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.

15% fewer med-school grads applied for residencies in Kentucky this year; med-school association attributes that to abortion ban

Photo by Phallin Ooi, Creative Commons

By Sylvia Goodman
Kentucky Public Radio

The Association of American Medical Schools says 15 percent fewer U.S. medical-school graduates applied to Kentucky residency programs in the 2023-24 academic year, part of a trend related to states' strong anti-abortion laws enacted after the federal right to abortion was abolished. The decline was even greater in programs for obstetricians and gynecologists.
 
The study found that U.S. medical students were less likely to put in an application in states with abortion bans in place. The state's near-total abortion ban only allows exceptions if the mother is in imminent risk of death or permanent injury to a life-sustaining organ.

Dr. Atul Grover, executive director of the AAMS Research and Action Institute, found that 15% fewer U.S. medical students applied to residency programs in Kentucky during the last academic year compared to the 2022-23 school year. That’s 1,050 fewer applicants across specialties.

In OB-GYN programs, there was an even sharper 23% decline, Grover said. “We do see these trends across specialties, though,” he said. “People get a little jittery around the idea that the state government is going to come in and tell you what is not appropriate care for a patient when you know otherwise.”

Grover noted that medical students overall applied to fewer schools, meaning students got pickier in where they applied. That accounts for some of the decrease in applications across states, but the remaining deficit, he said, is cause for concern — particularly to states with abortion bans.

“Health-care shortages, across specialties, across a lot of states, are already being felt by patients,” Grover said. “If I think about Kentucky, Alabama, Mississippi, these are states that already have trouble attracting and recruiting, retaining physicians.”

Kentucky hospitals are already dealing with an “acute shortage” of health care workers, with nearly 13,000 job vacancies in hospitals at the end of 2022, says the Kentucky Hospital Association.

Grover said medical-residency application numbers are one of the fastest ways to measure where doctors are moving or interested in moving. Other metrics are harder and take longer to track. Residents have a tendency to stay in the state where they train.

Grover said lawmakers should understand the full implications of abortion bans, especially in a state that already suffers from several physician shortages, including in women and reproductive health fields. According to the U.S. Health Resources and Services Administration, more than half of Kentucky’s 120 counties didn’t have a single OB-GYN specialist in 2022-23.

Louisville pediatrician Dr. Michelle Elisburg said many doctors entering residency are in their mid-to-late 20s, and may be considering having children themselves. The bans may keep those women or their partners from considering moving to the state either.

“You wouldn't come if you're a young woman and know that if something happens to you, you might die because they aren't gonna let you get the health care you need,” Elisburg said. “That's where you are going to lose the doctors.”

Elisburg was part of the lobbying effort by Kentucky Physicians for Reproductive Freedom to end the state’s abortion bans this year.

She said the bans keep students from receiving all the training they need to provide abortion care or require them travel out of state to get it. “If there's such a ban, that restricts the kind of training that people are able to do,” she said. “They're not going to want to come to a state where they can't be completely trained in all the techniques in their field.”

Blair Wooten, who attended the University of Louisville medical school, said the state’s abortion ban was one of the reasons she decided to leave the state. She ended up going to a program in Ohio for the last year. She said abortion medical training “is paramount to me. It's something I want to be in my practice.”

Wooten is moving to a residency program in Indiana, which has its own abortion ban, but that program gives students the opportunity to receive abortion training in a Detroit-based program, which eased some of her fears — and clinics in Ohio are just a few hours drive away.

Wooten said she’s not sure if she’d consider setting up a practice in a state without abortion access. She said the inability to immediately provide the care she believes is necessary would be painful, but she also wants to provide services in health care deserts.

“Family planning is something I want to be a big part of my practice, so I usually say, ‘No’,” Wooten said. “But I'm also keenly aware that people need resources in every place, especially places that are maybe a little more hostile. And they need providers who care and can help them even with limited resources.”

