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.

'Momnibus' bill to improve maternal health passes on final day, after being attached to another bill to avoid floor fight on abortion

Rep. Kim Moser presents SB 74
to the state House (Ky. LRC photo)

By Melissa Patrick and Al Cross
Kentucky Health News

On the last day of the 2024 legislative session, a bipartisan bill aimed at improving Kentucky's dismal maternal-mortality rate was finally passed, after parliamentary maneuvering to avoid divisive issues.

Provisions of House Bill 10, known as the "Momnibus" bill for its varied approach, were added to Senate Bill 74, a bill to require analysis of child and maternal fatalities and add reporting requirements.

The Momnibus bill, sponsored by Republican Rep. Kim Moser of Taylor Mill, came from an informal, bipartsan House-Senate workgroup of female legislators who tackled a big problem: the nation's second highest rate of death of mothers in the year following childbirth. 

From that came a multifaceted bill that 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, and several other things.

It 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-visiation 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.

Democratic Sen. Cassie Chambers Armstrong of Louisville told the Senate that Moser "brought together a bicameral, bipartisan group of women legislators and "This is a truly great piece of legislation that will absolutely save lives."

The final bill dropped controversial language that added by a Senate committee. It would have required all hospitals, birthing centers and midwives to refer patients to a perinatal palliative-care program if the patient had a prenatal diagnosis that indicated a "baby" might die before or after birth. Kentucky abortion law does not allow for the termination of such pregnancies, though it is considered a standard of care for a nonviable pregnancy.

Abortion prompted the parliamentary maneuvering. Democratic senators filed floor amendments to Moser's HB 10 to change "baby" to "fetus"; let a physician terminate a pregnancy if it is complicated by a fatal fetal anomaly, or in the good-faith belief that the pregnancy was caused by rape or incest. To avoid a Senate floor fight over the issue, Moser looked for another vehicle.

She found SB 74, sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, with an apt title. "I saw 'An act relating to maternal health'," she recalled. "It was germane, and apropos. . . . It works really well with the underlying bill."

Funke Frommyer said SB 74 was viewed favorbaly by a House committee, but didn't get a floor vote before legislators recessed to give Gov. Andy Beshear time to veto legislation and give them time to override his vetoes. Moser said the House considered the bill safe from a veto because it was non-controversial.

The original parts of SB 74 require the Cabinet for Health and Family Services to publish a report on its website for the most recent five years of available data on the number and types of delivery procedures for pregnancy by hospital.  It also has cleanup language for a number of health-cabinet programs.

The revised, combined bill passed the House 91-1, with Rep. Courtney Gilbert, R-Hodgenville, voting against it. On the House floor, Rep. Lindsey Burke, D-Lexington, praised the bill and Moser's work.

 "I have never been more delighted, proud or excited to vote for any single piece of legislation," Burke said. "It is a gift to the families of the commonwealth. I thank her for her hard work." 

The Senate agreed to the changes on a 29-5-2 vote, with Republicans Greg Elkins of Winchester, Jimmy Higdon of Lebanon, Chris McDaniel of Ryland Heights, Robby Mills of Henderson and Stephen West of Paris voting no and Republicans Donald Douglas of Nicholasville and Adrienne Southworth of Lawrenceburg passing. Republican John Schickel was absent.

Sen. Amanda Mays Bledsoe, R-Lexington, told the Senate, "I thought it was fantastic to have a Kentucky-crafted legislation that looked at solutions for us and not other states. . . . I just complement the bill sponsors and members of that working group for the good work."

Abortion did hit the Senate floor late in the day, as Sen. David Yates, D-Louisville, tried to bring up his SB 99, which would have added rape and incest exceptions to state abortion laws. Senate leaders ruled his action out of order, and when he appealed the ruling, senators upheld it largely along party lines.

'Momnibus' bill nears passage with change to require hospitals, birthing centers and midwives to offer perinatal palliative care

By Melissa Patrick
Kentucky Health News

A House-approved bill aimed at reducing maternal-mortality rates in Kentucky was approved without dissent by the Senate Health Services Committee on March 22 and sent to the Senate on the consent calendar, reserved for bills that are passed without debate.

State Rep. Kim Moser

"Kentucky has the ranking as second in the nation in maternal deaths in the year following childbirth," said the bill's sponsor, Rep. Kim Moser, R-Taylor Mill. "For this reason, we really started looking at some of the most significant problems and how to solve them."

Moser's House Bill 10 passed the House without disssent on March 5 and awaits a vote on the Senate floor with only six days left on the legislative calendar. 

The "Momnibus" bill would expand the Health Access Nurturing Development Services (HANDS) program and would allow the home-visitation program to be available up to three years after a child’s birth. It also would cover lactation consultation and needed equipment to encourage breastfeeding, and would educate mothers on the benefits of safe sleep for infants. These services would also be available via telehealth.

The bill would also ensure access to insurance coverage for pregnant women by adding pregnancy to the list of reasons a person would qualify for enrollment outside the normal open-enrollement period. This provision aims to help pregnant women address issues like obesity, diabetes and heart disease, all of which can cause complications and even death in pregnancy. 

"Deaths due to any of these factors are usually preventable," Moser said.

The bill would also address mental-health care by establishing a hotline for providers to get an immediate consultation for a mother in need of mental-health services. The hotline would be called Lifeline for Moms. It also aims to strengthen addiction services for those in need. 

