Why Nearly 50 California Hospitals Were Forced to End Maternity Ward Services
Maternity Group Care for and by Black People Is Improving Outcomes in Oakland
There's Only 1 Drug for Postpartum Depression. Why Does Kaiser Permanente Make It So Hard to Get?
Low-Income Families Could Get More Benefits With California Budget Surplus
Is THC a Health Risk to Pregnant Women? California Just Decided It Is
A Daily Baby Aspirin Could Help Many Pregnancies And Save Lives
Pregnant or Trying? Here’s How to Get the Most out of California’s New Paid Family Leave Law
A Black Mother Told Not to Scream in Labor Asks: Can California Fix Racism in Maternity Care?
Some Women Recovering From Opioid Addiction Wary of Painkillers During Childbirth
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In the past three years, 29 hospitals stopped delivering babies, according to a \u003ca href=\"https://calmatters.org/health/2023/11/california-hospitals-close-maternity-wards/\">CalMatters investigation on maternity ward closures\u003c/a>. Nearly 50 obstetrics departments have closed over the past decade.\u003c/p>\n\u003cp>Now, California lawmakers are trying to slow the trend.\u003c/p>\n\u003cp>Assemblymember \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/akilah-weber-165432\">Akilah Weber\u003c/a> and Sen. \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/dave-cortese-164699\">Dave Cortese\u003c/a> are pursuing legislation to increase transparency around planned maternity ward closures, potentially giving counties and the state time to intervene.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Weber, a Democrat from La Mesa, wants hospitals to notify the state a year in advance if labor and delivery services are at risk of ending. The measure would also require the state to conduct a community impact report when a hospital indicates that it may lose maternity care.\u003c/p>\n\u003cp>Cortese, a Democrat from Campbell, wants to increase the public notification requirement of an impending closure from 90 days to 120 days and require the hospital to analyze how a closure could increase costs for the county health system, where the next-closest maternity wards are located and who is most likely to be affected.\u003c/p>\n\u003cp>Cortese’s bill would also require increased notification for planned closures of inpatient psychiatric services.\u003c/p>\n\u003cp>“We cannot continue to just discuss these issues and not implement policies to prevent or mitigate the harms and the continued disparities,” Weber said during an Assembly Health Committee hearing on Tuesday.\u003c/p>\n\u003cp>Groups representing doctors and reproductive health advocates support the measure. Nurses and consumer health advocates support Cortese’s bill.\u003c/p>\n\u003ch2>Why are California maternity wards closing?\u003c/h2>\n\u003cp>Ryan Spencer, a lobbyist for the regional chapter of the American College of Obstetricians and Gynecologists who testified in support of Weber’s measure, said there are often situations during birth where “every minute can be the difference between life and death.”\u003c/p>\n\u003cp>“What if you are a patient like this and literally had nowhere to go, who had to drive hours upon hours to get care? We have to find a way to end this crisis,” Spencer said during his testimony.[aside postID=news_11968835 hero='https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-021-JY-qut-1020x680.jpg']Maternity wards are closing for several reasons, according to hospital administrators. They cite labor shortages, increasing costs, low reimbursements and declining birth rates.\u003c/p>\n\u003cp>The California Hospital Association opposes Cortese’s bill and has registered “concerns” about Weber’s. The group argues that neither bill will address the underlying reasons for maternity ward closures and may cause hospitals to terminate services sooner as employees leave and patients look elsewhere for care, said Kirsten Barlow, vice president of policy with the hospital association, during a Senate hearing earlier this month.\u003c/p>\n\u003cp>Current law requires hospitals to notify the public 90 days before a proposed service cut but doesn’t require the state to receive additional notification. Weber said that 90 days is “clearly not sufficient for the state to be able to intervene.”\u003c/p>\n\u003ch2>Maternity care deserts emerge\u003c/h2>\n\u003cp>CalMatters found that 12 counties have no hospital delivering babies, including Madera County, where the sudden closure of the county’s only hospital in 2022 spurred a flurry of emergency legislation supporting \u003ca href=\"https://calmatters.org/health/2023/08/california-hospitals-bailout-loans/\">distressed hospitals\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2024/02/madera-hospital-reopen/\">Madera Community Hospital\u003c/a> is now on track to reopen but without a maternity ward. The company reopening the hospital, American Advanced Management, has indicated that low insurance reimbursement rates factored into its decision to open without labor and delivery.[aside postID=news_11976372 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/02/010423-MaderaCommunityHospital-LV_CM_07-copy-1020x680.jpg']“Reopening maternity would be like reopening two hospitals at the same time,” Matthew Beehler, chief strategy officer at American Advanced Management, previously told CalMatters.\u003c/p>\n\u003cp>Still, the bill authors and advocates are adamant that access to maternity care is a necessity. National studies indicate that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885848/\">rates of preterm birth increase,\u003c/a> and \u003ca href=\"https://corey-white.com/assets/docs/frw_reduced_form_manuscript_AEJ_R1.pdf\">women receive less prenatal care\u003c/a> when labor and delivery units shut down, particularly in rural areas. CalMatters found that maternity closures in California disproportionately impact low-income and Latino communities.\u003c/p>\n\u003cp>“This is really a very simple bill. It doesn’t do much. It creates a public hearing opportunity at the local level to deal with issues that are …absolutely vital to the survival of our constituents,” Cortese said during a Senate Health Committee hearing on his measure.\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"Two California lawmakers introduced bills intended to slow maternity ward closures after an investigation found nearly 50 hospitals had ended labor and delivery services between 2012 and 2023.","status":"publish","parent":0,"modified":1713380834,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":778},"headData":{"title":"Why Nearly 50 California Hospitals Were Forced to End Maternity Ward Services | KQED","description":"Two California lawmakers introduced bills intended to slow maternity ward closures after an investigation found nearly 50 hospitals had ended labor and delivery services between 2012 and 2023.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"NewsArticle","headline":"Why Nearly 50 California Hospitals Were Forced to End Maternity Ward Services","datePublished":"2024-04-17T19:00:14.000Z","dateModified":"2024-04-17T19:07:14.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png","isAccessibleForFree":"Y","publisher":{"@type":"NewsMediaOrganization","@id":"https://www.kqed.org/#organization","name":"KQED","url":"https://www.kqed.org","logo":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}}},"sticky":false,"nprByline":"Kristen Hwang, CalMatters","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","articleAge":"0","path":"/news/11983217/why-nearly-50-california-hospitals-were-forced-to-end-maternity-ward-services","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In just the first few months of 2024, four California hospitals have closed or announced plans to close their maternity wards.\u003c/p>\n\u003cp>The closures are part of an accelerating trend unfolding across the state, creating maternity care deserts and decreasing access to prenatal care. In the past three years, 29 hospitals stopped delivering babies, according to a \u003ca href=\"https://calmatters.org/health/2023/11/california-hospitals-close-maternity-wards/\">CalMatters investigation on maternity ward closures\u003c/a>. Nearly 50 obstetrics departments have closed over the past decade.\u003c/p>\n\u003cp>Now, California lawmakers are trying to slow the trend.\u003c/p>\n\u003cp>Assemblymember \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/akilah-weber-165432\">Akilah Weber\u003c/a> and Sen. \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/dave-cortese-164699\">Dave Cortese\u003c/a> are pursuing legislation to increase transparency around planned maternity ward closures, potentially giving counties and the state time to intervene.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Weber, a Democrat from La Mesa, wants hospitals to notify the state a year in advance if labor and delivery services are at risk of ending. The measure would also require the state to conduct a community impact report when a hospital indicates that it may lose maternity care.\u003c/p>\n\u003cp>Cortese, a Democrat from Campbell, wants to increase the public notification requirement of an impending closure from 90 days to 120 days and require the hospital to analyze how a closure could increase costs for the county health system, where the next-closest maternity wards are located and who is most likely to be affected.\u003c/p>\n\u003cp>Cortese’s bill would also require increased notification for planned closures of inpatient psychiatric services.\u003c/p>\n\u003cp>“We cannot continue to just discuss these issues and not implement policies to prevent or mitigate the harms and the continued disparities,” Weber said during an Assembly Health Committee hearing on Tuesday.\u003c/p>\n\u003cp>Groups representing doctors and reproductive health advocates support the measure. Nurses and consumer health advocates support Cortese’s bill.\u003c/p>\n\u003ch2>Why are California maternity wards closing?\u003c/h2>\n\u003cp>Ryan Spencer, a lobbyist for the regional chapter of the American College of Obstetricians and Gynecologists who testified in support of Weber’s measure, said there are often situations during birth where “every minute can be the difference between life and death.”\u003c/p>\n\u003cp>“What if you are a patient like this and literally had nowhere to go, who had to drive hours upon hours to get care? We have to find a way to end this crisis,” Spencer said during his testimony.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11968835","hero":"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-021-JY-qut-1020x680.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Maternity wards are closing for several reasons, according to hospital administrators. They cite labor shortages, increasing costs, low reimbursements and declining birth rates.\u003c/p>\n\u003cp>The California Hospital Association opposes Cortese’s bill and has registered “concerns” about Weber’s. The group argues that neither bill will address the underlying reasons for maternity ward closures and may cause hospitals to terminate services sooner as employees leave and patients look elsewhere for care, said Kirsten Barlow, vice president of policy with the hospital association, during a Senate hearing earlier this month.\u003c/p>\n\u003cp>Current law requires hospitals to notify the public 90 days before a proposed service cut but doesn’t require the state to receive additional notification. Weber said that 90 days is “clearly not sufficient for the state to be able to intervene.”\u003c/p>\n\u003ch2>Maternity care deserts emerge\u003c/h2>\n\u003cp>CalMatters found that 12 counties have no hospital delivering babies, including Madera County, where the sudden closure of the county’s only hospital in 2022 spurred a flurry of emergency legislation supporting \u003ca href=\"https://calmatters.org/health/2023/08/california-hospitals-bailout-loans/\">distressed hospitals\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2024/02/madera-hospital-reopen/\">Madera Community Hospital\u003c/a> is now on track to reopen but without a maternity ward. The company reopening the hospital, American Advanced Management, has indicated that low insurance reimbursement rates factored into its decision to open without labor and delivery.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11976372","hero":"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/02/010423-MaderaCommunityHospital-LV_CM_07-copy-1020x680.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“Reopening maternity would be like reopening two hospitals at the same time,” Matthew Beehler, chief strategy officer at American Advanced Management, previously told CalMatters.\u003c/p>\n\u003cp>Still, the bill authors and advocates are adamant that access to maternity care is a necessity. National studies indicate that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885848/\">rates of preterm birth increase,\u003c/a> and \u003ca href=\"https://corey-white.com/assets/docs/frw_reduced_form_manuscript_AEJ_R1.pdf\">women receive less prenatal care\u003c/a> when labor and delivery units shut down, particularly in rural areas. CalMatters found that maternity closures in California disproportionately impact low-income and Latino communities.\u003c/p>\n\u003cp>“This is really a very simple bill. It doesn’t do much. It creates a public hearing opportunity at the local level to deal with issues that are …absolutely vital to the survival of our constituents,” Cortese said during a Senate Health Committee hearing on his measure.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11983217/why-nearly-50-california-hospitals-were-forced-to-end-maternity-ward-services","authors":["byline_news_11983217"],"categories":["news_457","news_8"],"tags":["news_18538","news_18543","news_18659","news_33578","news_21771","news_33583"],"affiliates":["news_18481"],"featImg":"news_11983218","label":"news_18481"},"news_11968835":{"type":"posts","id":"news_11968835","meta":{"index":"posts_1591205157","site":"news","id":"11968835","score":null,"sort":[1701703845000]},"guestAuthors":[],"slug":"maternity-group-care-for-and-by-black-people-is-improving-outcomes-in-oakland","title":"Maternity Group Care for and by Black People Is Improving Outcomes in Oakland","publishDate":1701703845,"format":"standard","headTitle":"Maternity Group Care for and by Black People Is Improving Outcomes in Oakland | KQED","labelTerm":{"site":"news"},"content":"\u003cp>Things didn’t go as planned when DeAnna Jones, 31, delivered her first child in Oakland three years ago.\u003c/p>\n\u003cp>She wanted to have a natural birth, but early contractions led doctors to medically induce her labor a week earlier than her due date. Her daughter’s birth turned out well, but she wished she had known more going into the experience.\u003c/p>\n\u003cp>“I did have a birth plan, and getting induced was not part of that,” Jones said. “So when it came at 39 weeks to be induced, I was like, okay … but I didn’t necessarily say why or can I wait until I’m actually 40 weeks or things that I probably should have asked.”\u003c/p>\n\u003cfigure id=\"attachment_11968844\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968844\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut.jpg\" alt=\"Two African American women smiles as they go over a chart.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">BElovedBIRTH Black Centering midwife Chantal Davis (left) holds up an infographic on decision making alongside program director Jyesha Wren (right) during a group care session for expectant Black mothers at the Alameda Wellness Center in Oakland on Wednesday, Nov. 8, 2023. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jones didn’t feel mistreated during her experience at the Wilma Chan Highland Hospital Campus, but it gave her pause when she became pregnant again.\u003c/p>\n\u003cp>So Jones was excited when, around eight weeks into her second pregnancy, she was invited to participate in a group perinatal care program that’s trying to improve the patient experience for Black women like her who live in Alameda County. The program, called BElovedBIRTH Black Centering, is resulting in healthier births and prompting state officials to look into expanding it to other public hospitals in California.\u003c/p>\n\u003cp>The program groups up to a dozen Black women in similar stages of pregnancy and offers them care from a team of Black doctors, midwives, doulas, nutritionists, breastfeeding experts and other wellness professionals. Participants receive a range of services before, during and after giving birth — from childbirth education to mental health support and social services.\u003c/p>\n\u003cfigure id=\"attachment_11968845\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968845\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut.jpg\" alt=\"African American women smile as they sit in a circle and listen to one of them speak.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Latasha Dixon (center) acts out a decision-making scenario during a BElovedBIRTH Black Centering group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The program also harnesses donations from the community to give away fresh produce, baby supplies, postpartum meal deliveries and pregnancy portraits with a professional photographer.\u003c/p>\n\u003cp>“We have really adopted the ‘it takes a village’ mindset and the commitment to say, okay, if we know better, we have to do better,” said Jyesha Wren, a midwife and director of the program.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jyesha Wren, director, BElovedBIRTH Black Centering\"]‘We have really adopted the ‘it takes a village’ mindset and the commitment to say, okay, if we know better, we have to do better.’[/pullquote]Wren, along with the Alameda Health System, which operates Highland Hospital and other community health centers, and the Alameda County Public Health Department, launched the program in 2020 to address the alarming rate of pregnancy-related deaths and complications affecting Black women. So far, the $3.5 million public-private initiative has served more than 200 patients who qualify for Medi-Cal because of their low income.\u003c/p>\n\u003cp>American women are dying during pregnancy or in the year after \u003ca href=\"https://www.commonwealthfund.org/blog/2022/us-maternal-mortality-crisis-continues-worsen-international-comparison\">at a far higher rate than in other wealthy nations\u003c/a>, and \u003ca href=\"https://www.cdc.gov/healthequity/features/maternal-mortality/index.html\">Black women are three times as likely to die\u003c/a> from giving birth as white mothers.\u003c/p>\n\u003cp>While California’s maternal mortality rate has been \u003ca href=\"https://www.cmqcc.org/research/maternal-mortality-review-ca-pamr/ca-pamr-recent-data\">lower than the rest of the \u003c/a>country in the last decade, \u003ca href=\"https://www.nber.org/system/files/working_papers/w30693/w30693.pdf\">a landmark study of babies born in the state (PDF)\u003c/a> between 2007 and 2016 found that childbirth is riskier for Black women, regardless of their socioeconomic status. The study, which examines birth, death and hospitalization records with income tax and demographic data, found that high-income Black mothers have the same risk of dying in the first year after giving birth as the poorest white mothers.\u003c/p>\n\u003cp>“There are many factors that may be driving this, but the primary factor behind all of that is racism in all of its forms, whether that’s structural or institutional or interpersonal racism,” said Kim Harley, a researcher at UC Berkeley’s School of Public Health. “We see that impacting the whole life course of Black birthing people, and it’s shown in the outcomes that they have during pregnancy.”\u003c/p>\n\u003cfigure id=\"attachment_11968851\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968851\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut.jpg\" alt=\"A pregnant African American woman looks on as someone handles a catheter in a room with chairs.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">DeAnna Jones watches as BElovedBIRTH Black Centering team members demonstrate a balloon catheter procedure during birth at a group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More recently, a survey of 2,400 mothers by the U.S. Centers for Disease Control and Prevention found that \u003ca href=\"https://www.cdc.gov/vitalsigns/respectful-maternity-care/index.html\">one in five women said they had been mistreated \u003c/a>while receiving maternity care. Mistreatment was reported most often by Black, Hispanic and multiracial moms and those with public or no insurance. What’s more, almost half of the women surveyed said they held back in asking questions or sharing concerns with their providers because they didn’t want to “make a big deal” or not feeling confident that they knew what they were talking about.\u003c/p>\n\u003ch2>A unique model of care\u003c/h2>\n\u003cp>BElovedBIRTH combines several strategies, such as having a doula provide nonmedical support during a birth, that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292163/\">has been shown to improve outcomes\u003c/a> for Black mothers and their babies.\u003c/p>\n\u003cp>While typical prenatal checkups last about 15 minutes and can leave parents feeling rushed and overwhelmed, BElovedBIRTH takes a different approach. Participants partake in group prenatal care, also known as centering, where they get two hours to learn about what’s happening to their bodies and ask questions.\u003c/p>\n\u003cfigure id=\"attachment_11968848\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968848\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut.jpg\" alt=\"A pregnant woman is laying down and receiving prenatal care from another woman.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Midwife Chantal Davis finishes checking Taj’ae Harris’ baby’s heartbeat during a checkup at BElovedBIRTH Black Centering’s group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>BElovedBIRTH participants meet twice a month at a clinic located in a former shopping mall in East Oakland, but the setting feels nothing like a medical office. Portraits of pregnant Black people hang on the wall and mellow Afrobeat music plays in the background. There’s a lounge filled with books where women sip tea and chat with each other.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=\"news_11965919,news_11943821,news_11958841\"]During a recent visit, six women, including DeAnna Jones, took turns going behind a room divider where a nurse measured their blood pressure and their baby’s heartbeat.\u003c/p>\n\u003cp>Then, they formed a circle to learn from a team of Black midwives and doulas about different methods for speeding up labor and the pros and cons of each one. They also role-played what it might be like if their deliveries don’t go as planned.\u003c/p>\n\u003cp>Dressed in a T-shirt that exposed her full belly, Jones went over a scenario where she was admitted to the hospital with high blood pressure. A midwife suggested speeding up contractions with medication or a balloon-like device to widen her cervix.\u003c/p>\n\u003cp>Jones weighed the risks and benefits of using either method or doing nothing at all and asked: “Is there a possibility that I can wait a little bit?” A doula stepped in and asked if she needed more time to discuss the options.\u003c/p>\n\u003cp>Jones said, “Yes,” seemingly relieved to have that choice.\u003c/p>\n\u003cfigure id=\"attachment_11968849\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968849\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut.jpg\" alt=\"An African American woman holds a natal chart in front of a class.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Doula Mysti Dyse holds up a chart displaying cervix dilation during a BElovedBIRTH Black Centering group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The purpose of the exercise was to empower patients to make informed decisions.\u003c/p>\n\u003cp>“These things may seem kind of simple and basic, but the sad reality is that in most medicalized health care, they’re not happening,” Wren said.\u003c/p>\n\u003cp>“There’s no time for them to get information. There’s no time for them to be actually taking charge of their health care in that way and knowing what’s going on with their bodies and making their decisions and having them respected.”\u003c/p>\n\u003cfigure id=\"attachment_11968850\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968850\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut.jpg\" alt=\"An African American woman smiles as she sits in front of a whiteboard with writing on it.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">BElovedBIRTH Black Centering Program Director Jyesha Wren holds a group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In an independent survey of Black moms who participated in the program, the majority said they felt less stressed during pregnancy and more prepared to advocate for themselves.\u003c/p>\n\u003cp>Taj’ae Harris, 20, said before coming here, much of what she knew about childbirth came from TikTok and YouTube.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Taj’ae Harris, program participant\"]‘I’ve been learning a lot of things, like the steps, like coping during labor, different tools being used, different things to ask the doctors, different things to make you feel safe.’[/pullquote]“But then actually coming in here and learning even more stuff, it all, like, pieced together,” she said. “So I’ve been learning a lot of things, like the steps, like coping during labor, different tools being used, different things to ask the doctors, different things to make you feel safe.”\u003c/p>\n\u003cp>Meanwhile, Jones said she feels more confident as she prepares for her second delivery.\u003c/p>\n\u003cp>“I wish I had this program then, but now that I’m in it, I’m excited and ready to go,” she said.\u003c/p>\n\u003cp>An ongoing study led by Harley, the reproductive epidemiologist at UC Berkeley, found that the BElovedBIRTH participants’ babies had a higher rate of being born at full term and with a healthy birth weight than other Black babies born at Highland, which is Alameda County’s main public hospital.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The California Department of Health Care Services, which administers Medi-Cal, is exploring ways to make a program like BElovedBIRTH financially sustainable so it can be implemented in other public health systems.\u003c/p>\n\u003cp>The program would expand the state’s recent efforts to\u003ca href=\"https://www.cdph.ca.gov/Programs/CFH/DMCAH/PEI/Pages/default.aspx\"> improve health equity for new parents and babies\u003c/a>. The state already expanded postpartum care and access to doulas for Medi-Cal patients. It’s starting to offer unconditional cash, ranging from $600 to $1000 per month, to pregnant people in certain communities who are at high risk for preterm birth or postpartum complications. The state’s pilot project is an expansion of \u003ca href=\"https://pretermbirthca.ucsf.edu/expecting-justice\">a San Francisco experiment that provides extra cash and doula care for Black and Pacific Islander pregnant people\u003c/a> — two groups that have the highest preterm birth rate in the city.\u003c/p>\n\u003cp>The state is also putting pressure on perinatal care providers to comply with a law requiring that their workers undergo unconscious bias training.\u003c/p>\n\u003cfigure id=\"attachment_11968854\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968854\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut.jpg\" alt=\"Five African American women sit in a room, smiling and conversing.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">From left to right: Monique Gomez, Taj’ae Harris, and Latasha Dixon attend a BElovedBIRTH Black Centering group care session for expectant Black mothers alongside midwife Chantal Davis and doula Mystic Dyse at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But two years after that law took effect, \u003ca href=\"https://www.kqed.org/news/11965919/california-hospitals-ignored-bias-training-despite-high-black-maternal-death-rate\">an investigation by the state Department of Justice\u003c/a> found only 17% of those providers began training their employees.\u003c/p>\n\u003cp>Wren said mandating unconscious bias training is a step in the right direction, but she thinks advancing health equity will also require empowering pregnant Black people so that they can demand a higher standard of care and holding health care providers accountable.\u003c/p>\n\u003cp>“It really is a matter of life and death for our health system to do things differently because we know that if we continue to deliver health care in the way that we have, we’ll continue to have preventable morbidity and mortality,” she said.\u003c/p>\n\u003ch2>A legacy of fighting for health equity\u003c/h2>\n\u003cp>Wren says the BElovedBIRTH Black Centering is thriving because of grassroots support in a community with a tradition of activism. It draws inspiration from the Black Panthers Party, which operated more than a dozen free medical clinics for Black communities in Oakland and elsewhere in the 1960s and 70s.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jyesha Wren, director, BElovedBIRTH Black Centering\"]‘It really is a matter of life and death for our health system to do things differently because we know that if we continue to deliver health care in the way that we have, we’ll continue to have preventable morbidity and mortality.’[/pullquote]They “really recognized the health impacts of racism in all of its forms and the need to do community-centered health care work that was by and for us,” she said.\u003c/p>\n\u003cp>The Oakland area also benefits from having a larger than usual pool of Black midwives, doulas and maternity care providers.