Texas attorney Shawn Thierry knew that hers was a high-risk pregnancy, as she was giving birth to her first child at age 42. But she also knew that her health insurance paid for more than adequate prenatal care, as well as a modern, well-equipped delivery room in a hospital with a good reputation.

But then, she said, she almost died.

“When I got the epidural, I started to feel the lower half of my body in excruciating pain,” Thierry recalled. “The nurses said, ‘You shouldn’t feel anything.’ But then the pain traveled up my body and I began having chest pains. I started crying and screaming. I said, ‘I think I’m not going to make it.’”

After some medical intervention, including general anesthesia, her daughter, Klaire, was born. “I was completely under,” she said. “Then just woke up and there was a baby there.”

Doctors later told Thierry she may have received too much of the epidural medication, which can cause heart attacks in some women, though that wasn’t what happened in Thierry’s case.

Still Thierry knows she could have ended up one of the 189 pregnancy-related deaths in the state in 2012 — when deaths in childbirth in Texas skyrocketed, for reasons health officials are still trying to discern.

Recent reports show that African-American women in Texas have disproportionately high rates of maternal death, which has, in turn, given Texas the highest maternal mortality rate not only in the U.S. but in the developed world. By 2014, the state’s maternal death rate reached 35.8 per 100,000 live births, according to a study in Obstetrics and Gynecology. That’s significantly higher than any other country in the Organization for Economic Cooperation and Development group of wealthy nations with the exception of Mexico, the study reports.

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Now, in her role as a state legislator, Rep. Thierry wants to get to the bottom of why this is.

In July, she sponsored HB 11, colloquially called the “Texas Moms Matter Act,” which gives a state task force more time to collect data and study the causes of childbirth-related deaths.

“I survived, but we need to find out why so many mothers here don’t survive,” she said.

The state’s Maternal Mortality and Morbidity Task Force was formed in 2013. So far it has produced two reports digging into data of how and why women are dying in childbirth in the state.

Thierry’s bill would specifically direct the task force to gather more information on the deaths of black women. According to a 2016 report from the task force, though only 11 percent of all births in the state were to black women, they accounted for 29 percent of all maternal deaths.

Thierry’s bill is just one of 20 pieces of legislation Texas lawmakers are rushing to review in a special session that lasts through Aug. 18. The state House unanimously passed the bill this week, and it has been sent to the Senate.

Looking for causes

Maternal deaths have been on the rise across the U.S. A study published last year in Obstetrics and Gynecology showed that the U.S. maternal mortality rate more than doubled since the turn of the century — from 9.8 maternal deaths per 100,000 live births in 2000, to 21.5 in 2014. Texas had been a modest part of the trend until a sudden increase in 2011–2012.

There are some suspected contributors to this worrying trend, said Dr. Lisa Hollier, president-elect of the American College of Obstetricians and Gynecologists and chair of the Texas task force. “Women are having babies at later ages. Along with that, we’re seeing an increase in high blood pressure, obesity, diabetes, and cardiovascular disease among women.”

The study also points out a reduction in health care access for women in Texas immediately prior to the state’s spike in maternal deaths.

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“There were some changes in the provision of women’s health services in Texas from 2011 to 2015, including the closing of several women’s health clinics,” the researchers wrote. But they go on to indicate that there was no explanation for the high number of maternal deaths, and that a closer look at racial differences might offer insight. “A future study will examine Texas data by race-ethnicity and detailed causes of death to better understand this unusual finding,” they wrote.

ACOG has issued a set of recommended interventions for high-risk pregnancies. Among them: Women with conditions such as preeclampsia, adult respiratory syndrome, and placenta previa should have specialists in high-risk birth available to at the time of delivery, and not just on call in case of complications.

Hollier said that the most important part of the Thierry bill is that it extends the length of time for the Texas task force to continue its review of maternal death data. Originally set to end in 2019, the task force will remain in place until 2026 if the bill passes.

“That will give us a chance to see if our interventions work,” Hollier said.

Hollier added that while ACOG is recommending these solutions nationally, the group is especially focused on Texas.

“I’m really hoping that Texas will do some of what states like California have done, to bring down the numbers of maternal deaths.”