31% of Kentucky women live more than half an hour from a hospital with a maternity unit; across the U.S., only 9.7% do

Map from 2023 March of Dimes report

By John McGary, WEKU

“Estill Medical. This is Madisyn. How may I help you?”

It’s a few minutes before lunch at Estill Medical Clinic, in Irvine. The practice is owned by nurse practitioner and Estill native Donna Isfort. It offers many services, but, like every other medical facility in the county, no obstetrician/gynecologist.

Isfort said, “Many, many of my patients at least have to travel anywhere from 30 minutes to 60, 70, minutes just to get to obstetrical care. There's just not any here. We have no nurse midwives. . . . I do family practice, so I do a lot of women's health at my clinic, but not prenatal care.

Estill County does have a hospital, but a spokesman for Mercy Health-Marcum and Wallace Hospital said it hasn't delivered babies since 1986, not counting unplanned births in the emergency room.

According to a 2023 report by the March of Dimes, women living in what some call “maternity care deserts” like Estill and several nearby counties must travel more than twice as far to get the care they need. Multiple studies conclude that greater distance puts women, expectant and otherwise, at greater risk.

The report says 31 percent of Kentucky women live more than 30 minutes form a birthing hospital; the national figure is 9.7%.

Isfort says she and her staff work closely with the Estill County Health Department to provide the help they can and out-of-county referrals for services they can’t provide.

Some think Kentucky’s maternity care deserts may spread. At a June 24 rally in Lexington to mark the two-year anniversary of the Supreme Court’s toppling of Roe v. Wade, second-year medical student Shriya Dodwani painted a bleak picture.

“The Accreditation Council for Graduate Medical Education requires that OB/GYN residents have access to abortion training,” Dodwani said. “This isn't about politics. It's about ensuring that we have the comprehensive skills needed to provide the best possible care for our patients. Without this training in Kentucky, we're left with no choice but to leave and pursue our education elsewhere.”

In a recent survey of students at Kentucky’s three medical universities, 62 percent of respondents said they’re considering finishing elsewhere because of the state’s near-total abortion ban.

A week later, University of Kentucky HealthCare officials unveiled a plan that could help some women in rural areas. The outreach division of UK Women’s Health OBGYN announced they’d add services at 19 new sites, several in Eastern Kentucky, and expand telehealth services.

Dr. Emily DeFranco is chair of UK’s Department of Obstetrics and Gynecology, said “We'll send a sonographer with an ultrasound machine to the site, and they'll perform the ultrasound and then virtually, by telemedicine, the physician who is in Lexington is able to view the images from the ultrasound, and then have a video conference with the patient on that site and counsel her about the findings.”

That sort of outreach could eliminate some of the long trips many women must make for routine care. Another program, funded in part by Medicaid and tobacco-settlement dollars, helps expectant and new mothers: HANDS, which stands for Health Access Nurturing Development Services. It’s available to all women during pregnancy through a child’s third birthday.

At the Estill County Health Department, Teresa Talbott is the ongoing home visitor, dropping in weekly with 15 to 20 families per year for the last 17 years.

“We're not coming in to look at your home. We're not coming, you know, to tell you what t“o do, Talbott said. “We're just coming in and giving you the information and helping you along with it.”

One woman she’s helping now is Whitney Bingham, who happens to be the health department’s Women, Infants and Children program coordinator. Talbott, who Bingham calls TT, is assisting her and her two-year-old son through challenges ranging from potty training to car-seat installations.

But Bingham says that when it’s time for her to leave for an OB-GYN visit, she makes the hour-long drive to Lexington.

The state Cabinet for Health and Family Services declined our request for an interview with the Department for Public Health’s director of women’s health.

Kentucky gets a 'D' grade on second annual report card on maternal mental health, a bit worse than the national average

By Melissa Patrick
Kentucky Health News

Kentucky received a D grade on the second annual report from the Policy Center for Maternal Mental Health, moving up from a D-minus in last year's report card. The national grade was D-plus; D was the most common grade, and 23 states had grades higher than Kentucky's.

“Maternal mental health is core to the health and well-being of women and families. Our report cards provide state government and advocacy leaders with a tool for identifying areas of opportunity and the ability to track annual progress,” Joy Burkhard, executive director of the policy center, said in a news release from the Milken Institute School of Public Health at George Washington University, which supported creation of the report cards.

“We are particularly hopeful about one of the new measures added this year, which tracks how often women are being screened for these disorders,” Burkhard said. ”Asking about symptoms is the first step toward diagnosis and treatment.”

The report notes that two things changed in Kentucky to improved the state's grade, however slightly. The state now meets the recommended maternal-mental-health prescriber ratio for the perinatal population and has a perinatal quality collaborative that prioritizes maternal mental health (a new category).  

The 2024 report cards include 18 measures that are divided into three key domains: Providers and Programs, Screening and Screening Reimbursement, and  Insurance Coverage and Treatment Payment. 

Kentucky met six of the 18 measures on the report card, with most of them in the Insurance Coverage and Treatment Payment domain, for things like expanding Medicaid, extending Medicaid coverage to one year after birth, and the ability to submit claims to proivate insurers for pre- and post-birth maternal mental-health treatment.

Kentucky got a D for providers and programs, an F for screening and screening reimbursement, and a C for insurance coverage and treatment payment.

What's Kentucky doing? 

Kentucky has several groups working on this issue, including a mental-health initiative in the state Department for Public Health, called the Maternal Mental Health Collaborative, and the Kentucky Perinatal Quality Collaborative, an effort of hospitals, doctors, nurses, public-health experts and others.

Another group working on this issue is the Mind the Gap Kentucky Coalition, which includes Postpartum Support International along with a host of other members, led by Nikki Boyd, the director of maternal infant health initiatives with the March of Dimes. 

"One thing all the groups involved in maternal mental health are doing is being sure to work together, to share resources and reduce unnecessary duplication of effort across the board," Marcie Timmerman, executive director of Mental Health America Kentucky, said in an email. 

In 2023, the legislature passed Senate Bill 135 to require the Cabinet for Health and Family Services to make information on postpartum depression and a postpartum assessment tool available on its website. It also required the cabinet to develop and implement a collaborative program aimed at improving the quality of prevention and treatment of postpartum depression.

In 2024, legislators passed a multifaceted bill dubbed the "Momnibus" as part of Senate Bill 74. It was originally House Bill 10, sponsored by Rep. Kim Moser, D-Taylor Mill. The Momnibus portion of this bill came out of a working group of Republican and Democratic women in the House and the Senate. 

Among other things, the Momnibus ensures access to health-insurance coverage for pregnant women by adding pregnancy to the list of exceptions for enrollment outside the normal open-enrollment period.

It also establishes a mental-health hotline called Lifeline for Moms that allows providers access to an immediate mental-health consultation for a mother in need; expands the Health Access Nurturing Development Services (HANDS) home-visitation program and lets it be available up to three years after birth; covers lactation consultation and needed equipment to encourage breastfeeding; and will educate mothers on the benefits of safe sleep for infants. These services would also be available via telehealth.

"I'm not surprised by our report card here, but I am energized by the existence of more than one advocacy group, the commitment to improving maternal mental health by legislators who were involved in HB 10, which turned into SB 74, and by providers who are increasingly involved in this effort to improve and ultimately save lives," said Timmerman, of Mental Health America.

Boyd said the results of the report card drive a lot of work being done by the Mind the Gap Coalition and the state task force. 