\u003c/p>\n\u003cp>Wren credits the former head of Highland Hospital’s Maternal and Child Health department for taking the unusual step in the 1980s of including midwives in the labor and delivery room. That wasn’t common practice then but has since been shown to lower birth complications. The move created a robust midwife department, and some of its staff members are now supporting BElovedBIRTH participants.\u003c/p>\n\u003cfigure id=\"attachment_11968855\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968855\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut.jpg\" alt=\"A wall full of photos, cards, messages.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Pregnancy portraits fill the walls of BElovedBIRTH Black Centering at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The doctor who advocated for midwives was James Jackson. His son, James E.T. Jackson, is now CEO of Alameda Health System.\u003c/p>\n\u003cp>“He understood their value, and what the Beloved program has shown is that the cohort model and working with midwives and doulas create a safe space for these mothers that they did not have before,” he said.\u003c/p>\n\u003cp>Alameda Health System is encouraged by the outcomes, the younger Jackson said and is looking to expand the program to other ethnic groups experiencing disproportionate rates of maternal and infant mortality.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"A new group prenatal care program called BElovedBIRTH Black Centering is resulting in healthier births and prompting state officials to look into expanding it to other public hospitals in California.","status":"publish","parent":0,"modified":1710964134,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":45,"wordCount":2273},"headData":{"title":"Maternity Group Care for and by Black People Is Improving Outcomes in Oakland | KQED","description":"A new group prenatal care program called BElovedBIRTH Black Centering is resulting in healthier births and prompting state officials to look into expanding it to other public hospitals in California.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"NewsArticle","headline":"Maternity Group Care for and by Black People Is Improving Outcomes in Oakland","datePublished":"2023-12-04T15:30:45.000Z","dateModified":"2024-03-20T19:48:54.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png","isAccessibleForFree":"Y","publisher":{"@type":"NewsMediaOrganization","@id":"https://www.kqed.org/#organization","name":"KQED","url":"https://www.kqed.org","logo":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}}},"audioUrl":"https://traffic.omny.fm/d/clips/0af137ef-751e-4b19-a055-aaef00d2d578/ffca7e9f-6831-41c5-bcaf-aaef00f5a073/88bc4eaa-6bfe-46ec-b9ca-b0c901106cce/audio.mp3","sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/news/11968835/maternity-group-care-for-and-by-black-people-is-improving-outcomes-in-oakland","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Things didn’t go as planned when DeAnna Jones, 31, delivered her first child in Oakland three years ago.\u003c/p>\n\u003cp>She wanted to have a natural birth, but early contractions led doctors to medically induce her labor a week earlier than her due date. Her daughter’s birth turned out well, but she wished she had known more going into the experience.\u003c/p>\n\u003cp>“I did have a birth plan, and getting induced was not part of that,” Jones said. “So when it came at 39 weeks to be induced, I was like, okay … but I didn’t necessarily say why or can I wait until I’m actually 40 weeks or things that I probably should have asked.”\u003c/p>\n\u003cfigure id=\"attachment_11968844\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968844\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut.jpg\" alt=\"Two African American women smiles as they go over a chart.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">BElovedBIRTH Black Centering midwife Chantal Davis (left) holds up an infographic on decision making alongside program director Jyesha Wren (right) during a group care session for expectant Black mothers at the Alameda Wellness Center in Oakland on Wednesday, Nov. 8, 2023. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jones didn’t feel mistreated during her experience at the Wilma Chan Highland Hospital Campus, but it gave her pause when she became pregnant again.\u003c/p>\n\u003cp>So Jones was excited when, around eight weeks into her second pregnancy, she was invited to participate in a group perinatal care program that’s trying to improve the patient experience for Black women like her who live in Alameda County. The program, called BElovedBIRTH Black Centering, is resulting in healthier births and prompting state officials to look into expanding it to other public hospitals in California.\u003c/p>\n\u003cp>The program groups up to a dozen Black women in similar stages of pregnancy and offers them care from a team of Black doctors, midwives, doulas, nutritionists, breastfeeding experts and other wellness professionals. Participants receive a range of services before, during and after giving birth — from childbirth education to mental health support and social services.\u003c/p>\n\u003cfigure id=\"attachment_11968845\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968845\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut.jpg\" alt=\"African American women smile as they sit in a circle and listen to one of them speak.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Latasha Dixon (center) acts out a decision-making scenario during a BElovedBIRTH Black Centering group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The program also harnesses donations from the community to give away fresh produce, baby supplies, postpartum meal deliveries and pregnancy portraits with a professional photographer.\u003c/p>\n\u003cp>“We have really adopted the ‘it takes a village’ mindset and the commitment to say, okay, if we know better, we have to do better,” said Jyesha Wren, a midwife and director of the program.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘We have really adopted the ‘it takes a village’ mindset and the commitment to say, okay, if we know better, we have to do better.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Jyesha Wren, director, BElovedBIRTH Black Centering","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Wren, along with the Alameda Health System, which operates Highland Hospital and other community health centers, and the Alameda County Public Health Department, launched the program in 2020 to address the alarming rate of pregnancy-related deaths and complications affecting Black women. So far, the $3.5 million public-private initiative has served more than 200 patients who qualify for Medi-Cal because of their low income.\u003c/p>\n\u003cp>American women are dying during pregnancy or in the year after \u003ca href=\"https://www.commonwealthfund.org/blog/2022/us-maternal-mortality-crisis-continues-worsen-international-comparison\">at a far higher rate than in other wealthy nations\u003c/a>, and \u003ca href=\"https://www.cdc.gov/healthequity/features/maternal-mortality/index.html\">Black women are three times as likely to die\u003c/a> from giving birth as white mothers.\u003c/p>\n\u003cp>While California’s maternal mortality rate has been \u003ca href=\"https://www.cmqcc.org/research/maternal-mortality-review-ca-pamr/ca-pamr-recent-data\">lower than the rest of the \u003c/a>country in the last decade, \u003ca href=\"https://www.nber.org/system/files/working_papers/w30693/w30693.pdf\">a landmark study of babies born in the state (PDF)\u003c/a> between 2007 and 2016 found that childbirth is riskier for Black women, regardless of their socioeconomic status. The study, which examines birth, death and hospitalization records with income tax and demographic data, found that high-income Black mothers have the same risk of dying in the first year after giving birth as the poorest white mothers.\u003c/p>\n\u003cp>“There are many factors that may be driving this, but the primary factor behind all of that is racism in all of its forms, whether that’s structural or institutional or interpersonal racism,” said Kim Harley, a researcher at UC Berkeley’s School of Public Health. “We see that impacting the whole life course of Black birthing people, and it’s shown in the outcomes that they have during pregnancy.”\u003c/p>\n\u003cfigure id=\"attachment_11968851\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968851\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut.jpg\" alt=\"A pregnant African American woman looks on as someone handles a catheter in a room with chairs.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">DeAnna Jones watches as BElovedBIRTH Black Centering team members demonstrate a balloon catheter procedure during birth at a group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More recently, a survey of 2,400 mothers by the U.S. Centers for Disease Control and Prevention found that \u003ca href=\"https://www.cdc.gov/vitalsigns/respectful-maternity-care/index.html\">one in five women said they had been mistreated \u003c/a>while receiving maternity care. Mistreatment was reported most often by Black, Hispanic and multiracial moms and those with public or no insurance. What’s more, almost half of the women surveyed said they held back in asking questions or sharing concerns with their providers because they didn’t want to “make a big deal” or not feeling confident that they knew what they were talking about.\u003c/p>\n\u003ch2>A unique model of care\u003c/h2>\n\u003cp>BElovedBIRTH combines several strategies, such as having a doula provide nonmedical support during a birth, that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292163/\">has been shown to improve outcomes\u003c/a> for Black mothers and their babies.\u003c/p>\n\u003cp>While typical prenatal checkups last about 15 minutes and can leave parents feeling rushed and overwhelmed, BElovedBIRTH takes a different approach. Participants partake in group prenatal care, also known as centering, where they get two hours to learn about what’s happening to their bodies and ask questions.\u003c/p>\n\u003cfigure id=\"attachment_11968848\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968848\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut.jpg\" alt=\"A pregnant woman is laying down and receiving prenatal care from another woman.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Midwife Chantal Davis finishes checking Taj’ae Harris’ baby’s heartbeat during a checkup at BElovedBIRTH Black Centering’s group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>BElovedBIRTH participants meet twice a month at a clinic located in a former shopping mall in East Oakland, but the setting feels nothing like a medical office. Portraits of pregnant Black people hang on the wall and mellow Afrobeat music plays in the background. There’s a lounge filled with books where women sip tea and chat with each other.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"Related Stories ","postid":"news_11965919,news_11943821,news_11958841"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>During a recent visit, six women, including DeAnna Jones, took turns going behind a room divider where a nurse measured their blood pressure and their baby’s heartbeat.\u003c/p>\n\u003cp>Then, they formed a circle to learn from a team of Black midwives and doulas about different methods for speeding up labor and the pros and cons of each one. They also role-played what it might be like if their deliveries don’t go as planned.\u003c/p>\n\u003cp>Dressed in a T-shirt that exposed her full belly, Jones went over a scenario where she was admitted to the hospital with high blood pressure. A midwife suggested speeding up contractions with medication or a balloon-like device to widen her cervix.\u003c/p>\n\u003cp>Jones weighed the risks and benefits of using either method or doing nothing at all and asked: “Is there a possibility that I can wait a little bit?” A doula stepped in and asked if she needed more time to discuss the options.\u003c/p>\n\u003cp>Jones said, “Yes,” seemingly relieved to have that choice.\u003c/p>\n\u003cfigure id=\"attachment_11968849\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968849\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut.jpg\" alt=\"An African American woman holds a natal chart in front of a class.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Doula Mysti Dyse holds up a chart displaying cervix dilation during a BElovedBIRTH Black Centering group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The purpose of the exercise was to empower patients to make informed decisions.\u003c/p>\n\u003cp>“These things may seem kind of simple and basic, but the sad reality is that in most medicalized health care, they’re not happening,” Wren said.\u003c/p>\n\u003cp>“There’s no time for them to get information. There’s no time for them to be actually taking charge of their health care in that way and knowing what’s going on with their bodies and making their decisions and having them respected.”\u003c/p>\n\u003cfigure id=\"attachment_11968850\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968850\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut.jpg\" alt=\"An African American woman smiles as she sits in front of a whiteboard with writing on it.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">BElovedBIRTH Black Centering Program Director Jyesha Wren holds a group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In an independent survey of Black moms who participated in the program, the majority said they felt less stressed during pregnancy and more prepared to advocate for themselves.\u003c/p>\n\u003cp>Taj’ae Harris, 20, said before coming here, much of what she knew about childbirth came from TikTok and YouTube.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘I’ve been learning a lot of things, like the steps, like coping during labor, different tools being used, different things to ask the doctors, different things to make you feel safe.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Taj’ae Harris, program participant","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“But then actually coming in here and learning even more stuff, it all, like, pieced together,” she said. “So I’ve been learning a lot of things, like the steps, like coping during labor, different tools being used, different things to ask the doctors, different things to make you feel safe.”\u003c/p>\n\u003cp>Meanwhile, Jones said she feels more confident as she prepares for her second delivery.\u003c/p>\n\u003cp>“I wish I had this program then, but now that I’m in it, I’m excited and ready to go,” she said.\u003c/p>\n\u003cp>An ongoing study led by Harley, the reproductive epidemiologist at UC Berkeley, found that the BElovedBIRTH participants’ babies had a higher rate of being born at full term and with a healthy birth weight than other Black babies born at Highland, which is Alameda County’s main public hospital.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The California Department of Health Care Services, which administers Medi-Cal, is exploring ways to make a program like BElovedBIRTH financially sustainable so it can be implemented in other public health systems.\u003c/p>\n\u003cp>The program would expand the state’s recent efforts to\u003ca href=\"https://www.cdph.ca.gov/Programs/CFH/DMCAH/PEI/Pages/default.aspx\"> improve health equity for new parents and babies\u003c/a>. The state already expanded postpartum care and access to doulas for Medi-Cal patients. It’s starting to offer unconditional cash, ranging from $600 to $1000 per month, to pregnant people in certain communities who are at high risk for preterm birth or postpartum complications. The state’s pilot project is an expansion of \u003ca href=\"https://pretermbirthca.ucsf.edu/expecting-justice\">a San Francisco experiment that provides extra cash and doula care for Black and Pacific Islander pregnant people\u003c/a> — two groups that have the highest preterm birth rate in the city.\u003c/p>\n\u003cp>The state is also putting pressure on perinatal care providers to comply with a law requiring that their workers undergo unconscious bias training.\u003c/p>\n\u003cfigure id=\"attachment_11968854\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968854\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut.jpg\" alt=\"Five African American women sit in a room, smiling and conversing.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">From left to right: Monique Gomez, Taj’ae Harris, and Latasha Dixon attend a BElovedBIRTH Black Centering group care session for expectant Black mothers alongside midwife Chantal Davis and doula Mystic Dyse at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But two years after that law took effect, \u003ca href=\"https://www.kqed.org/news/11965919/california-hospitals-ignored-bias-training-despite-high-black-maternal-death-rate\">an investigation by the state Department of Justice\u003c/a> found only 17% of those providers began training their employees.\u003c/p>\n\u003cp>Wren said mandating unconscious bias training is a step in the right direction, but she thinks advancing health equity will also require empowering pregnant Black people so that they can demand a higher standard of care and holding health care providers accountable.\u003c/p>\n\u003cp>“It really is a matter of life and death for our health system to do things differently because we know that if we continue to deliver health care in the way that we have, we’ll continue to have preventable morbidity and mortality,” she said.\u003c/p>\n\u003ch2>A legacy of fighting for health equity\u003c/h2>\n\u003cp>Wren says the BElovedBIRTH Black Centering is thriving because of grassroots support in a community with a tradition of activism. It draws inspiration from the Black Panthers Party, which operated more than a dozen free medical clinics for Black communities in Oakland and elsewhere in the 1960s and 70s.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘It really is a matter of life and death for our health system to do things differently because we know that if we continue to deliver health care in the way that we have, we’ll continue to have preventable morbidity and mortality.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Jyesha Wren, director, BElovedBIRTH Black Centering","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>They “really recognized the health impacts of racism in all of its forms and the need to do community-centered health care work that was by and for us,” she said.\u003c/p>\n\u003cp>The Oakland area also benefits from having a larger than usual pool of Black midwives, doulas and maternity care providers.\u003c/p>\n\u003cp>Wren credits the former head of Highland Hospital’s Maternal and Child Health department for taking the unusual step in the 1980s of including midwives in the labor and delivery room. That wasn’t common practice then but has since been shown to lower birth complications. The move created a robust midwife department, and some of its staff members are now supporting BElovedBIRTH participants.\u003c/p>\n\u003cfigure id=\"attachment_11968855\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968855\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut.jpg\" alt=\"A wall full of photos, cards, messages.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Pregnancy portraits fill the walls of BElovedBIRTH Black Centering at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The doctor who advocated for midwives was James Jackson. His son, James E.T. Jackson, is now CEO of Alameda Health System.\u003c/p>\n\u003cp>“He understood their value, and what the Beloved program has shown is that the cohort model and working with midwives and doulas create a safe space for these mothers that they did not have before,” he said.\u003c/p>\n\u003cp>Alameda Health System is encouraged by the outcomes, the younger Jackson said and is looking to expand the program to other ethnic groups experiencing disproportionate rates of maternal and infant mortality.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11968835/maternity-group-care-for-and-by-black-people-is-improving-outcomes-in-oakland","authors":["11829"],"categories":["news_457","news_8"],"tags":["news_33582","news_33580","news_33579","news_33581","news_23820","news_32102","news_27626","news_23654","news_33578","news_21771","news_33583","news_32123","news_23209"],"featImg":"news_11968843","label":"news"},"news_11879309":{"type":"posts","id":"news_11879309","meta":{"index":"posts_1591205157","site":"news","id":"11879309","score":null,"sort":[1624878098000]},"guestAuthors":[],"slug":"theres-only-1-drug-for-postpartum-depression-why-does-kaiser-permanente-make-it-so-hard-to-get","title":"There's Only 1 Drug for Postpartum Depression. Why Does Kaiser Permanente Make It So Hard to Get?","publishDate":1624878098,"format":"standard","headTitle":"KQED News","labelTerm":{"site":"news"},"content":"\u003cp>[dropcap]W[/dropcap]hen Miriam McDonald decided she wanted to have another baby at age 44, her doctor told her she had a better chance of winning the lottery. So when she got pregnant, she and her husband were thrilled. But within three days of giving birth to their son, everything turned.\u003c/p>\n\u003cp>“I was thinking, ‘Oh my God, what did I do?’ I just brought this baby into this world and I can barely take care of myself right now,” she said. “I feel exhausted. I haven't slept in three days. I haven't really eaten in three days.”\u003c/p>\n\u003cp>As the weeks went by, her depression got worse. She felt sad, but also indifferent. She didn’t want to hold her baby, she didn’t want to change him. She said she felt no connection with him at all.\u003c/p>\n\u003cp>This confused her – she never felt anything like this after her first two kids – and she worried her mood might hurt her son. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/#R2\">Untreated postpartum depression can affect babies’ cognitive and social development\u003c/a>. For the mother, it can be life or death. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/\">Suicide accounts for 20% of maternal deaths\u003c/a>.\u003c/p>\n\u003cp>“Every day, I was crying. Every day, I felt like I just wanted to die. Every day, I thought about ending my life,” said McDonald, who is Latina and works at UC Davis as an IT professional.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She went to Kaiser Permanente, her health care provider, for help. She said they put her on a merry-go-round of medication trial and error. The first drug her doctor prescribed made her anxious. The second drug gave her horrific nightmares. A third drug gave her auditory and visual hallucinations that took seven weeks to go away. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Then, her doctor retired. And when McDonald complained to her new doctor that she was still depressed four months after giving birth, the physician suggested more medications.\u003c/span>\u003c/p>\n\u003cp>\"I was desperate,\" McDonald said. \"I was like, 'I'm trying to help myself, but things are just getting worse.' So what am I left with?\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started doing her own research and learned about a new treatment called brexanolone. It’s \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression\">the \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">first and only drug\u003c/span>\u003cspan style=\"font-weight: 400\"> approved by the U.S. Food and Drug Administration to treat postpartum depression, which \u003ca href=\"https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/postpartum_depression/state/CA\">affects \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">1 out of 8 new mothers\u003c/span>\u003cspan style=\"font-weight: 400\"> in California. Instead of targeting the serotonin system in the brain, like most antidepressants, brexanolone works by rebalancing the stress hormones that can get out of kilter after having a baby. It’s delivered through an IV infusion over 2 1/2 days in the hospital. \u003c/span>\u003c/p>\n\u003cp>In \u003cspan style=\"font-weight: 400\">clinical trials\u003c/span>\u003cspan style=\"font-weight: 400\">, \u003ca href=\"https://www.fda.gov/media/121348/download\">75% of women who got brexanolone started to feel better\u003c/a> immediately after the three-day treatment. Half the women went into complete remission.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald wanted to try it. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879318\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg class=\"size-full wp-image-11879318\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1920\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg 2560w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-1536x1152.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-2048x1536.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-1920x1440.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">For the first year of her son’s life, Miriam McDonald says all her smiles were fake or strained. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“People walk out of the hospital, wanting to be with their child, wanting to return home,” said \u003c/span>\u003ca href=\"https://www.med.unc.edu/psych/directory/riah-patterson/\">\u003cspan style=\"font-weight: 400\">Dr. Riah Patterson\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, who has been treating women with brexanolone at the University of North Carolina at Chapel Hill since it became available in summer 2019. “There is a hopefulness, a brightness. You can really see that transformation in the hospital room over those 60 hours. It’s pretty miraculous.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When McDonald asked her doctor for brexanolone, she said no. \u003c/span>\u003c/p>\n\u003cp>In an email, she said the existing studies were “not very impressive.” She told McDonald that she didn’t meet Kaiser’s criteria for the drug: She would have had to try and fail four medications and electroconvulsive therapy before she could try brexanolone. And all this had to happen within six months of having her baby, or she couldn't try it at all.\u003c/p>\n\u003cp>How could anyone qualify, McDonald wondered?\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“This is crazy. By the time you even try one drug, that's like four weeks out,” she said. “Another drug is four weeks out, another drug is four weeks out. There’s just no way.\"\u003c/span>\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"State Sen. Scott Wiener, D-San Francisco\"]'If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law.'[/pullquote]\u003cspan style=\"font-weight: 400\">Kaiser’s guidance is an outlier. KQED analyzed guidelines from a dozen health plans operating in California. Three of them require women to fail one medication before trying brexanolone. One plan – the state’s Medi-Cal program for low-income women – requires two fails. But Kaiser is the only system KQED found that recommends women first fail four drugs.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s absurd,” said UNC’s Patterson, one of several experts in postpartum depression who, in turn, called Kaiser’s guidance “ridiculous,” “harsh,” “abusive\" and “insane.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It may also be illegal. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Under a \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">new state law that took effect in January\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> , health plans must conform to \"generally accepted standards of care,\" including nonprofit guidelines, scientific literature and expert consensus, when making decisions about mental health treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law,” said state Sen. Scott Wiener, D-San Francisco, the bill’s author. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser says it always follows the law. It says its integrated structure makes it different from traditional insurers. At Kaiser, a patient’s doctor determines whether a medication is necessary, not the health plan, and the criteria doctors use are recommendations, not requirements or prerequisites that patients need to “exhaust,” said Dr. Maria Koshy, Kaiser’s chair of psychiatry for Northern California. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“At the end of the day, this is an individual clinical decision by both the provider – the physician – and the patient,” she said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But former Kaiser clinicians and legislative experts familiar with Kaiser’s model say the culture around these recommendations is to follow them. Doctors get questioned or can face consequences if they don’t, said Wiener.\u003c/span>\u003c/p>\n\u003ch3>'It Saved My Life'\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald’s physician followed the criteria as if they were prerequisites when she declined to prescribe brexanolone. Kaiser’s grievance department sent a letter to another woman, Yesenia Muñoz, denying brexanolone because she had not failed enough medications.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“When I talked to the caseworker at Kaiser that had denied the medication, he said that Zulresso was very expensive,” said Muñoz, referring to brexanolone’s brand name.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Brexanolone treatment costs $34,000 for the medication, plus the cost of the three-day hospital stay, which can tack on another $30,000, at least. Kaiser is not yet certified to administer the treatment in-house, so it must pay outside hospitals to provide it. It says it has plans to eventually open three of its own certified centers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz was devastated by the denial. She was overwhelmed by postpartum depression and anxiety shortly after her daughter was born and, as a Latina, she said she was hesitant to seek help at first. When she did, none of the medications or therapies Kaiser offered her worked. She still felt suicidal.