"Our substance-use problem is one of the most significant issues," said Moser, noting that 53% of mothers who die in the year after childbirth "die from their substance abuse problem." 

The bill also has a provision to study doula programs and their benefit to those most at risk of poor maternal outcomes. Doulas provide moral, physical or other support in pregnancy, delivery and the postpartum period. 

What's in the committee substitute? 

The Senate committee substitute for the bill added language to require all hospitals, birthing centers and midwives to "provide or make referrals to a perinatal palliative care program, or perinatal palliative care support services" when there is a "prenatal diagnosis indicating that a baby may die before or after birth, diagnosis of fetal anomalies where the likelihood of long-term survival is uncertain or minimal or (the) newborn is diagnosed with a potentially life-limiting illness." The bill would also require this service to be covered by insurance. 

This addition comes from language in House Bill 467, sponsored by Rep. Nancy Tate, R-Brandenburg. It is titled the "Love Them Both Part II Act." Alex Acquisto of the Lexington Herald-Leader expands on the tension caused by HB 467 saying it is intended to offer "alternatives to pregnancy termination." 

Acquisto reports that "termination is one of the handful of options considered the standard of care health care providers present to patients with nonviable pregnancies," but with abortion illegal in Kentucky, this is not an option unless they go to another state for those services. 

Further, health care providers have told the Herald-Leader that such services already exist in hospitals across the state, thought not always in a formalized program.

HB 467 cleared the House Health Services Committee , which Moser chairs, on March 7. At that time, Kentucky Health News asked Moser, who is a primary co-sponsor of the bill, if she anticipated a greater need for perinatal palliative care since the state no longer allows abortions for nonviable pregnancies if there is cardiac activity present.

"I don't know that we're going to see a sudden uptick, but we just want to be available to moms and families," she said, adding later, "The intent is to provide support to a family who is dealing with a devastating diagnosis." 

The substitute bill would also require Safe Haven Baby Boxes to be staffed continuously by a licensed emergency-medical-services provider except when personnel are temporarily off-site providing emergency medical services. It also would require every public school to prominently display the Safe Haven Baby Boxes Crisis Line. This  language comes from House Bill 272, also sponsored by Tate.

House passes 'Momnibus' bill with measures for maternal health

Rep. Kim Moser speaks about her 'Momnibus' bill. (LRC photo)

By Isabella Sephaban
Kentucky Lantern

A maternal-health bill nicknamed “Momnibus’ was unanimously approved by the Kentucky House Tuesday after about 20 minutes of discussion.

The bipartisan House Bill 10 came out of a working group of Republican and Democratic women in the House and the Senate.

The Momnibus legislation would expand the Health Access Nurturing Development Services (HANDS) program and allow such home-visitation programs to be available up to three years after a child’s birth. It also would educate mothers on topics such as the benefits of breastfeeding, safe sleep for infants, and provide lactation consultation and equipment. These services would also be available via telehealth.

Supporters say Momnibus addresses Kentucky’s high rate of maternal deaths following childbirth.

Rep. Kimberly Poore Moser, the bill’s main sponsor, said “53 percent of women who die in the year following childbirth die as a result of their substance-use disorder.”

Other factors that increase maternal mortality include diabetes, heart disease and mental illness.

“These are all made more difficult during and after pregnancy, and can cause dangerous situations,” said Moser, a Republican from Taylor Mill in Northern Kentucky.

Although these situations are harmful and at times, even deadly, Moser said that “deaths due to any of these factors are usually preventable, and the ways to prevent these deaths are to identify and treat these diseases early in the pregnancy, if not before.”

“This is why prenatal care is so critical,” she said.

During their workgroup, Moser and her colleagues discovered that “there’s no structured mechanism to accessing mental health care quickly, in that Kentucky families lack support during the postpartum period to keep mothers, babies, and their families healthy.”

Momnibus aims to help decrease these high maternal mortality rates by ensuring access to insurance coverage for pregnant women.

Although there are special enrollment periods to buy insurance coverage for marriage, divorce, and fostering children, there are no special enrollment periods available for pregnancy, said Moser.

“A special enrollment period will allow pregnant women to purchase insurance coverage for pregnancy to get the care that she and her baby need during the prenatal period, for a healthy delivery, and during postpartum,” she said.

Momnibus also aims to address the lack of mental health care available to pregnant women by implementing a new psychiatric access program called Lifeline for Moms.

Moser said this program will establish “a hotline for providers to get an immediate consultation for a mother in need of mental health services.”

The lawmakers working on Momnibus have already applied and received a $750,000 grant to start implementing the program. This grant would be used to “specify the needed stakeholders to study birth and pregnancy outcomes, make recommendations to improve outcomes, provide oversight for the Lifeline for Moms program, and provide an annual report of their research and observations,” according to Moser.

The bill is in the Senate awaiting a committee assignment. Moser told Kentucky Health News that it will be handled by Sen. Julie Raque Adams, R-Louisville.

'Momnibus' bill aimed at lowering state's maternal-mortality rate, second highest in the nation, moves to the full House for a vote

By Melissa Patrick
Kentucky Health News

A bill aimed at decreasing the state's high maternal-mortality rate was approved by the House Health Services Committee Thursday and now awaits a vote in the full House. It's been dubbed the "Momnibus" bill.