"These are things that can't be done overnight," she said. "There's a lot of policy involved and a lot of across the aisle work that needs to happen for these to happen. . . . It's a good guide, a good metric to help us figure out what the needs are." 

Boyd said each measure on the report card needs to be considered related to the needs of the state. For example, the report card shows Kentucky does not have at least one inpatient maternal-mental-health treatment program, but does not consider that the state does not  have enough patient volume to support one. Places are available to provide this kind of care, but she said this is something the state should monitor. 

Boyd said she's excited that Kentucky is taking the reins on this issue. 

"Kentucky's really doing a good job around prioritizing this and doing small things to ensure that Kentuckians are getting access," she said. "So obviously, there's a long way to go, but  I think getting it started, it's a great, great start." 

National numbers and efforts

The national grade improved slightly from a D to a D+, with four states earning B grades, up from one in the 2023 report; 19 states receiving C grades, up from 10 in 2023; 24 states receiving D grades, down from 25 in 2023; and five states getting a failing grade, down from 15 in 2023.  

"The U.S. is failing mothers," says the report. 

On May 14, the U.S. Department of Health and Human Services released the Task Force on Maternal Mental Health's national strategy to address maternal mental health, calling it an "urgent public-health crisis." The news release said the U.S. has the highest maternal death rate among high-income countries and 22% of the deaths are related to suicide, drug overdose, mental-health issues and substance-use disorder. 

“Many of these tragic deaths can be prevented by eliminating health disparities and understanding the impact of mental health during pregnancy and in the first months as a parent,” said HHS Secretary Xavier Becerra. “We want to address the challenges people are facing, decrease stigma associated with these challenges, and improve access to support both inside and outside of the health-care system.”

The five pillars of the national strategy are: building a national infrastructure that prioritizes perinatal mental health and well-being, with a focus on reducing disparities; making care and services accessible, affordable, and equitable; using data and research to improve outcomes and accountability; promoting prevention and engaging, educating, and partnering with communities; and lifting up the voices of people with lived experience, according to the news release.

Does Ky. law protect in vitro fertilization? Depends on who's asked

State Rep. Lindsey Burke, D-Lexington, whose son was born through in
vitro fertilization, said state law doesn't protect the procedure. (LRC photo) 

By Sarah Ladd
Kentucky Lantern

None of the bills to explicitly protect in vitro fertilization in Kentucky got a hearing this legislative session, making them effectively dead on arrival.

With roughly eight months until the next session, some lawmakers and attorneys disagree on what protections exist for IVF under current Kentucky law.

Republican Sen. Whitney Westerfield — who has children thanks to IVF — believes there is an appetite in the General Assembly to pass specific IVF protections. The failure to do so, he said, was probably “a function of time.”

Westerfield filed a bill to protect the process on the filing deadline for Senate bills. His House and Senate colleagues who filed similar bills also did so right before or on the filing deadlines.

The issue, he noted, wasn’t on “anybody’s radar” until an Alabama Supreme Court decision — which came down right before the deadline to file Kentucky bills — seemingly complicated the treatment.

Westerfield, of Fruit Hill in Christian County, announced before the legislative session began that he would not seek re-electin this year.

 
‘They should always be preserved’

Westerfield and his wife, Amanda, are expecting triplets this summer. The three, as well as their 6-year-old son, were adopted as embryos — the result of someone going through IVF and donating eggs. The Westerfields also have a daughter who joined their family as a “traditional domestic adoption.” They have another embryo they are paying around $500 annually to preserve.

“I think they should always be preserved,” Westerfield said. “But I also understand not everybody holds that view. My son is one of those that was preserved, thankfully. These boys that are on the way were preserved.”

The Westerfields chose to have children this way because, had they gone through IVF themselves, “We were worried that we might have more than we could try to transfer on our own,” Westerfield said.

“We didn’t want to have so many left over that we couldn’t … bring to full-term birth ourselves and give a home to. And then you worry about making sure they end up in a home somewhere because we don’t want them destroyed. Not everybody wants to adopt an embryo and be pregnant. Some people do, thankfully.”

Even though the legislature didn’t pass the IVF-specific bills this year, it did pass House Bill 159, which Gov. Andy Beshear then signed into law. It gives health-care providers immunity from criminal charges for medical mistakes.

On the day HB 159 passed the Senate, Westerfield said he believed it would protect IVF by default because it broadly protects “providers.”

The law states: “A health-care provider providing health services shall be immune from criminal liability for any harm or damages alleged to arise from an act or omission relating to the provision of health services.”

Westerfield, who is also a lawyer, said this is “more comprehensive” than what he proposed to specifically protect IVF. “It covered everything mine covered and then some,” he said.

Ben Potash, a lawyer representing three Jewish women who are suing over Kentucky’s abortion law, believes HB 159 does not protect IVF since discarding extra eggs in the IVF process is a willful act.

HB 159 says “Nothing … limits any liability for gross negligence or wanton, willful, malicious, or intentional misconduct.”

 
‘No one really knows what the law is’

Potash believes the two topics — abortion and IVF — are too closely related to be separated. Going through IVF in Kentucky right now is “precarious,” he said. “No one really knows what the law is.”

Kentucky Attorney General Russell Coleman has called IVF “an incredible blessing for so many seeking to become parents,” and said “The plain language of Kentucky’s laws makes it clear that neither IVF nor the disposal of embryos created through IVF and not yet implanted are prohibited.”

But Potash says, “Making it civil, secular law that life begins at conception introduces all kinds of complications to IVF, to motherhood in general, to parenthood in general.”

Kentucky’s “Human Life Protection Act” — the trigger law that went into effect after the U.S. Supreme Court overturned Roe v. Wade in 2022 — states that an embryo is an “unborn human being” from egg fertilization to birth.

The 1973 Roe v. Wade decision established abortion as a constitutional right. Once that federal protection was gone, Kentucky’s law updated to all but ban abortion entirely, except in rare and life-threatening situations. 

Judith Daar, dean of Northern Kentucky University’s Chase College of Law and a legal expert on reproductive assistance, said that while “Many states have language in their statutes regarding abortion that declare life begins at conception or fertilization,” those laws also link abortion to pregnancy, which “is defined as an attachment of the embryo inside the mom.”

That is the case in Kentucky. The law states that “‘pregnant’ means the human female reproductive condition of having a living unborn human being within her body throughout the entire embryonic and fetal stages.”

“To the extent that all the abortion laws tether and condition the conduct on the existence of a pregnancy, then IVF really does escape application of the abortion laws, at least in the preimplantation stage when the embryos are still in the laboratory,” Daar explained. “That is not, per se, a pregnancy because it doesn’t meet the definition of the attachment of the embryo into the uterus.”

Because of this, Daar said, Kentucky doesn’t necessarily need to pass an explicit bill on IVF at this time: “There’s nothing that I’m aware of … that suggests that any aspect of IVF practice is illegal under Kentucky law.”

 
The IVF process

Dr. Sigal Klipstein, chair of the Ethics Committee of the American Society for Reproductive Medicine, said people need IVF for many reasons. Some seek it because of infertility — a man has little to no sperm or a woman does not ovulate, for example. Same-sex couples may undergo IVF as a way to have biological children, she said, or uncoupled people may seek that service for themselves.

“In a typical IVF cycle, a woman might take about 10 days of injections,” Klipstein explained. These are “little, under the skin injections, kind of like insulin needles.”