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I could get out the door sometimes and take the stroller and go walk, and my mind kept on saying, ‘If you just step in front of the car, it's all going to go away,' ” she remembers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz got help from family and co-workers to appeal Kaiser’s decision to the state, and after reviewing her medical records, regulators ordered Kaiser to pay for the brexanolone treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz went to UC Davis Medical Center to get it, and she started feeling better within the first day.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879428\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11879428\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby.jpg\" alt=\"Yesenia smiling holding baby\" width=\"1920\" height=\"1760\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby-800x733.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby-1020x935.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby-160x147.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby-1536x1408.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">After Yesenia Muñoz received brexanolone to treat her postpartum depression, she felt blessed, connected with her daughter and 'happy enough to want to live.' \u003ccite>(Courtesy Yesenia Munoz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The nurse came in and she said something funny and I laughed,” Muñoz said. “It was the first time I had laughed in so long.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started looking through photos and videos of her daughter on her phone and she says it was like she was experiencing those moments for the first time. She started making plans for the future. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It was like a switch flicked and it made me happy enough to want to live,” she said. “It saved my life.”\u003c/span>\u003c/p>\n\u003ch3>'There Is No Place Where We Say Kaiser Is Exempt'\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">In 2008, Congress passed a landmark federal law aimed at correcting imbalances in how insurers covered mental health treatments compared to physical health, later reinforced by the Affordable Care Act in 2010. \u003c/span>\u003cspan style=\"font-weight: 400\">But \u003c/span>\u003ca href=\"https://www.kqed.org/stateofhealth/series/state-of-mind\">\u003cspan style=\"font-weight: 400\">insurers found loopholes\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, creating overly restrictive or self-serving criteria that made it easy to deny services, and as a result, save money.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">California’s new law, \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">Senate Bill 855\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, is aimed at tightening those loopholes, and has been \u003c/span>\u003ca href=\"https://www.statnews.com/2020/10/14/new-california-law-should-serve-as-a-national-model-for-mental-health-care-reform/\">\u003cspan style=\"font-weight: 400\">hailed by advocates as a national model\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for mental health reform. It requires health plans to use clinically based, expert-recognized criteria and guidelines in making medical decisions, with the goal of limiting arbitrary or cost-driven denials. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser raises questions about how precisely the new law applies to them, given its unique integrated structure, where doctors make determinations about what is medically necessary rather than the health plan side of the organization. Kaiser's Dr. Koshy said SB 855’s requirement to comply with generally accepted standards of care “does not apply” to its brexanolone recommendations because they were developed and are used by doctors, not plan administrators. (When KQED asked Kaiser to provide the brexanolone policy its health plan uses, it said it didn’t have one.)\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We 100% intended this law to apply to the care people get at Kaiser,” said Julie Snyder, government affairs director at \u003ca href=\"https://steinberginstitute.org/\" target=\"_blank\" rel=\"noopener noreferrer\">the Steinberg Institute\u003c/a>, which co-sponsored the law. “There is no place where we say Kaiser is exempt.” \u003c/span>\u003c/p>\n\u003cp>[aside postID=stateofhealth_185796,stateofhealth_193386,stateofhealth_191734 label='Related Coverage']\u003cspan style=\"font-weight: 400\">Doctors at Kaiser have historically been “gatekeepers” for services in the system, said \u003ca href=\"https://psych-appeal.com/meiram-bendat-attorney-founder/\" target=\"_blank\" rel=\"noopener noreferrer\">Meiram Bendat\u003c/a>, an attorney and licensed psychotherapist who also advised on the law. It doesn’t matter if practice recommendations for brexanolone were written by doctors or administrators, or whether the recommendations are mandatory or optional – Bendat says they must be compliant with the law. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If it’s inconsistent with generally accepted standards of care, then it has no place in California,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some of Kaiser’s recommended criteria for brexanolone are aligned with generally accepted standards of care; for example, reserving the drug for women who are six months or less postpartum, which was a criterion used in the \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">clinical trials the FDA relied on when it approved the drug\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the recommendation to try four or five alternative treatments before considering brexanolone conflicts with the judgment of half a dozen women’s health experts interviewed for this story. They say there just isn’t enough time in the postpartum period. And there’s too much at stake. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Not only are babies at risk of developmental and emotional problems if their mother is depressed, \u003c/span>\u003ca href=\"https://neurosciencenews.com/paternal-anxiety-18177/#:~:text=Summary%3A%20A%20new%20study%20reports,this%20period%20was%20under%204%25.\">\u003cspan style=\"font-weight: 400\">husbands and partners are also at higher risk for depression and anxiety\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. And because new moms are learning to breastfeed, and figuring out what’s part of the new normal and what’s not, it can take months just to recognize there’s a problem, said UNC’s Riah Patterson.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It takes so long for this illness to come to recognition and for someone to actually get into an appointment and actually be seen by a provider,” she said.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879416\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11879416\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson.jpg\" alt=\"\" width=\"1920\" height=\"1436\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson-800x598.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson-1020x763.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson-1536x1149.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Riah Patterson discusses patients and treatment plans with her trainee, a third-year psychiatry resident at the Center for Women's Mood Disorders at UNC-Chapel Hill. \u003ccite>(Courtesy Riah Patterson)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Indeed, the FDA fast-tracked the approval of brexanolone in part because of how quickly it worked, allowing women to feel better and get back to their families in three days.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s new, it’s promising,” said Kaiser’s Koshy, but, she added, “it’s not a benign medication.” \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">Six women in the clinical trials experienced loss or near loss of consciousness,\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> which is why the FDA requires women to be continuously monitored in certified health centers when getting the infusion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Also, the safety and efficacy data is limited, Koshy said. The clinical trials only compared brexanolone to placebo, not to alternative treatments. So while the data show brexanolone works better than nothing, there’s no data on whether it works better than Zoloft or electroconvulsive therapy. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Koshy says Kaiser is always reviewing practice recommendations as new evidence becomes available, but also acknowledged that Kaiser’s recommendations for brexanolone have not been updated since they were first developed two years ago, in July 2019. \u003c/span>\u003c/p>\n\u003cp>It is unclear what role the \u003ca href=\"https://dmhc.ca.gov/\">Department of Managed Health Care\u003c/a>, the state agency that regulates Kaiser, will play in resolving these questions. In a statement, the department said it will review any criteria or guidelines the Kaiser health plan uses for brexanolone, but said it does not have jurisdiction over physician decisions.\u003c/p>\n\u003cp>The DMHC also monitors patient complaints around new medications and treatments in order to identify problems with access to care. So far, \u003ca href=\"https://wpso.dmhc.ca.gov/imr/\">the DMHC has published two complaints about brexanolone in its public database\u003c/a> – both were filed by Kaiser patients.\u003c/p>\n\u003cp>\u003ca href=\"https://www.benefitscafe.com/insurance-companies/kaiserpermanente/\"> \u003cspan style=\"font-weight: 400\">Kaiser is the \u003c/span>\u003cspan style=\"font-weight: 400\">largest insurer in California\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It holds a 40% share of the market, covering 6.1 million patients. But at UC Davis, where Kaiser says it sends all patients who need brexanolone in Northern California, Kaiser patients are only 15% of those who got the drug, according to \u003c/span>\u003ca href=\"https://health.ucdavis.edu/team/search/1499/shannon-clark---obstetrics-and-gynecology-sacramento\">\u003cspan style=\"font-weight: 400\">Dr. Shannon Clark\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a psychiatrist and OB-GYN overseeing the treatments. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She says of the 13 women who’ve been treated at UC Davis in the last two years, only two were from Kaiser. One was Muñoz, who was approved only after the state intervened. The other was Whitney Worthington. Both women canceled their coverage with Kaiser over the postpartum mental health care they received.\u003c/span>\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Marcus Worthington, husband of Whitney Worthington\"]'The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit ... It finally got on somebody’s radar who wasn’t going to ignore it.'[/pullquote]\u003cspan style=\"font-weight: 400\">Worthington struggled with depression for most of her adult life, but when she decided to get pregnant, she got help from her psychiatrist and therapist to wean off her antidepressant. It was a grueling withdrawal process. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That was the worst two months of my life,” she said. “Feeling suicidal at times. It was just miserable.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She knew then that if she got depressed after her baby was born, she did not want to take medication because she wanted to have more children and didn’t want to go through withdrawal again. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When she ended up in the Kaiser ER with suicidal thoughts a few weeks after giving birth, she had to repeatedly decline offers — even threats — of medication. She saw a series of providers at two Kaiser hospitals and several told her she needed brexanolone. One said “it was her only hope.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But Worthington was also told by other Kaiser providers that it wasn’t necessary, that Kaiser didn’t offer it at all, and that cost was an issue. The official denial that came from Kaiser’s billing department offered no reason, said Marcus Worthington, Whitney’s husband. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He spent weeks on the phone with multiple Kaiser representatives, fighting, negotiating and pleading, until a high-level administrator stepped in and personally approved it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit,” said Marcus, who is Latino and Native American. “I have a relatively Anglo-Saxon name and Whitney is a young white woman. Frankly, I think it all plays in that it finally got on somebody’s radar who wasn’t going to ignore it.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After getting the treatment at UC Davis, Whitney says she could think clearly again and truly enjoy the last two months of maternity leave she had with her daughter. She called brexanolone “a total miracle.”\u003c/span>\u003c/p>\n\u003ch3>'This Is How You Treat Postpartum Mental Health?'\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser said it cannot comment on any individual cases because of privacy laws, but said generally, “We feel deep compassion for any patient experiencing the difficult and serious effects of postpartum depression, and our goal is always to support every patient’s safe return to a healthy mental state.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When Miriam McDonald called Kaiser’s grievance department to complain about her treatment, Kaiser sent the cops to her house for a welfare check.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The officers were calm and nice, McDonald said, but when she closed the door, she cried her eyes out.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> \u003c/span>\u003cspan style=\"font-weight: 400\">“It just brought me to a whole new low,” she said. “Why didn't my doctor call me and talk to me first? I mean, this is how you treat postpartum mental health? How dare\u003c/span> \u003cspan style=\"font-weight: 400\">you.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald also appealed Kaiser’s denial of brexanolone to state regulators, \u003ca href=\"https://www.2020mom.org/\" target=\"_blank\" rel=\"noopener noreferrer\">with help from advocates at 2020 Mom\u003c/a>, but by the time she got there, the clock had already run out. She was past the six-month postpartum cutoff. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She never got brexanolone.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Still, she continued to fight for relief and eventually got Kaiser to cover a different treatment called \u003c/span>\u003ca href=\"https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625\">\u003cspan style=\"font-weight: 400\">transcranial magnetic stimulation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which uses an electromagnetic coil to stimulate nerve cells in the brain that control mood.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879420\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11879420\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog.jpg\" alt=\"\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog-1536x1152.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Miriam McDonald said she is finally feeling like herself again, a year and a half after her son's birth. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>McDonald had to go five days a week for three months. Now, more than a year and a half after having her baby, she is finally feeling like herself again.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I can remember I woke up one day and I was excited. I had actual joy,” she remembers. “I got up and I walked into his room and I was like, ‘Hey, Nico! Hi! Hey, baby!’ And he jumped up from his crib and giggled and put his arms out. And I just swooped him up in my arms and cried. Because I was like, ‘I am so proud to be your mom.’ ”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now when her son smiles at her, she genuinely smiles back. But she can’t help but grieve all the smiles she didn’t return. How she felt like she was barely there when her son took his first steps.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I felt like I've been robbed really of all those moments,” she said, “of those little milestones, that I'm never going to get back.” \u003c/span>\u003c/p>\n\n","blocks":[],"excerpt":"Kaiser's practices around the new drug, brexanolone, may run afoul of a new California law designed to limit unfair denials of mental health treatment.","status":"publish","parent":0,"modified":1634588606,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":72,"wordCount":3273},"headData":{"title":"There's Only 1 Drug for Postpartum Depression. Why Does Kaiser Permanente Make It So Hard to Get? | KQED","description":"Kaiser's practices around the new drug, brexanolone, may run afoul of a new California law designed to limit unfair denials of mental health treatment.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"NewsArticle","headline":"There's Only 1 Drug for Postpartum Depression. Why Does Kaiser Permanente Make It So Hard to Get?","datePublished":"2021-06-28T11:01:38.000Z","dateModified":"2021-10-18T20:23:26.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png","isAccessibleForFree":"Y","publisher":{"@type":"NewsMediaOrganization","@id":"https://www.kqed.org/#organization","name":"KQED","url":"https://www.kqed.org","logo":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}}},"disqusIdentifier":"11879309 https://ww2.kqed.org/news/?p=11879309","disqusUrl":"https://ww2.kqed.org/news/2021/06/28/theres-only-1-drug-for-postpartum-depression-why-does-kaiser-permanente-make-it-so-hard-to-get/","disqusTitle":"There's Only 1 Drug for Postpartum Depression. Why Does Kaiser Permanente Make It So Hard to Get?","audioUrl":"https://traffic.omny.fm/d/clips/0af137ef-751e-4b19-a055-aaef00d2d578/ffca7e9f-6831-4[…]f-aaef00f5a073/172b2060-a68e-42b5-b0c0-ad75014b5a55/audio.mp3","path":"/news/11879309/theres-only-1-drug-for-postpartum-depression-why-does-kaiser-permanente-make-it-so-hard-to-get","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">W\u003c/span>\u003c/p>\u003cp>hen Miriam McDonald decided she wanted to have another baby at age 44, her doctor told her she had a better chance of winning the lottery. So when she got pregnant, she and her husband were thrilled. But within three days of giving birth to their son, everything turned.\u003c/p>\n\u003cp>“I was thinking, ‘Oh my God, what did I do?’ I just brought this baby into this world and I can barely take care of myself right now,” she said. “I feel exhausted. I haven't slept in three days. I haven't really eaten in three days.”\u003c/p>\n\u003cp>As the weeks went by, her depression got worse. She felt sad, but also indifferent. She didn’t want to hold her baby, she didn’t want to change him. She said she felt no connection with him at all.\u003c/p>\n\u003cp>This confused her – she never felt anything like this after her first two kids – and she worried her mood might hurt her son. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/#R2\">Untreated postpartum depression can affect babies’ cognitive and social development\u003c/a>. For the mother, it can be life or death. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/\">Suicide accounts for 20% of maternal deaths\u003c/a>.\u003c/p>\n\u003cp>“Every day, I was crying. Every day, I felt like I just wanted to die. Every day, I thought about ending my life,” said McDonald, who is Latina and works at UC Davis as an IT professional.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She went to Kaiser Permanente, her health care provider, for help. She said they put her on a merry-go-round of medication trial and error. The first drug her doctor prescribed made her anxious. The second drug gave her horrific nightmares. A third drug gave her auditory and visual hallucinations that took seven weeks to go away. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Then, her doctor retired. And when McDonald complained to her new doctor that she was still depressed four months after giving birth, the physician suggested more medications.\u003c/span>\u003c/p>\n\u003cp>\"I was desperate,\" McDonald said. \"I was like, 'I'm trying to help myself, but things are just getting worse.' So what am I left with?\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started doing her own research and learned about a new treatment called brexanolone. It’s \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression\">the \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">first and only drug\u003c/span>\u003cspan style=\"font-weight: 400\"> approved by the U.S. Food and Drug Administration to treat postpartum depression, which \u003ca href=\"https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/postpartum_depression/state/CA\">affects \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">1 out of 8 new mothers\u003c/span>\u003cspan style=\"font-weight: 400\"> in California. Instead of targeting the serotonin system in the brain, like most antidepressants, brexanolone works by rebalancing the stress hormones that can get out of kilter after having a baby. It’s delivered through an IV infusion over 2 1/2 days in the hospital. \u003c/span>\u003c/p>\n\u003cp>In \u003cspan style=\"font-weight: 400\">clinical trials\u003c/span>\u003cspan style=\"font-weight: 400\">, \u003ca href=\"https://www.fda.gov/media/121348/download\">75% of women who got brexanolone started to feel better\u003c/a> immediately after the three-day treatment. Half the women went into complete remission.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald wanted to try it. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879318\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg class=\"size-full wp-image-11879318\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1920\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg 2560w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-1536x1152.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-2048x1536.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-1920x1440.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">For the first year of her son’s life, Miriam McDonald says all her smiles were fake or strained. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“People walk out of the hospital, wanting to be with their child, wanting to return home,” said \u003c/span>\u003ca href=\"https://www.med.unc.edu/psych/directory/riah-patterson/\">\u003cspan style=\"font-weight: 400\">Dr. Riah Patterson\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, who has been treating women with brexanolone at the University of North Carolina at Chapel Hill since it became available in summer 2019. “There is a hopefulness, a brightness. You can really see that transformation in the hospital room over those 60 hours. It’s pretty miraculous.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When McDonald asked her doctor for brexanolone, she said no. \u003c/span>\u003c/p>\n\u003cp>In an email, she said the existing studies were “not very impressive.” She told McDonald that she didn’t meet Kaiser’s criteria for the drug: She would have had to try and fail four medications and electroconvulsive therapy before she could try brexanolone. And all this had to happen within six months of having her baby, or she couldn't try it at all.\u003c/p>\n\u003cp>How could anyone qualify, McDonald wondered?\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“This is crazy. By the time you even try one drug, that's like four weeks out,” she said. “Another drug is four weeks out, another drug is four weeks out. There’s just no way.\"\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"State Sen. Scott Wiener, D-San Francisco","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser’s guidance is an outlier. KQED analyzed guidelines from a dozen health plans operating in California. Three of them require women to fail one medication before trying brexanolone. One plan – the state’s Medi-Cal program for low-income women – requires two fails. But Kaiser is the only system KQED found that recommends women first fail four drugs.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s absurd,” said UNC’s Patterson, one of several experts in postpartum depression who, in turn, called Kaiser’s guidance “ridiculous,” “harsh,” “abusive\" and “insane.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It may also be illegal. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Under a \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">new state law that took effect in January\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> , health plans must conform to \"generally accepted standards of care,\" including nonprofit guidelines, scientific literature and expert consensus, when making decisions about mental health treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law,” said state Sen. Scott Wiener, D-San Francisco, the bill’s author. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser says it always follows the law. It says its integrated structure makes it different from traditional insurers. At Kaiser, a patient’s doctor determines whether a medication is necessary, not the health plan, and the criteria doctors use are recommendations, not requirements or prerequisites that patients need to “exhaust,” said Dr. Maria Koshy, Kaiser’s chair of psychiatry for Northern California. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“At the end of the day, this is an individual clinical decision by both the provider – the physician – and the patient,” she said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But former Kaiser clinicians and legislative experts familiar with Kaiser’s model say the culture around these recommendations is to follow them. Doctors get questioned or can face consequences if they don’t, said Wiener.\u003c/span>\u003c/p>\n\u003ch3>'It Saved My Life'\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald’s physician followed the criteria as if they were prerequisites when she declined to prescribe brexanolone. Kaiser’s grievance department sent a letter to another woman, Yesenia Muñoz, denying brexanolone because she had not failed enough medications.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“When I talked to the caseworker at Kaiser that had denied the medication, he said that Zulresso was very expensive,” said Muñoz, referring to brexanolone’s brand name.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Brexanolone treatment costs $34,000 for the medication, plus the cost of the three-day hospital stay, which can tack on another $30,000, at least. Kaiser is not yet certified to administer the treatment in-house, so it must pay outside hospitals to provide it. It says it has plans to eventually open three of its own certified centers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz was devastated by the denial. She was overwhelmed by postpartum depression and anxiety shortly after her daughter was born and, as a Latina, she said she was hesitant to seek help at first. When she did, none of the medications or therapies Kaiser offered her worked. She still felt suicidal.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I could get out the door sometimes and take the stroller and go walk, and my mind kept on saying, ‘If you just step in front of the car, it's all going to go away,' ” she remembers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz got help from family and co-workers to appeal Kaiser’s decision to the state, and after reviewing her medical records, regulators ordered Kaiser to pay for the brexanolone treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz went to UC Davis Medical Center to get it, and she started feeling better within the first day.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879428\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11879428\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby.jpg\" alt=\"Yesenia smiling holding baby\" width=\"1920\" height=\"1760\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby-800x733.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby-1020x935.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby-160x147.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby-1536x1408.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">After Yesenia Muñoz received brexanolone to treat her postpartum depression, she felt blessed, connected with her daughter and 'happy enough to want to live.' \u003ccite>(Courtesy Yesenia Munoz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The nurse came in and she said something funny and I laughed,” Muñoz said. “It was the first time I had laughed in so long.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started looking through photos and videos of her daughter on her phone and she says it was like she was experiencing those moments for the first time. She started making plans for the future. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It was like a switch flicked and it made me happy enough to want to live,” she said. “It saved my life.”\u003c/span>\u003c/p>\n\u003ch3>'There Is No Place Where We Say Kaiser Is Exempt'\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">In 2008, Congress passed a landmark federal law aimed at correcting imbalances in how insurers covered mental health treatments compared to physical health, later reinforced by the Affordable Care Act in 2010. \u003c/span>\u003cspan style=\"font-weight: 400\">But \u003c/span>\u003ca href=\"https://www.kqed.org/stateofhealth/series/state-of-mind\">\u003cspan style=\"font-weight: 400\">insurers found loopholes\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, creating overly restrictive or self-serving criteria that made it easy to deny services, and as a result, save money.