The prime sponsor, Rep. Kim Moser, R-Taylor Mill, who chairs the committee, said House Bill 10 was the result of an informal House-Senate workgroup that dug into Kentucky's maternal-mortality data over the summer to try to understand why the state has the nation's second highest rate of death in the year following a childbirth in the nation, according to the Centers for Disease Control and Prevention.

Reps. Kim Moser and Nancy Tate
presented the "Momnibus" bill
to the House Health Services
Committee. (Photo by Melissa Patrick)

“It was a bipartisan, bicameral look at what’s wrong with our maternal health in Kentucky, why are our numbers so high and what can we do about it,” she later told reporters. “So this really addresses the priorities that we thought we could tackle.”

She told the committee that the bill addresses a number of contributors to the state's high maternal-death rate. 

"Initiatives that are included in this legislation will address the high rate of substance-use disorders, which are now the number one reason that Kentucky women die in the first year following childbirth; a lack of access to prenatal care, a lack of access to mental health treatment, a lack of education and this also provides a referral to service including treatment support and follow up care," she said.

Kentucky's maternal-mortality rate is 38.4 maternal deaths per 100,000 live births, according to CDC data gathered by the Kaiser Family Foundation. This number includes the deaths of women while pregnant or within 42 days of termination of pregnancy in 2018-21. During that time, Kentucky had 81 maternal deaths.

Rep. Nancy Tate, R-Brandenburg, a co-sponsor of the bill, said 89% of the deaths could be preventable and that 54% of the deaths are related to substance-use disorder. 

Moser agreed, telling reporters, " “I mean, if we’re talking about the maternal-mortality numbers that rival a third-world country, we have got to get serious about this."

What would the bill do? 

A key part of the bill would allow a special health-insurance enrollment period for pregnancy by allowing it to be designated as a "qualifying life event." Said another way, this would allow a woman without health insurance to sign up for coverage at any time after becoming pregnant.

“We discovered that pregnancy was not considered a qualifying life event for some insurance, and we just want to close that gap and make sure that moms can get the prenatal care that they need,” said Moser. "That's the period of time when we know that any chronic disease or any health issue is picked up and can more easily be dealt with." 

It also would establish the Kentucky maternal psychiatric access program, called the "Kentucky Lifeline for Moms." 

This program would establish a dedicated hotline to allow health-care providers to connect with a psychiatrist or a psychologist as a way to help address maternal mental health issues. It would be operated by the Cabinet for Health and Family Services and open weekdays from 8 a.m. to 5 p.m.

Moser said the state has a $750,000 grant to implement this program, but it is important to codify it to make sure it is long-lasting. 

"We know that mental health is an issue that is not being adequately addressed," she told reporters. 

The bill also calls on the cabinet to establish the Kentucky maternal and infant health collaborative. A committee substitute added two additional members to the collaborative, one from the cabinet's Department for Public Health and one from a local health department. 

Moser said this collaborative will oversee the psychiatric lifeline, will collect data, monitor the program and inform future policy needs. CHFS will also study doula certification, and whether or not this is a valuable service, said Moser. 

It also amends and expands the Health Access Nurturing Development Services (HANDS) program, a voluntary home-visitation program for new or expectant parents, to require it to provide lactation counseling, education about the importance of breastfeeding and to provide information about safe sleep for babies. It would also ensure that HANDS clients can participate via telehealth if needed. 

“Telehealth has become a really common-sense way to help address some of the health situations that we’re seeing," Moser told reporters. " If there are some needs that a mom has, we were looking for any way to help her." 

The amended version of the bill also included remote patient monitoring as a billable service for prenatal care and added in-home addiction treatment as a billable service. It also changed the phrase "pregnant individual" to "pregnant woman." 

Rep. Rachel Roarx, D-Louisville, asked Moser whether a person who identifies with a "gender marker of a different sex" would be excluded from this bill. Moser said the bill would "cover anyone who is carrying that pregnancy. . . . At this point in time, women are the only persons who can conceive and carry a pregnancy to term.”

The bill passed out of the Feb. 8 committee meeting on a vote of 15-0-2, with Reps. Josh Bray, R-Mount Vernon, and Felicia Rabourn, R-Pendleton, passing. Bray said he had questions about the "defrayal" cost to the state Department of Insurance and about a possible floor amendment. 

Earlier, Moser mentioned the possibility of a floor amendment to "really target who is able to provide this open enrollment." She also noted that she had not seen this bill marked as a "cost defrayal" to the state and that it "doesn't substantially raise the rates." The department's financial-impact statement estimates that the bill would increase premiums as much as $1.42 per member per month, or might not increase them at all.

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.

UK has $3 million grant to study impact of mothers' opioid use on babies; Ky. 3rd in rate of babies with opioid-withdrawal syndrome

Photo: healthychildren.org

By Lindsay Travis
University of Kentucky

A team of researchers at the University of Kentucky is working to better understand the impact of opioid-use disorder on mothers and babies.

Every 24 minutes in the United States, a baby is born with neonatal opioid withdrawal syndrome (NOWS) after being exposed via  a mother with opioid-use disorder.

In Kentucky, about 2 percent of babies born in 2020 had symptoms of NOWS — the third-highest rate in the U.S. In Appalachia Kentucky, that frequency increases to 7.7 percent — 77 of every 1,000 babies.

