There is a lot more to this article that you left out that provides very important context. The state health department is imposing really quite reasonable regulations on the birthing centers for the health and safety of the mothers. Some of the requirements include formal nursing education for midwives (who can otherwise calls themselves midwives after taking barely-regulated online courses), proximity to a hospital that has obstetrics and pediatrics in case of emergency (must be within 30 minutes by ambulance), and building requirements that allow for things like ADA compliance and appropriate medical facilities at the birthing center.
The article does also address the significant systemic problems that mothers, particularly black mothers, face in many hospital settings, as well as the black maternal fatality rates. While these issues are important to discuss and address, inadequately staffed and equipped birthing centers 45 minutes away from the nearest hospital by ambulance are not the answer here. In my professional medical experience working in such a hospital, I’ve seen transfers from birthing centers like the ones discussed in the article that were unable to address maternal uterine hemorrhage and neonatal hypoxia. Luckily, they were close enough to proper hospitals that could care for the mother and newborn, but if they were 45 minutes away by ambulance, the mother and newborn very likely would have died.
I agree with much you have said, but the problem still exists that 30% of counties don’t have hospitals … so expecting that all birthing centers should be within a reasonable range is in the state’s lap, not expectant mothers.
This is setting aside the prohibitive cost for those hundreds of thousands of Americans who don’t have insurance.
Not to oversimplify, but they could build these birthing centers 20 minutes away from the town and 25 minutes away from the hospital rather than in town and 45 minutes away from the hospital. They could also pivot to offer assistance to mothers in the form of facilitating transportation, doulas, and help setting up pre- and peri-natal Medicaid.
These birthing centers are just a small step above home births in the grander scheme of things. The regulations being imposed are absolutely necessary for the centers to actually be better options. Even if the pregnancy has had no complications and is very low risk, things like uterine hemorrhage, neonatal hypoxia, or other unpredictable complications can occur. When those things happen, being an hour away from proper emergency care is very likely to be lethal. The 30 minutes away from the hospital by ambulance rule isn’t even taking into account the time it takes to recognize the problem and the time for the ambulance to arrive in the first place.
If these centers are going to exist and claim to be a safe option, they need to have adequately trained staff, appropriate facilities, and viable access to emergency care in case of unpredictable complications.
So, if a facility that’s 20 minutes away doesn’t quite meet all the regulations, let’s close it down and make people have to drive over an hour to a facility that does meet all the regulations?
I guess that leaves three options then, deliver at home, just hold it in, or break out the chainsaw…
Actual medical training and appropriate facilities are not high bars to clear if they want to actually do things right. The education requirements for being a midwife as opposed to a nurse midwife are appallingly lax. It’s like saying that a class taught by a high school graduate is equivalent to one taught by someone with an education degree. The person interviewed in the article is an OB/Gyn, but it doesn’t sound like her staff has any qualifications. Hell, EMTs get more education on how to actually deliver a baby and care for the mother than some midwives.
Agreed. Yet still, once upon a time the solution was ‘hey, let’s invent a hand crank chainsaw’…
Just because a facility might not technically meet every single regulation doesn’t mean that a woman can just hold her hoo-hoo shut for an hour or more to get to a proper facility.
I can speak a little on this. I am a resident of Alabama in one of the poorer counties, Pickens. Median household income per Wikipedia is $26,254. I’d say that ranks pretty low. 20% of families, and 24% of people here live below the poverty line. I have lived here all my life. Prior to COVID in the US, our only local hospital closed in 2020. It is now a 30-40 minute drive to Tuscaloosa or Columbus MS for emergency care on a good day. There are local clinics, but nothing for OBGYN care or emergency treatment. There was a doctor who came to the local hospital weekly for local appointments prior to the closure.
During my wife’s first pregnancy, care was pretty good even having to drive the 40 minutes to each appointment and waiting in the car. (During COVID, the OB offices would only allow the patient inside).
The second pregnancy my wife miscarried towards the end of the 1st trimester, and we had to wait until the following day to come back for her D&C procedure. She collapsed the following morning at the hospital due to blood loss. Or what I’d call lack of care from Alabama hospitals. Thankfully, this was prior to Alabama’s new silly abortion and pregnancy laws. I can’t imagine how this would’ve been handled then.
Her third (and hopefully final from both of our standpoints) pregnancy went fairly well, but it sure seemed the doctors and quality of care and ability to do things changed between the 1st and 3rd pregnancy. The only thing I can think of is Alabama’s new stupid laws around pregnancy. I’m glad we are both done with having kids.
We aren’t well off, but compared to many here, we are. I can’t imagine it working out well for many of our fellow citizens in Alabama.