“They sort of bypass the system,” she said. “So instead of having enough hormone to release one egg, you might release five or 10 or 20 eggs.”

A final shot at the end of those 10 days triggers ovulation, Klipstein said. The patient then undergoes anesthesia and eggs are removed with a needle that enters through the vagina under ultrasound guidance.

Eggs are then mixed with sperm in a lab and grown for five to six days. The best one is then implanted into the uterus.

Usually, there are extra eggs leftover, Klipstein said. They can be donated, stored, discarded, or be placed in the uterus during a time that won’t result in pregnancy. This is called “compassionate transfer,” Klipstein explained. In this process, “you’re sort of more physiologically, more naturally, allowing the embryos to reabsorb into the body.”

Potash said the “routine” extra eggs make the process complicated if they are considered human beings by law. The Alabama Supreme Court set the precedent for that complication when it ruled in mid February that frozen embryos are children.

“It’s unrealistic and cost prohibitive, as well as I think a little cruel,” Potash said, “to make those mothers keep those fertilized ova on ice, essentially, forever.”

Klipstein agreed, and asked: What happens if someone stops paying or a storage facility closes? “Do you require them to have more babies than they want? I mean, I don’t think you can compel someone to get pregnant against their will to prevent them from discarding those embryos.”

“It would be nice if we had one embryo for one baby, and we could do it as a one to one ratio,” she added. “But, you know, medicine doesn’t work that way. And IVF doesn’t work that way.”

Westerfield has a different perspective. “It’s hard for me to imagine someone going into that process without an awareness of the cost,” he said.

IVF can cost between $15,000 and $30,000 per cycle, according to a 2023 article in Forbes. Storage can cost from $350 to $600 per year as well, the magazine reported.

“I don’t think anybody goes into that without knowing whether or not they either can afford it, or have insurance to cover it, or what have you,” Westerfield said.

He and his wife wouldn’t have adopted as many embryos as they did, he said, “if we thought we couldn’t afford to keep this one on ice, frozen.”

“We wouldn’t have done more than what we could transfer at a time,” he said. “We wouldn’t have adopted three; we would have adopted one or maybe two.”

Providers, parents in ‘limbo’

Sen. Cassie Chambers Armstrong, D-Louisville, filed one of several unsuccessful bills to protect IVF this session. She said she is “disappointed” that no specific protections passed.

It might be plausible, she said, that HB 159 “does provide protection to IVF.” But, she said: “I don’t think that it’s decisive.”

The new law deals with criminal and not civil prosecution. That makes it unlikely to be applied to IVF, NKU’s Daar said.

“Instances of physicians acting in a criminal manner in the IVF setting is virtually non-existent,” Daar said. “I’m not saying it never happens, but it’s very, very rare. So a bill that generalizes criminal immunity … would not have a tremendous impact, if any impact, on IVF because that conduct just doesn’t occur.”

For now, Chambers Armstrong is particularly worried about how providers view the law. She wants to spend the interim talking to those people ahead of the next session.

“If IVF providers feel as though they have protection and this bill gives that to them, they will continue to offer services,” she said. “If they are concerned that they’re going to be subject to criminal liability for just doing their jobs, I’m worried that we’re going to see a chilling of making those services available.”

Meanwhile, she does think the state should “repeal … language that people believe could give embryos rights,” she said. But: “I don’t believe this General Assembly is going to do that anytime soon. I hope that people are correct when they say that we can provide some level of protection to IVF with those statutes on the books.”

Rep. Daniel Grossberg, D-Louisville, said the legislature has left “women and medical professionals” in “limbo”. He filed one of the unsuccessful bills to protect the process, and the only one in the House.

“The message that (this) sends,” he said, “is that women in Kentucky don’t have control over their reproductive choices.”

 
‘Let’s be proactive’

Rep. Lindsey Burke, D-Lexington, has openly discussed her journey with assault, infertility, IVF, miscarriage and abortion. She told the Lantern she doesn’t believe IVF is truly protected under current law.

“As long as fetal personhood is enshrined in Kentucky law, IVF is at risk,” said Burke, who is an attorney and mother of a son whom she had after undergoing IVF.

She is also paying $100 per month to store an embryo, as she hopes for another child someday.

Burke would like to file legislation to get “better insurance coverage for reproductive care” next year. She went into debt around $60,000 to have her son, she said. And: “I don’t think that anybody should have to do that.”

Chambers Armstrong, who is also a lawyer, said “I’m not sure that we’re going to get an answer as to whether this bill provides the type of protection for IVF that we’re hoping (for) unless and until it is challenged in court and we get a decision from the court.” But she doesn’t want to wait on litigation.

“Let’s be proactive. Let’s go ahead and pass a law that is very clear that it’s protecting IVF services and make sure that folks know that they can continue to receive the care that they have been seeking,” Chambers Armstrong said.

That must wait until at least 2025.

Kentucky's rate of teenagers having children is fourth in nation

Centers for Disease Control and Prevention chart, adapted by Kentucky Health News

By John McGary, WEKU

Kentucky has the fourth-highest teenage birth rate in the U.S., according to the latest figures from the Centers for Disease Control and Prevention, which show Kentucky’s teen birthrate to be 38 percent higher than the U.S. average.

At the same time, teen-birth rates are declining in Kentucky and the nation. The state's rate was 22.8 per 1,000 females aged 15 to 19 in 2019-21, down from 31.7 in 2014-16. This rate has decreased steadily since 2014-16 when that rate was 31.7 teen births per 1,000 females 15-19.

In 2020, Christian County had Kentucky's highest rate of birth to teens, 55 per 1,000 females aged 15-19. County-by-county teen birth rates since 2003 are available at https://www.cdc.gov/nchs/data-visualization/county-teen-births/.

Tamarra Wieder, state director for Planned Parenthood Alliance Advocates, said what children don’t learn in school is one reason Kentucky ranks high in teen births: “We're not having conversations around comprehensive sex education, and empowering our youth to know that they can say no to sex, that they can empower them to talk to their providers around birth control.”

Wieder said another reason for the high teen birthrate is a lack of proper medical care in many areas. She said 73 of the state's 120 counties have no practicing obstetrician-gynecologists, and "When you're already not having the these conversations in the classroom, and then you don't have access to providers, this is a huge problem for the commonwealth.”

Wieder said surveys show 83 percent of Kentuckians support comprehensive sex education supported by science and legitimate groups like the American College of Obstetricians and Gynecologists.

State's high maternal-death rate gets study; pregnancy-related deaths mostly from violence, substance use, anxiety, depression

UK researchers studying the state's high maternal-mortality rate include (front row, left to right) Anna Chamberlain, Ann Coker, Linda Berry, Heather Bush; (back, left to right) John O'Brien, Cynthia Cockerham, Dana Quesinberry and Josh Bush. (Photo by Jeremy Blackburn, UK Research Communications)

Thursday, April 11 is the International Day of Maternal Health and Rights.

By Lindsay Travis
University of Kentucky

A team of health-care providers and researchers at the University of Kentucky is working with community and government leaders across the state to address a pressing issue facing the state: its high rate of death and illness among women who give birth.

“Kentucky has one of the highest maternal mortality rates in the country. Lowering the proportion of women dying during or after childbirth in our state is not just a goal, but a necessity to safeguard the health and futures of both mothers and their children,” said Dr. John O’Brien, director of the Division of Maternal Fetal Medicine at UK HealthCare. O'Brien is also a professor in the Department of Obstetrics and Gynecology in the UK College of Medicine, and the appointed chair of the Kentucky Maternal Morbidity and Mortality Task Force in the state’s Cabinet for Health and Family Services.

