Program for mothers and pregnant women with substance-use disorder gets grant to help more Black women get its services

Freedom House (Photo provided to Kentucky Lantern)

By Sarah Ladd

Kentucky Lantern

The Volunteers of America chapter that includes Kentucky will spend $123,000 over the next nine months to figure out how to get more Black women into treatment for substance-use disorder.

Volunteers of America Mid-States received the money from the Kentucky Association of Health Plans, the trade group for health insurers in the state, to fund a new initiative called Access Justice.

With the grant money, scholar, writer and activist Brandy Kelly Pryor will evaluate VOA’s Freedom House, which is a program for “pregnant and parenting women” who have substance-use disorders. Her report is due in April.

The 31-year-old program, with locations in Louisville and Manchester, also lets minor children (under the age of 18) stay with their mothers during treatment. Kelly Pryor will primarily study Louisville and may branch out elsewhere at later.

Jennifer Hancock, president and CEO of Volunteers of America Mid-States, said this move is in direct response to the high rates of maternal mortality among Black women and the disproportionately high overdose rates among Black Kentuckians.

Kentucky overdose deaths decreased in 2023 for the second year in a row, according to the state's Drug Overdose Fatality Report.

In 2022, 2,135 Kentuckians died from an overdose, marking the first decline since 2018. Ninety percent of those deaths were from opioids and/or fentanyl.

In 2023, the number of fatal overdoses was down to 1,984. Fentanyl, a powerful synthetic opioid, was involbved in 1,570 of those — about 79% of the 2023 deaths. The 35-44 age group was most at risk, the report shows. Methamphetamine was involved in 55% of 2023’s overdose deaths.

Despite the overall decrease in the state, the number of Black Kentuckians who died from a drug overdose increased from 259 in 2022 to 264 in 2023.

A 2023 state report on maternal mortality also showed substance-use disorder contributed to nearly 60% of all maternal deaths. Most maternal deaths in Kentucky, 88%, are preventable, says the report from the state Cabinet for Health and Family Services.

Black partcipants at Freedom House's Kentucky locations are less likely to complete its program than those of other races, Hancock said.

“I think some of it is about the stigma that they face coming into treatment,” Hancock said. “I think that there could be some cultural and familial pressures that they experience disproportionately.”

Kelly Pryor’s study is expected to provide answers as to why Black Kentuckians leave the Freedom House program without completing it, she said.

“Women, generally speaking, have to be convinced that they deserve treatments and that they are worthy of getting this help and support versus trying to do it on their own,” Hancock said.

In her analysis, Kelly Pryor will “identify gaps in care and opportunities for improvement, ensuring that substance-use-disorder recovery services are equitable and accessible for everyone who needs them,” VOA said. The nonprofit will then come up with plans to fill any gaps in care and access.

Hancock doesn’t know if the solution will be “an internal-to-VOA process that needs to be improved, or if it’s more of a public campaign that we need to wage to reassure Black women that they’re worthy of treatment, that treatment is a place where they can feel supported and feel seen and heard.”

The measure of success, Hancock said, will be when VOA and Freedom House start seeing “better engagement rates of Black women” and higher program completion rates.

Kelly Pryor said in a prepared statement, “Building on principles of healing justice, we will ensure a process that facilitates those most affected, leading us toward the best solutions for recovery and prevention. This effort will take time and involve critical self-reflection, yet the return will have an indelible impact on Kentucky and beyond.”

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.

'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.

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."

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.”

Kentucky extends post-birth Medicaid coverage to one year

CDC photo

By Melissa Patrick
Kentucky Health News

The Centers for Medicare and Medicaid Services has approved a plan to expand Medicaid coverage for postpartum care in Kentucky from the current 60 days to 12 months, which will allow an estimated 10,000 mothers to maintain their health coverage for one year after giving birth.

“Currently, more than half of Kentucky’s children are covered in Medicaid or KCHIP, and each year we cover half of all births in the state," Cabinet for Health and Family Services Secretary Eric Friedlander said in a news release.