Early delivery can complicate pregnancies with opioid-use disorder and give children an increased risk of impaired neural development, including cognitive, motor, social and emotional abilities.

UK’s research team wants to understand how inflammation and dysregulation in the placenta caused by opioid use are linked to negative cognitive consequences in the baby.

The study titled “POPI: Placenta, Opioids and Perinatal Implications” is funded by a $3 million grant from the National Institute on Drug Abuse, part of the National Institutes of Health. Additional funding is possible, pending progress with the research.

Part of the research team, led by Ilhem Messaoudi, left
center (University of Kentucky photo by Jorge Castorena)

“This study is going to have a tremendous impact on Kentuckians, many of whom know first-hand the profound devastation opioid use has on the overall health of the commonwealth,” said Ilhem Messaoudi, chair of the Department of Microbiology, Immunology and Molecular Genetics in the College of Medicine and a principal investigator on the grant.

“NIDA specifically called for research on the placenta-brain axis — the idea that what happens during pregnancy and the placenta’s health will have long-term ramifications on the offspring, including brain development,” said Messaoudi. “The team assembled to find answers for our smallest Kentuckians all bring a variety of expertise to this study including to maternal-fetal medicine, pathology, neuroscience and neonatology.”

Pregnant women who seek care at UK HealthCare’s Perinatal Assistance and Treatment Home (PATHways) program will be eligible to enroll in the study. PATHways, a comprehensive treatment program, is designed to help pregnant and postpartum mothers who are living with substance use disorders.

“Kentucky has one of the highest maternal mortality rates in the country combined with a high rate of opioid use disorder. PATHways provides us a unique opportunity to support pregnant mothers and invest in those lives through this kind of project that blends a variety of scientific specializations,” said Dr. John O’Brien, chief of the Division of Maternal-Fetal Medicine at UK HealthCare, a professor in the Department of Obstetrics and Gynecology in the College of Medicine and co-principal investigator on the grant.

As part of the study, researchers will collect ultrasound data, blood samples, the placenta and umbilical cord blood and conduct neurodevelopment assessment on babies for one year after birth. The data will help them determine the impact of maternal opioid use disorder on both the health of the placenta and the baby’s brain.

“In previous studies, using a rat model, we’ve learned maternal opioid use disorder increases inflammation in the brain and alters microglia — cells that are like the housekeepers of the brain,” Messaoudi said. “The alteration can affect the way the brain continues to develop.”

Investigators can measure that change in the brain through another type of immune cells found in the blood, called monocytes. The team will track neurobehavioral outcomes through a series of assessments in the newborn period and at age 3, 6 and 12 months.

O'Brien said, “Our hope is this research project will provide health-care professionals the knowledge and evidence necessary to improve the care of pregnant mothers with opioid use disorder, reduce risks and optimize neonatal outcomes.”

The study also includes researchers in the College of Medicine’s departments of Pediatrics and Pathology and Laboratory Medicine, as well as the Spinal Cord and Brain Injury Research Center and the Dr. Bing Zhang Department of Statistics in the College of Arts and Sciences.

If you or someone you know is pregnant and dealing with substance-use disorder, contact UK's Polk-Dalton Clinic at 859-218-6165 to make an appointment for prenatal care.

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.

New Office of Rural Health is being created at the Centers for Disease Control and Prevention to address rural health disparities

Medical News photo illustration

The newly created Office of Rural Health at the Centers for Disease Control and Prevention will work to combat rural health disparities across the nation by addressing infrastructure needs and  creating a rural health strategic plan that ensures rural health interests are represented in all facets of health care, Maaisha Osman reports for The Nation's Health, a publication of the American Public Health Association.

The need for this office is well-documented, Osman reports, noting that while the 19% of Americans who live in rural areas die from the same causes of death as others in the U.S., they are more likely to die earlier than their urban counterparts. And, she writes, the Covid-19 pandemic added to this challenge with rural residents less likely to get vaccinated and more likely to die from the disease. 

The national government has a Federal Office of Rural Health Policy, but Congress's creation of a rural-health office at the CDC and funding it with $5 million was "a massive victory," said Carrie Cochran-McClain, chief policy officer of the National Rural Health Association.

Cochran-McClain told Osman that the CDC needs a voice inside the agency to speak about the unique challenges of rural areas, and will be responsible for the maintenance and enhancement of the rural public-health infrastructure and for connecting and collaborating with other federal agencies and state offices of rural health. She said the goal is for the office to open this year. 

She said there has long been discussion in the rural-health community about the need for such an office, and disparities between rural and urban populations during the pandemic generated momentum to create it. She said Covid-19 underscored the structural barriers to health care in rural areas and said the office is needed to support rural public-health agencies and workers. 

What can the office accomplish? "Really think about how we can grow the public-health workforce in rural communities, and how we can provide technical support and do research around some of the unique challenges that rural populations face," Cochran-McClain said. She pointed to "worrisome" maternal mortality and illness rates in rural areas, obesity, chronic diseases, the need for more preventive services, and an aging population that would like to age in place. 

And when asked what progress has been made to improve rural health, she ended up listing a whole list of other challenges, including the need for more suicide prevention, health education, more health workers and better health-care infrastructure, and noted closures of rural hospitals and skilled nursing homes. 

Cochran-McClain told Osman that if she could do one thing to improve rural health it would involve making sure rural areas have a robust rural health care workforce and public-health workforce. Further, she said, we need to figure out how to retain and grow a new generation of health-care workers.