And now onto the rural hospitals part. As mentioned above, our local hospital closed just prior to COVID. I am a first responder as a volunteer fireman for the community. With the closure of the local hospital, our local ambulance company (which is coincidentally managed by a company from Tuscaloosa county) has been hard pressed to keep up with emergency demand. They may have 2 trucks on a good day to cover a population of 20,000 people spread over 900 square miles. (2300 km2). It is not unusual for us to wait 40 minutes or longer for an ambulance. Our situation is also not helped by frequent flyers or people that could get there on their own but think going by ambulance gets them in and out faster. (it’s a really common misconception.)
Prior to the local hospital closure, we’d work a code all the way to the hospital in the back of an ambulance with the paramedics. Nowadays, the ambulance arrives, we state how long we’ve been doing CPR, the ambulance crew observes, sometimes assists, and watches, gets an ECG reading, calls the doctor on duty at one of the ERs, and if there’s no good news, we stop there and tell the family we’ve done all we can. It FUCKING SUCKS. At least prior to the closure, they had that hope as we loaded them into the ambulance and left with them that maybe they’d make it. Nowadays, you’re there for all of it. The initial hope, the shock, the crushing realization. It takes a toll on all of us. Volunteers are down, and I can’t help but think the stresses of all this are a major part of it.
And the final kick in the dick for all of this is remember where I said our local ambulance service is managed out of Tuscaloosa? Tuscaloosa fines them if they don’t have an ambulance available. Our county has no such stipulation. So if their county’s ambulances are tied up, ours get pulled over there, and we are left with nothing and no local care.
There has been a major push by local mayors to get funding to open the hospital ER back up and use the hospital part as a mental health unit for teens from across the state. We thought a good deal had been reached, but our own state senator out of Tuscaloosa shot it down and spent the money elsewhere. I’ll remember that next time I vote, and I’ve been telling everyone that I see in the community to remember it also. The mayors even got a group together to go to the state capital and make their case only to be told that they thought they were speaking to the wrong committee about it. So we were told to wait until 2024 and see what happens. I suspect nothing will change in this dump, and people will continue to suffer. That’s what I expect.
Sorry for the long rant, this is something I’m directly involved with, and rather passionate about. Thanks for reading this far if you have.
It’s honestly heartbreaking to hear how bad things have gotten. I’ve been part of plenty of failed codes in the hospital and I don’t think I could deal with your situation day in and day out.
My hope for these birthing centers is that they either get things up to code and really, truly provide a necessary service, or they don’t give women a false sense of security. Labor usually tends to take a while, particularly in low risk pregnancies, and it really sounds like mothers would be in better hands driving 40 minutes to the nearest hospital than ending up in the worst case scenario with almost an hour and a half or more to get them to the hospital from an inadequate birthing center.
I am so freaken grateful that my wife wanted a normal hospital birth, the way skydaddy intended. Doctors, nurses, and machines. Especially given what almost happened.
China can claim anything they want. They will never enforce it because they can’t. They might be an economic superpower (selling off your population as slaves to do labour for basically no money in awful conditions tends to do that), but they will never be a military one. Their weapons are copied, low quality garbage, their soldiers untrained, and undisciplined.
Ruzzia may have been the biggest paper tiger in history, China is the second biggest.
I would say China might actually be a better military power than Russia. No one would have believed just how fucking bad Russia’s military crumbled away. I doubt China has the same issues (but I don’t really know). Let’s say their weapons are copied (copies of what? State of the art weapons systems?) - I’d guess that means they can do some serious damage eitherway, and probably better than what Russia has. They have nukes too.
We can’t know if that’s true until the shooting starts. Nobody knew for sure how strong Russia was until they went to war in Ukraine. In fact, the people who were in the best position to know (the Russians themselves) clearly didn’t know because they never would have started this fight if they knew it would expose them as so weak.
We do know a bit about how powerful the US would be because they get involved in so many conflicts. But, even then, they haven’t really faced a near-peer opponent since… who knows when.
In any sustained conflict, the ability to keep feeding troops, food, and supplies to the front line would matter, and that’s where China might have an advantage. They have so many people they could keep feeding into the meat grinder. They have a huge manufacturing-based economy that could supply more and more arms and armour. One weakness is that they’re a net importer of food, which would be a problem if those imports were disrupted.
One thing’s certain, every country in the world is closely watching what’s happening in Ukraine and trying to learn things without having to put their own soldiers in the firing line. I’m actually sure that that’s one of the conditions for the military aid from the west. Sure, you can use these very modern weapons systems, but you have to turn on telemetry and share everything with us.
One lesson I’m sure they’re learning so far is that drone warfare is going to be key. They’re key for intelligence gathering, targeted strikes, artillery spotting, etc. A cheap drone can take out much more expensive weapons systems, and they allow a “pilot” to be very close to the action while not being in any danger. Because of China’s drone industry, they’d have an edge in that area.
I’m not too concerned. They can get medicine to him, so as long as that works and his condition improves enough, they can get him out.
If the medicine doesn’t work and whatever issues he’s facing deteriorates further, then there’s a real problem.