This change is important to address the health-care needs of postpartum women in the year after giving birth. A federal report that looked at the implications of extending postpartum coverage found that one in three pregnancy-related deaths occur between one week and one year after childbirth. It adds that the postpartum period is critical for recovering from childbirth, addressing complications of delivery, ensuring mental health, managing infant care and transitioning from obstetric to primary care.

The change was made possible by a provision in the American Rescue Plan Act and the 2022 General Assembly's passage of Senate Bill 178, directing the state to extend postpartum Medicaid coverage to 12 months. A spokeswoman from the Cabinet for Health and Family Services told Kentucky Health News that the coverage will be retroactive to April 1, 2022. 

Speaking about the bill in the House, Rep. Kim Moser, R-Taylor Mill, said, "Kentucky has rates of maternal death that rival third world countries. We have 37.7 maternal deaths per 100,000 live births, which is the highest in the nation."

The state Department for Public Health's 2020 Maternal Mortality Review report, with data from 2013-18, shows that 76 mothers in Kentucky died from complications related to pregnancy and birth in 2018. The report also shows that in 2018. Black mothers in Kentucky had a death rate of 42.1 per 100,000 live births compared to 17.2 for white mothers. The state estimated in 2017, 78% of maternal deaths were preventable. 

Kentucky joined California, Florida and Oregon in obtaining the latest rounds of approval for 12-month postpartum care. States that previously received approval were Illinois, Louisiana, Michigan, New Jersey, South Carolina, Tennessee and Virginia.

“This coverage will allow them to access medical services to make sure their health-care needs, as well as the health care needs of their babies, continue to be met," Kentucky Medicaid Commissioner Lisa Lee said in the release.

Legislature passes four abortion bills in last days of session, likely to pass one more; federal judge blocks two of them (updated)

Gov. Matt Bevin, shown speaking at a Right to Life event, is taking credit for the legislative action.

By Melissa Patrick
Kentucky Health News

Since Republicans took complete control of Kentucky lawmaking in 2016, the General Assembly has passed several bills to restrict or eliminate abortion, and this year is no different. Four anti-abortion measures passed in the last days of the session and one more is likely to pass on the final day, March 28.

The bills take several measures to limit or monitor abortions in Kentucky, but the centerpiece is one that would ban abortion once a fetal heartbeat is detected, around six weeks of pregnancy.

Part of the impetus for that bill is the hope that two new Supreme Court justices could lead to the reversal of Roe v. Wade, the court's 1973 decision creating a limited constitutional right to abortion.

The legal process quickly followed the legislative process. Immediately after Gov. Matt Bevin signed one bill into law, the American Civil Liberties Union of Kentucky filed a lawsuit on behalf of EMW Women's Surgical Center in Louisville, the state's only remaining abortion provider.

Hours later, U.S. District Judge David Hale of Louisville granted the ACLU's request for a temporary restraining order blocking enforcement of the law banning abortion of a fetus with a beating heart.

"The heartbeat is the first sign of life and it is the last thing that you will hear when a person dies," Rep. Chris Fugate, a Republican from Chavies in Perry County, said on the House floor as he managed Senate Bill 9, sponsored by Sen. Matt Castlen, R-Owensboro, to passage on a 71-19 vote.

One of the "no" votes came from Democratic Rep. Chris Harris of Pikeville, who described himself as pro-life. He said the bill's constitutionality had already been decided, the state was already a defendant in three other lawsuits over other abortion bills, and "We have a responsibility to the people to not waste their money."

The ACLU says every "heartbeat" bill passed to date has been overturned in state or federal court. Kentucky is the second state this year to enact such a near-total ban on abortion, but the first to take effect, because SB 9 had an emergency clause. Mississippi's law will go into effect July 1. (Rewire.News offers a legislative tracker for abortion bills in the 50 states.)

Opponents of "heartbeat bills" say they are unconstitutional, near-total bans because most women don't know they are pregnant until after six weeks of pregnancy, and ultrasounds to determine the health of a fetus aren't typically done until the 14th week of pregnancy.

"There are no exceptions for rape, incest, fetal anomalies, or if there is a tragic condition with the fetal anomalies," said Tamarra Wieder, the public affairs and policy director for Planned Parenthood of Indiana and Kentucky.