Maternal deaths up in Ky., U.S., especially among Blacks; state's rate is sixth in nation; drug and substance abuse are big factors

National Center for Vital Statistics graph, via Centers for Disease Control, adapted by Ky. Health News

By Melissa Patrick

Kentucky Health News

Pregnancy-related deaths continue to be on the rise across the nation, going up nearly 40 percent between 2020 and 2021, according to the Centers for Disease Control and Prevention.  

The National Center for Health Statistics found that 1,205 women in the U.S. died from pregnancy-related causes in 2021, up from 861 deaths in 2020 and up from 754 deaths in 2019, or nearly 60%.

The national maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births, compared with a rate of 23.8 in 2020 and 20.1 in 2019. The report also found that maternal death rates increased with maternal age.

The report did not provide state-level data, but data provided to Kentucky Health News by the CDC shows that in 2018-21, 38.9 Kentucky women out of 100,000 died while they were pregnant or within 42 days after childbirth.

During that period, Kentucky had the nation's sixth highest maternal mortality rate, one that was 65% higher than the national rate of 23.5 deaths per 100,000 births. And when compared to surrounding states, Kentucky had the third highest rate, behind Virginia and Tennessee, both with rates of 41.7 deaths per 100,000 births. 

That said, the CDC calls for caution when comparing state maternal-death data because the actual numbers are small and reporting systems vary by state.  

The United Health Foundation's America's Health Ranking report, using federally available data, shows Kentucky's annual maternal death rates were 24.3 per 100,000 births in 2020; 29.7 in 2021; and 34.6 deaths in 2022. 

To address this issue, Kentucky legislators established the Maternal Mortality Review Committee in 2018 to review all maternal deaths from any cause that occurred during pregnancy or within a year of delivery.

Key findings in the annual 2021 report, for 2013-19, include: 91% of maternal deaths in 2018 were deemed to be preventable; 16% were pregnancy-related; 52% were pregnancy-associated, meaning that the death resulted from a cause unrelated to pregnancy; and 52% had substance-use disorder linked to the death. 

It also found that of the 339 maternal deaths that occurred in 2013-19, 21 of them, or 6%, were by suicide and 128 of them, or nearly 38%, were accidental, meaning that the death occurred from an "inadvertent event," which includes, among other things, overdose deaths. For example, in 2019 alone, the report found that 44% of the accidental deaths were from drug overdose. 

A bill to ensure greater access to information and resources for mental-health care before and after the birth of a child passed out of the legislature this year and has already been signed into law. 

Senate Bill 135, sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, calls on the state Cabinet for Health and Family Services to create written information on perinatal mental-health disorders, including postpartum depression, and make it available on its website. It also requires the cabinet to provide access to online clinical assessment tools to help providers detect the symptoms of perinatal mental-health disorders.

The cabinet is also charged with creating a panel of maternal- and infant-health experts to explore the issue of perinatal mental-health disorders, including prevention, treatment and gaps in service. The panel is required to report its findings to the Interim Joint Committee on Health, Welfare and Family Services and the Advisory Council for Medicaid Services on or before Nov. 1 of each year.

CDC photo

In 2018, Black women in Kentucky had a maternal pregnancy-related death rate of 40.2 deaths per 100,000 births -- three times the rate of white women, at 13.1 deaths per 100,000 births. 

Maternal deaths among black women are higher across the nation. In 2021, the CDC report found that the maternal mortality rate for Black women was was 69.9 deaths per 100,000 births, which was 2.6 times the rate for white women, at 26.6 deaths per 100,000 births. 

Black Maternal Health Week is April 11-17 and the Louisville Coalition for Black Maternal Health is holding programs each day to bring awareness to this issue. The list of events can be found on their Facebook page. 

The state report points to a number of risk factors impacting maternal mortality, including, "tobacco use, obesity, racial disparities, depression, opioid use, and other social determinants of health such as transportation, access to care, domestic violence, and a rural state."  It also notes that conditions such as diabetes, hypertension, or other health conditions require additional follow-up and management during the pregnancy.

That said, the state report found that 21% of the women who died had received no prenatal care and 26% of them had had less than four visits during their pregnancy.

Bill to address postpartum depression and other maternal mental-health problems has passed and awaits the governor's action

By Melissa Patrick

Kentucky Health News

A bill to ensure greater access to information and resources for mental-health care before and after the birth of a child passed without dissent in both houses of the General Assembly and has gone to Gov. Andy Beshear.

Sen. Shelley Funke Frommeyer

"Kentucky, sadly, has one of the worst maternal mortality rates in the country," the bill's sponsor, Sen. Shelley Funke Frommeyer, R-Alexandria, told the Senate Families & Children Committee in February.  "And we're looking to get upstream of that. We really want to work towards a solution." 

Senate Bill 135 calls on the state Cabinet for Health and Family Services to create written information on perinatal mental-health disorders, including postpartum depression, and make it available on its website. It also requires the cabinet to provide access to online clinical assessment tools to help providers detect the symptoms of perinatal mental-health disorders. 

The cabinet is also charged with creating a panel of maternal- and infant-health experts to explore the issue of perinatal mental-health disorders, including prevention, treatment and gaps in service.  The panel is required to report its findings to the Interim Joint Committee on Health, Welfare and Family Services and the Advisory Council for Medicaid Services on or before Nov. 1 of each year. 