As doctors plead for end to state abortion ban, legislators file bills to protect in vitro fertilization from court rulings like Alabama's

Dr. Virginia Stokes, an obstetrician-gynecologist, said she’s treated many conditions that required abortion to prevent sepsis and preserve patients’ fertility. (Kentucky Lantern photo by Sarah Ladd)

By Sarah Ladd

Kentucky Lantern

In response to a ruling from the Alabama Supreme Court stating that frozen embryos are children, Kentucky state senators from both parties have filed bills aimed at protecting access to in vitro fertilization in Kentucky.

Meanwhile, nearly 300 Kentucky health-care providers and medical students signed a letter asking legislators to restore access to abortion in the state, saying its ban on abortion handicaps their ability to provide comprehensive care.

Republican Sen. Whitney Westerfield of Christian County, a staunch opponent of abortion, filed a bill Wednesday saying that any facility or “procedure related to in vitro fertilization shall not be liable” for damages “to a patient or patient’s surviving spouse or partner resulting from the loss of a human embryo, except in cases of negligence or wanton, willful, malicious or intentional misconduct.”

It also protects health care providers “performing any procedure” related to IVF from criminal charges. The day before, Sen. Cassie Chambers Armstrong, a Louisville Democrat, filed a similar bill. The Alabama Legislature passed similar legislation Thursday.

Alabama, Kentucky and at least eight other states have laws saying human life begins at conception, with the fertilization of an egg by a sperm cell; Kentucky's law speaks of the "unborn human being."

IVF is used to treat infertility, and can help other people trying to get pregnant to do so, according to the Mayo Clinic. About 2 percent of U.S. births are results of the procedure. It sometimes involves freezing embryos for future attempts at insemination; damage to frozen embryos at a fertility clinic prompted the lawsuit that led to the Alabana ruling.

Westerfield’s filing comes as he and his wife are expecting triplets, which he announced in January. He said at that time in a Senate floor speech that they adopted and transferred embryos for the pregnancy. His 6-year-old son is an “embryo adoption” baby, he said.

At a Thursday news conference, Democratic Gov. Andy Beshear said the Alabama ruling “is what happens . . . when you embrace extremism.”

He cited Kentucky’s near-total abortion ban as another example: “Women that have non-viable pregnancies still have to oftentimes carry that pregnancy to term knowing they’re going to hear their child die moments afterwards if it hasn’t already happened.”  

Kentucky bans abortion except in cases of threat to the woman's life or of serious, permanent damage to a life-sustaining organ, under a law triggered by the U.S. Supreme Court's 2022 overturn of Roe v. Wade, the 1973 decision that created a constitutional right to abortion. 

The ban causes “devastating consequences” for patients, Louisville’s Dr. Marjorie Fitzgerald said at the health-care providers' event. “We are losing obstetricians who will not practice in our state,” a nd because of the restrictions, “Doctors are violating their Hippocratic oath to do no harm.”

Fitzgerald was joined in the Capitol Annex by Democratic lawmakers, other medical providers and a second-year medical student in Frankfort to discuss the letter written by the Kentucky Physicians for Reproductive Freedom and signed by 280 providers.

They detailed the complex nature of medical decisions that lead to abortions and slammed lawmakers for restricting their ability to provide that care.

Dr. Nancy Newman, a board-certified obstetrician, said she would not now come to the state because of a “culture of fear that our legislature has created” in which providers have to decide between jail time and what their patients need. “How do you practice medicine in a culture of fear? I don’t think you can.”

Dr. Michelle Elisburg, a Louisville pediatrician, told the story of a 14-year-old patient who was raped by a 60-year-old landlord and got pregnant.

“She had the baby and then dropped out of high school to get a job” to support herself and her child, Elisburg said. “Now both mother and child have multiple risk factors for poor health, educational and vocational outcomes, requiring more financial assistance from the state.”

Elisburg said that as a Jewish physician, she’s governed not only by the Hippocratic oath to do no harm, but also a faith-based oath to act in the best interest of her patients: “As a physician in Kentucky, I am now being forced to make impossible choices that put my professional ethics and my faith in direct conflict with the law.”

Urooj Nasim, who attends the University of Louisville medical school and said she spoke only for herself, said abortion bans may keep her and her classmates from getting the hands-on training they need to become obstetrician-gyneciogists and tackle Kentucky’s high rates of maternal mortality.