The task force is funded by a $5.2 million, five-year grant from the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

The state has a Maternal Mortality Review Committee that determines the causes of maternal deaths and identify opportunities for preventing future deaths, through policy or practice. The panel has documented that substance use, injury and behavioral-health conditions are all common contributing factors to maternal death or maternal illness, also called maternal morbidity.

“In Kentucky, the study of severe maternal morbidities reveals a stark reality that these outcomes are deeply intertwined with health-care disparities,” O’Brien said. “Rural communities and people of color bear a disproportionate burden, highlighting the urgent need to address systemic inequalities in maternal healthcare access and quality.”

O'Brien's task force will work with hospitals, other health-care providers, community partners and state agencies to implement and promote best practices to make birth safer, improve maternal health outcomes and, ultimately, save lives.

The task force will work with state agencies to develop a scorecard to track severe maternal-health issues, using hospital records. The team will also create a data surveillance system to monitor maternal deaths and injuries, with a goal of making this information publicly available.

“Our team also wants to be able to provide critically important hands-on learning opportunities for smaller hospitals to be prepared to handle pregnancy-related complications,” said O’Brien. “We also want to extend and assist coordination of telehealth services to birthing facilities throughout the state as we have shown reduction of severe morbidity in rural communities is possible through telehealth availability.”

The federal grant will also fund bystander-informed violence intervention and prevention training specifically for obstetric health-care providers to address maternal health related to violence.

“In Kentucky, the majority of pregnancy-associated maternal deaths stem from partner or family violence, substance use and anxiety or depression,” said Dana Quesinberry, associate director of the Kentucky Injury and Prevention Research Center and an assistant professor of health management and policy in the UK College of Public Health. “Our goal is to leverage our collective expertise to share violence intervention and prevention training models statewide to make a targeted effort to reduce these types of death.”

“The majority of violence-related maternal deaths ARE preventable. We are firm in our belief that this proactive approach will offer hope to mothers in our state and make a measurable difference in health outcomes,” said Ann Coker, one of the team leaders on the project. She is the Verizon Wireless Endowed Chair in the Center for Research on Violence Against Women and a professor of epidemiology in the Department of Obstetrics and Gynecology.

O'Brien said, “This task force is a comprehensive project involving multiple stakeholders and a crucial step for Kentucky moving forward. By uniting expertise, resources and advocacy, our goal is to ensure every mother receives care and support.”

In addition to the grant, HRSA provided $170,233 to be used for Medicaid redetermination and postpartum-care coverage navigation for pregnant and postpartum individuals and their families. “We have utilized these funds to establish a Perinatal Community Health Worker Program . . . to provide culturally and linguistically matched services to pregnant and postpartum persons in the state,” said Cynthia Cockerham, community program and research director for UK HealthCare’s Division of Maternal Fetal Medicine.

The study team also includes Linda Berry, a registered nurse and perinatal substance use coordinator at UK HealthCare; Public Health Dean Heather Bush, an endowed professor in the Center for Research on Violence Against Women; and Dr. Barbara Parilla, medical director of the UK HealthCare Perinatal Assistance and Treatment Home (PATHways) program and a professor in the Department of Obstetrics and Gynecology.

To inquire about the task force, email Kentucky_MMM@uky.edu. For more information about the Perinatal Community Health Worker Program, email PerinatalCHW@uky.edu.

A webinar to discuss how a new Transforming Maternal Health Model provides opportunities to improve rural maternal-health access will be held at 12:30 p.m. ET April 18. This is the newest model from the Centers for Medicare and Medicaid Services.  At 2 p.m. April 23, the Rural Helath Information Hub is hosting a webinar obstetric readiness in rural facilities without birth units.

Senate sends House bill to have Medicaid cover midwife services

By Sarah Ladd
Kentucky Lantern

Kentucky Medicaid would begin covering licensed certified professional midwife services under a bill the state Senate sent to the House Thursday by a vote of 34-3, after little discussion.

The primary sponsor, Sen. Shelley Funke Frommeyer, R-Alexandria, said the legislation is a chance to “innovate” in Kentucky.

Under her bill, she said, a Medicaid-insured patient with a low-risk pregnancy could have the costs of using a certified professional midwife for a home birth covered by the federal-state program, which already pays for about half of all Kentucky births.

State Sen. Shelley Funke Frommeyer, R-Alexandria

Funke Frommeyer, who is also an advocate for freestanding birth centers in Kentucky, cited previously reported numbers showing the state recorded 177 home births in 1988 and 900 in 2021, said mothers should have “maternity care options,” and gave some:

“We see people doing one of the following: They may forego the care truly desired and plan a hospital birth, which is covered by Medicaid. They may make sacrifices and find a way to pay out of pocket for LCPMs. They may have a home birth without a trained provider — or sometimes without anyone at all.”

Sen. Karen Berg (D-Louisville), a physician, asked if a midwife could do an episiotomy if needed, and Funke Frommeyer said the procedure is within the scope of their practice. An episiotomy is an incision in the tissue between the vagina and the anus, which may be necessary if the baby’s shoulder is stuck behind the pelvic bone, among other reasons. Midwives may also suture the incision.

Bipartisan 'momnibus' bill aims to improve health of mothers, kids

State Rep. Kim Moser, a Republican from Taylor Mill in Northern Kentucky, spoke with other female legislators at a press conference Wednesday to announce their "Momnibus" bill. (Legislative photo)

Kentucky Health News

Legislators are accustomed to seeing "omnibus" bills that deal with many subjects, sometimes related, sometimes not. Now the Kentucky General Assembly has a "momnibus" bill intended to improve the health of children and mothers, including expectant ones.

House Bill 10 was developed by an informal, bipartisan group of female legislators concerned about the state's poor maternal health, said its main sponsor, Rep. Kim Moser, R-Taylor Mill.

"Addressing Kentucky's high maternal mortality rate and saving mothers and babies is obviously a priority for all of us," Moser said at a Wednesday press conference. Kentucky had the nation's sixth highest maternal death rate, 38.4 deaths per 100,000 live births, from 2018 through 2021. The national rate for that period was 23.5 per 100,000.

More than 90% of the state’s maternal deaths are preventable, Dr. Jeffrey M. Goldberg, legislative advocacy chair of the Kentucky chapter of the American College of Obstetricians and Gynecologists, told a state Senate committee last year. Just over 14 percent of Kentuckians lack access to adequate prenatal care, according to the March of Dimes.

Moser, a mother of five who was a neonatal intensive-care nurse, spoke from her own experiences: “I’ve really worked with mothers and babies and sick newborns, in their newborn phase, oftentimes through their first year, and I was able to really see some of the reasons for poor health disparities, especially in our poor areas of our state.”

Citing the advocacy group Every Mother Counts, Moser said “The leading causes of maternal death in the U.S. [are] lack of access to health care, including a shortage of caregivers, a lack of insurance, inadequate postpartum supports and certainly socioeconomic disparities, including the stress of racism and discrimination.” In Kentucky, she added, the risks are greater because of the prevalence of heart disease and diabetes.