"This bill is simple, but the impact will be wide reaching and could mean the difference between life and death for some Kentucky mothers," said Rep. Stephanie Dietz, R-Edgewood, who carried the bill in the House.

Amendment for pediatric recovery centers

A House floor amendment that included language from House Bill 436 was added to the bill and agreed to in the Senate. It directs the cabinet to submit a state plan amendment application by Nov. 1, 2023 to the federal Centers for Medicare and Medicaid Services to provide medical assistance "to the fullest extent permitted under federal law" for inpatient and outpatient services provided by a residential pediatric recovery center. 

Rep. Matt Lockett, R-Nicholasville, sponsor of HB 436 and the amendment, told the House that there is a great need for these centers because they care for babies with neonatal abstinence syndrome, noting that Kentucky has 15 babies born with NAS per 1,000 births. 

"These centers provide a unique non-hospital holistic approach that saves taxpayer dollars by avoiding expensive hospital stays and unnecessary foster care placements," said "They provide high quality inpatient medical care in a home like setting for babies born exposed to addictive substances."

Freestanding birth center bill hits roadblock: Senate floor leader

3/10/23: This story has been updated. 

By Melissa Patrick

Kentucky Health News

Even though a Senate bill to remove the state's certificate of need requirements from freestanding birthing centers has passed out of the same committee twice, most recently in weaker form, and the House version of the bill has cleared a committee, the prospects of it becoming law have dimmed. 

Sen. Damon Thayer

Senate Majority Floor Leader Damon Thayer, R-Georgetown, said at the March 3 Licensing and Occupations Committee meeting that while he appreciated the sponsor's efforts to improve the bill, made at his request, bills regarding certificates of need for health-care facilities "are not moving forward this session." 

Thayer, who calls bills up for a vote on the Senate floor, said "It’s very likely that we’re going to have a task force or a working group or one or two committee meetings dedicated to the certificate of need issue this summer."

Senate Bill 67, sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, cleared the Licensing and Occupations Committee on Feb. 21 on a 9-2 vote. On March 3, it was recommitted to the same committee, and on March 7 the panel approved an amended version of the bill by a vote of 7-3. 

The "no" votes came from Republican Sens. Amanda Mays Bledsoe of Lexington, Chris McDaniel of Ryland Heights, and Thayer. Sen. Donald Douglas, R-Nicholasville, a physician, passed.

"The committee sub is good and it moves it in the right direction," Thayer said in explaining his vote. "But I think I would be disingenuous knowing that we're probably going to take a deep dive into this issue during the interim. . . . I'm going to vote no because I just don't think it's ready for prime time yet." 

The new version of the bill would only allow freestanding birthing centers that have four or fewer beds to be exempt from having a certificate of need.

"This truly is a concession to the Kentucky Hospital Association," Funke Frommeyer said.

Funke Frommeyer told Kentucky Health News that the changes to the bill that were suggested after it passed the first committee "came straight from the KHA," even though "not once did they reach out to me to talk through their concerns before I brought the bill to committee." 

Freestanding birthing centers only provide vaginal deliveries for women with low-risk pregnancies.  Funke Frommeyer told the committee that Kentucky is one of only eight states that do not offer freestanding birthing centers. 

When asked, Funke Frommeyer wouldn't say the bill was dead. However, she suggested an immediate way forward for freestanding birthing centers in Kentucky is for hospitals to open and run them, like the Vanderbilt model the KHA described in the committee. 

Thayer was not so optimistic when asked if there was any hope for the bill this session.

"It doesn't look good for this session," he said. "It just doesn't have the votes to pass the Senate and it's probably going to go into this entire certificate of need conversation we're going to have during the interim."

Senate Concurrent Resolution 165 to establish the CON Task Force was introduced in the Senate March 10, with 27 sponsors. The resolution calls for all findings and recommendations to be submitted to the Legislative Research Commission by Dec. 1, 2023. 

Kentucky hasn't had a freestanding birthing center since the 1980s, although it has administrative regulations for licensing them and qualifying them for Medicaid reimbursement.

The revisions also added that the Cabinet for Health and Family Services would delineate requirements for medical malpractice insurance for the freestanding birthing centers, refers to the centers as health facilities instead of institutions and adds some screening and reporting requirements. 

Proponents of the birthing centers say the greatest roadblock to these centers is the certificate-of-need law, which require a center to prove that there is an unmet need for services before it can open, which allows providers and hospitals to challenge the would-be competitor's application.   

Several hospital officials spoke against removing the requirement. KHA President Nancy Galvagni argued that the certificate-of-need process is necessary for the health and safety of patients. 

"The proposed legislation and the committee sub to remove freestanding birthing centers from CON would require a change in regulation, removing the requirement for oversight of the facility by an obstetrician with admitting privileges at a local hospital," Galvagni said.

She also noted that the bill does not require a written transfer agreement with a Kentucky hospital. "If a complication during birth arises, a quick transfer from the birthing center to the hospital is going to be critical to the health and life of the mother and child. And without those written transfer agreements in place, a complicated birth could easily lead to the death of the mother, the baby or both," she said. 

Thayer and Committee Chair John Schickel, R-Union, scolded the KHA for not bringing its issues to the committee during the interim between legislative sessions, when the issue was discussed. Galvagni said they did not testify because they thought their position on this bill was "very well known." 