“In order to make the best calls for the patients of my future, I need to receive high quality training and all of the tools and procedures available,” Nasim said. “And in a state where physicians live in fear of being prosecuted for delivering standard care, that is just not possible.”

The American College of Obstetricians and Gynecologists says “In states with abortion bans, medical students and residents are not able to receive the hands-on training they need in order to provide patients with comprehensive care.”

Nasim, who was born in St. Louis and lived in Somerset until she was 8, told the Lantern she is “undecided” on her specialty path but was “moved by that patient population” when she worked with an obstetrician previously.

“I’m a very … mission-driven medical student,” she said. “I really want to help patients with a lot of the social factors that affect their health. And OB is a really great specialty to do that in.”

Latest in a line of protests

The Thursday letter is the latest in a long line of efforts to protest Kentucky’s tight abortion bans.

In 2022, Kentucky voters defeated a constitutional amendment that would have keptt courts from finding a right to an abortion in the state constitution.

In late 2023, a Kentucky woman sued for the right to access abortion and end an unwanted pregnancy, but dropped the lawsuit when the fetus lost cardiac activity.

Republicans and Democrats have filed bills seeking to loosen or undo Kentucky’s abortion bans, to no avail.

Several anti-abortion lawmakers have focused their efforts during the 2024 session on making Kentucky a safer place to give birth and codifying support for expectant parents.

This week state Rep. Ken Fleming, R-Louisville, filed a bill seeking rape and incest exceptions to Kentucky’s abortion bans — but only in the fist six weeks of pregnancy

Newman, an obstetrician, said “Most women don’t even know that they’re pregnant by six weeks,”  an in case of assault, “The victim likely may not even tell anyone before six weeks.”

Dr. Virginia Stokes, a board-certified obstetrician-gynecologist, said she’s treated many conditions in her tenure as a physician that required abortion — placenta previa, first and second trimester ectopic pregnancies, preterm rupture of membranes, cancer, sepsis and more.

A lack of early interventions, she said, can cause “total body sepsis and death due to the sepsis. And if death is avoided, there is a frequent loss of fertility due to disruption of the uterus.”

“The fetus will not survive if the mother doesn’t survive,” Stokes said.

In such cases she’s treated, she said, these are “gut wrenching decisions with no choice to be made” involving “very much wanted and cherished pregnancies.”

“There are lots of really bad things that can happen between six and 12 weeks,” Stokes added. “and we need to have permission to take care of those patients.”

“I am pro-life,” Stokes said. “I am for saving the life of these women who have these early pregnancy complications that require, unfortunately, a cessation of the pregnancy …. As an OB-GYN, my first priority is the life of my female patient. Please don’t tie my hands.”

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.”

Ky. abortion ban makes more women seek sterilization; doctors try to clarify uncertainty about the limited exceptions to the ban

With Kentucky's near-total abortion ban in place at least until November, and state law unclear about the very limited exceptions, there has been a "swell of demand" for surgical sterilizations, doctors calling for clarity around when an abortion is allowed, and to top it off, uncertainty around who is going to provide that clarity, Alex Acquisto reports for the Lexington Herald-Leader.

Kentucky's abortion ban was triggered when the U.S. Supreme Court overturned Roe v Wade, the 1973 decision that created a constitutional right to abortion. The law immediately banned abortion in the state, with exceptions to prevent the woman's death or serious impairment of a life-sustaining organ; another law bans abortion after six weeks of pregnancy.

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

The sudden lack of access to abortion care has resulted in hundreds of Kentucky women seeking surgical sterilization, what is often called having your tubes tied or a tubal ligation, Acquisto reports. 

Ashley Watson (Herald-Leader photo)

Ashley Watson, a 36-year-old from Wilmore, told Acquisto that she decided to seek permanent sterilization because she had severe postpartum depression following each of her daughters' births. 

“My mental health wouldn’t survive another pregnancy,” Watson told Acquisto. 

She added, "We live in a very conservative state, and there’s this fear that birth control is going to be the next thing on [legislators’] agenda." To avoid remaining pregnant against her will, she told Acquisto that permanent sterilization “is the only thing I can do to guarantee that I’m never going to be put in that position.”