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">California’s new law, \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">Senate Bill 855\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, is aimed at tightening those loopholes, and has been \u003c/span>\u003ca href=\"https://www.statnews.com/2020/10/14/new-california-law-should-serve-as-a-national-model-for-mental-health-care-reform/\">\u003cspan style=\"font-weight: 400\">hailed by advocates as a national model\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for mental health reform. It requires health plans to use clinically based, expert-recognized criteria and guidelines in making medical decisions, with the goal of limiting arbitrary or cost-driven denials. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser raises questions about how precisely the new law applies to them, given its unique integrated structure, where doctors make determinations about what is medically necessary rather than the health plan side of the organization. Kaiser's Dr. Koshy said SB 855’s requirement to comply with generally accepted standards of care “does not apply” to its brexanolone recommendations because they were developed and are used by doctors, not plan administrators. (When KQED asked Kaiser to provide the brexanolone policy its health plan uses, it said it didn’t have one.)\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We 100% intended this law to apply to the care people get at Kaiser,” said Julie Snyder, government affairs director at \u003ca href=\"https://steinberginstitute.org/\" target=\"_blank\" rel=\"noopener noreferrer\">the Steinberg Institute\u003c/a>, which co-sponsored the law. “There is no place where we say Kaiser is exempt.” \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"stateofhealth_185796,stateofhealth_193386,stateofhealth_191734","label":"Related Coverage "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cspan style=\"font-weight: 400\">Doctors at Kaiser have historically been “gatekeepers” for services in the system, said \u003ca href=\"https://psych-appeal.com/meiram-bendat-attorney-founder/\" target=\"_blank\" rel=\"noopener noreferrer\">Meiram Bendat\u003c/a>, an attorney and licensed psychotherapist who also advised on the law. It doesn’t matter if practice recommendations for brexanolone were written by doctors or administrators, or whether the recommendations are mandatory or optional – Bendat says they must be compliant with the law. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If it’s inconsistent with generally accepted standards of care, then it has no place in California,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some of Kaiser’s recommended criteria for brexanolone are aligned with generally accepted standards of care; for example, reserving the drug for women who are six months or less postpartum, which was a criterion used in the \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">clinical trials the FDA relied on when it approved the drug\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the recommendation to try four or five alternative treatments before considering brexanolone conflicts with the judgment of half a dozen women’s health experts interviewed for this story. They say there just isn’t enough time in the postpartum period. And there’s too much at stake. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Not only are babies at risk of developmental and emotional problems if their mother is depressed, \u003c/span>\u003ca href=\"https://neurosciencenews.com/paternal-anxiety-18177/#:~:text=Summary%3A%20A%20new%20study%20reports,this%20period%20was%20under%204%25.\">\u003cspan style=\"font-weight: 400\">husbands and partners are also at higher risk for depression and anxiety\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. And because new moms are learning to breastfeed, and figuring out what’s part of the new normal and what’s not, it can take months just to recognize there’s a problem, said UNC’s Riah Patterson.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It takes so long for this illness to come to recognition and for someone to actually get into an appointment and actually be seen by a provider,” she said.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879416\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11879416\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson.jpg\" alt=\"\" width=\"1920\" height=\"1436\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson-800x598.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson-1020x763.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson-1536x1149.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Riah Patterson discusses patients and treatment plans with her trainee, a third-year psychiatry resident at the Center for Women's Mood Disorders at UNC-Chapel Hill. \u003ccite>(Courtesy Riah Patterson)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Indeed, the FDA fast-tracked the approval of brexanolone in part because of how quickly it worked, allowing women to feel better and get back to their families in three days.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s new, it’s promising,” said Kaiser’s Koshy, but, she added, “it’s not a benign medication.” \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">Six women in the clinical trials experienced loss or near loss of consciousness,\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> which is why the FDA requires women to be continuously monitored in certified health centers when getting the infusion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Also, the safety and efficacy data is limited, Koshy said. The clinical trials only compared brexanolone to placebo, not to alternative treatments. So while the data show brexanolone works better than nothing, there’s no data on whether it works better than Zoloft or electroconvulsive therapy. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Koshy says Kaiser is always reviewing practice recommendations as new evidence becomes available, but also acknowledged that Kaiser’s recommendations for brexanolone have not been updated since they were first developed two years ago, in July 2019. \u003c/span>\u003c/p>\n\u003cp>It is unclear what role the \u003ca href=\"https://dmhc.ca.gov/\">Department of Managed Health Care\u003c/a>, the state agency that regulates Kaiser, will play in resolving these questions. In a statement, the department said it will review any criteria or guidelines the Kaiser health plan uses for brexanolone, but said it does not have jurisdiction over physician decisions.\u003c/p>\n\u003cp>The DMHC also monitors patient complaints around new medications and treatments in order to identify problems with access to care. So far, \u003ca href=\"https://wpso.dmhc.ca.gov/imr/\">the DMHC has published two complaints about brexanolone in its public database\u003c/a> – both were filed by Kaiser patients.\u003c/p>\n\u003cp>\u003ca href=\"https://www.benefitscafe.com/insurance-companies/kaiserpermanente/\"> \u003cspan style=\"font-weight: 400\">Kaiser is the \u003c/span>\u003cspan style=\"font-weight: 400\">largest insurer in California\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It holds a 40% share of the market, covering 6.1 million patients. But at UC Davis, where Kaiser says it sends all patients who need brexanolone in Northern California, Kaiser patients are only 15% of those who got the drug, according to \u003c/span>\u003ca href=\"https://health.ucdavis.edu/team/search/1499/shannon-clark---obstetrics-and-gynecology-sacramento\">\u003cspan style=\"font-weight: 400\">Dr. Shannon Clark\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a psychiatrist and OB-GYN overseeing the treatments. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She says of the 13 women who’ve been treated at UC Davis in the last two years, only two were from Kaiser. One was Muñoz, who was approved only after the state intervened. The other was Whitney Worthington. Both women canceled their coverage with Kaiser over the postpartum mental health care they received.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit ... It finally got on somebody’s radar who wasn’t going to ignore it.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Marcus Worthington, husband of Whitney Worthington","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cspan style=\"font-weight: 400\">Worthington struggled with depression for most of her adult life, but when she decided to get pregnant, she got help from her psychiatrist and therapist to wean off her antidepressant. It was a grueling withdrawal process. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That was the worst two months of my life,” she said. “Feeling suicidal at times. It was just miserable.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She knew then that if she got depressed after her baby was born, she did not want to take medication because she wanted to have more children and didn’t want to go through withdrawal again. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When she ended up in the Kaiser ER with suicidal thoughts a few weeks after giving birth, she had to repeatedly decline offers — even threats — of medication. She saw a series of providers at two Kaiser hospitals and several told her she needed brexanolone. One said “it was her only hope.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But Worthington was also told by other Kaiser providers that it wasn’t necessary, that Kaiser didn’t offer it at all, and that cost was an issue. The official denial that came from Kaiser’s billing department offered no reason, said Marcus Worthington, Whitney’s husband. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He spent weeks on the phone with multiple Kaiser representatives, fighting, negotiating and pleading, until a high-level administrator stepped in and personally approved it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit,” said Marcus, who is Latino and Native American. “I have a relatively Anglo-Saxon name and Whitney is a young white woman. Frankly, I think it all plays in that it finally got on somebody’s radar who wasn’t going to ignore it.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After getting the treatment at UC Davis, Whitney says she could think clearly again and truly enjoy the last two months of maternity leave she had with her daughter. She called brexanolone “a total miracle.”\u003c/span>\u003c/p>\n\u003ch3>'This Is How You Treat Postpartum Mental Health?'\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser said it cannot comment on any individual cases because of privacy laws, but said generally, “We feel deep compassion for any patient experiencing the difficult and serious effects of postpartum depression, and our goal is always to support every patient’s safe return to a healthy mental state.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When Miriam McDonald called Kaiser’s grievance department to complain about her treatment, Kaiser sent the cops to her house for a welfare check.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The officers were calm and nice, McDonald said, but when she closed the door, she cried her eyes out.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> \u003c/span>\u003cspan style=\"font-weight: 400\">“It just brought me to a whole new low,” she said. “Why didn't my doctor call me and talk to me first? I mean, this is how you treat postpartum mental health? How dare\u003c/span> \u003cspan style=\"font-weight: 400\">you.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald also appealed Kaiser’s denial of brexanolone to state regulators, \u003ca href=\"https://www.2020mom.org/\" target=\"_blank\" rel=\"noopener noreferrer\">with help from advocates at 2020 Mom\u003c/a>, but by the time she got there, the clock had already run out. She was past the six-month postpartum cutoff. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She never got brexanolone.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Still, she continued to fight for relief and eventually got Kaiser to cover a different treatment called \u003c/span>\u003ca href=\"https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625\">\u003cspan style=\"font-weight: 400\">transcranial magnetic stimulation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which uses an electromagnetic coil to stimulate nerve cells in the brain that control mood.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879420\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11879420\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog.jpg\" alt=\"\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog-1536x1152.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Miriam McDonald said she is finally feeling like herself again, a year and a half after her son's birth. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>McDonald had to go five days a week for three months. Now, more than a year and a half after having her baby, she is finally feeling like herself again.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I can remember I woke up one day and I was excited. I had actual joy,” she remembers. “I got up and I walked into his room and I was like, ‘Hey, Nico! Hi! Hey, baby!’ And he jumped up from his crib and giggled and put his arms out. And I just swooped him up in my arms and cried. Because I was like, ‘I am so proud to be your mom.’ ”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now when her son smiles at her, she genuinely smiles back. But she can’t help but grieve all the smiles she didn’t return. How she felt like she was barely there when her son took his first steps.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I felt like I've been robbed really of all those moments,” she said, “of those little milestones, that I'm never going to get back.” \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11879309/theres-only-1-drug-for-postpartum-depression-why-does-kaiser-permanente-make-it-so-hard-to-get","authors":["3205"],"categories":["news_457","news_8","news_356"],"tags":["news_29623","news_29621","news_18538","news_27626","news_18543","news_683","news_421","news_6637","news_27960","news_2109","news_24622","news_21771","news_29622"],"featImg":"news_11879317","label":"news"},"news_11876711":{"type":"posts","id":"news_11876711","meta":{"index":"posts_1591205157","site":"news","id":"11876711","score":null,"sort":[1622833910000]},"guestAuthors":[],"slug":"low-income-families-could-get-more-benefits-with-california-budget-surplus","title":"Low-Income Families Could Get More Benefits With California Budget Surplus","publishDate":1622833910,"format":"standard","headTitle":"KQED News","labelTerm":{},"content":"\u003cp>Amid a pandemic that has pushed millions of \u003ca href=\"https://www.census.gov/library/stories/2021/03/moms-work-and-the-pandemic.html\" target=\"_blank\" rel=\"noopener noreferrer\">mothers out of the workplace\u003c/a>, caused \u003ca href=\"https://www.latimes.com/california/story/2021-05-24/obamacare-made-iuds-affordable-one-reason-behind-californias-covid-baby-bust\" target=\"_blank\" rel=\"noopener noreferrer\">fertility rates to plunge\u003c/a> and \u003ca href=\"https://jamanetwork.com/journals/jamapediatrics/fullarticle/2779182\" target=\"_blank\" rel=\"noopener noreferrer\">heightened the risk of death for pregnant women\u003c/a>, Gov. Gavin Newsom and state Democratic lawmakers are seeking a slate of health proposals for low-income families and children.\u003c/p>\n\u003cp>Newsom, a self-described feminist and the father of four young children, has long advocated family-friendly health and economic policies. Flush with a projected \u003ca href=\"https://www.kqed.org/news/11874125/californias-historic-budget-surplus-is-it-76-billion-or-38-billion\" target=\"_blank\" rel=\"noopener noreferrer\">budget surplus of $75.7 billion\u003c/a>, state politicians have come up with myriad legislative and budget proposals to make poorer families healthier and wealthier.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Assemblymember Cristina Garcia (D-Bell Gardens)\"]'We don’t need to balance the budget on half of the population that has a uterus.'[/pullquote]They include ending sales taxes on \u003ca href=\"https://esd.dof.ca.gov/dofpublic/public/trailerBill/pdf/414\" target=\"_blank\" rel=\"noopener noreferrer\">menstrual products and diapers\u003c/a>; adding benefits such as doulas and early childhood trauma screenings to Medi-Cal, the state’s Medicaid program; allowing pregnant women to retain Medi-Cal coverage for a year after giving birth; and a pilot program to provide a universal basic income to low-income new parents.\u003c/p>\n\u003cp>“COVID-19 laid inequity bare for all to see,” Assemblymember Wendy Carrillo (D-Los Angeles) said in a written statement. She is the co-author of Senate Bill 65, led by Sen. Nancy Skinner (D-Berkeley), which would pour hundreds of millions of dollars into family and health care programs annually, focusing on minority groups that Carrillo said were “pushed out of the social safety net by the prior White House.”\u003c/p>\n\u003cp>Newsom and the Democratic-controlled legislature are unified on major health care and social safety-net expansions, which would direct billions in health benefits and cash assistance to the state’s most vulnerable residents and low-income parents. Legislative Democrats for years have pushed a progressive agenda to help struggling parents and families, featuring proposals like those to permanently end taxes on menstrual products and diapers — \u003ca href=\"https://lao.ca.gov/Publications/Report/4040\" target=\"_blank\" rel=\"noopener noreferrer\">expected to cost the state millions\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We don’t need to balance the budget on half of the population that has a uterus,” said Assemblymember Cristina Garcia (D-Bell Gardens), who has \u003ca href=\"https://www.politico.com/states/california/story/2019/05/07/newsom-to-unveil-may-budget-thursday-with-focus-on-low-income-families-1009021\" target=\"_blank\" rel=\"noopener noreferrer\">for years sought an end\u003c/a> to the “pink tax” on diapers and menstrual products.\u003c/p>\n\u003cp>Skinner, chair of the Senate budget committee, is among the powerful lawmakers who’ve put forward legislation to make childbirth safer and parenthood more affordable. Her bill, which cleared the Senate and was up for consideration this week in the state Assembly, has several features that would dramatically expand maternal health care (transgender men also get pregnant and give birth).\u003c/p>\n\u003cp>[aside tag='childbirth' label='Maternity in California']Before the pandemic, Medi-Cal covered mothers only up to 60 days after their pregnancies ended unless their income fell below a certain line or they had a mental health diagnosis. Skinner’s bill, part of a \u003ca href=\"https://www.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/\" target=\"_blank\" rel=\"noopener noreferrer\">broader national push\u003c/a> to improve birth outcomes, would expand full Medi-Cal coverage to 12 months after the end of a pregnancy. Other \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB65\" target=\"_blank\" rel=\"noopener noreferrer\">parts of the bill\u003c/a> would intensify state reporting and reviews of fetal and pregnancy-related deaths and severe maternal morbidity, expand housing benefits for families that have a pregnant member, and increase training programs for midwives.\u003c/p>\n\u003cp>Newsom’s $268 billion budget blueprint includes about $200 million a year to fully implement the expansion of Medi-Cal coverage for new mothers, with matching dollars from the federal government until those funds expire in 2027. If the expansion were not renewed, the state would revert to previous Medi-Cal qualifications.\u003c/p>\n\u003cp>\u003ca href=\"https://www.chcf.org/publication/2019-edition-maternity-care-in-california/\" target=\"_blank\" rel=\"noopener noreferrer\">Medi-Cal covered 45% of all births\u003c/a> in California in 2017, the last year for which data could be found.\u003c/p>\n\u003cp>“Not all postpartum issues end at 60 days, and when patients lose insurance, we can’t address them in the usual way,” said Dr. Yen Truong, an OB-GYN who works with the American College of Obstetricians and Gynecologists on legislative issues in California.\u003c/p>\n\u003cp>About half of pregnancy-related deaths occur during the pregnancy or on the day of delivery, but about 12% take place \u003ca href=\"https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm\" target=\"_blank\" rel=\"noopener noreferrer\">between seven weeks and a year\u003c/a> after giving birth, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The U.S. had 17.4 early maternal deaths per 100,000 live births in 2018, according to the most recent CDC data with state figures. California’s rate, \u003ca href=\"https://www.cdc.gov/nchs/maternal-mortality/MMR-2018-State-Data-508.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">11.7 per 100,000\u003c/a>, was among the lowest in the nation, but the state collects data on maternal deaths in a way that could result in underestimates.\u003c/p>\n\u003cp>California’s overall numbers also obscure stark racial disparities. Statewide, Black infants averaged \u003ca href=\"https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/CHSP_2021_ADA_FINAL.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">7.8 deaths per 1,000 live births\u003c/a>, compared with an average of three deaths among white babies. Data from 2013 from \u003ca href=\"http://publichealth.lacounty.gov/owh/docs/DataReport/2017-HealthIndicatorsforWomeninLACounty.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Los Angeles County\u003c/a> showed Black women had pregnancy-related deaths at rates more than four times as high as the overall rate in the state’s largest county.\u003c/p>\n\u003cp>“Given our state’s wealth and medical advancements, this is unacceptable,” Skinner, vice chair of the Legislative Women’s Caucus, said in a news release.\u003c/p>\n\u003cp>Democrats also appear unified on another aspect of Skinner’s bill: a pilot program to test a universal basic income program for struggling families. The bill would give $1,000 a month to low-income expectant and new parents with kids under 2 years old in counties that decide to participate. Newsom has also proposed \u003ca href=\"http://www.ebudget.ca.gov/2021-22/pdf/Revised/BudgetSummary/HealthandHumanServices.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$35 million over five years\u003c/a> for pilot programs for universal basic income.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Rose Kapolczynski, a campaign consultant\"]'The budget surplus is allowing many things that were called impossible to be possible, and that includes health care bills.'[/pullquote]These issues could play well, especially among women, and improve Newsom’s standing going into a \u003ca href=\"https://www.kqed.org/news/11875264/new-poll-shows-support-idling-for-newsom-recall-effort\" target=\"_blank\" rel=\"noopener noreferrer\">recall election\u003c/a> later this year, said Rose Kapolczynski, a longtime campaign consultant to former U.S. Sen. Barbara Boxer who has worked on reproductive health care issues in Sacramento.\u003c/p>\n\u003cp>Indefinitely rescinding sales taxes on diapers and menstrual products — the taxes have been \u003ca href=\"https://www.kcra.com/article/sales-tax-for-tampons-diapers-eliminated-in-california-for-2-years/30463779\" target=\"_blank\" rel=\"noopener noreferrer\">temporarily lifted since early last year\u003c/a> — is a particular no-brainer because of its bipartisan appeal, she said.\u003c/p>\n\u003cp>“It’s hard for Republicans to attack something that is a tax cut, and sales taxes are regressive, so progressives would like it,” Kapolczynski said.\u003c/p>\n\u003cp>As for Medi-Cal expansions, Kapolczynski said that even though it wouldn’t affect most Californians, the pandemic has made health care even more important to voters. “The budget surplus is allowing many things that were called impossible to be possible, and that includes health care bills,” she said.\u003c/p>\n\u003cp>[aside tag=\"california-budget\" label=\"More California budget coverage\"]Investing in California’s young families could help close the racial gap in maternal and infant mortality, said \u003ca href=\"https://www.bwwla.org/nourbese-flint-ma/\" target=\"_blank\" rel=\"noopener noreferrer\">Nourbese Flint\u003c/a>, executive director of the Black Women for Wellness Action Project, which endorsed Skinner’s bill.\u003c/p>\n\u003cp>Flint is especially excited about the possibility of covering doulas through Medi-Cal. Doulas, trained as emotional and physical supports for women in pregnancy and postpartum, have been linked to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538578/\" target=\"_blank\" rel=\"noopener noreferrer\">lower odds of cesarean births\u003c/a> and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595013/\" target=\"_blank\" rel=\"noopener noreferrer\">greater satisfaction with the birth experience\u003c/a>. If doulas saved Medi-Cal money by reducing cesarean births, that could enable the state to renegotiate payments for labor and delivery, according to \u003ca href=\"http://analyses.chbrp.com/document/view.php?id=1496\" target=\"_blank\" rel=\"noopener noreferrer\">an analysis by the independent California Health Benefits Review Program\u003c/a>. Under Newsom’s proposed budget, Medi-Cal coverage of doulas would cost about \u003ca href=\"http://www.ebudget.ca.gov/2021-22/pdf/Revised/BudgetSummary/HealthandHumanServices.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$4.4 million a year\u003c/a>.\u003c/p>\n\u003cp>California’s would become the first Medicaid program to include “full spectrum” doula coverage, meaning it would include care for women who have abortions, miscarriages and stillbirths, said Amy Chen, a senior attorney at the \u003ca href=\"https://healthlaw.org/about/\" target=\"_blank\" rel=\"noopener noreferrer\">National Health Law Program\u003c/a>.\u003c/p>\n\u003cp>“California has always led the country and been a little bit in front of where our federal government is when it comes to covering folks,” Flint said.\u003c/p>\n\u003cp>\u003cem>California Healthline correspondent Angela Hart contributed to this report.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/about-us/\" target=\"_blank\" rel=\"noopener noreferrer\">KHN\u003c/a> (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). \u003ca href=\"https://www.kff.org/about-us/\" target=\"_blank\" rel=\"noopener noreferrer\">KFF\u003c/a> is an endowed nonprofit organization providing information on health issues to the nation.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"State lawmakers are seeking a slate of health proposals for low-income families and children, including ending the pink tax and creating a universal basic income pilot program for low-income new parents.","status":"publish","parent":0,"modified":1622833910,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":1393},"headData":{"title":"Low-Income Families Could Get More Benefits With California Budget Surplus | KQED","description":"State lawmakers are seeking a slate of health proposals for low-income families and children, including ending the pink tax and creating a universal basic income pilot program for low-income new parents.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"NewsArticle","headline":"Low-Income Families Could Get More Benefits With California Budget Surplus","datePublished":"2021-06-04T19:11:50.000Z","dateModified":"2021-06-04T19:11:50.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png","isAccessibleForFree":"Y","publisher":{"@type":"NewsMediaOrganization","@id":"https://www.kqed.org/#organization","name":"KQED","url":"https://www.kqed.org","logo":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}}},"disqusIdentifier":"11876711 https://ww2.kqed.org/news/?p=11876711","disqusUrl":"https://ww2.kqed.org/news/2021/06/04/low-income-families-could-get-more-benefits-with-california-budget-surplus/","disqusTitle":"Low-Income Families Could Get More Benefits With California Budget Surplus","source":"California Healthline","sourceUrl":"https://californiahealthline.org/","nprByline":"\u003ca href=\"https://californiahealthline.org/news/author/anna-almendrala/\">Anna Almendrala\u003c/a>","path":"/news/11876711/low-income-families-could-get-more-benefits-with-california-budget-surplus","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Amid a pandemic that has pushed millions of \u003ca href=\"https://www.census.gov/library/stories/2021/03/moms-work-and-the-pandemic.html\" target=\"_blank\" rel=\"noopener noreferrer\">mothers out of the workplace\u003c/a>, caused \u003ca href=\"https://www.latimes.com/california/story/2021-05-24/obamacare-made-iuds-affordable-one-reason-behind-californias-covid-baby-bust\" target=\"_blank\" rel=\"noopener noreferrer\">fertility rates to plunge\u003c/a> and \u003ca href=\"https://jamanetwork.com/journals/jamapediatrics/fullarticle/2779182\" target=\"_blank\" rel=\"noopener noreferrer\">heightened the risk of death for pregnant women\u003c/a>, Gov. Gavin Newsom and state Democratic lawmakers are seeking a slate of health proposals for low-income families and children.\u003c/p>\n\u003cp>Newsom, a self-described feminist and the father of four young children, has long advocated family-friendly health and economic policies. Flush with a projected \u003ca href=\"https://www.kqed.org/news/11874125/californias-historic-budget-surplus-is-it-76-billion-or-38-billion\" target=\"_blank\" rel=\"noopener noreferrer\">budget surplus of $75.7 billion\u003c/a>, state politicians have come up with myriad legislative and budget proposals to make poorer families healthier and wealthier.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'We don’t need to balance the budget on half of the population that has a uterus.