House Bill 129, sponsored by Rep. Jason Nemes, R-Louisville, passed out of the Feb. 22 House Licensing, Occupations & Administrative Regulations Committee without dissent and two pass votes. It has received two of its three required readings but still awaits a vote in the full House.

Nemes told Kentucky Health News that even though the Senate bill had stalled, he was heartened by its movement forward this session, largely because it revealed the opponents objections, which will now allow them to address those concerns.  

"I still feel good about it because we got really long into the process," he said. "If we don't get this resolved this session, we're going to have a strong, strong push over the interim and try to get it done next session."

Free-standing birth centers would no longer be subject to 'competitor's veto' under bills awaiting votes in Senate and House

Sen. Shelley Funke Frommeyer

By Melissa Patrick

Kentucky Health News

Bills to exempt free-standing birth centers from Kentucky's certificate-of-need law have cleared committees in the House and Senare and are poised for floor votes, despite opposition from the chair of the House health committee and two legislators in the sponsor's home region of Northern Kentucky.

"It's still important to have hospitals that have great options for giving birth, but consumers are asking for more," Sen. Shelley Funke Frommeyer, R-Alexandria, told the Senate Licensing and Occupations Committee Feb. 21. "Consumers are asking for free-standing birthing centers. . . .  Kentucky is one of only eight states that does not offer free-standing birthing centers." 

Funke Frommeyer, a freshman senator, is the sponsor of Senate Bill 67 and veteran Rep. Jason Nemes, R-Louisville, is the sponsor of House Bill 129, the latest version of legislation he has sponsored in previous sessions. 

Mary Kathryn DeLodder, director of the Kentucky Birth Coalition, told the Senate committee that Kentucky hasn't had a freestanding birthing center since the late 1980s, although it has administrative regulations for licensing them and qualifying them for Medicaid reimbursement. 

But the state's certificate of need law requires a propsoed center to prove that there is an unmet need for its services before it can open, a process that allows providers and hospitals to challenge the would-be competitor's application. DeLodder said the CON law is sometimes called "the competitor's veto," adding, "It is not about safety, but it's about market share." 

Frontier Nursing University said in a letter of support for the bills that it did a feasibility study in 2018 of establishing a free-standing birth center on its campus in Versailles and found the CON law was "the major barrier. . . . The CON process has been lengthy and effective at the goal which appears to be to allow hospitals to block the development of FSBCs regardless of the benefits to the women of Kentucky." 

Christy Peterson, an advanced practice registered nurse and certified nurse midwife, explained to the Senate committee what a freestanding birthing center is: "A freestanding birth center is a health-care facility. It offers a home-like setting where families can receive maternity care and give birth with appropriate levels of intervention. These facilities are not hospitals and they do not perform C-sections or anesthesia. They provide evidence-based care using the midwifery model of care and use informed consent and shared decision-making. One of the key components of the birth center is continuous risk screening. . . . Not everyone is a candidate for birthing at a freestanding birth center. There are mothers who should be in the hospital setting, and so birth centers don't just take on anybody." 

She also pointed to studies that show that care in freestanding birth centers is "safe, cost-effective and leads to excellent outcomes." 

Meredith Strayhorn, a Campbell County resident and senior certified professional midwife student, told the committee that in 2022, 34% of Kentucky births resulted in Caesarean sections, ranking the state in the top 10 for the procedure. She said C-section births have "been associated with maternal mortality and severe maternal morbidities." 

She added, "Research shows that when low-risk women give birth within the midwifery model of care, there are lower rates of Caesarean. That's also decreasing the rates of repeat cesareans and the various complications that follow. This will also save thousands and thousands of dollars for the state."

Sen. Donald Douglas, R-Nicholasville, a physician, voted against the bill, saying, “I don’t see it as a competition issue; I see this as a patient-care issue." Douglas said he was not convinced that birth centers would result in the best care and improved health outcomes. 

The committee approved the bill by a vote of 9-2, with Sen. Chris McDaniel, R-Ryland Heights (Kenton County), casting the other "no" vote. Sen. Damon Thayer, R-Georgetown, said he voted "yes" to get it out of committee, but said Douglas's concerns should be noted. 

Rep. Jason Nemes

The next day, there were no dissenting votes as the House Licensing, Occupations & Administrative Regulations Committee approved Nemes's bill. Nemes told the committee that each year he has been presented the legislation it has been improved. 

"The touchstone for me has been safety," Nemes said. "We want to make sure that this is a safe environment for women to have their babies."

He said in Kentucky mothers can have babies in a hospital or at home, and he thinks many who are choosing home births would choose a birthing center if it were available, "which I believe are safer for those individuals." He noted that the American College of Obstetricians and Gynecologists supports free standing birth centers. 

The maternity mortality rate in Kentucky is "alarmingly high," especially among women of color, said Kazia Bryant, executive director of Mama to Mama, a Louisville nonprofit support group for mothers.

"The more and more that Black women and women of color learn about the climate and rate of maternal deaths that plague our community, the more and more we are searching for alternatives to birth our babies," she told the committee.

While no House committee member voted against the bill, Rep. Kim Moser, R-Taylor Mill, passed, along with Rep. Mike Clines, R-Alexandria.