The bill passed the Senate 31-6 on Feb. 14. The House rejected an amendment from Rep. Jason Nemes, R-Louisville, that would have allowed abortion of a fetus that was medically determined to be incompatible with life outside the womb.

Rep. Robert Goforth of East Bernstadt, who is challenging Bevin in the May 21 Republican primary for governor, filed a measure similar to SB 9, House Bill 100. "My bill's been held hostage and passed over and not heard because of politics," he told the House as he supported SB 9.

Bill would ban discriminatory abortions

The other bill targeted by the ACLU lawsuit, and the first of the four to pass, would ban abortion for women seeking to terminate a pregnancy because of an unborn child's sex, race, color, national origin or the diagnosis or potential diagnosis of Down syndrome or any other disability.

House Bill 5, sponsored by Rep. Melinda Gibbons Prunty, R-Greenville, passed the House Feb. 26 on a 67-25 vote and the Senate March 13 by 32-4. It will become became effective immediately upon Bevin's expected signature March 19. He published an article March 11 saying that the effort to pass anti-abortion bills was led by his administration. UPDATE, March 20: Judge Hale issued a temporary restraining order blocking the law.

Prunty told the House that HB 5 is a "common sense" measure because allowing abortions for any of these reasons is "reminiscent of the social evil of eugenics," the science of improving a human population by controlled breeding to increase the occurrence of desirable, inheritable characteristics.

Sen. Ralph Alvarado of Winchester, who presented the bill in the Senate, repeated that point, which Bevin has also made. Alvarado is Bevin's running mate for lieutenant governor.

Sen. Reginald Thomas, D-Lexington, unsuccessfully offered an amendment for lifetime coverage of medical expenses for children born with certain disabilities. He said, “I cannot comprehend how we want to bring life into this world with a child who has the disabilities I have enumerated, and then abandon that child once that child comes into this world.”

ACLU spokeswoman Brigitte Amiri said in a press release on the bill, “Decisions about whether to end a pregnancy must be made by the woman and her family. But this law takes the decision away from them and hands it over to politicians. Kentucky women must be able to have private conversations with their health-care providers, and must be able to decide whether to have an abortion.” She said the bill is part of a campaign to ban all abortions.

Other bills

House Bill 148, sponsored by Rep. Joseph Fischer, R-Fort Thomas, would ban all abortions in Kentucky if the Supreme Court overturns Roe v. Wade. It passed the House with Feb. 15 on a vote of 69-20 and the Senate on March 14 by 32-5.

Such bills are called "trigger bills" because the legislative action would take effect only constitutional law changes. The ACLU says "trigger laws" have been filed in seven states this year.

Fischer told the House, “Abortion is not a divisive issue in this state; the people of Kentucky are overwhelmingly against abortion. House Bill 148 will serve as a message from the people of Kentucky to the Supreme Court and every other state ... if you allow us to protect life, we will protect all unborn life.”

But freshman Rep. Patti Minter, D-Bowling Green, said the bill was premature. “It does nothing to advance any policy objectives,” she said. “We should not be in the business of passing a bill now that may or may not be valid, depending on what might or might not get handed down by the Supreme Court.”

Senate Bill 50, which would require health-care providers to report any prescriptions used to induce an abortion to the state Vital Statistics Branch, is also on its way to Bevin, with an amendment that would require providers to tell patients who take these medications that the abortion can be reversed — information that the American Congress of Obstetricians and Gynecologists says in an August 2017 fact sheet is "unproven and unethical."

The bill, sponsored by Sen. Robby Mills, R-Henderson, passed the House 75-19 on March 13. The next day, the Senate accepted the amendment and passed the revised bill 31-4. The vote on the original bill, in January, was 30-6.

"With the passing of these four bills, we basically now have zero access and zero exemptions," Wieder, of Planned Parenthood, said Friday. "What we saw on the floor last night was simply callous, to deny even exemptions for families where the fetus will not survive to birth and there cannot be any exemptions even for their circumstances. I think that actually speaks to all of these bills, especially Senate Bill 9, that there is no concern for the lived experiences of women and families in the Commonwealth."