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Assemblymember Cristina Garcia (D-Bell Gardens)","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>They include ending sales taxes on \u003ca href=\"https://esd.dof.ca.gov/dofpublic/public/trailerBill/pdf/414\" target=\"_blank\" rel=\"noopener noreferrer\">menstrual products and diapers\u003c/a>; adding benefits such as doulas and early childhood trauma screenings to Medi-Cal, the state’s Medicaid program; allowing pregnant women to retain Medi-Cal coverage for a year after giving birth; and a pilot program to provide a universal basic income to low-income new parents.\u003c/p>\n\u003cp>“COVID-19 laid inequity bare for all to see,” Assemblymember Wendy Carrillo (D-Los Angeles) said in a written statement. She is the co-author of Senate Bill 65, led by Sen. Nancy Skinner (D-Berkeley), which would pour hundreds of millions of dollars into family and health care programs annually, focusing on minority groups that Carrillo said were “pushed out of the social safety net by the prior White House.”\u003c/p>\n\u003cp>Newsom and the Democratic-controlled legislature are unified on major health care and social safety-net expansions, which would direct billions in health benefits and cash assistance to the state’s most vulnerable residents and low-income parents. Legislative Democrats for years have pushed a progressive agenda to help struggling parents and families, featuring proposals like those to permanently end taxes on menstrual products and diapers — \u003ca href=\"https://lao.ca.gov/Publications/Report/4040\" target=\"_blank\" rel=\"noopener noreferrer\">expected to cost the state millions\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We don’t need to balance the budget on half of the population that has a uterus,” said Assemblymember Cristina Garcia (D-Bell Gardens), who has \u003ca href=\"https://www.politico.com/states/california/story/2019/05/07/newsom-to-unveil-may-budget-thursday-with-focus-on-low-income-families-1009021\" target=\"_blank\" rel=\"noopener noreferrer\">for years sought an end\u003c/a> to the “pink tax” on diapers and menstrual products.\u003c/p>\n\u003cp>Skinner, chair of the Senate budget committee, is among the powerful lawmakers who’ve put forward legislation to make childbirth safer and parenthood more affordable. Her bill, which cleared the Senate and was up for consideration this week in the state Assembly, has several features that would dramatically expand maternal health care (transgender men also get pregnant and give birth).\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"tag":"childbirth","label":"Maternity in California "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Before the pandemic, Medi-Cal covered mothers only up to 60 days after their pregnancies ended unless their income fell below a certain line or they had a mental health diagnosis. Skinner’s bill, part of a \u003ca href=\"https://www.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/\" target=\"_blank\" rel=\"noopener noreferrer\">broader national push\u003c/a> to improve birth outcomes, would expand full Medi-Cal coverage to 12 months after the end of a pregnancy. Other \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB65\" target=\"_blank\" rel=\"noopener noreferrer\">parts of the bill\u003c/a> would intensify state reporting and reviews of fetal and pregnancy-related deaths and severe maternal morbidity, expand housing benefits for families that have a pregnant member, and increase training programs for midwives.\u003c/p>\n\u003cp>Newsom’s $268 billion budget blueprint includes about $200 million a year to fully implement the expansion of Medi-Cal coverage for new mothers, with matching dollars from the federal government until those funds expire in 2027. If the expansion were not renewed, the state would revert to previous Medi-Cal qualifications.\u003c/p>\n\u003cp>\u003ca href=\"https://www.chcf.org/publication/2019-edition-maternity-care-in-california/\" target=\"_blank\" rel=\"noopener noreferrer\">Medi-Cal covered 45% of all births\u003c/a> in California in 2017, the last year for which data could be found.\u003c/p>\n\u003cp>“Not all postpartum issues end at 60 days, and when patients lose insurance, we can’t address them in the usual way,” said Dr. Yen Truong, an OB-GYN who works with the American College of Obstetricians and Gynecologists on legislative issues in California.\u003c/p>\n\u003cp>About half of pregnancy-related deaths occur during the pregnancy or on the day of delivery, but about 12% take place \u003ca href=\"https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm\" target=\"_blank\" rel=\"noopener noreferrer\">between seven weeks and a year\u003c/a> after giving birth, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The U.S. had 17.4 early maternal deaths per 100,000 live births in 2018, according to the most recent CDC data with state figures. California’s rate, \u003ca href=\"https://www.cdc.gov/nchs/maternal-mortality/MMR-2018-State-Data-508.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">11.7 per 100,000\u003c/a>, was among the lowest in the nation, but the state collects data on maternal deaths in a way that could result in underestimates.\u003c/p>\n\u003cp>California’s overall numbers also obscure stark racial disparities. Statewide, Black infants averaged \u003ca href=\"https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/CHSP_2021_ADA_FINAL.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">7.8 deaths per 1,000 live births\u003c/a>, compared with an average of three deaths among white babies. Data from 2013 from \u003ca href=\"http://publichealth.lacounty.gov/owh/docs/DataReport/2017-HealthIndicatorsforWomeninLACounty.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Los Angeles County\u003c/a> showed Black women had pregnancy-related deaths at rates more than four times as high as the overall rate in the state’s largest county.\u003c/p>\n\u003cp>“Given our state’s wealth and medical advancements, this is unacceptable,” Skinner, vice chair of the Legislative Women’s Caucus, said in a news release.\u003c/p>\n\u003cp>Democrats also appear unified on another aspect of Skinner’s bill: a pilot program to test a universal basic income program for struggling families. The bill would give $1,000 a month to low-income expectant and new parents with kids under 2 years old in counties that decide to participate. Newsom has also proposed \u003ca href=\"http://www.ebudget.ca.gov/2021-22/pdf/Revised/BudgetSummary/HealthandHumanServices.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$35 million over five years\u003c/a> for pilot programs for universal basic income.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'The budget surplus is allowing many things that were called impossible to be possible, and that includes health care bills.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Rose Kapolczynski, a campaign consultant","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>These issues could play well, especially among women, and improve Newsom’s standing going into a \u003ca href=\"https://www.kqed.org/news/11875264/new-poll-shows-support-idling-for-newsom-recall-effort\" target=\"_blank\" rel=\"noopener noreferrer\">recall election\u003c/a> later this year, said Rose Kapolczynski, a longtime campaign consultant to former U.S. Sen. Barbara Boxer who has worked on reproductive health care issues in Sacramento.\u003c/p>\n\u003cp>Indefinitely rescinding sales taxes on diapers and menstrual products — the taxes have been \u003ca href=\"https://www.kcra.com/article/sales-tax-for-tampons-diapers-eliminated-in-california-for-2-years/30463779\" target=\"_blank\" rel=\"noopener noreferrer\">temporarily lifted since early last year\u003c/a> — is a particular no-brainer because of its bipartisan appeal, she said.\u003c/p>\n\u003cp>“It’s hard for Republicans to attack something that is a tax cut, and sales taxes are regressive, so progressives would like it,” Kapolczynski said.\u003c/p>\n\u003cp>As for Medi-Cal expansions, Kapolczynski said that even though it wouldn’t affect most Californians, the pandemic has made health care even more important to voters. “The budget surplus is allowing many things that were called impossible to be possible, and that includes health care bills,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"tag":"california-budget","label":"More California budget coverage "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Investing in California’s young families could help close the racial gap in maternal and infant mortality, said \u003ca href=\"https://www.bwwla.org/nourbese-flint-ma/\" target=\"_blank\" rel=\"noopener noreferrer\">Nourbese Flint\u003c/a>, executive director of the Black Women for Wellness Action Project, which endorsed Skinner’s bill.\u003c/p>\n\u003cp>Flint is especially excited about the possibility of covering doulas through Medi-Cal. Doulas, trained as emotional and physical supports for women in pregnancy and postpartum, have been linked to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538578/\" target=\"_blank\" rel=\"noopener noreferrer\">lower odds of cesarean births\u003c/a> and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595013/\" target=\"_blank\" rel=\"noopener noreferrer\">greater satisfaction with the birth experience\u003c/a>. If doulas saved Medi-Cal money by reducing cesarean births, that could enable the state to renegotiate payments for labor and delivery, according to \u003ca href=\"http://analyses.chbrp.com/document/view.php?id=1496\" target=\"_blank\" rel=\"noopener noreferrer\">an analysis by the independent California Health Benefits Review Program\u003c/a>. Under Newsom’s proposed budget, Medi-Cal coverage of doulas would cost about \u003ca href=\"http://www.ebudget.ca.gov/2021-22/pdf/Revised/BudgetSummary/HealthandHumanServices.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$4.4 million a year\u003c/a>.\u003c/p>\n\u003cp>California’s would become the first Medicaid program to include “full spectrum” doula coverage, meaning it would include care for women who have abortions, miscarriages and stillbirths, said Amy Chen, a senior attorney at the \u003ca href=\"https://healthlaw.org/about/\" target=\"_blank\" rel=\"noopener noreferrer\">National Health Law Program\u003c/a>.\u003c/p>\n\u003cp>“California has always led the country and been a little bit in front of where our federal government is when it comes to covering folks,” Flint said.\u003c/p>\n\u003cp>\u003cem>California Healthline correspondent Angela Hart contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/about-us/\" target=\"_blank\" rel=\"noopener noreferrer\">KHN\u003c/a> (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). \u003ca href=\"https://www.kff.org/about-us/\" target=\"_blank\" rel=\"noopener noreferrer\">KFF\u003c/a> is an endowed nonprofit organization providing information on health issues to the nation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11876711/low-income-families-could-get-more-benefits-with-california-budget-surplus","authors":["byline_news_11876711"],"categories":["news_8"],"tags":["news_29447","news_402","news_23820","news_29542","news_21771"],"featImg":"news_11876712","label":"source_news_11876711"},"news_11790733":{"type":"posts","id":"news_11790733","meta":{"index":"posts_1591205157","site":"news","id":"11790733","score":null,"sort":[1576114189000]},"guestAuthors":[],"slug":"is-thc-a-health-risk-to-pregnant-women-california-just-decided-it-is","title":"Is THC a Health Risk to Pregnant Women? California Just Decided It Is","publishDate":1576114189,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{"term":72,"site":"news"},"content":"\u003cp>Scientists appointed by Gov. Gavin Newsom voted on Wednesday to put both cannabis smoke and THC — the psychoactive compound in marijuana — on the state's list of \"reproductive toxicants.\"\u003c/p>\n\u003cp>The panel of scientists with the California Office of Environmental Health Hazard Assessment (OEHHA) met in Sacramento to wrestle with the reliability and accuracy of dense research studies, and to consider whether to declare marijuana's potent, high-inducing chemical a health risk to pregnant women and require warnings for pot products legally sold in California.\u003c/p>\n\u003cp>Surveys have indicated that a rising number of mothers-to-be have turned to marijuana products for relief from morning sickness and headaches, though its effectiveness has not been backed by science.\u003c/p>\n\u003cp>The panel's finding means THC will now join hundreds of other chemicals judged to cause cancer or birth defects that California requires to carry warning labels, such as arsenic and lead.\u003c/p>\n\u003cp>But don't expect to see developmental toxicity warnings for expectant mothers on cannabis just yet.\u003c/p>\n\u003cp>\"There is a one-year grace period before any warnings are required, and several things could happen in that one-year period,\" said Sam Delson, deputy director of OEHHA. \"One, we can seek to determine a level of exposure that does not cause a significant health risk and therefore does not require warnings. We can also work to develop special warnings that address the unique characteristics of these substances and the specific health effects.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The panel delved into numerous studies examining whether cannabis use during pregnancy can be linked to low birth weight, early deliveries, infant mortality or cognitive or other health problems with children.\u003c/p>\n\u003cp>They debated whether studies were sufficiently comprehensive and scientifically sound to make judgments about the effects of THC and pregnancy. Some studies didn't make clear how frequently a mother used cannabis during pregnancy or what products were being used. Others didn't account for instances when mothers were using marijuana and tobacco, and whether that could skew the results.\u003c/p>\n\u003cp>Because some studies included only tests on animals, such as mice or rats, the panel discussed whether those results could be used to consider the effects on people. In other cases, studies relied on self-reporting by new mothers, putting the reliability of the information in doubt.\u003c/p>\n\u003cp>Cannabis industry officials say too little sound research is available on THC to support the panel's move, and warn that it could make marijuana companies a target for lawsuits with unverified claims of injuries from pot use during pregnancy.\u003c/p>\n\u003cp>“That seems like an open-ended checkbook. How do we defend ourselves?\" said Los Angeles dispensary owner Jerred Kiloh, who heads the United Cannabis Business Association, an industry group.\u003c/p>\n\u003cp>[aside postID=news_11644951 hero='https://ww2.kqed.org/wp-content/uploads/sites/10/2018/01/Sauter-1180x919.jpg']\u003c/p>\n\u003cp>The review was carried out under the umbrella of the Safe Drinking Water and Toxic Enforcement Act, better known as Proposition 65. It requires warning labels for chemicals judged as dangerous and allows residents, advocacy groups and attorneys to sue on behalf of the state and collect a portion of civil penalties for failure to provide warnings.\u003c/p>\n\u003cp>The 1986 law has been credited with weeding out cancer-causing chemicals from products but also faulted for setting the stage for legal shakedowns.\u003c/p>\n\u003cp>Lawyers looking for a quick buck will say \"give us $10,000 or we are going to take you into a long court case,\" Kiloh said.\u003c/p>\n\u003cp>The California Cannabis Industry Association echoed that fear, noting that pot's standing as an illegal drug at the federal level has choked off research by government agencies. Those studies are needed to determine if THC poses health risks for pregnant women, the group said.\u003c/p>\n\u003cp>“Good policy and consumer protections are based on facts and data,” spokesman Josh Drayton said.\u003c/p>\n\u003cp>Since 2009, California has listed marijuana smoke as being known to cause cancer, similar to tobacco smoke.\u003c/p>\n\u003cp>The U.S. surgeon general warned in August that smoking marijuana is dangerous for pregnant women and their developing babies. Mainstream medicine advises against pot use in pregnancy because of studies suggesting it might cause premature birth, low birth weight or other health problems, but many of those studies were in animals or had findings that were open to dispute.\u003c/p>\n\u003cp>The National Institute on Drug Abuse is paying for several studies on marijuana use during pregnancy.\u003c/p>\n\u003cp>Now that the California panel has declared pot a risk for pregnant women, it's not clear what the immediate impact will be on the state's legal pot industry.\u003c/p>\n\u003cp>Presumably, packaging will need to be changed over time to carry warning labels for pregnant women. But such requirements would likely take additional steps by agencies that oversee marijuana regulation and packaging.\u003c/p>\n\u003cp>Even products containing CBD, a trendy ingredient extracted from marijuana or hemp, can contain trace amounts of THC.\u003c/p>\n\u003cp>\u003cem>This post includes reporting from The Associated Press's Michael R. Blood, and KQED's Peter Jon Shuler and David Marks.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"A panel of scientists appointed by Gov. Gavin Newsom voted on Wednesday to put both cannabis smoke and THC on the state’s list of 'reproductive toxicants.'","status":"publish","parent":0,"modified":1576175250,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":832},"headData":{"title":"Is THC a Health Risk to Pregnant Women? California Just Decided It Is | KQED","description":"A panel of scientists appointed by Gov. Gavin Newsom voted on Wednesday to put both cannabis smoke and THC on the state’s list of 'reproductive toxicants.'","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"NewsArticle","headline":"Is THC a Health Risk to Pregnant Women? California Just Decided It Is","datePublished":"2019-12-12T01:29:49.000Z","dateModified":"2019-12-12T18:27:30.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png","isAccessibleForFree":"Y","publisher":{"@type":"NewsMediaOrganization","@id":"https://www.kqed.org/#organization","name":"KQED","url":"https://www.kqed.org","logo":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}}},"disqusIdentifier":"11790733 https://ww2.kqed.org/news/?p=11790733","disqusUrl":"https://ww2.kqed.org/news/2019/12/11/is-thc-a-health-risk-to-pregnant-women-california-just-decided-it-is/","disqusTitle":"Is THC a Health Risk to Pregnant Women? California Just Decided It Is","audioTrackLength":80,"path":"/news/11790733/is-thc-a-health-risk-to-pregnant-women-california-just-decided-it-is","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2019/12/ShulerTHC.mp3","audioDuration":80000,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Scientists appointed by Gov. Gavin Newsom voted on Wednesday to put both cannabis smoke and THC — the psychoactive compound in marijuana — on the state's list of \"reproductive toxicants.\"\u003c/p>\n\u003cp>The panel of scientists with the California Office of Environmental Health Hazard Assessment (OEHHA) met in Sacramento to wrestle with the reliability and accuracy of dense research studies, and to consider whether to declare marijuana's potent, high-inducing chemical a health risk to pregnant women and require warnings for pot products legally sold in California.\u003c/p>\n\u003cp>Surveys have indicated that a rising number of mothers-to-be have turned to marijuana products for relief from morning sickness and headaches, though its effectiveness has not been backed by science.\u003c/p>\n\u003cp>The panel's finding means THC will now join hundreds of other chemicals judged to cause cancer or birth defects that California requires to carry warning labels, such as arsenic and lead.\u003c/p>\n\u003cp>But don't expect to see developmental toxicity warnings for expectant mothers on cannabis just yet.\u003c/p>\n\u003cp>\"There is a one-year grace period before any warnings are required, and several things could happen in that one-year period,\" said Sam Delson, deputy director of OEHHA. \"One, we can seek to determine a level of exposure that does not cause a significant health risk and therefore does not require warnings. We can also work to develop special warnings that address the unique characteristics of these substances and the specific health effects.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The panel delved into numerous studies examining whether cannabis use during pregnancy can be linked to low birth weight, early deliveries, infant mortality or cognitive or other health problems with children.\u003c/p>\n\u003cp>They debated whether studies were sufficiently comprehensive and scientifically sound to make judgments about the effects of THC and pregnancy. Some studies didn't make clear how frequently a mother used cannabis during pregnancy or what products were being used. Others didn't account for instances when mothers were using marijuana and tobacco, and whether that could skew the results.\u003c/p>\n\u003cp>Because some studies included only tests on animals, such as mice or rats, the panel discussed whether those results could be used to consider the effects on people. In other cases, studies relied on self-reporting by new mothers, putting the reliability of the information in doubt.\u003c/p>\n\u003cp>Cannabis industry officials say too little sound research is available on THC to support the panel's move, and warn that it could make marijuana companies a target for lawsuits with unverified claims of injuries from pot use during pregnancy.\u003c/p>\n\u003cp>“That seems like an open-ended checkbook. How do we defend ourselves?\" said Los Angeles dispensary owner Jerred Kiloh, who heads the United Cannabis Business Association, an industry group.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11644951","hero":"https://ww2.kqed.org/wp-content/uploads/sites/10/2018/01/Sauter-1180x919.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The review was carried out under the umbrella of the Safe Drinking Water and Toxic Enforcement Act, better known as Proposition 65. It requires warning labels for chemicals judged as dangerous and allows residents, advocacy groups and attorneys to sue on behalf of the state and collect a portion of civil penalties for failure to provide warnings.\u003c/p>\n\u003cp>The 1986 law has been credited with weeding out cancer-causing chemicals from products but also faulted for setting the stage for legal shakedowns.\u003c/p>\n\u003cp>Lawyers looking for a quick buck will say \"give us $10,000 or we are going to take you into a long court case,\" Kiloh said.\u003c/p>\n\u003cp>The California Cannabis Industry Association echoed that fear, noting that pot's standing as an illegal drug at the federal level has choked off research by government agencies. Those studies are needed to determine if THC poses health risks for pregnant women, the group said.\u003c/p>\n\u003cp>“Good policy and consumer protections are based on facts and data,” spokesman Josh Drayton said.\u003c/p>\n\u003cp>Since 2009, California has listed marijuana smoke as being known to cause cancer, similar to tobacco smoke.\u003c/p>\n\u003cp>The U.S. surgeon general warned in August that smoking marijuana is dangerous for pregnant women and their developing babies. Mainstream medicine advises against pot use in pregnancy because of studies suggesting it might cause premature birth, low birth weight or other health problems, but many of those studies were in animals or had findings that were open to dispute.\u003c/p>\n\u003cp>The National Institute on Drug Abuse is paying for several studies on marijuana use during pregnancy.\u003c/p>\n\u003cp>Now that the California panel has declared pot a risk for pregnant women, it's not clear what the immediate impact will be on the state's legal pot industry.\u003c/p>\n\u003cp>Presumably, packaging will need to be changed over time to carry warning labels for pregnant women. But such requirements would likely take additional steps by agencies that oversee marijuana regulation and packaging.\u003c/p>\n\u003cp>Even products containing CBD, a trendy ingredient extracted from marijuana or hemp, can contain trace amounts of THC.\u003c/p>\n\u003cp>\u003cem>This post includes reporting from The Associated Press's Michael R. Blood, and KQED's Peter Jon Shuler and David Marks.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11790733/is-thc-a-health-risk-to-pregnant-women-california-just-decided-it-is","authors":["237"],"programs":["news_72"],"categories":["news_457","news_8","news_13","news_356"],"tags":["news_19963","news_102","news_21771","news_19921","news_26775","news_24859"],"featImg":"news_11790801","label":"news_72"},"news_11775881":{"type":"posts","id":"news_11775881","meta":{"index":"posts_1591205157","site":"news","id":"11775881","score":null,"sort":[1569186664000]},"guestAuthors":[],"slug":"a-daily-baby-aspirin-could-help-many-pregnancies-and-save-lives","title":"A Daily Baby Aspirin Could Help Many Pregnancies And Save Lives","publishDate":1569186664,"format":"standard","headTitle":"KQED News","labelTerm":{},"content":"\u003cp>Bridget Desmukes was surprised when \u003ca href=\"https://www.hopkinsmedicine.org/profiles/results/directory/profile/6263239/rita-driggers\" target=\"_blank\" rel=\"noopener\">Dr. Rita Driggers\u003c/a>, Desmukes' OB-GYN in Washington, D.C., recommended low-dose aspirin at her first prenatal appointment this past spring. She knew about daily low-dose aspirin being prescribed to people recovering from a heart attack or stroke. But for pregnant women?\u003c/p>\n\u003cp>In a past pregnancy, Desmukes, who is now 42, had developed preeclampsia, a potentially serious complication that involves high blood pressure. A small amount of daily aspirin, it turns out, can significantly cut the risk of developing preeclampsia in pregnancy. It's currently recommended for many pregnant women by two influential groups — the \u003ca href=\"https://acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Low-Dose-Aspirin-Use-During-Pregnancy?IsMobileSet=false\" target=\"_blank\" rel=\"noopener\">American College of Obstetricians and Gynecologists\u003c/a> and the \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication\" target=\"_blank\" rel=\"noopener\">U.S. Preventive Services Task Force\u003c/a>, an independent panel of experts commissioned by the federal government.\u003c/p>\n\u003cp>The challenge, some OB-GYNs believe, is getting the word out to women who are at risk that the low-dose aspirin regimen is something that could benefit them. In that way, Desmukes and her husband, Jeffrey, were lucky to hear about it early in her pregnancy.\u003c/p>\n\u003cp>She says her doctor, an associate professor at Johns Hopkins School of Medicine, \"explained to us that because of my age and the fact that I had a history of preeclampsia, aspirin would be recommended for me to take. Just precautionarily — to keep the flow of nutrients and oxygen and everything to the baby and help it continue to thrive and grow.\"\u003c/p>\n\u003cfigure id=\"attachment_11775892\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11775892\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/09/aprin_2_custom-d7da3fdb07319c6661a38386c1662a4d8c2a26bd-s800-c85-800x387.jpg\" alt=\"A photo of Bridget Desmukes, next to a photo of her hand, holding a baby aspirin. \" width=\"800\" height=\"387\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/09/aprin_2_custom-d7da3fdb07319c6661a38386c1662a4d8c2a26bd-s800-c85.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/09/aprin_2_custom-d7da3fdb07319c6661a38386c1662a4d8c2a26bd-s800-c85-160x77.jpg 160w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">As an older mom with a history of preeclampsia, Desmukes is considered at high risk for developing the condition again. She's a nurse by training and knows the risks, so she agreed with her OB-GYN that taking a single baby aspirin daily is a good idea. \"Just precautionarily,\" she says, \"to keep the flow of nutrients and oxygen ... to the baby.\" \u003ccite>(Ryan Kellman/NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Desmukes says at first she was hesitant. A nurse by training, she knows any medicine can have side effects and says she prefers a \"holistic\" approach to her own health. But she also knows the risks of preeclampsia, and how it can be fatal — it's a leading cause of the \u003ca href=\"https://www.npr.org/series/543928389/lost-mothers\">high maternal mortality rate in the U.S\u003c/a>. And as a black woman, Desmukes' risk of dying in childbirth is elevated; maternal mortality rates among black women in the U.S. are about three times those of white women.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She did some research, thought about it, and decided to take the aspirin. She is due in November, and so far everything's going well — no signs of hypertension.\u003c/p>\n\u003cp>\u003cstrong>How it works\u003c/strong>\u003c/p>\n\u003cp>The cause of preeclampsia in a pregnant woman \u003ca href=\"https://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/causes\" target=\"_blank\" rel=\"noopener\">is still unknown\u003c/a>, but the mechanism of danger is clear: Her blood vessels constrict, which means, among other things, blood can't flow easily to her kidneys or brain or uterus. \u003ca href=\"https://www.preeclampsia.org/health-information/sign-symptoms\" target=\"_blank\" rel=\"noopener\">Telltale signs\u003c/a> include a terrible headache and swollen hands and feet.\u003c/p>\n\u003cp>\"What aspirin does is relax blood vessels, [which] lowers the blood pressure, but also improves blood flow to the baby, to the kidneys, and to the brain, lowering the chance that the woman would have any complications to her pregnancy that would affect either her or her baby,\" says \u003ca href=\"https://www.bmc.org/about-us/directory/doctor/jodi-f-abbott-md-msc-mhcm\" target=\"_blank\" rel=\"noopener\">Dr. Jodi Abbott\u003c/a>, an OB-GYN who specializes in treating high-risk pregnancies at Boston Medical Center and is also an associate professor at Boston University School of Medicine.