it work outside of where they already have been utilized,” Flynn says.

A model for everyone

The MHA might be focused on a regional crisis, but Flynn sees it as a model for what medical schools in communities everywhere can do. His message to administrators: You don’t have to lead the charge yourself.

“I don’t think an individual has to be the one rolling up sleeves, boots on the ground,” Flynn says. “Just advocate for it and support those who want to be champions for a life-saving program.”

TCU was well-equipped to play a leading role, Flynn says. Serving the community is embedded into the school’s DNA, one of its four pillars alongside education, patient care, and research.

“This kind of program crosses all four areas of distinction,” Flynn says. “This is our community, and the mayor leaned on us to launch this — not by ourselves, but to bring people together.”

What’s more, TCU’s innovative approach to training the next generation of doctors well-positioned the medical school to play a leading role in the MHA, Bleich says. Unlike most medical schools, TCU’s students complete a four-year research project and begin caring for patients in their first year. Its more than 1,600 clinician faculty span both counties through a distributed clinical training model, giving the school direct connections to clinics, patients, and doctors across the region.

“The Burnett School of Medicine has been an alliance builder from the very beginning,” Bleich says. “Our distributed model allows us to partner with multiple healthcare systems and bring them all to the table with a common goal of educating the next generation of physicians. Now we are building bridges across the Metroplex.”

April Bleich, M.D., chair of Obstetrics and Gynecology for the Burnett School of Medicine, provides counsel to an expectant mother.

Right now, the MHA’s leaders are laser-focused on demonstrating outcomes and scalability in North Texas as they launch new programs and initiatives, Flynn says. From there, leaders hope to influence national practice, improving the support and care for pregnant and postpartum women across the country. It has been shown that just in Tarrant and Dallas Counties, success in the initiatives of the MHA will save $60 million annually in healthcare costs, a byproduct of the true goal of improving health for mothers and babies.

And Flynn forecasts plenty of new territory to tackle in the overall effort to bolster women’s health because the MHA has created something that extends beyond any single program. What stands out is the collaborative network of TCU, community, government, and philanthropic partners now working in sync and ready for whatever comes next. That kind of coalition is exactly what a medical school should be building.

Through its involvement in the MHA, TCU is demonstrating the essential role that medical schools continue to play in advancing innovations in healthcare that can improve the quality of care for patients. “At the end of the day, this is part of the mission of a medical school,” Flynn says. “And it's part of what the medical school does for the mission of its university — and that feels great.”

This content was paid for and created by Texas Christian University. The editorial staff of The Chronicle had no role in its preparation. Find out more about paid content.