HB 10 would:

• Add pregnancy to the list of "qualifying life events" that allow people to get health-insurance coverage outside normal enrolment, which could encourage more prenatal care.
• Create the Lifeline for Moms Psychiatry Access Program, for which Kentucky has received a $750,000 grant. Moser said she will also ask for an appropriation in the state budget “to make sure that’s a sustainable program.” It would be required to operate a hotline from 8 a.m. to 5 p.m. Mondays through Fridays.
• Expand the HANDS (Health Access Nurturing Development Services) home-visitation program for new and expectant parents to include breastfeeding counseling and assistance, education on safe sleep, as well as expanding the program to include telehealth, which Moser said she believes will help “reach moms in underserved areas or areas where she may have a transportation issue.”
• Require the Cabinet for Health and Family Services to study and make recommendations about the role of doulas, who provide assistance with the birth experience. 
• Strengthen an advisory council that provides policy guidance to increase collaboration, improve data collection, and suggest additional improvements.

Some Kentucky Republican legislators began paying more attention to such issues after the U.S. Supreme Court eliminated the federal right to abortion, activating a state "trigger law" that bans abortion except to save the mother's life or prevent permnent damage to a life-sustaining organ. 

"The wide gulf between abortion-rights and anti-abortion lawmakers was felt when Moser invited Addia Wuchner, executive director of the Kentucky Right to Life Association, to speak at the end of the press conference," reports Rebecca Grapevine of the Courier Journal. "That prompted most of the assembled Democratic lawmakers . . . to quietly walk out of the room."

State Rep. Sarah Stalker

One Democrat who remained, Rep. Sarah Stalker of Louisville, told the Courier Journal, "If we're going to force people to have children when they are not prepared to, when they are not ready to, when they are not interested in the family, it is critical that we give them the access to the health insurance . . . It doesn't help me and it doesn't help Kentucky, you know, Kentuckians at large and particularly women, to dig in my heels."

The second listed sponsor of the bill is Rep. Nancy Tate, R-Brandenburg, a leading anti-abortion legislator. Other Republican sponsors are Reps. Danny Bentkey of Russell, Emily Callaway of Louisville, Stephanie Dietz of Edgewood, Robert Duvall of Bowling Green, Ken Fleming of Louisville, Mark Hart of Falmouth, Kiom KIng of Harrodsburg, Amy Neighbors of Edmonton, Rebecca Raymer of Morgantown, Tom Smith of Corbin, Nick Wilson of Williamsburg and Susan Witten of Louisville.

Besides Stalker, the bill's Democratic sponsors are Reps. Lindsey Burke and Cherlynn Stevenson of Lexington. Democratic Reps. Lisa Willner of Louisivlle and Rachel Roberts of Newport initially attended the press conference but left and are not listed as sponsors.

Information for this story was also provided by the Kentucky Lantern.

Baby death rate fell 6% in Kentucky in 2022 while it increased nationally and in most states that border Kentucky, CDC reports

By Al Cross

Kentucky Health News

For the first time in 20 years, the rate of infant mortality in the U.S. showed a statistically significant increase in 2022, according to preliminary data from the Centers for Disease Control and Prevention. The national baby-death rate rose 3 percent from 2021, but in Kentucky it dropped 6 percent.

The rate measures the percentage of babies who died before their first birthday. The national rate rose from 5.44 deaths per 1,000 births in 2021 to 5.6 per 1,000 in 2022. Kentucky's rate fell from 6.15 in 2021 to 5.77 in 2022 and now ranks 28th among the states. In 2021, the state ranked 17th.

Cabinet for Health and Family Services graph; click to enlarge

Kentucky's infant-mortality rate has usually been higher than the nation's, reflecting its status as a poor state with lower-than-average health, but in 2019 its rate was 4.9 deaths per 1,000 births and the national rate was 5.6 per 1,000.

The state has fared worse in maternal mortality, the rate of women who die while pregnant or within six weeks of givign birth. It led the nation in 2021. Last year, when it ranked sixth nationally, state officials extended postpartum Medicaid coverage to one year after birth; it had lasted for only 60 days.

Infant mortality declined in Kentucky and 17 other states in 2022, led by Nevada at 22 percent, followed by Alabama, New Hampshire, Arkansas, Alaska, Colorado, Connecticut, Rhode Island, Minnesota, South Carolina and Kentucky.

Following Kentucky on the list of states with decreases were Mississippi, which still had the nation's highest rate, 9.11 per 1,000; North Carolina, 6.49; Oklahoma, 6.89 (all down about 3%); and Illinois, 5.59 (down 1%).

Most bordering states showed an increase in rates: Ohio, 7.11 (up 1%); Virginia, 6.21 (up 4%), Indiana, 7.16 (up 6%); Tennessee, 6.61 (up 7%); West Virginia, 7.32 (up 8%); and Missouri, 6.77 (up 16%). Arkansas continued to have one of the higher rates, 7.67 per 1,000, but had one of the bigger decreases, 11%.

Experts were uncertain of the reasons for the national increase. They noted increases in maternal complications and cases of bacterial meningitis, influenza and respiratory syncitial virus (RSV), both of which "rebounded last fall after two years of pandemic precautions, filling pediatric emergency rooms across the country," Mike Stobbe of The Associated Press reports.

"The U.S. infant mortality rate has been worse than other high-income countries, which experts have attributed to poverty, inadequate prenatal care and other possibilities," Stobbe notes. "But even so, the U.S. rate generally gradually improved because of medical advances and public-health efforts."

Proponents of freestanding birthing centers say they have a better bill, but hospital association keeps lobbying against it

Kentucky Hospital Association President Nancy Galvagni opposed the idea. (Image via Kentucky Lantern)

By Sarah Ladd

Kentucky Lantern

Two Kentucky legislators who have championed freestanding birth centers said Monday that they have agreed to concessions in their latest proposal, but the head of the state’s hospital association and two obstetrician-gynecologists testified that the changes are not enough to protect patients.

Advocates for each side of the years-long debate spoke Monday before the Interim Joint Committee on Licensing, Occupations, & Administrative Regulations, as Kentucky lawmakers consider changes in the state’s certificate-of-need law, which has been used to block the opening of freestanding birth centers.

Both sides agree on at least one point: Safety of the baby and the person giving birth is the most important consideration.

The Kentucky Hospital Association and two OB-GYNs testified that birth is unpredictable, and hospitals are best equipped to handle complications like hemorrhage.

The idea behind certificate-of-need laws is to limit health-care costs. Thirty-five states and Washington D.C. had such laws as of December 2021.

To obtain a certificate in Kentucky, a freestanding birth center would have to prove there is a lack of similar services. These facilities are home-like settings for low-risk births and do not offer services like surgery.

The existence of the requirement makes it nearly impossible to get centers in the state. Kentucky hasn’t had any since the 1980s, Mary Kathryn DeLodder, the director of the Kentucky Birth Coalition, testified previously.

Meanwhile, hundreds of Kentuckians seeking to give birth outside a hospital are traveling to neighboring states that have freestanding birth centers for the service.

A longtime sponsor of freestanding birthing center legislation, Rep. Jason Nemes, R-Louisville, told his colleagues that “over the years we’ve made a lot of improvements, a lot of changes” in proposals to satisfy the hospital association and The American College of Obstetricians and Gynecologists (ACOG).

Nemes testified alongside Sen. Shelley Funke Frommeyer, R-Alexandria, who sponsored legislation on the issue in the 2023 session, and DeLodder.