Destinee Ott, a 25-year-old Beattyville teacher, told Acquisto that she decided to have her tubes tied because she would be have no option to terminate a pregnancy if her birth control failed.

Acquisto reports that Ott has polycystic ovary syndrome and endometriosis, and that if she gets pregnant, the PCOS creates a high likelihood of an ectopic pregnancy, which is when a fertilized egg implants outside of the uterus, often in a fallopian tube.

"Though an ectopic fetus can have a heartbeat, none are viable," Acquisto notes. "If not treated early enough, an ectopic will rupture and cause serious medical complications for the pregnant person, even death." She reports that treatment for an ectopic pregnancy is either a surgical or medical abortion, which means it is regulated by Kentucky's trigger law. 

"An ectopic pregnancy will eventually become life-threatening. But it might not be life-threatening, initially, depending when it’s diagnosed in a pregnancy," Acquisto writes.

Herein lies the gray area and Otts knows this, she writes: "Under the law, if she were to have an ectopic pregnancy, she worries she wouldn’t reliably be able to get an abortion until it progressed to the point of endangering her life, which is partly what’s propelling her to get a tubal now," she writes.  

“I hadn’t really worried about it before now, just because there were other options if something did go wrong,” Otts told Acquisto, referring to in-state abortion access. “But now I’m wanting that security, just because, with my medical issues, I don’t want to risk it.” 

Both women quickly learned that they were just two of hundreds of Kentucky women seeking sterilization in a post-Roe state, Acquisto reports: "It’s a swell in demand that remains two months later, according to seven board-licensed obstetrician-gynecologists at Baptist Health, Lexington Women’s Health, Women’s Care of Lake Cumberland and University of Louisville Health."

Three of the OB-GYNs spoke with Acquisto on the condition of anonymity, fearing retaliation from their employer, which has demanded they not speak publicly about this topic, she reports.

Doctors are worried too

"The anxiety felt by Kentuckians around the future of abortion care extends to their doctors, too," Acquisto writes. "Some say legal gray areas are creating challenges in their practices and could have lasting impacts on health care." 

She adds, "Though clinics and hospitals did not have quantifiable data available, Baptist Health, Kentucky’s largest health-care system, said its patient demand within a week of Roe falling was 'significant' and 'notable'" for tubal ligations, vasectomies and other long-term birth-control measures.

The doctors Acquisto interviewed said there has been a shift in who is asking for tubal ligations; before, it was largely women with biological children, but now it is driven by women in their 20s with no children. Now the waiting list for the procedure, in some cases, is now months long. 

"Roe was tossed on Friday, June 24. The following Monday, an OB-GYN at Lexington Women’s Health told the Herald-Leader their front desk fielded a staggering 91 requests for tubals," Acquisto reports. "On July 12, Dr. Lynne Simms said her Baptist Health clinic provided 22 tubal consults,” and said at least five patients asked "what their options would be in the future regarding birth control."

"In short, women in Kentucky guarding their bodies against the possibility of pregnancy have descended in droves," Acquisto reports. 

A "vaguely worded law" 

Acquisto reports that doctors are trying to figure out "how to give medically necessary abortion care under a vaguely worded law, the violation of which could result in a felony charge or jail time."  

"No provider who spoke with the Herald-Leader had a clear understanding of the exact conditions and ailments that count as medical exemptions, but most agreed that an abortion is only legally allowed in the event of a medical emergency," she writes. 

The law says a licensed physician can perform an abortion without risking a Class D felony (punishable by one to five hears in prison) if it’s “necessary, in reasonable medical judgment to prevent the death or substantial risk of death due to a physical condition, or to prevent the serious, permanent impairment of a life-sustaining organ of a pregnant woman.” 

The law requires the physician to make “reasonable medical efforts under the circumstances to preserve both the life of the mother and the life of the unborn human being in a manner consistent with reasonable medical practice.”

But Acquisto writes that obstetrician-gynecologists she interviewed "want to know: what about anomalies that are un-survivable to a fetus, but aren’t a health risk to the mother?" 