Still pending is Senate Bill 227, sponsored by Sen. Whitney Westerfield, R-Hopkinsville. It would require physicians to try to save the life of an infant born alive after a failed abortion attempt. It is similar to the federal "Born Alive Infant Protection Act," which failed in the U.S. Senate last month.

Westerfield's bill passed the Senate Feb. 28 on a 32-0 vote and could pass the House on March 28, the day set aside for reconsidering bills Bevin may veto — or bills that he wouldn't.

Wieder said the bill isn't necessary because "there is no such thing as abortion after birth. . . . This is not medical practice." But she voiced concern that the bill would require life-saving care for babies who are not expected to survive, regardless of parental wishes.

Bevin's role

Wieder said of Bevin, "He is using rhetoric to stir up emotion and anger and fear out of a place that is not even from reality and that is a problem with so many of the conversations around abortion."

In his article, Bevin wrote, "As long as the Bevin administration exists, we will fight with all of our intellect, our talent, and our heart to defend the innocent. We will fight for life."

Citing the recent abortion laws passed in New York and Virginia, he wrote, "We now see that the true agenda of pro-abortion advocates across this nation is the mass murder of innocent babies, even after they have been born and are crying for their mothers" and that "pro-abortion radicals are even suing for the right to dismember a third-trimester baby."

Wieder said, "The idea that the bills in New York and Virginia somehow allow women and families to have an abortion up to or until a person gives birth is flat-out untrue. That's not how medical care works, and it's irresponsible to imply that. We all know that the vast majority of abortions occur very early in pregnancy and the ones that occur late in pregnancy are because of severe fetal anomalies, the baby won't survive out of womb or the woman is at risk. They are almost exclusively because the mother's health is at risk, a woman's life is at risk or the baby cannot survive."

Kentucky lawmakers have passed two abortion statutes that were recently struck down by federal judges: an old one that required abortion clinics to have signed agreements with a hospital and ambulance service, and a recent one to require providers to perform an ultrasound, describe it and show it to the patient prior to an abortion. The state is appealing both rulings.

A third case involves a 2018 law that would ban the most common type of abortion, known as "dilation and evacuation" at roughly 11 weeks of pregnancy or after. The case was heard in the U.S. District Court in Louisville last year and awaits a decision from the judge.

Brief therapy sessions can greatly improve mental health of women caring for children with severe health issues, U of L finds

Just a little therapy can greatly improve the mental health of women who are overwhelmed by caring for children with severe health issues, says a study done at the University of Louisville.

After five sessions of cognitive behavioral therapy, "study participants reported significantly decreased depressive symptoms, negative thinking and chronic stressors, and experienced improved sleep quality," U of L said in a news release.

Lynne Hall, Dr.P.H., R.N. (University of Louisville photo)

Lynne Hall, associate dean of research at the U of L School of Nursing, presented the findings Friday at the Council for the Advancement of Nursing Science State of the Science Congress on Nursing Research in Washington, D.C.

“Women caring for children with chronic conditions such as cerebral palsy and cystic fibrosis are at high risk for depressive symptoms,” Hall said. “They have many things to juggle, including caring for the child, administering medications and coordinating physician and therapy visits. They’re stressed and overwhelmed by the amount of care their children require and the number of hours a day it takes.”

About 15 million American children have special health needs and 72 percent of their caregivers are women, the news release said. Hall said women caring for such children should be screened for depression and that brief cognitive behavioral therapy is an essential treatment for them.

Brief CBT is a short-term, goal-oriented psychotherapy that "takes a hands-on, practical approach to problem solving and focuses on changing patterns of thinking or behavior to decrease negative thoughts and improve recognition of one’s ability to cope," the release said.

Many women in the study “said they felt very isolated and there was no one who would listen to them,” said Catherine Batscha, psychiatric-mental health nurse practitioner who provided CBT to the study participants. “Because of their child’s care requirements, the women had difficulty getting together with friends because they couldn’t hire a babysitter who knows about medical equipment or complex health conditions, so people were cut off from a lot of social support.”

The study was funded by a $75,000 grant from Passport Health Plan’s Improved Health Outcomes Program and a $50,000 grant from Kosair Charities.