Of course the real nightmare is if he’s developed a chronic health issue, he’ll have to get treated for the rest of his life, here in the States. I’d wish that fate on no one.
What’s the alternative? It’s easy to comment on it like the universe was created today. But we are all born into the world as it exists. That means understanding the history and geopolitics of the regions in question. One can’t just jump in and say that they don’t like Xi Jin Ping on the global stage, because the west was happily content leaning on the cheap labour of China for the past 50 years. Nevermind the fact that U.S saudi relationship has existed for well over 50 years now or more.
It’s not like India isn’t already shipping huge amounts of goods to Europe. They just do it on heavily polluting ships. Rail is the greenest shipping solution.
I’d vote against Pelosi in the primaries for the same reason I’d vote against Biden or Trump or McConnell or Feinstein in the primaries. They’re all too fucking old. The average age of the Senate is 64 years. The average age of the House of Representatives is 57 years.
Here’s every senator or congressperson age 68 or older.
…in an effort to force the Biden administration’s defense department to rescind a policy of leave and expense reimbursement for service members and their dependents traveling for abortions.
I can only assume this is for bases that don’t have the means to just do it themselves. I was a surgical tech in the Air Force, and every hospital I was stationed at provided abortion services.
The VA does, too.
Cuz abortion services ARE FUCKING HEALTHCARE. You want to destroy a service member’s mission readiness? Give them a kid they can’t support.
You don’t want to pay service members to travel for abortions? Fine. Fine. Equip and staff every single military base with an OBGYN clinic w/ surgical capabilities. Don’t want to give them med leave to recover from an abortion? Fucking FINE. Schedule a uteroscopy and biopsy along with it so we can throw in a cancer screen, nab any polyps, ablate any endometriosis, etc; and give them extra leave for those, cuz damn was that one a bleeder! She’ll need extra time to recover for sure!!
Then declare a state of emergency in the Y’all Qaeda infested regions of the US on the basis of denied healthcare leading to the current and worsening humanitarian crisis; and in doing so, enabling the VA to provide abortion services to non-veterans under section §1784 of title 38, United States Code.
This dystopian GOP shit is maddening. We need to stop trying to argue with it, and start finding ways to just work around it. Fuck em.
The problem with that is that it may have been legal at the place it was done, but states would absolutely place police next door to wait for those women to come out. They already have laws that criminalize women who go out of state
How is that legal? I thought states can only enforce laws that are broken in their own jurisdiction? Interstate would make it a federal matter, no? (In regards to women going out of state)
It’s almost certainly unconstitutional, but there’s not specific case law so it has to be litigated to know for sure. So there needs to be people charged who have the means and willingness to go through several years of trials and appeals. And they have to maintain that motivation for a long time - some cases drag on for a decade or longer.
The point isn’t to make it illegal forever, it’s to scare people and organizations without the resources to engage in a legal fight to stop supporting interstate care for the next three or five or ten years.
Then we need to do the short term solution while we work on the long term solution. I’m kind of sick of one side trying to keep it a fair fight. GOP politicians have all shown they don’t care about that and will employ any means necessary to get their policies enacted while doing everything they can to disrupt the policies on the other side
The fucked up thing is that people are still gonna vote for her. No one cares about corruption or acrually having good political leaders, they just need their team to win like it’s some kind of stupid sport.
There’s corruption. The whole system is corrupt and Pelosi is a whirlwind of corruption. Does not make right wing conspiracy theories any more correct, though.
Or they know how important it is that the Republicans not win.
It’s not just about keeping score and keeping points for the red team. The blue team is currently fighting for white supremacy, christian supremacy, male supremacy, and to change the rules to make any other political party irrelevant.
If someone as wonderful as Mr. Rogers ran against Nancy Pelosi, but that person said he’d vote with his Republican colleagues on every important issue, his own personal qualities wouldn’t matter. He personally might not lie, cheat or steal, but he’d be supporting a party that openly does all those things.
It sucks, but when it’s a first-past-the-post system with 2 major parties, you mostly have to hold your nose and vote against the greater evil.
Yup they’re the largest healthcarrier because they get away with all the crap and are rarely held accountable. Their CEO died at age 60. The most powerful man at a healthcare conglomerate died of CV causes at age 60.
As in, it should be a proportion of their overall revenue as a business, if you just take a proportion of their profit then it’s less likely to actually harm them in some way. A single heavy fine calculated from profit will never put them at risk of not actually making a profit due to their horrendous misdeeds.
I will then amend my solution to add this: the fine should be 50% of their profits.
I am somewhat wary of hitting revenue as companies could then use it as an excuse to let go of staff, and that is a cost I’m unwilling to stand up for.
Honestly, without specific regulation to prevent it, cost cutting like slashing staff will be the first thing a company does to protect its expected profits regardless of how you do it. That’s unavoidable whether you go for profit or revenue.
news
Hot
This magazine is from a federated server and may be incomplete. Browse more on the original instance.