They told the committee that their new legislation would limit birth centers to four beds, include language to address the need for malpractice insurance, and unifying language that defines the centers across all state laws. The result, Funke Frommeyer said, will be a “very attractive” piece of legislation in 2024. But hurdles to a law passing remain.

Childbirth: ‘Normal until it’s not’

Going through labor and giving birth is “normal until it’s not,” said Dr. Dan Goulson, chairman of the physician leadership forum in the hospital association, the chief medical officer for the CHI St. Joseph’s Health System and a board-certified anesthesiologist.

“Once it’s not normal anymore, time is critical,” Goulson told lawmakers.

St. Elizabeth Healthcare obstetrician Dr. Allana Oak said she handles many transfer births in Northern Kentucky, and “Catastrophic things can happen during childbirth.”

She asked, “And in areas where there is limited access to care, do we really want to create legislation that can put a birthing center far from a birthing hospital because then you cannot deal with it in a timely fashion?”

Nancy Galvagni, president and CEO of the hospital association, said hemorrhage is a top problem that’s both unpredictable and not treatable at a birthing center.

“We feel that removing birthing centers from certificate of need and weakening the licensing standards would put women and babies at risk,” Galvagni argued. “This is really going to roll back decades of progress in maternal care.”

These witnesses said they’re not opposed to the freestanding birthing center model of care, but argued that such facilities should be covered by certificate of need laws, should have transfer agreements with hospitals, and an OB-GYN in a director's position.

On the other hand, Nemes said, “In Kentucky, you can have a birth at home. A lot of the women who would be choosing this option would otherwise have them at home. So it’d be a more safe environment for that person.”

Committee Co-Chair Sen. John Schickel, R-Union, also seemed to lean into Nemes’ point.

“For me, it boils down to this,” Schickel said. “Is there anywhere geographically in Kentucky you’re not allowed to have a home birth?”

Oak’s answer: “No.”

“It’s not against the law to be high risk and deliver at home,” she said, adding that she wants mothers to have informed consent. “That’s a choice that every mother can make.”

When rural hospitals stop delivering babies, fewer expectant mothers receive prenatal care, Iowa study finds

University of Missouri Health Care photo

When rural counties lose their last labor-and-delivery unit, fewer expectant mothers in those counties get adequate prenatal care, even though that care is still available, according to a University of Iowa study.

 “Our study reflects continuing problems in our maternal health system in general, and in rural areas in particular,” Tom Gruca, co-author and professor of marketing, said in a news release. “It suggests a breakdown of maternal health care in rural areas.”

The study, published in the Journal of Rural Health, looked at the impact of the closure of seven labor and delivery units in 2018 and 2019 in rural Iowa, where prenatal care continued after the closure of those units. 

The researchers found that 18 percent of expectant mothers were making an inadequate number of prenatal care visits to a doctor in those hospitals before the closings. Following the closing, that number increased to 22%. “And 18% is not a great number, to begin with,” Gruca said.

Research shows that prenatal care reduces preterm birth and low birth weight babies. 

"All women in rural counties where the only labor-and-delivery unit closed have a 24% higher likelihood of having inadequate prenatal care compared to those in counties that still have a unit. For women enrolled in Medicaid, the difference is even more pronounced, with a 38% higher likelihood of receiving inadequate prenatal care," says the release. 

The researchers said the drop in prenatal-care rates might be attributed to expectant mothers' thinking that the hospital did away with all maternity services when the labor-and-delivery unit closed. They said poor mothers' access to prenatal care is complicated because not all health care providers accept Medicaid. 

Gruca said one solution could be creation of a central source of information that expectant mothers can use to find health-care professionals who provide the care they need and accept the insurance they have.

Too many pregnant Kentuckians and babies in 'maternity deserts' and Ky. has no birthing centers; midwives say they could help

Laura Browning, an Eastern Kentucky doula and midwife student, with her four children in a selfie.

By Sarah Ladd
Kentucky Lantern

During three of her four pregnancies, Laura Browning drove three hours round-trip past hospitals to get prenatal care from midwives in Lexington, the only place that offered what she needed.

She even made the trip while in labor with her first baby, feeling that “the care that I was receiving” from midwives “was worth that risk” of birthing in her car.

As deaths from pregnancy rise in the United States, Browning and other advocates say Kentucky could fill gaps in prenatal care by educating and certifying more midwives, attracting more to the doula profession and encouraging the creation of freestanding birth centers in the state.

The shortage of care for pregnant people is documented in a recent March of Dimes report, “Nowhere To Go: Maternity Care Deserts Across the U.S.”

More than 2 million Americans, most of them rural, live in “maternity care deserts,” defined in the report as having “no hospitals providing obstetric care, no birth centers, no obstetrician/gynecologist and no certified nurse midwives.”

In 2021, 14.2 percent of mothers received inadequate prenatal care, says the March of Dimes, which gave Kentucky an F on its annual report card this year, making it one of just nine states (plus Puerto Rico) to get a failing rating.

Almost half of Kentucky’s 120 counties — 48% — are maternity-care deserts, according to the March of Dimes study.

Prenatal care provided by midwives has been shown to prevent costly complications in mothers and babies, including cesarean deliveries and low birth weights. The March of Dimes reports that “midwifery care has been associated with an increased chance of having a low-intervention birth and lower cost of care due to significantly lower odds of medical intervention.”

Yet only about 8% of births in the U.S. are attended by midwives. In Kentucky, 700 to 800 babies are born every year outside hospitals, and are usually delivered with midwives present. There were 51,688 live births in Kentucky in 2020.

Certified nurse-midwives and certified midwives are accredited by the Accreditation Commission for Midwifery Education and pass national exams after graduate-level studies, according to the American College of Nurse Midwives.

The midwives and midwifery students who spoke with the Kentucky Lantern expressed passion for serving their communities and reported low rates of transfer to hospitals, easing the burden of hospital staff shortages.

Mary Harman

Also, midwives can provide important inclusive services to people who are “beyond the binary,” said Mary Harman, the only midwife within a two-hour drive from Pike County who travels that far for clients.

“Not every person needs an OB-GYN,” Harman said, but they cannot accept insurance or Medicaid, which is another barrier to their practice, Canary Nest Midwifery.

Research also suggests that freestanding birth centers, which are staffed by midwives and offer holistic birthing options for people who qualify, reduce the cost of care while producing higher patient satisfaction.

Kentucky is in the minority of states that have no freestanding birth centers. The American Association of Birthing Centers reports that more than 384 freestanding birthing centers are operating in 37 states and the District of Columbia, a 97 % increase since 2010.

Advocates attribute the lack of birthing centers to the difficulty of obtaining the state-required certificate of need in the face of opposition from hospitals that can mount costly legal battles, such as the one waged by three hospitals against a retired Army officer who tried to open a birthing center in Elizabethtown.

She prevailed in Franklin Circuit Court, which overturned a hearing officer’s denial of a certificate of need, but was forced to give up in 2017 when the hospitals won on appeal.

Rep. Jason Nemes, R-Louisville, has sponsored legislation in the past to remove the certificate-of-need requirement for birthing centers and will continue to support them. He has called the law mandating the certificate “very cumbersome.”

In 2019, the legislature did take action aimed at licensing more certified professional midwives, after the Kentucky Hospital Association and Kentucky Medical Association dropped their years of opposition.

The results have been underwhelming. In the almost four years since the law was enacted, the number of certified nurse-midwives and certified midwives in Kentucky has increased by only 12 — to 131 providers, reports the American Midwifery Certification Board.