Moser is chair of the House Health Services Committee. She agreed that Nemes had improved the legislation, but she noted her work as a neonatal intensive-care nurse and said, "I am concerned about safety." She asked if there was a geographic requirement for transfer agreements to hospitals, and was told that there is not one that is related to distance between the facilities. 

Nemes said he considers birth centers safe and secure because their licensing requirements are strict, women are making a choice to have their babies there, and the centers constantly screen their patients to make sure they have low-risk pregnancies.

Both bills would also require the state Cabinet for Health and Human Services to update and modernize its regulations, including requiring accreditation by the Commission for the Accreditation of Birth Centers, compliance with the American Association of Birth Centers standards, and consistent plans for transfer and safe transport to a hospital as needed.

If passed, the legislation would be called the Mary Carol Akers Birth Centers Act, after a certified nurse midwife who wanted to open a birthing center in Elizabethtown and was thwarted by the cabinet and the state Court of Appeals. She exhausted her resources and left the state, Birth Monopoly reports.

University of Kentucky researchers find Covid-19 vaccinations and boosters for mothers protect them and their babies

Ilhem Messaoudi, Ph.D., chair of the University of
Kentucky Department of Microbiology, Immunology
and Molecular Genetics (Photo: Mark Cornelison, UK)

By Lindsay Travis

University of Kentucky

University of Kentucky researchers have found that maternal vaccination against Covid-19 protects both the mother and the baby.

The study, funded by a National Institutes of Health grant, was published in the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine. The findings come as Covid-19 cases and hospitalizations are on the rise across the U.S. and the state after the holidays.

“Covid-19 is here to stay. It’s not going anywhere," said Ilhem Messaoudi, chair of the Department of Microbiology, Immunology and Molecular Genetics in the UK College of Medicine. "The study shows that vaccines are safe and maternal vaccinations are an effective way to protect not only the mom but the baby until they become eligible for the vaccine. We don’t think that you can fully protect the baby by just breastfeeding.”

Messaoudi and her team at UK conducted the study in collaboration with Oregon Health & Science University. They monitored 120 women from March 2021 until June 2022 through pregnancy, delivery and postpartum, plus two rounds of Covid-19 vaccinations and their booster shot. Roughly 90% of participants received Pfizer-BioNTech vaccine.

“What we’ve learned is the first series of the vaccine induces a pretty good immune response in the moms that we can track by looking at antibodies in their plasma,” said Messaoudi.

Scientists monitored antibody response in blood samples from the mother, umbilical cord and newborn along with donated breast milk from the vaccinated participants. Researchers found that antibodies passively transfer from mother to fetus in utero, offering the most protection.

“So at birth, these babies had maternal antibodies in circulation, which is fantastic. Getting vaccinated during pregnancy not only protected the mom, but also now provided passive protection for their newborns who are not eligible for the vaccine,” said Messaoudi.

In this study, the participants received their boosters after giving birth. Within a couple of weeks, researchers saw a dramatic increase in antibodies in the mother’s plasma, which were not directly passed to newborns at the time. But the antibodies in breast milk increased two- to three-fold, Messaoudi said, with a half-life of more than 200 days.

“There was a massive increase in antibodies, which was unexpected but great to see,” said Messaoudi. “You really needed the first two shots and the booster to achieve excellent protection, to have that very long-lived, durable immune response. Then the newborn is protected via antibody transfer in utero through the placenta and postnatal through breastfeeding.”

The Centers for Disease Control and Prevention recommends all 6 months and older get a Covid-19 vaccine, including women who are pregnant, breastfeeding, trying to get pregnant, or who might get pregnant.

Those who are pregnant or were recently pregnant are more likely to get severely ill from Covid-19 than those who are not pregnant, and have a higher risk for preterm birth, according to the CDC.

“Pregnancy is a state of immunosuppression to facilitate the growth and development of a fetus. That’s why it’s even more important that pregnant women get vaccinated,” said Messaoudi, the UK immunologist.

She explained that it’s the first step in a mother giving potentially lifesaving help to their child, like putting on an oxygen mask while on a plane before you help others.

“Not only is it important to get vaccinated, but it's important to go through the whole series of vaccinations because we also know from the study that just getting the first two shots is not going to be enough. You have to get your booster and the Omicron bivalent booster so that you can get the full benefit,” said Messaoudi.

Researchers will continue to monitor study participants and expect to release more findings on the boosters’ efficacy against the omicron variant in the continued fight against Covid-19.

“We now have a really large number of studies on vaccinations in pregnant women,” said Messaoudi. “They’ve all shown great safety, tolerability and immunogenicity, so we’ve hit the trifecta. The vaccines are safe and work. That’s what’s really important.”

Messaoudi told Travis that there were "no adverse outcomes" in the study, adding that every time a mother came in to give a breast-milk sample they also did a nasal swab to check for Covid-19. In addition, she said they got samples from the babies.

"We had very, very few breakthrough infections," she said. "It was great to see that. It’s doing what it’s supposed to be doing.”

UPDATE, Jan. 16: Another study "provides more evidence that the breast milk of people vaccinated against Covid-19 provides protection to infants too young to receive the vaccine," the University of Florida reports. The UF study, published in the Journal of Perinatology, analyzed stools of infants who consumed breast milk. It did not determine whether those babies are less likely to get Covid; the researchers said larger studies are needed to answer that question; the latest study included only 37 mothers and 25 infants.