\u003c/p>\n\u003cp>Prenatal aspirin can \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/final-evidence-summary51/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication#results\" target=\"_blank\" rel=\"noopener\">cut the risk\u003c/a> of preeclampsia by 24%, according to a \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication\" target=\"_blank\" rel=\"noopener\">comprehensive review\u003c/a> of the scientific evidence by the USPSTF in 2014. That guidance described the harms of taking low-dose aspirin in pregnancy as \"no greater than small.\"\u003c/p>\n\u003cp>\"It's been shown to be very safe,\" says \u003ca href=\"https://www.bmc.org/about-us/directory/doctor/nyia-l-noel-md-mph\" target=\"_blank\" rel=\"noopener\">Dr. Nyia Noel\u003c/a>, who is Abbott's co-director of the \u003ca href=\"https://www.prenatalaspirin.com/\" target=\"_blank\" rel=\"noopener\">Prenatal Aspirin Project\u003c/a>, an initiative at BMC created to increase implementation of the task force's recommendations. \"Things that people worry about — such as bleeding in pregnancy or something called placental abruption, which is early separation of the placenta — have not shown to be increased in women on low-dose aspirin.\"\u003c/p>\n\u003cp>Now, this is not like taking aspirin for pain relief — that's a much higher dose, usually 325 mg per pill, and one or two pills every four to six hours. In contrast, low-dose aspirin tablets are about 81 mg. They're usually cheap and can be prescribed — they're often covered by insurance — or bought over the counter.\u003c/p>\n\u003cp>Noel says for her, telling women about the benefits of prenatal aspirin is personal. African American women are \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/preeclampsia-screening1#clinical-considerations\" target=\"_blank\" rel=\"noopener\">more likely than white women\u003c/a> to develop preeclampsia, and they're more likely to die from it.\u003c/p>\n\u003cp>\"This topic is very important to me — as a black woman — but also as a black obstetrician-gynecologist in the service of women of color every day,\" she says. \"I've experienced what feels like one degree of separation between myself and women just like me that have died or almost died from preeclampsia,\" Noel says. \"So I really feel aspirin is not the only thing, but it is a step, and women should really feel empowered to speak with their providers about this.\"\u003c/p>\n\u003cp>\u003cstrong>Aspirin coming to a prenatal vitamin near you?\u003c/strong>\u003c/p>\n\u003cp>Any woman pregnant with twins or triplets, or who has diabetes or hypertension, or who has had preeclampsia before, is considered at \u003ca href=\"https://acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Low-Dose-Aspirin-Use-During-Pregnancy?IsMobileSet=false\">high risk\u003c/a> of the condition and should talk to her doctor about taking low-dose aspirin, Abbott says.\u003c/p>\n\u003cp>Beyond that group of \"high risk\" characteristics, there are the moderate risk factors — like being pregnant with a first baby, or being obese, or over 35, or African American. Having two or more of those characteristics means low-dose aspirin should be considered for you, too, the guidelines suggest.\u003c/p>\n\u003cp>Abbott says when you add up the women in all those categories, it equals a whole lot of people.\u003c/p>\n\u003cp>\"Eighty-six percent of our patients [at Boston Medical Center] would be eligible for aspirin based on those criteria,\" Abbott says. \"When you look at a number like 86% you can understand why I would be in favor — as a public health initiative — of all pregnant women getting it.\"\u003c/p>\n\u003cp>As Abbott sees it, screening for all those risk factors means someone who could benefit will inevitably get missed. And since she doesn't see significant downsides to low-dose aspirin, she thinks it should just go to everybody who's pregnant.\u003c/p>\n\u003cp>\"My suspicion — if I had to guess ahead 10 years — is that you'll be able to buy, included in your prenatal vitamin, low-dose aspirin,\" she says.\u003c/p>\n\u003cp>\u003cstrong>The need for research on the universal question\u003c/strong>\u003c/p>\n\u003cp>But not everyone is convinced — at least at this point — that every pregnant woman should take aspirin. Count \u003ca href=\"https://feinstein.northwell.edu/institutes-researchers/our-researchers/karina-davidson-phd\" target=\"_blank\" rel=\"noopener\">Karina Davidson\u003c/a> among them. She's the senior vice president for research at Northwell Health and a member of the U.S. Preventive Services Task Force panel that reviewed the evidence on this issue in 2014.\u003c/p>\n\u003cp>\"We know that aspirin prevents the devastating consequences of preeclampsia and of many of the hypertensive disorders of pregnancy for those who are at risk,\" she says. \"For those who are at risk, we absolutely want both clinicians and patients to know they should be discussing whether aspirin is right for them to help them minimize their exposure — and their infants' exposure — to those devastating consequences.\"\u003c/p>\n\u003cp>Still, that group's current \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/final-evidence-summary51/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication\" target=\"_blank\" rel=\"noopener\">recommendations\u003c/a> stop short of advising prenatal aspirin for all.\u003c/p>\n\u003cp>\"We have a very specific mandate, which is that we make recommendations based on evidence,\" Davidson says. \"When we looked in 2014 we found little evidence that existed that in average-risk populations there was benefit.\" In other words, there needs to be a benefit to taking aspirin for women currently considered at low risk of developing preeclampsia — not just the absence of significant harm.\u003c/p>\n\u003cp>In June, the task force began looking to see whether new research has been done since 2014 that would make the group want to change its prenatal aspirin guidance, but \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/draft-research-plan/aspirin-use-to-prevent-preeclampsia-and-related-morbidity-and-mortality-preventive-medication1\" target=\"_blank\" rel=\"noopener\">that review\u003c/a> won't be finished for several years.\u003c/p>\n\u003cp>\u003cstrong>Dr. Google, and other barriers\u003c/strong>\u003c/p>\n\u003cp>Boston Medical Center's Prenatal Aspirin Project began in 2017 with the goal of getting the word out about the benefits of low-dose aspirin in pregnancy for eligible women and researching the barriers to implementing the task force's recommendations.\u003c/p>\n\u003cp>Through focus groups, leaders of the project found most of their patients had never heard of preeclampsia. \"We also found that they had been told it's not safe to take medications in pregnancy or that aspirin can be dangerous and you shouldn't take it,\" Abbott says. \"[Or they would] go to the pharmacy and the pharmacist would tell them that aspirin was unsafe in pregnancy.\"\u003c/p>\n\u003cp>Abbott believes pharmacists may have not been aware of the prenatal aspirin recommendations from the past few years or may have been thinking of the guidance that \u003ca href=\"https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/headaches-during-pregnancy/faq-20058265\" target=\"_blank\" rel=\"noopener\">pregnant women take Tylenol\u003c/a> (rather than aspirin) for headaches.\u003c/p>\n\u003cp>The team at the Prenatal Aspirin Project ended up reaching out to big commercial pharmacies — CVS, Walgreens and Walmart — and got them to remove warnings on prenatal aspirin prescriptions. After having some patients tell them \"I got a prescription, but I'm going to Google it before I take it,\" members of the project team also worked to bump up their Google rankings so the project's advice would appear above information that might be outdated.\u003c/p>\n\u003cp>Eliminating these barriers is important, Abbott says. \"Everybody deserves a healthy baby and a healthy mother, and we're failing at that right now,\" she says. \"This is really an opportunity for all women — but especially for women of color — to be able to claim back some power over their ability to have healthy pregnancies and healthy children.\"\u003c/p>\n\u003cp>Of course, low-dose aspirin isn't the only answer to the country's high rate of maternal mortality. \"There are certainly other things to be addressed — structural barriers, structural racism involved in the disparities that exist,\" says Noel.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This tiny pill isn't going to fix all of that. However, Noel says, it has great potential to reduce the number of cases of preeclampsia, a condition that is killing a lot of women.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 NPR. To see more, visit \u003ca href=\"http://www.npr.org\" target=\"_blank\" rel=\"noopener\">www.npr.org\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+Daily+Baby+Aspirin+Could+Help+Many+Pregnancies+And+Save+Lives&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Pregnant women at high or even moderate risk of developing the life-threatening condition preeclampsia should consider taking a very small dose of aspirin daily to prevent it, doctors say.","status":"publish","parent":0,"modified":1569186664,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":37,"wordCount":1720},"headData":{"title":"A Daily Baby Aspirin Could Help Many Pregnancies And Save Lives | KQED","description":"Pregnant women at high or even moderate risk of developing the life-threatening condition preeclampsia should consider taking a very small dose of aspirin daily to prevent it, doctors say.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"NewsArticle","headline":"A Daily Baby Aspirin Could Help Many Pregnancies And Save Lives","datePublished":"2019-09-22T21:11:04.000Z","dateModified":"2019-09-22T21:11:04.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png","isAccessibleForFree":"Y","publisher":{"@type":"NewsMediaOrganization","@id":"https://www.kqed.org/#organization","name":"KQED","url":"https://www.kqed.org","logo":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}}},"disqusIdentifier":"11775881 https://ww2.kqed.org/news/?p=11775881","disqusUrl":"https://ww2.kqed.org/news/2019/09/22/a-daily-baby-aspirin-could-help-many-pregnancies-and-save-lives/","disqusTitle":"A Daily Baby Aspirin Could Help Many Pregnancies And Save Lives","source":"NPR","sourceUrl":"www.npr.org","nprImageCredit":"Ryan Kellman","nprByline":"\u003ca href= \"https://www.npr.org/people/349308023/selena-simmons-duffin\"> Selena Simmons-Duffin \u003ca/> \u003cbr>NPR","nprImageAgency":"NPR","nprStoryId":"753433968","nprApiLink":"http://api.npr.org/query?id=753433968&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2019/09/16/753433968/a-daily-baby-aspirin-could-help-many-pregnancies-and-save-lives?ft=nprml&f=753433968","nprRetrievedStory":"1","nprPubDate":"Tue, 17 Sep 2019 10:37:00 -0400","nprStoryDate":"Mon, 16 Sep 2019 05:02:00 -0400","nprLastModifiedDate":"Tue, 17 Sep 2019 10:37:11 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2019/09/20190916_me_a_daily_baby_aspirin_could_help_many_pregnancies_and_save_lives.mp3?orgId=1&topicId=1128&d=376&p=3&story=753433968&ft=nprml&f=753433968","nprAudioM3u":"http://api.npr.org/m3u/1761126925-f5505a.m3u?orgId=1&topicId=1128&d=376&p=3&story=753433968&ft=nprml&f=753433968","audioTrackLength":376,"path":"/news/11775881/a-daily-baby-aspirin-could-help-many-pregnancies-and-save-lives","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2019/09/20190916_me_a_daily_baby_aspirin_could_help_many_pregnancies_and_save_lives.mp3?orgId=1&topicId=1128&d=376&p=3&story=753433968&ft=nprml&f=753433968","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Bridget Desmukes was surprised when \u003ca href=\"https://www.hopkinsmedicine.org/profiles/results/directory/profile/6263239/rita-driggers\" target=\"_blank\" rel=\"noopener\">Dr. Rita Driggers\u003c/a>, Desmukes' OB-GYN in Washington, D.C., recommended low-dose aspirin at her first prenatal appointment this past spring. She knew about daily low-dose aspirin being prescribed to people recovering from a heart attack or stroke. But for pregnant women?\u003c/p>\n\u003cp>In a past pregnancy, Desmukes, who is now 42, had developed preeclampsia, a potentially serious complication that involves high blood pressure. A small amount of daily aspirin, it turns out, can significantly cut the risk of developing preeclampsia in pregnancy. It's currently recommended for many pregnant women by two influential groups — the \u003ca href=\"https://acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Low-Dose-Aspirin-Use-During-Pregnancy?IsMobileSet=false\" target=\"_blank\" rel=\"noopener\">American College of Obstetricians and Gynecologists\u003c/a> and the \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication\" target=\"_blank\" rel=\"noopener\">U.S. Preventive Services Task Force\u003c/a>, an independent panel of experts commissioned by the federal government.\u003c/p>\n\u003cp>The challenge, some OB-GYNs believe, is getting the word out to women who are at risk that the low-dose aspirin regimen is something that could benefit them. In that way, Desmukes and her husband, Jeffrey, were lucky to hear about it early in her pregnancy.\u003c/p>\n\u003cp>She says her doctor, an associate professor at Johns Hopkins School of Medicine, \"explained to us that because of my age and the fact that I had a history of preeclampsia, aspirin would be recommended for me to take. Just precautionarily — to keep the flow of nutrients and oxygen and everything to the baby and help it continue to thrive and grow.\"\u003c/p>\n\u003cfigure id=\"attachment_11775892\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11775892\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/09/aprin_2_custom-d7da3fdb07319c6661a38386c1662a4d8c2a26bd-s800-c85-800x387.jpg\" alt=\"A photo of Bridget Desmukes, next to a photo of her hand, holding a baby aspirin. \" width=\"800\" height=\"387\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/09/aprin_2_custom-d7da3fdb07319c6661a38386c1662a4d8c2a26bd-s800-c85.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/09/aprin_2_custom-d7da3fdb07319c6661a38386c1662a4d8c2a26bd-s800-c85-160x77.jpg 160w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">As an older mom with a history of preeclampsia, Desmukes is considered at high risk for developing the condition again. She's a nurse by training and knows the risks, so she agreed with her OB-GYN that taking a single baby aspirin daily is a good idea. \"Just precautionarily,\" she says, \"to keep the flow of nutrients and oxygen ... to the baby.\" \u003ccite>(Ryan Kellman/NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Desmukes says at first she was hesitant. A nurse by training, she knows any medicine can have side effects and says she prefers a \"holistic\" approach to her own health. But she also knows the risks of preeclampsia, and how it can be fatal — it's a leading cause of the \u003ca href=\"https://www.npr.org/series/543928389/lost-mothers\">high maternal mortality rate in the U.S\u003c/a>. And as a black woman, Desmukes' risk of dying in childbirth is elevated; maternal mortality rates among black women in the U.S. are about three times those of white women.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She did some research, thought about it, and decided to take the aspirin. She is due in November, and so far everything's going well — no signs of hypertension.\u003c/p>\n\u003cp>\u003cstrong>How it works\u003c/strong>\u003c/p>\n\u003cp>The cause of preeclampsia in a pregnant woman \u003ca href=\"https://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/causes\" target=\"_blank\" rel=\"noopener\">is still unknown\u003c/a>, but the mechanism of danger is clear: Her blood vessels constrict, which means, among other things, blood can't flow easily to her kidneys or brain or uterus. \u003ca href=\"https://www.preeclampsia.org/health-information/sign-symptoms\" target=\"_blank\" rel=\"noopener\">Telltale signs\u003c/a> include a terrible headache and swollen hands and feet.\u003c/p>\n\u003cp>\"What aspirin does is relax blood vessels, [which] lowers the blood pressure, but also improves blood flow to the baby, to the kidneys, and to the brain, lowering the chance that the woman would have any complications to her pregnancy that would affect either her or her baby,\" says \u003ca href=\"https://www.bmc.org/about-us/directory/doctor/jodi-f-abbott-md-msc-mhcm\" target=\"_blank\" rel=\"noopener\">Dr. Jodi Abbott\u003c/a>, an OB-GYN who specializes in treating high-risk pregnancies at Boston Medical Center and is also an associate professor at Boston University School of Medicine.\u003c/p>\n\u003cp>Prenatal aspirin can \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/final-evidence-summary51/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication#results\" target=\"_blank\" rel=\"noopener\">cut the risk\u003c/a> of preeclampsia by 24%, according to a \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication\" target=\"_blank\" rel=\"noopener\">comprehensive review\u003c/a> of the scientific evidence by the USPSTF in 2014. That guidance described the harms of taking low-dose aspirin in pregnancy as \"no greater than small.\"\u003c/p>\n\u003cp>\"It's been shown to be very safe,\" says \u003ca href=\"https://www.bmc.org/about-us/directory/doctor/nyia-l-noel-md-mph\" target=\"_blank\" rel=\"noopener\">Dr. Nyia Noel\u003c/a>, who is Abbott's co-director of the \u003ca href=\"https://www.prenatalaspirin.com/\" target=\"_blank\" rel=\"noopener\">Prenatal Aspirin Project\u003c/a>, an initiative at BMC created to increase implementation of the task force's recommendations. \"Things that people worry about — such as bleeding in pregnancy or something called placental abruption, which is early separation of the placenta — have not shown to be increased in women on low-dose aspirin.\"\u003c/p>\n\u003cp>Now, this is not like taking aspirin for pain relief — that's a much higher dose, usually 325 mg per pill, and one or two pills every four to six hours. In contrast, low-dose aspirin tablets are about 81 mg. They're usually cheap and can be prescribed — they're often covered by insurance — or bought over the counter.\u003c/p>\n\u003cp>Noel says for her, telling women about the benefits of prenatal aspirin is personal. African American women are \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/preeclampsia-screening1#clinical-considerations\" target=\"_blank\" rel=\"noopener\">more likely than white women\u003c/a> to develop preeclampsia, and they're more likely to die from it.\u003c/p>\n\u003cp>\"This topic is very important to me — as a black woman — but also as a black obstetrician-gynecologist in the service of women of color every day,\" she says. \"I've experienced what feels like one degree of separation between myself and women just like me that have died or almost died from preeclampsia,\" Noel says. \"So I really feel aspirin is not the only thing, but it is a step, and women should really feel empowered to speak with their providers about this.\"\u003c/p>\n\u003cp>\u003cstrong>Aspirin coming to a prenatal vitamin near you?\u003c/strong>\u003c/p>\n\u003cp>Any woman pregnant with twins or triplets, or who has diabetes or hypertension, or who has had preeclampsia before, is considered at \u003ca href=\"https://acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Low-Dose-Aspirin-Use-During-Pregnancy?IsMobileSet=false\">high risk\u003c/a> of the condition and should talk to her doctor about taking low-dose aspirin, Abbott says.\u003c/p>\n\u003cp>Beyond that group of \"high risk\" characteristics, there are the moderate risk factors — like being pregnant with a first baby, or being obese, or over 35, or African American. Having two or more of those characteristics means low-dose aspirin should be considered for you, too, the guidelines suggest.\u003c/p>\n\u003cp>Abbott says when you add up the women in all those categories, it equals a whole lot of people.\u003c/p>\n\u003cp>\"Eighty-six percent of our patients [at Boston Medical Center] would be eligible for aspirin based on those criteria,\" Abbott says. \"When you look at a number like 86% you can understand why I would be in favor — as a public health initiative — of all pregnant women getting it.\"\u003c/p>\n\u003cp>As Abbott sees it, screening for all those risk factors means someone who could benefit will inevitably get missed. And since she doesn't see significant downsides to low-dose aspirin, she thinks it should just go to everybody who's pregnant.\u003c/p>\n\u003cp>\"My suspicion — if I had to guess ahead 10 years — is that you'll be able to buy, included in your prenatal vitamin, low-dose aspirin,\" she says.\u003c/p>\n\u003cp>\u003cstrong>The need for research on the universal question\u003c/strong>\u003c/p>\n\u003cp>But not everyone is convinced — at least at this point — that every pregnant woman should take aspirin. Count \u003ca href=\"https://feinstein.northwell.edu/institutes-researchers/our-researchers/karina-davidson-phd\" target=\"_blank\" rel=\"noopener\">Karina Davidson\u003c/a> among them. She's the senior vice president for research at Northwell Health and a member of the U.S. Preventive Services Task Force panel that reviewed the evidence on this issue in 2014.\u003c/p>\n\u003cp>\"We know that aspirin prevents the devastating consequences of preeclampsia and of many of the hypertensive disorders of pregnancy for those who are at risk,\" she says. \"For those who are at risk, we absolutely want both clinicians and patients to know they should be discussing whether aspirin is right for them to help them minimize their exposure — and their infants' exposure — to those devastating consequences.\"\u003c/p>\n\u003cp>Still, that group's current \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/final-evidence-summary51/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication\" target=\"_blank\" rel=\"noopener\">recommendations\u003c/a> stop short of advising prenatal aspirin for all.\u003c/p>\n\u003cp>\"We have a very specific mandate, which is that we make recommendations based on evidence,\" Davidson says. \"When we looked in 2014 we found little evidence that existed that in average-risk populations there was benefit.\" In other words, there needs to be a benefit to taking aspirin for women currently considered at low risk of developing preeclampsia — not just the absence of significant harm.\u003c/p>\n\u003cp>In June, the task force began looking to see whether new research has been done since 2014 that would make the group want to change its prenatal aspirin guidance, but \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/draft-research-plan/aspirin-use-to-prevent-preeclampsia-and-related-morbidity-and-mortality-preventive-medication1\" target=\"_blank\" rel=\"noopener\">that review\u003c/a> won't be finished for several years.\u003c/p>\n\u003cp>\u003cstrong>Dr. Google, and other barriers\u003c/strong>\u003c/p>\n\u003cp>Boston Medical Center's Prenatal Aspirin Project began in 2017 with the goal of getting the word out about the benefits of low-dose aspirin in pregnancy for eligible women and researching the barriers to implementing the task force's recommendations.\u003c/p>\n\u003cp>Through focus groups, leaders of the project found most of their patients had never heard of preeclampsia. \"We also found that they had been told it's not safe to take medications in pregnancy or that aspirin can be dangerous and you shouldn't take it,\" Abbott says. \"[Or they would] go to the pharmacy and the pharmacist would tell them that aspirin was unsafe in pregnancy.\"\u003c/p>\n\u003cp>Abbott believes pharmacists may have not been aware of the prenatal aspirin recommendations from the past few years or may have been thinking of the guidance that \u003ca href=\"https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/headaches-during-pregnancy/faq-20058265\" target=\"_blank\" rel=\"noopener\">pregnant women take Tylenol\u003c/a> (rather than aspirin) for headaches.\u003c/p>\n\u003cp>The team at the Prenatal Aspirin Project ended up reaching out to big commercial pharmacies — CVS, Walgreens and Walmart — and got them to remove warnings on prenatal aspirin prescriptions. After having some patients tell them \"I got a prescription, but I'm going to Google it before I take it,\" members of the project team also worked to bump up their Google rankings so the project's advice would appear above information that might be outdated.\u003c/p>\n\u003cp>Eliminating these barriers is important, Abbott says. \"Everybody deserves a healthy baby and a healthy mother, and we're failing at that right now,\" she says. \"This is really an opportunity for all women — but especially for women of color — to be able to claim back some power over their ability to have healthy pregnancies and healthy children.\"\u003c/p>\n\u003cp>Of course, low-dose aspirin isn't the only answer to the country's high rate of maternal mortality. \"There are certainly other things to be addressed — structural barriers, structural racism involved in the disparities that exist,\" says Noel.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This tiny pill isn't going to fix all of that. However, Noel says, it has great potential to reduce the number of cases of preeclampsia, a condition that is killing a lot of women.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 NPR. To see more, visit \u003ca href=\"http://www.npr.org\" target=\"_blank\" rel=\"noopener\">www.npr.org\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+Daily+Baby+Aspirin+Could+Help+Many+Pregnancies+And+Save+Lives&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11775881/a-daily-baby-aspirin-could-help-many-pregnancies-and-save-lives","authors":["byline_news_11775881"],"categories":["news_457","news_8","news_356"],"tags":["news_1930","news_21771"],"featImg":"news_11775882","label":"source_news_11775881"},"news_11767839":{"type":"posts","id":"news_11767839","meta":{"index":"posts_1591205157","site":"news","id":"11767839","score":null,"sort":[1565908354000]},"guestAuthors":[],"slug":"pregnant-or-trying-heres-how-to-get-the-most-out-of-californias-new-paid-family-leave-law","title":"Pregnant or Trying? Here’s How to Get the Most out of California’s New Paid Family Leave Law","publishDate":1565908354,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{},"content":"\u003cp>California recently approved a \u003ca href=\"https://calmatters.org/economy/2019/01/newsom-paid-family-leave-proposal-analyzed/\">longer paid family leave\u003c/a>, allowing workers whose pregnancies fall on the right side of the new law to take up to eight weeks off with partial pay to bond with a new baby. How’s that going to work? We asked the experts and read the fine print to help you figure it out now, before you’re too sleep deprived to think straight.\u003c/p>\n\u003cp>The ovulation calendar, that part’s on you.\u003c/p>\n\u003ch3>I’m about to have or adopt a baby. Do I get the longer paid leave?\u003c/h3>\n\u003cp>Probably not. The new eight-week plan kicks in on July 1, 2020. If you file a claim to take paid family leave before that date, you will likely be put on the current plan that allows for six weeks of paid leave, according to Loree Levy, deputy director of the Employment Development Department. She said the rules are still being finalized, but that’s how she expects it will work.\u003c/p>\n\u003cp>Remember: Paid family leave is on top of the six weeks of\u003ca href=\"https://www.dfeh.ca.gov/resources/frequently-asked-questions/employment-faqs/pregnancy-disability-leave-faqs/\"> disability pay\u003c/a> that women can get after childbirth.\u003c/p>\n\u003ch3>Can I take six weeks of paid family leave now and get two more weeks after July 1, 2020?\u003c/h3>\n\u003cp>Probably not, Levy said. Again, the rules aren’t final but that’s her expectation based on how changes have been made in the past.\u003c/p>\n\u003ch3>Does my baby have to be born after July 1, 2020, for me to take eight weeks of paid leave?\u003c/h3>\n\u003cp>Probably not. Whether you get six or eight weeks of paid leave will likely depend on the \"effective date\" you enter on the paperwork you file with the state, not when your baby is born or adopted. Same caveat as above: The rules are still in the works.\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"family-leave\"]\u003c/p>\n\u003cp>A glimmer of good news for families expecting a baby in the spring: If your baby is born before July 1 and you can wait to start taking paid leave, you may be able to get eight weeks of paid leave by putting a July 1, 2020, effective date on your claim.\u003c/p>\n\u003ch3>I’m not pregnant but my partner is. Do I get eight weeks of paid leave too?\u003c/h3>\n\u003cp>Yes. Both parents can take up to eight weeks of paid family leave.\u003c/p>\n\u003ch4>How much will I get paid?\u003c/h4>\n\u003cp>About 60% to 70% of your normal wages, \u003ca href=\"https://www.edd.ca.gov/Disability/Calculating_PFL_Benefit_Payment_Amounts.htm\">depending on your income\u003c/a>. Gov. Gavin Newsom has put together a task force to study how to increase that to 90% for low-income workers, but it hasn’t yet come up with a plan.\u003c/p>\n\u003cp>Some employers may allow you to take vacation time or provide other benefits to get your paycheck up to 100%, said Sebastian Chilco, an employment attorney with Littler, a law firm in San Francisco. Though you can file for paid family leave through the state without telling your employer, he recommends letting your company know so you can find out what other benefits are available.\u003c/p>\n\u003cp>“It’s a lot easier to deal with things in advance,” Chilco said.\u003c/p>\n\u003ch3>How do I know if I qualify for paid family leave?\u003c/h3>\n\u003cp>You need to have paid into the State Disability Insurance fund in the last five to 18 months. In general, this is a program for private sector workers, though some government employees also participate. Check your pay stub for payments to “CASDI” and \u003ca href=\"https://www.edd.ca.gov/Disability/Am_I_Eligible_for_PFL_Benefits.htm\" target=\"_blank\" rel=\"noopener\">click here\u003c/a> for more details.