Some hospitals have doula and midwife programs, such as the University of Kentucky’s midwife clinic and Norton Healthcare’s doula program.

Among the barriers to increasing midwifery care in Kentucky is the $1,000 cost of renewing a Certified Professional Midwife license. Compare that with $110 in Tennessee, $200 in California or $322 in New York.

Earlier this year, Kentucky took advantage of an opportunity in the American Rescue Act Plan to put in place one of the March of Dimes recommendations by increasing postpartum care under Medicaid from 60 days to 12 months. The change will allow an estimated 10,000 Kentucky mothers to maintain their health coverage for one year after giving birth.

Stark racial disparities in maternal mortality

The March of Dimes reports that deaths from pregnancy are increasing in the United States, which already has one of the highest maternal death rates among high-income countries.

About 900 women in the U.S. died from pregnancy-related issues in 2020, up 14% from 2019 and up a whopping 30% from 2018. Sixty-three percent of pregnancy-related fatalities are preventable, says the report. In Kentucky, preterm births increased in 2021 to 12%, up from 11% in 2020.

Pregnancy is especially dangerous for Black Americans, who are three times more likely to die from pregnancy than their white counterparts. Conversely, white women are more likely to have access to good prenatal care than Native, Black, Pacific Islander, Asian and Hispanic women. 

Those stark disparities are not lost on the expectant mothers who turn to doulas to guide them through their pregnancies and births. Doulas provide moral, physical or other support to pregnant people throughout pregnancy, delivery and postpartum.

Meka Kpoh, a doula in Louisville, founded the nonprofit Black Birth Justice to help mothers and babies get off to a healthy start all the way through the critical postpartum period. She has been in birth work long enough that the March of Dimes report wasn’t news to her.

She said these gaps in care should be taken seriously.

“The maternity care deserts aren’t going to just erase themselves,” said Kpoh, who is also in training to be a midwife. “It’s not going to be like next year there’s going to be a new hospital and every community has a hospital at least 30 to 40 minutes away. That’s not going to happen, at least not anytime soon. So it’s really important for there to be options for families like licensed certified home birth midwives.”

Kpoh said many of the clients she sees are driving hours from rural areas. “It’s really insane to me,” she said, “that we are their only option.”

In addition to more doulas and midwives, she said Kentucky needs freestanding birthing centers.

“Pregnant people are driving three hours just to get prenatal care, just to give birth, just to have postpartum appointments,” she said. “It’s ridiculous.”

To get the kind of care they want, Kpoh said many pregnant people end up facing a difficult choice: “Either they drive three hours to a hospital or they catch their baby by (themselves),” she said, adding: “I don’t recommend that for anyone.” 

Renee Basham, a doula, founded the nonprofit community doula program Hope’s Embrace to help pregnant people who are often cut off from help. Basham and her 30 doulas serve those who are unhoused and those with drug addictions.

“You’re not necessarily treated well if you are by yourself,” said Basham. “And so having people … vouch for you, or speak up for you or remind you to speak up for yourself … all of that … contributes to better outcomes.”

 
The stigma of going against the norm

Anihhya Trumbo, a doula who serves the Lexington area, said there remains a stigma about birth outside a hospital.

“Kentucky is a state where it’s always been preached that doctors know best,” she said. “It’s a bit of a taboo if you go outside of what is … considered the norm here.” 

Doula and midwife-assisted birth isn’t a new thing, either, she said.

“This is something that’s been going around since the beginning of time,” said Trumbo, who is also a military veteran. “We just got Western medicine and that’s what changed the norm but home birth and having the natural birth — that’s how we got here.”

Browning was so committed to midwifery care for herself that from six weeks gestation to birth, she drove three hours for her prenatal appointments. She’s now living in Laurel County but lived in Estill at the time of that first pregnancy.

Already a doula, Browning told the Kentucky Lantern that she is in midwifery school herself now “because women should not have to drive that far for care.”

“It’s definitely a need that we have here.”

With no exceptions for rape or incest, Kentucky's near-total abortion ban can force children as young as 9 to deliver a baby

Courier Journal graphic; for a larger version, click on it; to download, right-click.

While pregnancy in very young girls is rare, it does happen. 

"In Kentucky, the two youngest patients to receive an abortion over the past two years were age 9. Under Kentucky law, sexual intercourse with a 9-year-old is considered first-degree rape," Deborah Yetter reports for the Louisville Courier Journal.

"In 2021, and again this year, one 9-year-old each year had a pregnancy terminated, according to data from the Kentucky Office of Vital Statistics obtained by The Courier Journal through an open records request. The records provide no other details about the individuals. In all, 34 girls ages 15 or younger received abortions in 2021, according to state statistics, with 16 generally regarded as the age where minors are able to consent to sexual intercourse."

As the laws stand today in Kentucky, those abortions would be illegal, even if a pregnancy resulted from rape and despite the age of a parson, Yetter notes. 

That's because a ban on almost all abortions in the state was triggered when the U.S. Supreme Court overturned Roe v Wade, the 1973 decision that created a constitutional right to abortion. The law has exceptions to prevent the woman's death or serious impairment of a life-sustaining organ; a law revived by the court decision bans abortion after six weeks of pregnancy.

A Louisville judge blocked the law pending resolution of a lawsuit against it, but a Pikeville judge on the Court of Appeals vacated that ruling, and the Supreme Court left it in place until it hears arguments in the case Nov. 15. The Nov. 8 ballot has a referendum that would make the case moot by making the state constitution say it guarantees no right to abortion or funding of it.

Yetter reports that such stringent abortion bans outrage abortion-rights advocates, including medical professionals who care for young girls.

"Do we expect a fourth-grader to carry a pregnancy to term, deliver and expect that child to carry on after this horror without permanent psychological trauma," asked Dr. Anne-Marie Amies Oelschlager, a University of Washington professor of pediatric and adolescent gynecology. "Are we really expecting this of our pregnant youth, even if the pregnancy may not result in death?"

Furthermore, Oelschlager said, young girls and teens aren't physically mature enough to carry a pregnancy to term, which increases risks to the patient as well as the fetus. Her comments were provided by the American College of Obstetricians and Gynecologists, which considers abortion to be essential health care.

Abortion opponents in Kentucky appear unwilling to allow exceptions beyond those in the trigger law. 

Rep. Joe Fischer, R-Fort Thomas, told a legislative committee in 2019 that the trigger law, which he was sponsoring, "will reflect what I think are Kentucky values and will protect all human life from the moment of conception." Fischer is running to unseat state Supreme Court Justice Michelle Keller in a nonpartisan election.

Addia Wuchner, executive director of the Kentucky Right to Life Association, declined to say whether an exception should be made for girls as young as 9 who become pregnant. Instead, she asked who was there to protect that child and whether the rape had been reported to the authorities. "It is still a life that has been formed," she told Yetter. "All life is sacred and we're in an area where this child, this unborn child, is being punished because of the father."

Planned Parenthood disagrees. 

“Every person, in every circumstance, deserves access to health care when and where they need it," Katie Rodihan, a spokeswoman for the six-state Planned Parenthood group that includes Kentucky, told Yetter. "Shame on lawmakers in Kentucky for abandoning victims of rape and incest ― including children ― and subjecting them to the immense trauma of forced pregnancy by their predator. This law is cruel and inhumane."

Yetter reports that Kentucky's abortion numbers for 2021 are not available, but in 2020, 4,104 abortions were performed, with 36 of the patients 15 or younger; 368 were 19 or younger, according to a state report.