Kentucky's breastfeeding rate is one of the lowest in the U.S.

Photo: Kybreastfeeding.com
(Click link for more information)

By Melissa Patrick
Kentucky Health News

The federal Centers for Disease Control and Prevention says breastfeeding is a key strategy to improve public health, and Kentucky ranks 48th among the states in the percentage of mothers who breastfeed.

Studies show that children who have been breastfed have less risk of respiratory infections, Sudden Infant Death Syndrome, Type 1 and Type 2 diabetes, obesity and asthma. Mothers who breastfeed have a decreased risk of  breast, ovarian and endometrial cancers and heart disease, all conditions that plague Kentucky.

"I don't think we have any pill, any vitamin, any thing that we can take that can reduce the risk of all these diseases just at once. Like, take this pill once a day and you will be able to decrease all these diseases. There is nothing like that," Ana Maria Linares, an associate professor at the University of Kentucky College of Nursing, said in a telephone interview. "But we can give that to our babies with exclusive breastfeeding."

The American Academy of Pediatrics recommends that infants be only breastfed for the first six months, with continued breastfeeding alongside complementary foods for at least one year.

"Breast milk is especially adapted to be easily absorbed by the baby gut . . . and produces a specific microorganism in the gut that (will) protect the infant," Linares said.

The CDC's 2016 Breastfeeding Report Card says Kentucky's breastfeeding rates are slowly improving, but remain very low.

The U.S. Department of Health and Human Services sets Healthy People goals in a plan to improve the nation's health.

Six months after giving birth, 35.3 percent of Kentucky mothers reported  breastfeeding their infants some of the time, with only Louisiana (31.2 percent) and Mississippi (23.9 percent) having lower rates. Only 19 percent of mothers in Kentucky breastfed exclusively after six months; that was much closer to the national figure of 22.3 percent.

Two-thirds of mothers in Kentucky said they tried breastfeeding at least once, indicating a willingness to do so and perhaps a lack of support to continue, the report said. Nationally, 81 percent of mothers tried breastfeeding at least once.

"We are getting there," said Linares, the UK professor whose research focuses on breastfeeding. "I am really positive about that  because more and more mothers are willing to breastfeed now, at least give it a try. And that is a lot to say because before they wouldn't even consider it."

Rates for Kentucky mothers who have breastfed their infant for six months has improved by almost 34 percent since the CDC started publishing these report cards in 2007, up from 26.4 percent. And improved 153 percent for Kentucky mothers who breastfed exclusively for six months, from 7.5 percent. Data from the 2007 report came from 2004.

Linares said Kentucky is working to teach health-care providers about the importance of breastfeeding and has increased its pre-natal education about breastfeeding. The state offers a peer-counseling program that puts mothers who have had a good breastfeeding experience in touch with new breastfeeding mothers.

"The peer counselor program is one of the most important programs in the state," because it provides support for mothers not only to start breastfeeding, but to also maintain it, Linares said.

The state is also working to get hospitals certified as "Baby Friendly," which, among other requirements, allows the mother and baby to have "skin-to-skin" contact for at least two hours, with has been proven to prompt breastfeeding.

Kentucky has three such hospitals: Norton Women's and Kosair Children's Hospital in Louisville, St. Elizabeth Medical Center in Northern Kentucky, and University of Kentucky Hospital in Lexington.

Linaes said that Kentucky has work to do on its societal views of breastfeeding, because some mothers still feel that they don't have enough support to do it, especially in public places. Kentucky has had a law since 2006 that allows mothers to breastfeed anywhere.

"We need to have a law that protects mothers so that they can have maternity leave, to stay home for at least one month so that they can establish breastfeeding," Linares said, adding that six months would be preferable.

Linares said the U.S. is one of only three developed countries that doesn't offer paid maternity leave, which she said creates a situation which poses a question for mothers: "Should I work or should I breastfeed my baby?" She cited a study indicating if 90 percent of U.S. mothers were able to breastfeed exclusively for the first six months, it would save the country "billions of dollars" and "many lives."