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/c01df46d-aa66-4d56-bc4b-5041f4eac695?src=embed\" title=\"paid family leave\" width=\"800\" height=\"850\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003ch3>Does my employer have to let me take the longer leave if I want it?\u003c/h3>\n\u003cp>Only in certain circumstances. If you have worked at your company for at least 26 hours a week over the last year \u003cem>and\u003c/em> your worksite has at least 20 employees, your employer has to hold your job for you while you take baby-bonding leave.\u003c/p>\n\u003cp>But smaller companies are not required to hold your job for you. That means about 25% of California workers are paying into the leave system but could be fired if they take it, said Jenna Gerry, an attorney at Legal Aid at Work.\u003c/p>\n\u003cp>Her group supported \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB135\" target=\"_blank\" rel=\"noopener\">a bill\u003c/a> this year that would have aligned the rules \"so if you qualify for paid family leave you also qualify for the right to take time off and return to your job after your leave,\" Gerry said. The bill stalled, but advocates plan to try again next year.\u003c/p>\n\u003ch3>I thought Gov. Newsom proposed six months of paid leave for new parents. Why are you talking about eight weeks?\u003c/h3>\n\u003cp>It’s true that Newsom proposed six months of paid leave, saying in January that \"there is no substitute for parents spending time with their children.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But his idea is that each baby in California will be \u003ca href=\"https://calmatters.org/economy/2019/01/newsom-paid-family-leave-proposal-analyzed/\">cared for by a parent or close family member for six months\u003c/a>, not that each worker will get six months of paid leave. Newsom’s plan envisions two family members each taking two to four months off to care for their baby. So for two-parent families, the new eight-week paid leave gets pretty close to that goal. If one parent is the birth mother who also takes six weeks of pregnancy disability pay, the family would get 22 weeks of paid time off, or about five and a half months.\u003c/p>\n\u003cp>Newsom’s task force is studying how California could structure a paid leave plan that would allow six months of family care for every baby. It’s expected to make recommendations in November.\u003c/p>\n\u003ch3>Who’s paying for all this?\u003c/h3>\n\u003cp>You are, if you’re among the 95% of California workers who pay into the State Disability Insurance fund through a 1% tax on your paycheck. The state is lowering the amount of money held in the fund’s reserves to cover the cost of the additional two weeks of leave.\u003c/p>\n\u003ch3>Paid leave isn’t just for parents, though — right?\u003c/h3>\n\u003cp>Right. You can take six weeks of paid family leave to care for a seriously ill child, parent, parent-in-law, grandparent, grandchild, sibling, spouse or registered domestic partner. And that increases to eight weeks on July 1, 2020. But the job protection rules are a little different than they are for people taking leave to bond with a baby.\u003c/p>\n\u003cp>\u003ca href=\"http://calmatters.org/\">CalMatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"Gov. Gavin Newsom just expanded California's paid family leave law. Will you and your baby make the most of it?\r\n","status":"publish","parent":0,"modified":1565967116,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":1085},"headData":{"title":"Pregnant or Trying? Here’s How to Get the Most out of California’s New Paid Family Leave Law | KQED","description":"Gov. Gavin Newsom just expanded California's paid family leave law. Will you and your baby make the most of it?\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"NewsArticle","headline":"Pregnant or Trying? Here’s How to Get the Most out of California’s New Paid Family Leave Law","datePublished":"2019-08-15T22:32:34.000Z","dateModified":"2019-08-16T14:51:56.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png","isAccessibleForFree":"Y","publisher":{"@type":"NewsMediaOrganization","@id":"https://www.kqed.org/#organization","name":"KQED","url":"https://www.kqed.org","logo":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}}},"disqusIdentifier":"11767839 https://ww2.kqed.org/news/?p=11767839","disqusUrl":"https://ww2.kqed.org/news/2019/08/15/pregnant-or-trying-heres-how-to-get-the-most-out-of-californias-new-paid-family-leave-law/","disqusTitle":"Pregnant or Trying? Here’s How to Get the Most out of California’s New Paid Family Leave Law","source":"CalMatters","sourceUrl":"https://calmatters.org/","nprByline":"\u003ca href=\"https://calmatters.org/author/laurel-rosenhall/\">Lauren Rosenhall\u003c/a>\u003cbr>CalMatters","path":"/news/11767839/pregnant-or-trying-heres-how-to-get-the-most-out-of-californias-new-paid-family-leave-law","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>California recently approved a \u003ca href=\"https://calmatters.org/economy/2019/01/newsom-paid-family-leave-proposal-analyzed/\">longer paid family leave\u003c/a>, allowing workers whose pregnancies fall on the right side of the new law to take up to eight weeks off with partial pay to bond with a new baby. How’s that going to work? We asked the experts and read the fine print to help you figure it out now, before you’re too sleep deprived to think straight.\u003c/p>\n\u003cp>The ovulation calendar, that part’s on you.\u003c/p>\n\u003ch3>I’m about to have or adopt a baby. Do I get the longer paid leave?\u003c/h3>\n\u003cp>Probably not. The new eight-week plan kicks in on July 1, 2020. If you file a claim to take paid family leave before that date, you will likely be put on the current plan that allows for six weeks of paid leave, according to Loree Levy, deputy director of the Employment Development Department. She said the rules are still being finalized, but that’s how she expects it will work.\u003c/p>\n\u003cp>Remember: Paid family leave is on top of the six weeks of\u003ca href=\"https://www.dfeh.ca.gov/resources/frequently-asked-questions/employment-faqs/pregnancy-disability-leave-faqs/\"> disability pay\u003c/a> that women can get after childbirth.\u003c/p>\n\u003ch3>Can I take six weeks of paid family leave now and get two more weeks after July 1, 2020?\u003c/h3>\n\u003cp>Probably not, Levy said. Again, the rules aren’t final but that’s her expectation based on how changes have been made in the past.\u003c/p>\n\u003ch3>Does my baby have to be born after July 1, 2020, for me to take eight weeks of paid leave?\u003c/h3>\n\u003cp>Probably not. Whether you get six or eight weeks of paid leave will likely depend on the \"effective date\" you enter on the paperwork you file with the state, not when your baby is born or adopted. Same caveat as above: The rules are still in the works.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"related coverage ","tag":"family-leave"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A glimmer of good news for families expecting a baby in the spring: If your baby is born before July 1 and you can wait to start taking paid leave, you may be able to get eight weeks of paid leave by putting a July 1, 2020, effective date on your claim.\u003c/p>\n\u003ch3>I’m not pregnant but my partner is. Do I get eight weeks of paid leave too?\u003c/h3>\n\u003cp>Yes. Both parents can take up to eight weeks of paid family leave.\u003c/p>\n\u003ch4>How much will I get paid?\u003c/h4>\n\u003cp>About 60% to 70% of your normal wages, \u003ca href=\"https://www.edd.ca.gov/Disability/Calculating_PFL_Benefit_Payment_Amounts.htm\">depending on your income\u003c/a>. Gov. Gavin Newsom has put together a task force to study how to increase that to 90% for low-income workers, but it hasn’t yet come up with a plan.\u003c/p>\n\u003cp>Some employers may allow you to take vacation time or provide other benefits to get your paycheck up to 100%, said Sebastian Chilco, an employment attorney with Littler, a law firm in San Francisco. Though you can file for paid family leave through the state without telling your employer, he recommends letting your company know so you can find out what other benefits are available.\u003c/p>\n\u003cp>“It’s a lot easier to deal with things in advance,” Chilco said.\u003c/p>\n\u003ch3>How do I know if I qualify for paid family leave?\u003c/h3>\n\u003cp>You need to have paid into the State Disability Insurance fund in the last five to 18 months. In general, this is a program for private sector workers, though some government employees also participate. Check your pay stub for payments to “CASDI” and \u003ca href=\"https://www.edd.ca.gov/Disability/Am_I_Eligible_for_PFL_Benefits.htm\" target=\"_blank\" rel=\"noopener\">click here\u003c/a> for more details.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/c01df46d-aa66-4d56-bc4b-5041f4eac695?src=embed\" title=\"paid family leave\" width=\"800\" height=\"850\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003ch3>Does my employer have to let me take the longer leave if I want it?\u003c/h3>\n\u003cp>Only in certain circumstances. If you have worked at your company for at least 26 hours a week over the last year \u003cem>and\u003c/em> your worksite has at least 20 employees, your employer has to hold your job for you while you take baby-bonding leave.\u003c/p>\n\u003cp>But smaller companies are not required to hold your job for you. That means about 25% of California workers are paying into the leave system but could be fired if they take it, said Jenna Gerry, an attorney at Legal Aid at Work.\u003c/p>\n\u003cp>Her group supported \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB135\" target=\"_blank\" rel=\"noopener\">a bill\u003c/a> this year that would have aligned the rules \"so if you qualify for paid family leave you also qualify for the right to take time off and return to your job after your leave,\" Gerry said. The bill stalled, but advocates plan to try again next year.\u003c/p>\n\u003ch3>I thought Gov. Newsom proposed six months of paid leave for new parents. Why are you talking about eight weeks?\u003c/h3>\n\u003cp>It’s true that Newsom proposed six months of paid leave, saying in January that \"there is no substitute for parents spending time with their children.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But his idea is that each baby in California will be \u003ca href=\"https://calmatters.org/economy/2019/01/newsom-paid-family-leave-proposal-analyzed/\">cared for by a parent or close family member for six months\u003c/a>, not that each worker will get six months of paid leave. Newsom’s plan envisions two family members each taking two to four months off to care for their baby. So for two-parent families, the new eight-week paid leave gets pretty close to that goal. If one parent is the birth mother who also takes six weeks of pregnancy disability pay, the family would get 22 weeks of paid time off, or about five and a half months.\u003c/p>\n\u003cp>Newsom’s task force is studying how California could structure a paid leave plan that would allow six months of family care for every baby. It’s expected to make recommendations in November.\u003c/p>\n\u003ch3>Who’s paying for all this?\u003c/h3>\n\u003cp>You are, if you’re among the 95% of California workers who pay into the State Disability Insurance fund through a 1% tax on your paycheck. The state is lowering the amount of money held in the fund’s reserves to cover the cost of the additional two weeks of leave.\u003c/p>\n\u003ch3>Paid leave isn’t just for parents, though — right?\u003c/h3>\n\u003cp>Right. You can take six weeks of paid family leave to care for a seriously ill child, parent, parent-in-law, grandparent, grandchild, sibling, spouse or registered domestic partner. And that increases to eight weeks on July 1, 2020. But the job protection rules are a little different than they are for people taking leave to bond with a baby.\u003c/p>\n\u003cp>\u003ca href=\"http://calmatters.org/\">CalMatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11767839/pregnant-or-trying-heres-how-to-get-the-most-out-of-californias-new-paid-family-leave-law","authors":["byline_news_11767839"],"programs":["news_72"],"categories":["news_457","news_8"],"tags":["news_26428","news_18919","news_19542","news_25405","news_21771","news_17041"],"featImg":"news_11767857","label":"source_news_11767839"},"news_11760903":{"type":"posts","id":"news_11760903","meta":{"index":"posts_1591205157","site":"news","id":"11760903","score":null,"sort":[1563037209000]},"guestAuthors":[],"slug":"a-black-mother-told-not-to-scream-in-labor-asks-can-california-fix-racism-in-maternity-care","title":"A Black Mother Told Not to Scream in Labor Asks: Can California Fix Racism in Maternity Care?","publishDate":1563037209,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{},"content":"\u003cp>Bettye Jean Ford was in her second trimester when the pressure she had been feeling in her abdomen for weeks turned to excruciating pain. She rushed to a Los Angeles emergency room, where she was diagnosed with a urinary tract infection and sent home with antibiotics. Still cramping severely, the first-time expectant mother spent the next 24 hours trying to sleep.\u003c/p>\n\u003cp>The next morning, her obstetrician found her dilated and sent her to the hospital next door where an ultrasound confirmed she was in labor. Rather than being admitted, she was sent back to the clinic with paperwork to finish.\u003c/p>\n\u003cp>Finally, at 23 weeks and six days, Ford gave birth to a premature baby girl while a nurse told her to close her mouth so as not to scream while pushing. After delivery, the new mother was sedated; her child, whom she had named Kally, had died by the time she awoke.\u003c/p>\n\u003cp>That was 2006. Since then, California has worked hard to improve health care for pregnant women—so hard, in fact, that the state is now often held up as a national success story in improving maternal outcomes.\u003c/p>\n\u003cp>But for African American mothers, that improvement has remained elusive. \u003ca href=\"https://www.youtube.com/watch?v=FSjHIr1Z7kc&feature=youtu.be\">Statewide\u003c/a> as well as \u003ca href=\"https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm?s_cid=mm6818e1_w\">nationally\u003c/a>, black women are substantially more likely than white women to suffer life-threatening complications during pregnancy, give birth prematurely, die in childbirth and lose their babies.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/8e172bc0-8640-4937-9869-c974fddc198a?src=embed\" title=\"Maternal Morbidity\" width=\"800\" height=\"752\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003cbr>\n Mortality rates among black infants in California are triple those of white infants, according to state birth records. California Department of Public Health statistics show the rate of preterm births among black mothers to be nearly twice that of white mothers, and the rate of maternal mortality to be quadruple, in part because of complications from underestimated or undiagnosed cardiovascular conditions.\u003c/p>\n\u003cp>A host of factors underlie this health gap, but studies consistently point to an ugly one: the persistence of racial bias in perinatal care \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847630/\">for women of color\u003c/a>.\u003c/p>\n\u003cp>[aside tag='childbirth' label='Maternity in California']Even when studies control for socioeconomic differences, the health care experience for black mothers is particularly—and often lethally—inadequate compared to that of other ethnic groups, not to mention traumatizing.\u003c/p>\n\u003cp>“Giving birth was horrible,” said Ford. “It was just an awful experience emotionally, physically.”\u003c/p>\n\u003cp>Democratic state Sen. Holly Mitchell—who represents Los Angeles, where Ford still lives—is carrying \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201920200SB464\">legislation\u003c/a> that would make California the first state to mandate implicit bias training for obstetricians, delivery nurses and other perinatal health care providers at hospitals and birthing centers. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB464\">Senate Bill 464\u003c/a> would require that providers be taught to spot bias, to communicate across identities and be educated on how racial bias impacts maternal and infant health.\u003c/p>\n\u003cp>Mitchell’s bill, called the Dignity in Pregnancy and Childbirth Act, would also require maternal deaths to be registered more consistently on death certificates by requiring coroners to list whether a woman was pregnant at the time of her death or in the year preceding.\u003c/p>\n\u003cp>Advocacy groups including \u003ca href=\"https://www.bwwla.org/aboutus/\">Black Women for Wellness\u003c/a> and\u003ca href=\"https://wclp.org/about-us/\"> The Western Center on Law and Poverty\u003c/a>, an anti-poverty organization, sponsored the bill after noticing how racial discrimination persists in medicine regardless of a patient’s ability to pay. The issue has also drawn national attention.\u003c/p>\n\u003cfigure id=\"attachment_11760930\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11760930\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Bettye Jean Ford holds the tiny urn containing the ashes of her first child Kally. Complications Ford says she wasn't warned of resulted in a birth so premature that the child died within hours. \u003ccite>(Iris Schneider/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Tennis star \u003ca href=\"https://www.cnn.com/2018/02/20/opinions/protect-mother-pregnancy-williams-opinion/index.html\">Serena Williams\u003c/a> underscored the dangers facing pregnant black women in sharing her labor and delivery experience. Singer Beyoncé echoed her concerns. And in Congress, California Sen. Kamala Harris, a presidential contender, has proposed the \u003ca href=\"https://www.harris.senate.gov/imo/media/doc/ERN18510.pdf\">Maternal Care Access and Reducing Emergencies (CARE) Act\u003c/a>, which would provide $125 million to train for the detection of high-risk pregnancies.\u003c/p>\n\u003cp>Nourbese Flint, policy director at Black Women for Wellness, said supporters of SB 464 drew inspiration in part from Harris’ legislation. Just as civil rights advocates have initiated tough conversations about race in the classroom or in the criminal justice system, she said, moms and nurses believe it’s time to have “the talk” about the doctor’s office.\u003c/p>\n\u003cp>“Delivering a baby is probably a moment in time when you feel the most vulnerable,” Mitchell said. “And to have to layer on top concerns about whether or not your health care provider sees you, hears you, listens to you—is an unfair burden black women are bearing.”\u003c/p>\n\u003cp>Though the bill has influential supporters, including nurses and MomsRising, a multicultural organization with more than 1 million members, physicians say the bill is too abstract and unwieldy to implement.\u003c/p>\n\u003cp>“It’s not a question of whether this training is needed, just how best to do it,” said Anthony York, spokesman for the influential California Medical Association.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/b5579ce1-479e-4be4-b5d1-f4570b28592c?src=embed\" title=\"Physicians by race\" width=\"800\" height=\"817\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003cbr>\n Doctors don’t dispute there’s discrimination. A \u003ca href=\"https://www.pnas.org/content/113/16/4296\">2016 University of Virginia\u003c/a> study found biological myths about black patients still persist among white medical students, such as the notions that African Americans have less sensitive nerve endings, can tolerate more pain and have thicker skin. In other \u003ca href=\"https://www.medscape.com/features/slideshow/lifestyle/2017/womens-health#page=11\">surveys\u003c/a>, one in seven ob/gyns said that a patient’s race impacted treatment.\u003c/p>\n\u003cp>But while the California Hospital Association supported the bill after requesting technical changes, doctors have called Mitchell’s bill unenforceable since \u003ca href=\"https://calmatters.org/economy/2019/06/california-dynamex-gig-worker-classification-independent-contractors-uber-lyft-strippers-truckers-freelancers/\">physicians are not employees\u003c/a>.\u003c/p>\n\u003cp>Researchers agree that a physicans’ employment status is an obstacle.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation='Monica McLemore, reproductive health researcher at UCSF']'I think we’ve done a real disservice where you have a health care workforce that does not live, work, play, pray, thrive in the same communities where they actually provide care.'[/pullquote] Doctors throughout the state contract with hospitals so they don’t receive the same oversight or accountability as an employee would, and they cannot be disciplined or rewarded for biased care, said Monica McLemore, a reproductive health researcher at University of California, San Francisco, who has focused on \u003ca href=\"https://reproductive-health-journal.biomedcentral.com/track/pdf/10.1186/s12978-019-0729-2\">inequality and mistreatment during pregnancy and childbirth\u003c/a>.\u003c/p>\n\u003cp>“The same institutions and mechanisms that we use for accountability within organizations don’t exist for contract individuals,” she said. “There’s no established mechanisms to be able to enforce whether or not individuals actually deal with their own bias.”\u003c/p>\n\u003cp>McLemore said that, despite the legislation’s good intentions, it’s naive to believe systemic change will occur by leaving the implementation of implicit bias training up to health care facilities. A better solution, she said, would be more diversity in the health care workforce, with a push similar to campaigns for more \u003ca href=\"https://hechingerreport.org/whats-wrong-white-teachers/\">teachers who reflect the students in their classrooms.\u003c/a>\u003c/p>\n\u003cp>[ad fullwidth]\u003cbr>\nA 2018 \u003ca href=\"https://www.chcf.org/wp-content/uploads/2018/06/CAPhysicianSupply2018.pdf\">report\u003c/a> by the California Health Care Foundation found that Latinos and African Americans are profoundly underrepresented in the state’s physician workforce. Latinos, for instance, make up 38% of California’s population but only 5% of the state’s active physicians. African Americans make up 3% of the physician workforce, compared to 6% of the state population. And while the proportion of white doctors largely mirrors the rest of the state, Asians are overly represented in the field, with twice their share of the population.\u003c/p>\n\u003cp>“I think we’ve done a real disservice where you have a health care workforce that does not live, work, play, pray, thrive in the same communities where they actually provide care,” McLemore said.\u003c/p>\n\u003cp>And without buy-in from doctors, advocates say, California will continue to have a tough time making experiences like Ford’s a thing of the past for women of all races.\u003c/p>\n\u003cfigure id=\"attachment_11760958\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11760958\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Bettye Jean Ford at home with her 11-year-old daughter, Skylar, June 21, 2019. Skylar was born a year and a day after the due date of Ford’s first child. \u003ccite>(Iris Schneider/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Since the\u003ca href=\"https://www.cmqcc.org/who-we-are\"> California Maternal Quality of Care Collaborative\u003c/a> was adopted in 2006 to improve health outcomes for mothers and infants in California, the overall maternal mortality rate in the state has declined 55%—far better than most of the U.S. In 2017, the national maternal mortality rate was 21.6 deaths per 100,000 live births compared to 8.7 deaths per 100,000 live births in California.\u003c/p>\n\u003cp>Women of color, however, continue to face worse outcomes.\u003c/p>\n\u003cp>“While we have been somewhat successful, we can’t really be jumping for joy yet,” said Holly Smith of the California Nurse-Midwives Association, which supports mandating racial bias training.\u003c/p>\n\u003cp>During Ford’s preterm delivery, for example, she was unaware that black women are \u003ca href=\"http://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html\">three times more likely\u003c/a> than white women to have fibroids, which can have a harmful impact on \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874080/\">fertility and pregnancy\u003c/a>. Ford said her doctor never warned her that the ones resting on her uterus could complicate her own childbirth.\u003c/p>\n\u003cp>[aside tag='women-of-color' label='More on women of color']\u003c/p>\n\u003cp>When Ford did get pregnant again, she took extra precautions fearing she would have to relive her trauma. It wasn’t until she was 27 weeks along that she and her husband felt comfortable enough to bring the crib intended for her first daughter back into their home.\u003c/p>\n\u003cp>A year and one day after Kally’s due date, Ford gave birth to her daughter Skylar, who is now 11.\u003c/p>\n\u003cp>“I really appreciate every day with my daughter,” says the therapist, who sought help to cope with her own grief and anger. “But I have a niece and a goddaughter who were born right around the time that Kally was born. So watching the three of these girls grow up, I always have this feeling of like there should be one more.”\u003c/p>\n\u003cp>Her first born, she said, is never far from memory. Her remains rest in a tiny urn at Ford’s home.\u003c/p>\n\u003cp>\u003ca href=\"http://calmatters.org/\">\u003cem>CALmatters.org\u003c/em>\u003c/a>\u003cem> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"A host of factors underlie the maternal health gap between black and white women, but studies consistently point to an ugly one: the persistence of racial bias.","status":"publish","parent":0,"modified":1563227376,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":37,"wordCount":1707},"headData":{"title":"A Black Mother Told Not to Scream in Labor Asks: Can California Fix Racism in Maternity Care? | KQED","description":"A host of factors underlie the maternal health gap between black and white women, but studies consistently point to an ugly one: the persistence of racial bias.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"NewsArticle","headline":"A Black Mother Told Not to Scream in Labor Asks: Can California Fix Racism in Maternity Care?","datePublished":"2019-07-13T17:00:09.000Z","dateModified":"2019-07-15T21:49:36.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png","isAccessibleForFree":"Y","publisher":{"@type":"NewsMediaOrganization","@id":"https://www.kqed.org/#organization","name":"KQED","url":"https://www.kqed.org","logo":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}}},"disqusIdentifier":"11760903 https://ww2.kqed.org/news/?p=11760903","disqusUrl":"https://ww2.kqed.org/news/2019/07/13/a-black-mother-told-not-to-scream-in-labor-asks-can-california-fix-racism-in-maternity-care/","disqusTitle":"A Black Mother Told Not to Scream in Labor Asks: Can California Fix Racism in Maternity Care?","source":"CALmatters","sourceUrl":"https://calmatters.org/","nprByline":"Adria Watson \u003cbr>CALmatters","path":"/news/11760903/a-black-mother-told-not-to-scream-in-labor-asks-can-california-fix-racism-in-maternity-care","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Bettye Jean Ford was in her second trimester when the pressure she had been feeling in her abdomen for weeks turned to excruciating pain. She rushed to a Los Angeles emergency room, where she was diagnosed with a urinary tract infection and sent home with antibiotics. Still cramping severely, the first-time expectant mother spent the next 24 hours trying to sleep.\u003c/p>\n\u003cp>The next morning, her obstetrician found her dilated and sent her to the hospital next door where an ultrasound confirmed she was in labor. Rather than being admitted, she was sent back to the clinic with paperwork to finish.\u003c/p>\n\u003cp>Finally, at 23 weeks and six days, Ford gave birth to a premature baby girl while a nurse told her to close her mouth so as not to scream while pushing. After delivery, the new mother was sedated; her child, whom she had named Kally, had died by the time she awoke.\u003c/p>\n\u003cp>That was 2006. Since then, California has worked hard to improve health care for pregnant women—so hard, in fact, that the state is now often held up as a national success story in improving maternal outcomes.\u003c/p>\n\u003cp>But for African American mothers, that improvement has remained elusive. \u003ca href=\"https://www.youtube.com/watch?v=FSjHIr1Z7kc&feature=youtu.be\">Statewide\u003c/a> as well as \u003ca href=\"https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm?s_cid=mm6818e1_w\">nationally\u003c/a>, black women are substantially more likely than white women to suffer life-threatening complications during pregnancy, give birth prematurely, die in childbirth and lose their babies.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/8e172bc0-8640-4937-9869-c974fddc198a?src=embed\" title=\"Maternal Morbidity\" width=\"800\" height=\"752\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003cbr>\n Mortality rates among black infants in California are triple those of white infants, according to state birth records. California Department of Public Health statistics show the rate of preterm births among black mothers to be nearly twice that of white mothers, and the rate of maternal mortality to be quadruple, in part because of complications from underestimated or undiagnosed cardiovascular conditions.