Such conditions include anencaphaly, in which a fetus never develops parts of its brain or skull, but does not pose a risk to the pregnant person to carry it to term. 

"Before Kentucky’s trigger law took effect, the typical treatment route was a palliative induction, or inducing labor early to abort the fetus, which won’t survive outside the womb," Acquisto reports." But since no medical risk is posed to the pregnant person, and since the fetus could still have a heartbeat, is abortion in this scenario illegal under the trigger law?" 

Or, she asks, "What if one’s water breaks early in a pregnancy — a pre-term pre-labor rupture of membranes — likely fatally limiting fetal development and increasing the risk of severe infection in the pregnant person. Is an abortion lawful only if a severe infection develops, even if the fetus isn’t viable?" 

The Kentucky Medical Association told Acquisto that Kentucky's abortion laws "raises a number of legal questions for Kentucky physicians" and that they are working with their legal experts to analyze them before issuing official guidance. 

Meanwhile, a Lexington obstetrician-gynecologist told Acquisto that there is a push to “document the crap out of these discussions,” and to get second and third opinions. She then went on to describe a miscarriage situation where she would have performed a surgical abortion prior to this law, but because of it ordered a second ultrasound to prove beyond a reasonable doubt that the patient needed it. 

“I know it’s a miscarriage, but I don’t want to risk anything,” she said. “It’s wasting health-care dollars, but I don’t want a felony charge.” 

Acquisto reports that care for a Kentucky woman with an ectopic pregnancy was delayed because a physician assistant in an emergency room refused to fill a called-in order from the patient's gynecologist for an injection of methotrexate because he didn't want his name on the order. Methotrexate is a drug used in medical abortions.

Acquisto reports in detail that some other states' abortion bans cite specific medical conditions that are exempt from them, including ectopic pregnancies and miscarriages; and notes differing interpretations between physicians in states where laws don't have them such specifics. 

In Kentucky, Acquisto reports, it is unclear which state agency is charged with translating or clarifying the trigger law, since the Department for Public Health told her it does not bear that responsibility. 

“Each provider should be exercising their clinical judgment and treating patients accordingly,” department spokeswoman Susan Dunlap said. “DPH does not have a role in this.”

Bill moving in legislature would ban abortions after 15 weeks

Max Wise (Photo by Ryan C. Hermens, Lexington Herald-Leader)

Update 3/16/2022: Senate Bill 321 passed out of the Senate on a 31-6 vote. 

Abortions in Kentucky would be illegal after the 15th week of pregnancy, if the legislature passes a bill that cleared its first hurdle Thursday.

The Senate Judiciary Committee voted along party lines to approve Senate Bill 321, which sponsor Max Wise, R-Campbellsville, said is “closely modeled” after a Mississippi law that awaits a U.S. Supreme Court ruling.

Many legal observers expect the court to uphold the law, setting a new limit for abortions in the U.S. Wise said, “I’m bringing this bill to you so that in the event the Supreme Court upholds the Mississippi legislation . . . we will have a pro-life law in place not subject to a good-faith legal challenge.”

The 2018 legislature banned "dilation and evacuation" abortions, which typically take place after 15 weeks, but that law was found unconstitutional under the Supreme Court's 1973 decision that established a right to abortion until the fetus could live on its own, about 23 weeks.

Andy Beshear, then attorney general and now governor, did not appeal the federal district court's ruling, but the high court recently allowed current Attorney General Daniel Cameron to file an appeal. Beshear said yesterday that any laws limiting abortion should have exceptions for cases of rape or incest.

Wise's bill would allow abortion after 15 weeks “to avoid a serious risk of the substantial and irreversible impairment of a major bodily function of the pregnant woman,” or to save her life.

It also "finds and declares according to contemporary medical research" that most abortions after 15 weeks "involve the use of surgical instruments to crush and tear the unborn child apart" and "that the intentional commitment of such acts for nontherapeutic or elective reasons is a barbaric practice, dangerous for the maternal patient, and demeaning to the medical profession."