Poor, rural mothers-to-be have high levels of stress, and few resources to help them handle it, small-scale study concludes

Low-income pregnant women in rural areas experience high levels of stress, but lack the appropriate means to manage their emotional well-being, according to a small-scale study at the University of Missouri. The authors suggest that rural doctors should link these women with resources to help manage stress, Medical Xpress reports.

"Many people think of rural life as being idyllic and peaceful, but in truth, there are a lot of health disparities for residents of rural communities," Mizzou nursing professor Tina Bloom told Medical Xpress. "Chronic, long-term stress is hard on pregnant women's health and on their babies' health. Stress is associated with increased risks for adverse health outcomes, such as low birth weights or pre-terms deliveries, and those outcomes can kill babies."

Researchers studied about 25 rural pregnant women. Through interviews, researchers discovered that financial problems were one of the biggest stressers for them. Financial stress was exacerbated by the women's lack of employment, reliable transportation and affordable housing. The women also said that small-town gossip, isolation and interdependence of their lives with extended family members also increased stress. Almost two out of three women showed symptoms of depression, and one in four displayed symptoms of post-traumatic stress disorder. (Read more)

National Breastfeeding Week, Aug. 1-7, focuses attention on need for supportive families, friends and employers

World Breastfeeding Week is Aug. 1-7, so the state Department for Public Health is pointing out the importance of providing support for breastfeeding families. “We encourage mothers to breastfeed to ensure that infants are getting the nutrition they need to grow and thrive,” said Health and Family Services Cabinet Secretary Audrey Haynes. “Even the most committed mothers can struggle to successfully breastfeed when they don’t have the kind of support system they need at home, at the workplace and in the community. If we want to send the message that breastfeeding is important and improve our breastfeeding rates, we need to support mothers who choose to breastfeed.”

The World Health Organization, the American Academy of Pediatrics and other medical organizations recommend that babies be exclusively breastfed for the first six months of life, and continue to be breastfed, along with other food sources, for at least a year. The cabinet and the department want fathers, other family members, friends, employers and others to know that, and the importance of support for breatfeeding mothers, especially in the workplace. “Continuing breastfeeding after returning to work is a tremendous challenge,” said Fran Hawkins, director of the state's Women, Infants and Children nutrition program. Public health officials stress that continuing breastfeeding after returning to work is often necessary to meet the recommendations for optimal infant nutrition.

The state says four steps help make workplaces more conducive to breastfeeding: support from managers and coworkers; flexible time to express milk (10 to 15 minutes three times per day); education for employees about how to combine breastfeeding and work; and a designated space to breastfeed or express milk in privacy. Kentucky law protects women who wish to breastfeed their babies in public. This law permits a mother to breastfeed her baby or express breast milk in any public or private location. This law also requires that breastfeeding not be considered an act of public indecency or indecent exposure. For more information, contact Marlene Goodlett at (502) 564-3827 ext. 3612 or marlene.goodlett@ky.gov. Information on breastfeeding can be found here.

Mothers should try to go to full term in their pregnancies, but many are unaware of the risks of early delivery, UK study finds

Illustration by Michelle Kumata via KRT

Babies who are born before the full term of 40 weeks may have health problems later in life, since important brain development takes place in the very last stages of pregnancy. As such, mothers should try to avoid being induced early or having elective C-sections.

A study conducted at the University of Kentucky College of Communication and Information found women often don't realize the important development that takes place at the end of pregnancy, write UK doctoral student Sarah Vos and H. Dan O'Hair, dean of the college, for the Lexington Herald-Leader.

Evidence shows that early, elective births are expensive. One study found reducing the number of elective births before 39 weeks of gestation to less than 2 percent of all U.S. births would save $1 billion each year.

But many women are uncomfortable at the end of their pregnancy, are anxious to know their children are healthy, and may even ask for early induction of labor because employers aren't flexible about time off. Sometimes doctors and other providers induce women early for their convenience.

Encouraging women to go full term and telling them the disadvantages of early labor — problems feeding and a higher incidence of Sudden Infant Death Syndrome — can influence their decision. As Vos and O'Hair conclude, "Babies are worth the wait." (Read more)