\u003c/p>\n\u003cp>A host of factors underlie this health gap, but studies consistently point to an ugly one: the persistence of racial bias in perinatal care \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847630/\">for women of color\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"tag":"childbirth","label":"Maternity in California "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Even when studies control for socioeconomic differences, the health care experience for black mothers is particularly—and often lethally—inadequate compared to that of other ethnic groups, not to mention traumatizing.\u003c/p>\n\u003cp>“Giving birth was horrible,” said Ford. “It was just an awful experience emotionally, physically.”\u003c/p>\n\u003cp>Democratic state Sen. Holly Mitchell—who represents Los Angeles, where Ford still lives—is carrying \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201920200SB464\">legislation\u003c/a> that would make California the first state to mandate implicit bias training for obstetricians, delivery nurses and other perinatal health care providers at hospitals and birthing centers. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB464\">Senate Bill 464\u003c/a> would require that providers be taught to spot bias, to communicate across identities and be educated on how racial bias impacts maternal and infant health.\u003c/p>\n\u003cp>Mitchell’s bill, called the Dignity in Pregnancy and Childbirth Act, would also require maternal deaths to be registered more consistently on death certificates by requiring coroners to list whether a woman was pregnant at the time of her death or in the year preceding.\u003c/p>\n\u003cp>Advocacy groups including \u003ca href=\"https://www.bwwla.org/aboutus/\">Black Women for Wellness\u003c/a> and\u003ca href=\"https://wclp.org/about-us/\"> The Western Center on Law and Poverty\u003c/a>, an anti-poverty organization, sponsored the bill after noticing how racial discrimination persists in medicine regardless of a patient’s ability to pay. The issue has also drawn national attention.\u003c/p>\n\u003cfigure id=\"attachment_11760930\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11760930\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Bettye Jean Ford holds the tiny urn containing the ashes of her first child Kally. Complications Ford says she wasn't warned of resulted in a birth so premature that the child died within hours. \u003ccite>(Iris Schneider/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Tennis star \u003ca href=\"https://www.cnn.com/2018/02/20/opinions/protect-mother-pregnancy-williams-opinion/index.html\">Serena Williams\u003c/a> underscored the dangers facing pregnant black women in sharing her labor and delivery experience. Singer Beyoncé echoed her concerns. And in Congress, California Sen. Kamala Harris, a presidential contender, has proposed the \u003ca href=\"https://www.harris.senate.gov/imo/media/doc/ERN18510.pdf\">Maternal Care Access and Reducing Emergencies (CARE) Act\u003c/a>, which would provide $125 million to train for the detection of high-risk pregnancies.\u003c/p>\n\u003cp>Nourbese Flint, policy director at Black Women for Wellness, said supporters of SB 464 drew inspiration in part from Harris’ legislation. Just as civil rights advocates have initiated tough conversations about race in the classroom or in the criminal justice system, she said, moms and nurses believe it’s time to have “the talk” about the doctor’s office.\u003c/p>\n\u003cp>“Delivering a baby is probably a moment in time when you feel the most vulnerable,” Mitchell said. “And to have to layer on top concerns about whether or not your health care provider sees you, hears you, listens to you—is an unfair burden black women are bearing.”\u003c/p>\n\u003cp>Though the bill has influential supporters, including nurses and MomsRising, a multicultural organization with more than 1 million members, physicians say the bill is too abstract and unwieldy to implement.\u003c/p>\n\u003cp>“It’s not a question of whether this training is needed, just how best to do it,” said Anthony York, spokesman for the influential California Medical Association.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/b5579ce1-479e-4be4-b5d1-f4570b28592c?src=embed\" title=\"Physicians by race\" width=\"800\" height=\"817\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003cbr>\n Doctors don’t dispute there’s discrimination. A \u003ca href=\"https://www.pnas.org/content/113/16/4296\">2016 University of Virginia\u003c/a> study found biological myths about black patients still persist among white medical students, such as the notions that African Americans have less sensitive nerve endings, can tolerate more pain and have thicker skin. In other \u003ca href=\"https://www.medscape.com/features/slideshow/lifestyle/2017/womens-health#page=11\">surveys\u003c/a>, one in seven ob/gyns said that a patient’s race impacted treatment.\u003c/p>\n\u003cp>But while the California Hospital Association supported the bill after requesting technical changes, doctors have called Mitchell’s bill unenforceable since \u003ca href=\"https://calmatters.org/economy/2019/06/california-dynamex-gig-worker-classification-independent-contractors-uber-lyft-strippers-truckers-freelancers/\">physicians are not employees\u003c/a>.\u003c/p>\n\u003cp>Researchers agree that a physicans’ employment status is an obstacle.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'I think we’ve done a real disservice where you have a health care workforce that does not live, work, play, pray, thrive in the same communities where they actually provide care.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Monica McLemore, reproductive health researcher at UCSF","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp> Doctors throughout the state contract with hospitals so they don’t receive the same oversight or accountability as an employee would, and they cannot be disciplined or rewarded for biased care, said Monica McLemore, a reproductive health researcher at University of California, San Francisco, who has focused on \u003ca href=\"https://reproductive-health-journal.biomedcentral.com/track/pdf/10.1186/s12978-019-0729-2\">inequality and mistreatment during pregnancy and childbirth\u003c/a>.\u003c/p>\n\u003cp>“The same institutions and mechanisms that we use for accountability within organizations don’t exist for contract individuals,” she said. “There’s no established mechanisms to be able to enforce whether or not individuals actually deal with their own bias.”\u003c/p>\n\u003cp>McLemore said that, despite the legislation’s good intentions, it’s naive to believe systemic change will occur by leaving the implementation of implicit bias training up to health care facilities. A better solution, she said, would be more diversity in the health care workforce, with a push similar to campaigns for more \u003ca href=\"https://hechingerreport.org/whats-wrong-white-teachers/\">teachers who reflect the students in their classrooms.\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cbr>\nA 2018 \u003ca href=\"https://www.chcf.org/wp-content/uploads/2018/06/CAPhysicianSupply2018.pdf\">report\u003c/a> by the California Health Care Foundation found that Latinos and African Americans are profoundly underrepresented in the state’s physician workforce. Latinos, for instance, make up 38% of California’s population but only 5% of the state’s active physicians. African Americans make up 3% of the physician workforce, compared to 6% of the state population. And while the proportion of white doctors largely mirrors the rest of the state, Asians are overly represented in the field, with twice their share of the population.\u003c/p>\n\u003cp>“I think we’ve done a real disservice where you have a health care workforce that does not live, work, play, pray, thrive in the same communities where they actually provide care,” McLemore said.\u003c/p>\n\u003cp>And without buy-in from doctors, advocates say, California will continue to have a tough time making experiences like Ford’s a thing of the past for women of all races.\u003c/p>\n\u003cfigure id=\"attachment_11760958\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11760958\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Bettye Jean Ford at home with her 11-year-old daughter, Skylar, June 21, 2019. Skylar was born a year and a day after the due date of Ford’s first child. \u003ccite>(Iris Schneider/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Since the\u003ca href=\"https://www.cmqcc.org/who-we-are\"> California Maternal Quality of Care Collaborative\u003c/a> was adopted in 2006 to improve health outcomes for mothers and infants in California, the overall maternal mortality rate in the state has declined 55%—far better than most of the U.S. In 2017, the national maternal mortality rate was 21.6 deaths per 100,000 live births compared to 8.7 deaths per 100,000 live births in California.\u003c/p>\n\u003cp>Women of color, however, continue to face worse outcomes.\u003c/p>\n\u003cp>“While we have been somewhat successful, we can’t really be jumping for joy yet,” said Holly Smith of the California Nurse-Midwives Association, which supports mandating racial bias training.\u003c/p>\n\u003cp>During Ford’s preterm delivery, for example, she was unaware that black women are \u003ca href=\"http://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html\">three times more likely\u003c/a> than white women to have fibroids, which can have a harmful impact on \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874080/\">fertility and pregnancy\u003c/a>. Ford said her doctor never warned her that the ones resting on her uterus could complicate her own childbirth.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"tag":"women-of-color","label":"More on women of color "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When Ford did get pregnant again, she took extra precautions fearing she would have to relive her trauma. It wasn’t until she was 27 weeks along that she and her husband felt comfortable enough to bring the crib intended for her first daughter back into their home.\u003c/p>\n\u003cp>A year and one day after Kally’s due date, Ford gave birth to her daughter Skylar, who is now 11.\u003c/p>\n\u003cp>“I really appreciate every day with my daughter,” says the therapist, who sought help to cope with her own grief and anger. “But I have a niece and a goddaughter who were born right around the time that Kally was born. So watching the three of these girls grow up, I always have this feeling of like there should be one more.”\u003c/p>\n\u003cp>Her first born, she said, is never far from memory. Her remains rest in a tiny urn at Ford’s home.\u003c/p>\n\u003cp>\u003ca href=\"http://calmatters.org/\">\u003cem>CALmatters.org\u003c/em>\u003c/a>\u003cem> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11760903/a-black-mother-told-not-to-scream-in-labor-asks-can-california-fix-racism-in-maternity-care","authors":["byline_news_11760903"],"programs":["news_72"],"categories":["news_457","news_8"],"tags":["news_24968","news_23820","news_4","news_21771","news_19216","news_24233"],"affiliates":["news_18481"],"featImg":"news_11760948","label":"source_news_11760903"},"news_11700111":{"type":"posts","id":"news_11700111","meta":{"index":"posts_1591205157","site":"news","id":"11700111","score":null,"sort":[1540278313000]},"guestAuthors":[],"slug":"women-recovering-from-opioid-addiction-wary-of-painkillers-during-childbirth","title":"Some Women Recovering From Opioid Addiction Wary of Painkillers During Childbirth","publishDate":1540278313,"format":"audio","headTitle":"The California Report | KQED News","labelTerm":{"term":72,"site":"news"},"content":"\u003cp>When she was in her early 20s, Nicole Veum says she made a lot of mistakes.\u003c/p>\n\u003cp>“I was really sad and I didn’t want to feel my feelings,” she said. “I turned to the most natural way I could find to cover that all up, and I started using drugs: prescription pills, heroin for a little bit of time.”\u003c/p>\n\u003cp>Her family got her into treatment. She’d been sober for nine years when she and her husband decided to have a baby. This was something she wanted to feel.\u003c/p>\n\u003cp>She told her doctor if she needed an epidural, she didn’t want any fentanyl in it. She didn’t want to feel high.\u003c/p>\n\u003cp>“'Cause I remembered seeing other friends, they’d used it, and they were feeling good and stuff,” she said. “I didn’t want that to be a part of my story.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Epidurals are usually a mix of two types of medications: a numbing agent, usually from the lidocaine family, and a painkiller, usually fentanyl. The amount of fentanyl is limited, and little passes into the bloodstream, experts say, but if a woman doesn’t want the fentanyl, it’s easy to formulate an epidural solution without it. Doctors either use a substitute medication or up the concentration of the numbing agent.\u003c/p>\n\u003cp>“There’s no medical reason why someone should be forced to be exposed to opioids if they don’t want to,” said Kelly Pfeifer, a family doctor and addiction expert who now works as director of high-value care at the California Health Care Foundation.\u003c/p>\n\u003cp>Especially for women who are in active treatment for opioid addiction and taking methadone or Suboxone, Pfeifer said there’s another issue to be wary of: Some other narcotics commonly used for pain during labor can immediately reverse the effects of those treatments.\u003c/p>\n\u003cp>“Suddenly, you’re in the middle of labor, which is already painful, and now you’re in the middle of the worst withdrawal of your life,” she said.\u003c/p>\n\u003cp>For Nicole Veum, it was the worst wildfire in California history that \u003ca href=\"https://www.kqed.org/news/11622370/giving-birth-is-hard-enough-now-try-it-in-the-middle-of-a-wildfire\" target=\"_blank\" rel=\"noopener\">interrupted her birth plan\u003c/a>. She was in active labor when the October 2017 wildfires broke out. Those blazes swept through the North Bay and parts of Northern California, burning more than 5,000 homes and killing 44 people.\u003c/p>\n\u003cp>“There was a ton of smoke in the hospital, like, you could visibly see it outside and smell it,” she said.\u003c/p>\n\u003cp>Nurses said everybody had to evacuate. Veum was transferred to another hospital five miles away. And the special instructions for her epidural got lost in the chaos.\u003c/p>\n\u003cp>“Then when they went to change the drug, I saw the tube said fentanyl on it, and by that point I was starting to feel, feel the itchies,” she said, referring to one of the signs that she could feel the opioid in her body.\u003c/p>\n\u003cp>Most women without a history of addiction wouldn’t experience this, said Jennifer Lucero, chief of obstetric anesthesiology at the UCSF Medical Center. Anytime a woman who is not in recovery asks for an epidural without fentanyl, usually out of concern for the baby, Lucero explains why it’s there.\u003c/p>\n\u003cfigure id=\"attachment_11700436\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11700436\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Nicole and Ben Veum with 10-month-old Adrian. \u003ccite>(Adam Grossberg/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The fentanyl allows the anesthesiologist to balance out the numbing agent in the solution, she says, so women don’t have as much pain from the contractions, but they can still feel the pressure, and move their legs a bit or shift in bed during labor. When she explains the trade off, and assures women that the opioid will have no effect on their fetus, most of them opt to keep it in the epidural solution.\u003c/p>\n\u003cp>But there are other ways doctors have been trying to cut down on opioids in labor and delivery, namely what they prescribe for after the birth. For years, women who had a normal, vaginal birth were sent home with a 30-day supply of Norco, Percocet or other opioid.\u003c/p>\n\u003cp>“And they would not use it and it’d just be sitting in the bathroom cabinet,” Lucero said. “Some people would think they’re supposed to take them all.”\u003c/p>\n\u003cp>Studies show that even after \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-to-use-opioids-safely/art-20360373\">five days of opioid use\u003c/a>, the chance of long-term dependence rises steeply; \u003ca href=\"https://www.uptodate.com/contents/prescription-of-opioids-for-acute-pain-in-opioid-naive-patients\">every week\u003c/a> of opioid use increases the risk of misuse by 20 percent. While most people who get a bottle of pills when leaving the hospital won’t develop an addiction, some will – about 0.6 percent.\u003c/p>\n\u003cp>Now, doctors are trying to prescribe limited amounts of opioids only to women who have had a cesarean section.\u003c/p>\n\u003cp>Women like Nicole Veum. After another 12 hours of labor at the new hospital with little progress, Veum agreed to a C-section. And doctors sent her home with a bottle of Percocet. They told her, if she was worried, to have her husband or a friend hold on to the bottle and control the dosage.\u003c/p>\n\u003cp>Addiction expert Dr. Kelly Pfeifer said, in a situation like this, just a few pills, or even ibuprofen, would’ve been fine.\u003c/p>\n\u003cp>“Any parent will tell you there’s nothing more stressful than the first week of being a parent and having a baby and being in sleep deprivation,” Pfeifer said. “And here you have a little bottle of Vicodin that you used to turn to to make you feel better when you’re stressed.”\u003c/p>\n\u003cp>First the fires. Then the fentanyl in her epidural, then the Percocet. It was Veum’s first test seeing how her sobriety and motherhood would line up.\u003c/p>\n\u003cp>She called a friend who’s also in recovery and talked it all through. She said the Percocet could have sent her down a rabbit hole, but it didn’t. She was fine leaving that behind.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I was OK. I was OK with it. It was just something that happened,” she says as her baby, now 1, played with a new toy. “A lot of people metaphorically felt it as a baby coming out of the ash, the life coming from the ashes. And I feel that. I feel like it was a big time for our community and me personally to be reborn in some way.\"\u003c/p>\n\n","blocks":[],"excerpt":"“There’s no medical reason why someone should be forced to be exposed to opioids if they don’t want to,” said Kelly Pfeifer, a family doctor and addiction expert.","status":"publish","parent":0,"modified":1540403297,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":1085},"headData":{"title":"Some Women Recovering From Opioid Addiction Wary of Painkillers During Childbirth | KQED","description":"“There’s no medical reason why someone should be forced to be exposed to opioids if they don’t want to,” said Kelly Pfeifer, a family doctor and addiction expert.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"NewsArticle","headline":"Some Women Recovering From Opioid Addiction Wary of Painkillers During Childbirth","datePublished":"2018-10-23T07:05:13.000Z","dateModified":"2018-10-24T17:48:17.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png","isAccessibleForFree":"Y","publisher":{"@type":"NewsMediaOrganization","@id":"https://www.kqed.org/#organization","name":"KQED","url":"https://www.kqed.org","logo":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}}},"disqusIdentifier":"11700111 https://ww2.kqed.org/news/?p=11700111","disqusUrl":"https://ww2.kqed.org/news/2018/10/23/women-recovering-from-opioid-addiction-wary-of-painkillers-during-childbirth/","disqusTitle":"Some Women Recovering From Opioid Addiction Wary of Painkillers During Childbirth","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/10/TCRAM20181024DemboskyOpioidMothers.mp3","audioTrackLength":157,"path":"/news/11700111/women-recovering-from-opioid-addiction-wary-of-painkillers-during-childbirth","audioDuration":173000,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When she was in her early 20s, Nicole Veum says she made a lot of mistakes.\u003c/p>\n\u003cp>“I was really sad and I didn’t want to feel my feelings,” she said. “I turned to the most natural way I could find to cover that all up, and I started using drugs: prescription pills, heroin for a little bit of time.”\u003c/p>\n\u003cp>Her family got her into treatment. She’d been sober for nine years when she and her husband decided to have a baby. This was something she wanted to feel.\u003c/p>\n\u003cp>She told her doctor if she needed an epidural, she didn’t want any fentanyl in it. She didn’t want to feel high.\u003c/p>\n\u003cp>“'Cause I remembered seeing other friends, they’d used it, and they were feeling good and stuff,” she said. “I didn’t want that to be a part of my story.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Epidurals are usually a mix of two types of medications: a numbing agent, usually from the lidocaine family, and a painkiller, usually fentanyl. The amount of fentanyl is limited, and little passes into the bloodstream, experts say, but if a woman doesn’t want the fentanyl, it’s easy to formulate an epidural solution without it. Doctors either use a substitute medication or up the concentration of the numbing agent.\u003c/p>\n\u003cp>“There’s no medical reason why someone should be forced to be exposed to opioids if they don’t want to,” said Kelly Pfeifer, a family doctor and addiction expert who now works as director of high-value care at the California Health Care Foundation.\u003c/p>\n\u003cp>Especially for women who are in active treatment for opioid addiction and taking methadone or Suboxone, Pfeifer said there’s another issue to be wary of: Some other narcotics commonly used for pain during labor can immediately reverse the effects of those treatments.\u003c/p>\n\u003cp>“Suddenly, you’re in the middle of labor, which is already painful, and now you’re in the middle of the worst withdrawal of your life,” she said.\u003c/p>\n\u003cp>For Nicole Veum, it was the worst wildfire in California history that \u003ca href=\"https://www.kqed.org/news/11622370/giving-birth-is-hard-enough-now-try-it-in-the-middle-of-a-wildfire\" target=\"_blank\" rel=\"noopener\">interrupted her birth plan\u003c/a>. She was in active labor when the October 2017 wildfires broke out. Those blazes swept through the North Bay and parts of Northern California, burning more than 5,000 homes and killing 44 people.\u003c/p>\n\u003cp>“There was a ton of smoke in the hospital, like, you could visibly see it outside and smell it,” she said.\u003c/p>\n\u003cp>Nurses said everybody had to evacuate. Veum was transferred to another hospital five miles away. And the special instructions for her epidural got lost in the chaos.\u003c/p>\n\u003cp>“Then when they went to change the drug, I saw the tube said fentanyl on it, and by that point I was starting to feel, feel the itchies,” she said, referring to one of the signs that she could feel the opioid in her body.\u003c/p>\n\u003cp>Most women without a history of addiction wouldn’t experience this, said Jennifer Lucero, chief of obstetric anesthesiology at the UCSF Medical Center. Anytime a woman who is not in recovery asks for an epidural without fentanyl, usually out of concern for the baby, Lucero explains why it’s there.\u003c/p>\n\u003cfigure id=\"attachment_11700436\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11700436\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2018/10/RS32433_0M6A0122-qut-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Nicole and Ben Veum with 10-month-old Adrian. \u003ccite>(Adam Grossberg/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The fentanyl allows the anesthesiologist to balance out the numbing agent in the solution, she says, so women don’t have as much pain from the contractions, but they can still feel the pressure, and move their legs a bit or shift in bed during labor. When she explains the trade off, and assures women that the opioid will have no effect on their fetus, most of them opt to keep it in the epidural solution.\u003c/p>\n\u003cp>But there are other ways doctors have been trying to cut down on opioids in labor and delivery, namely what they prescribe for after the birth. For years, women who had a normal, vaginal birth were sent home with a 30-day supply of Norco, Percocet or other opioid.\u003c/p>\n\u003cp>“And they would not use it and it’d just be sitting in the bathroom cabinet,” Lucero said. “Some people would think they’re supposed to take them all.”\u003c/p>\n\u003cp>Studies show that even after \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-to-use-opioids-safely/art-20360373\">five days of opioid use\u003c/a>, the chance of long-term dependence rises steeply; \u003ca href=\"https://www.uptodate.com/contents/prescription-of-opioids-for-acute-pain-in-opioid-naive-patients\">every week\u003c/a> of opioid use increases the risk of misuse by 20 percent. While most people who get a bottle of pills when leaving the hospital won’t develop an addiction, some will – about 0.6 percent.\u003c/p>\n\u003cp>Now, doctors are trying to prescribe limited amounts of opioids only to women who have had a cesarean section.\u003c/p>\n\u003cp>Women like Nicole Veum. After another 12 hours of labor at the new hospital with little progress, Veum agreed to a C-section. And doctors sent her home with a bottle of Percocet. They told her, if she was worried, to have her husband or a friend hold on to the bottle and control the dosage.\u003c/p>\n\u003cp>Addiction expert Dr. Kelly Pfeifer said, in a situation like this, just a few pills, or even ibuprofen, would’ve been fine.\u003c/p>\n\u003cp>“Any parent will tell you there’s nothing more stressful than the first week of being a parent and having a baby and being in sleep deprivation,” Pfeifer said. “And here you have a little bottle of Vicodin that you used to turn to to make you feel better when you’re stressed.”\u003c/p>\n\u003cp>First the fires. Then the fentanyl in her epidural, then the Percocet. It was Veum’s first test seeing how her sobriety and motherhood would line up.\u003c/p>\n\u003cp>She called a friend who’s also in recovery and talked it all through. She said the Percocet could have sent her down a rabbit hole, but it didn’t. She was fine leaving that behind.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I was OK. I was OK with it. It was just something that happened,” she says as her baby, now 1, played with a new toy. “A lot of people metaphorically felt it as a baby coming out of the ash, the life coming from the ashes. And I feel that. I feel like it was a big time for our community and me personally to be reborn in some way.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11700111/women-recovering-from-opioid-addiction-wary-of-painkillers-during-childbirth","authors":["3205"],"programs":["news_72"],"categories":["news_457","news_8"],"tags":["news_21434","news_23820","news_19542","news_22774","news_21771","news_17041"],"featImg":"news_11700419","label":"news_72"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. 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Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.","airtime":"MON-THU 11am-12pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Here-And-Now-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"http://www.wbur.org/hereandnow","meta":{"site":"news","source":"npr"},"link":"/radio/program/here-and-now","subsdcribe":{"apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=426698661","tuneIn":"https://tunein.com/radio/Here--Now-p211/","rss":"https://feeds.npr.org/510051/podcast.xml"}},"how-i-built-this":{"id":"how-i-built-this","title":"How I Built This with Guy Raz","info":"Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png","officialWebsiteLink":"https://www.npr.org/podcasts/510313/how-i-built-this","airtime":"SUN 7:30pm-8pm","meta":{"site":"news","source":"npr"},"link":"/radio/program/how-i-built-this","subscribe":{"npr":"https://rpb3r.app.goo.gl/3zxy","apple":"https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2","tuneIn":"https://tunein.com/podcasts/Arts--Culture-Podcasts/How-I-Built-This-p910896/","rss":"https://feeds.npr.org/510313/podcast.xml"}},"inside-europe":{"id":"inside-europe","title":"Inside Europe","info":"Inside Europe, a one-hour weekly news magazine hosted by Helen Seeney and Keith Walker, explores the topical issues shaping the continent. No other part of the globe has experienced such dynamic political and social change in recent years.","airtime":"SAT 3am-4am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Inside-Europe-Podcast-Tile-300x300-1.jpg","meta":{"site":"news","source":"Deutsche Welle"},"link":"/radio/program/inside-europe","subscribe":{"apple":"https://itunes.apple.com/us/podcast/inside-europe/id80106806?mt=2","tuneIn":"https://tunein.com/radio/Inside-Europe-p731/","rss":"https://partner.dw.com/xml/podcast_inside-europe"}},"latino-usa":{"id":"latino-usa","title":"Latino USA","airtime":"MON 1am-2am, SUN 6pm-7pm","info":"Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg","officialWebsiteLink":"http://latinousa.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/latino-usa","subscribe":{"npr":"https://rpb3r.app.goo.gl/xtTd","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Latino-USA-p621/","rss":"https://feeds.npr.org/510016/podcast.xml"}},"live-from-here-highlights":{"id":"live-from-here-highlights","title":"Live from Here Highlights","info":"Chris Thile steps to the mic as the host of Live from Here (formerly A Prairie Home Companion), a live public radio variety show. 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Updated Monday through Friday at about 3:30 p.m. PT.","airtime":"MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.marketplace.org/","meta":{"site":"news","source":"American Public Media"},"link":"/radio/program/marketplace","subscribe":{"apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=201853034&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/APM-Marketplace-p88/","rss":"https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"}},"mindshift":{"id":"mindshift","title":"MindShift","tagline":"A podcast about the future of learning and how we raise our kids","info":"The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. 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