Dr. Brittany Myers, a Louisville obstetrician-gynecologist, told the committee the bill has “false information and inflammatory language that is focused on shaming and falsely informing the non-medical community,” and said 15 weeks is an arbitrary limit, the Lexington Herald-Leader reports.

Wise's bill says that at 12 weeks, a fetus "can open and close his or her fingers, starts to make sucking motions, senses stimulation from the world outside the womb, and has taken on 'the human form' in all relevant aspects" under the Supreme Court decision upholding the 2003 Partial Birth Abortion Ban Act.

Though Wise's bill depends on the Supreme Court overturning the 1973 Roe v. Wade decision, the legislature has been "moving ahead as if the landmark law has already been struck down," writes Alex Acquisto of the Herald-Leader. "Over the past six years, Kentucky has not only adopted laws that would make abortion illegal (a 2019 “trigger law” bans abortion immediately if Roe is overturned), and revoke one’s constitutional right to the procedure (Kentuckians will vote on whether to do this in a statewide referendum later this year). But Republican lawmakers have buttressed those laws with a patchwork of other regulations to make the procedure as difficult as possible to access."

House Bill 3, in the Senate Health and Welfare Committee, "would disallow the mailing of abortion pills,' which now are used in most reported Kentucky abortions, "and create a new arduous certification and monitoring program that the Board of Pharmacy says it simply lacks the staff and resources to manage," Acquisto writes.

Republican legislator gives overview of 'pro-life omnibus bill' that opponents say is designed to push abortion out of reach

By Melissa Patrick
Kentucky Health News

Foes of abortion gave state legislators an overview Wednesday of a proposed bill that would strengthen parental-consent requirements, increase abortion-medication rules, require individual cremation of aborted fetuses and let medical providers refuse to do procedures that "violate their conscience."

Rep. Nancy Tate discussed her bill.
(Image from WTVQ, Lexington)

Rep. Nancy Tate, R-Brandenburg, told the Interim Joint Committee on Veterans, Military Affairs and Public Protection that her "pro-life omnibus bill" will not include exemptions for rape or incest.

Tate said, “If there’s a human baby that’s created from that tragedy,” Tate said, “then the life of that human baby needs to be treated with dignity and respect as well.”

Addia Wuchner, executive director of the Kentucky Right to Life Association and a former state representative, said the yet-to-be-filed bill will be called the "Humanity in Health Care Act."

Kentucky requires consent of one parent or legal guardian, or a "judicial bypass" court order, for a minor to obtain an abortion. Tate's bill would require a parent's identification to be recorded, and require a physician to sign an affidavit stating that proper parental consent had been given.  

While giving a summary of a PowerPoint presentation about the bill, Tate said it would also remove the ability of the physician to delegate the responsibility of obtaining proper parental consent to someone else.

Physicians who knowingly perform an abortion on a minor without following these rules would be  subject to discipline by the Kentucky Board of Medical Licensure and could be found guilty of a Class D felony, punishable by one to five years in prison. Performing an abortion without knowing that the patient is a minor would be a Class A misdemeanor, punishable by up to a year in jail. The bill has no criminal sanctions against the patient. 

Tate said the bill would also raise standards for a minor to qualify for judicial bypass. Her presentation said a judge must find "clear and convincing evidence that the minor is mature, that the abortion is in the best interest of the minor, and that the pregnancy is not a result of abuse by the parent or guardian." 

Further, the judge must ensure the minor is not seeking an abortion due to influence or pressure from an outside source, and would not be allowed to consider a minor's financial situation as a reason to approve an abortion.

Tamarra Wieder, state director of Planned Parenthood Alliance Advocates, told the committee that the bill would make getting parental consent and judicial bypass more difficult. She added that "the vast majority" of teens in Kentucky already involve their parents in their abortion decisions. 

"This bill as we heard today would make the already comprehensive judicial bypass process more onerous and prevent many young people from obtaining a court waiver to ensure their access to care, which is directly what this bill is trying to do — to stop young people from accessing abortion," Wieder said.

She noted that national groups such as the American Medical Association, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics oppose parental-consent laws because they delay access to critical care and threaten the privacy and safety of vulnerable young people.