Young mother who had a rare Stage 4 cancer is now in remission

Anne Sydney Parrish and family (Photo by Amani Nichae) 

By Elizabeth Chapin
University of Kentucky

With around-the-clock feedings, diaper changes and sleepless nights, the weeks after bringing home a new baby can feel surreal and overwhelming.

After giving birth to a healthy baby girl on Aug. 21, 2020, Anne Sydney Parrish of Lexington was ready for the joys and challenges that come with adjusting to life with a newborn.

Then, Parrish’s world was turned upside down in a way she could have never imagined.

A day after having her daughter, Parrish noticed abdominal pain but figured it was an expected side effect. After all, she’d just had a cesarean section. But day after day, the pain continued. And worsened.

“I thought it was maybe gas or heartburn, and I took over-the-counter medications, but nothing really helped,” Parrish said. “It would almost be okay one day, and then the next the pain would be back.”

After one particularly bad morning, Parrish realized the pain wasn’t a normal part of postpartum recovery. Something wasn’t right.

Her brother-in-law, an emergency-room doctor, insisted she go to an ER for a CT scan. The scan showed a bowel obstruction and Parrish underwent emergency surgery the next morning to remove the mass from her colon.

Five days later the 33-year-old was diagnosed with Burkitt lymphoma, a rare type of blood cancer.

As a physician assistant, Parrish says she’d heard of Burkitt lymphoma, but didn’t know details of the diagnosis because it was so uncommon. And like many other patients, she couldn't keep herself from looking to the internet for more answers.

“The first things I read online were that ‘It's rare and very aggressive’,” Parrish said. “So I’m thinking I'm going to die.”

Burkitt lymphoma can be rapidly fatal if left untreated. Parrish needed to act fast.

Hours after her diagnosis, she and her husband were in an appointment at the UK HealthCare Markey Cancer Center, developing a plan for treatment. She had a positron emission tomography (PET) scan, which showed her lymphoma was stage 4, and it had spread throughout her abdomen.

Burkitt lymphoma is a type of b-cell lymphoma, a group of cancers that affect the immune system. Fast-growing b-cell lymphomas can be deadly because they release toxins that can damage vital organs and cause many other adverse effects. But when treated early and aggressively, outcomes for patients with Burkitt lymphoma are good, says Dr. Chaitanya Iragavarapu, a member of the hematology and blood-and-marrow transplant team at Markey, and part of Parrish's larger care team.

“With an exceptionally aggressive lymphoma in such an advanced stage, Mrs. Parrish needed to begin treatment immediately,” Iragavarapu said. “The good news for Mrs. Parrish is that Burkitt lymphoma does have high rates of remission for patients that start treatment right away.”

Parrish was admitted to Markey’s inpatient unit in the Albert B. Chandler Hospital four days after her diagnosis and just four weeks after the birth of her daughter. She stayed there for the next 15 days as she took intensive chemotherapy treatments daily.

For two weeks, she wasn’t able to hold her newborn, and it was also the longest she’d been away from her 4-year-old daughter. Parrish says it was hard on her and her family, but also a blessing.

“UK was the only hospital in the area that had the ability to treat my type of lymphoma because it was aggressive and required inpatient chemotherapy,” Parrish said. “Living in Lexington, I was so thankful that this level of care was right in my backyard. I know there are so many people that drive hours to come to Markey.”

Treatment lasted more than five months. Parrish had than 570 hours of chemotherapy, plus transfusions, lumbar punctures, bone-marrow biopsies, and near-constant CT scans, MRIs and ultrasounds.

Family and friends rallied to support her. Parrish’s mother and mother-in-law moved in to help care for her and her daughters.

“I remember after I got out of the hospital the first time, I was too weak to really do anything, even put my daughter to bed at night. I'd just had two surgeries, I had a C-section and then a colon resection, so I was swollen and distended and I was in a lot of pain,” Parrish said. “Honestly, I was so sick for the first six months of the baby's life that I was afraid she wouldn’t know who I was. I was in bed most of the time.”

The chemotherapy took an emotional and physical toll. But it was working.

Her last treatment was on Jan. 10, 2021. In February, she got the word that the cancer was in remission. Parrish says she was amazed that the treatment worked so well, and so quickly.

“It's like one of those things, where it was almost gone as quickly as it came on,” she said. “But gosh, my body went through so much in order to get the cancer to go away. But from the very beginning, I knew I was in good hands with the team at Markey. My doctors and nurses became like family.”

“Her primary oncologist and team at the time moved very, very quickly in terms of trying to get her started on the right chemotherapy combination,” said Iragavarapu. “And that essentially saved her life.”

Parrish’s latest scan shows no signs of cancer. Iragavarapu says Burkitt lymphoma, especially if it's responsive to chemotherapy, is unlikely to come back once in remission.

“Two years ago, my life changed in an instant. This experience just made me appreciate my health and my family a lot more than I did before,” Parrish said. “It's easy to get caught up in little things and in everyday life. It’s such a blessing to have my kids and my family.”

Beshear allows 'born alive' bill to become law without his signature; it's the first anti-abortion bill he has not vetoed

Gov. Andy Beshear has allowed to become law without his signature an anti-abortion bill that the legislature would have enacted anyway if he had vetoed it, and that critics say is unnecessary.

The new law requires medical providers to give “medically appropriate and reasonable life-saving and life-sustaining medical care and treatment to preserve the life and health of a born-alive infant,” including after a failed abortion. It also requires them to give any “nourishment, medical care, medical treatment and surgical care that is medically appropriate.”

The bill was the first anti-abortion measure not vetoed by Beshear, who had the backing of abortion-rights supporters when he ran for governor in 2019. His office declined to comment.

Samuel Crankshaw, a spokesman for the ACLU of Kentucky, told Daniel Desrochers of the Lexington Herald-Leader, “We are incredibly disappointed Governor Beshear allowed Senate Bill 9 to become law. It is an inflammatory law that was motivated purely by politics and has no basis in the real-life practice of medicine. Lawmakers heard from a physician and advocates who testified to these facts, yet they still passed the legislation to score cheap political points.”

Sen. Karen Berg, D-Louisville, said as the Senate passed the bill that it could force doctors to try to save an infant not mature enough to survive. “As a practicing physician who understands better than most in this room the limits of what medicine can and cannot do, I cannot vote for a bill that requires for a physician to do something that is not doable,” she said.

The next day, Dr. Brittany Myers, an obstetrician-gynecologist in Louisville, told a House committee that it would only apply to miscarriages, since abortions can’t be performed in Kentucky after 20 weeks of pregnancy. Before that, a fetus is not viable, and there are already standards of care for physicians to follow to care for a child that is born prematurely, she said.

“This bill does not address any real-world problem in the setting of abortion care in the state of Kentucky,” she said. “This bill’s intent, I believe, is to shame patients and threaten providers and further limit access to abortion care.”

The bill's sponsor, Sen. Whitney Westerfield, R-Crofton, said, “We’re not asking for extraordinary measures. We are asking for medically appropriate and reasonable measures.”

Told what Beshear had done, Westerfield told the Herald-Leader, “I’m disappointed he didn’t sign it, but I’m grateful he didn’t veto it. I’ll take what I can get.” He noted that it "became law on the 48th anniversary of the Roe v. Wade decision, which legalized abortion in every state," Desrochers writes.