The annual abortion report from the cabinet's Office of Vital Statistics says that in 2020, 4,104 abortions were recorded in Kentucky. Of those, 13 were performed on girls younger than 15 and 353 were for those 15 to 19. Most abortions (2,421) were among Kentucky women 20 to 29; 779 were for those 30-34; 399 for  those 35-39; and 139 for women 40 or older. 

Tate's bill would also increase regulations on abortions induced by drugs, by not allowing them to be mailed. Tate said more than half of the abortions done in Kentucky each year are done with such drugs.

The bill also would require a physician providing chemical abortions to be credentialed, and to have a signed contract with another physician "who is able to handle complications if they arise," and an emergency transfer agreement. 

It also adds a list of things physicians must do prior to the abortion, including a requirement for the physician to examine the patient in person, conduct a range of blood tests, and do an ultrasound to determine the fetus' gestational age.

Sue Liebel, state policy director of Susan B. Anthony List, an anti-abortion political action committee, said abortion activists have been "quietly building a whole new business model to target young women on their phones" and providing them with information about how to get abortion drugs by mail. 

"This is the goal that would make every bathroom, whether it's in our own homes, or in the dorm bathroom, an abortion clinic," she said. "This bill modernizes Kentucky laws to align with the pharmaceutical dangers of chemical abortion." 

The bill would add several new elements to the informed-consent form, including information about "abortion-pill reversal," and require the Cabinet for Health and Family Services to create a website and publish printed material about the reversal process, and where patients can find a provider who offers it. The technique involves a series of oral or injected doses of the hormone progesterone after the first drug used in a chemical abortion is taken.

Wieder said the claims about abortion-pill reversal are based on "junk science," pointing out that it is not recommended by the American College of Obstetricians and Gynecologists, which says claims supporting the treatment "are not based on science and do not meet clinical standards” and that "legislative mandates based on unproven, unethical research are dangerous to women's health." 

Tate disagreed, saying studies have shown abortion-pill reversal to be successful. 

The bill would also require a physician to ensure that the patient seeking an abortion is not being coerced or forced into having the procedure, and would update the reporting requirements. 

Also, the Kentucky Board of Pharmacy would be required to create a program to monitor distribution of abortion-inducing drugs. Physicians who do not follow these certificate guidelines would be subject to a $250,000 fine. 

The bill would also write new rules for handling fetal remains, giving parents options for disposal, and require each fetus to be cremated individually. 

“We recognize it as a human baby,” Tate said. “It should not be treated as medical waste, it should not be thrown into an incinerator, it should be treated with dignity; and then, therefore, it should be disposed of on an individual basis.”

Wieder said that is a “blatant attempt to create shame and stigma,” adding that there are already regulations about how medical tissue is disposed of. 

Jackie McGranahan, Kentucky policy strategist for the American Civil Liberties Union, said in a prepared statement that the legislation is a "blatant attempt to push abortion care entirely out of reach under the guise of "public protection." 

"The bills would increase the government’s involvement in family relationships and force pregnant Kentuckians, including children, to remain pregnant against their will," she said. "Additionally, the bills are rife with medical fallacies and outright untruths about abortion care." 

Late last month, Democrats pre-filed a bill that would provide every individual in Kentucky with access to comprehensive sexual and reproductive health care, including abortion and contraception. With a Republican super-majority in both the House and Senate, the bill seems unlikely to gain any traction. 

Under House Bill 91 passed by the legislature this year, Kentucky voters will decide in November 2022 if they want to add language to the state constitution a statement that the state's basic law does not secure or protect a right to abortion, or funding of it.

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

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

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

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

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

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

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

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

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

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

Humana continues move away from fee-for-service model, toward paying for a whole case and incentivizing better outcomes

Health insurer Humana Inc. "has reached an agreement to pay five maternity-care providers, including three near Louisville, based at least in part on patient outcomes, rather than the number of health-care services they provide," reports Boris Ladwig of Insider Louisville.

The deals show how Humana is "moving away from the traditional fee-for-service model, in which health-care providers are paid for each individual care procedure, and toward so-called bundled care or capitation models, in which providers are paid for entire health episode or per patient," Ladwig writes. "Humana and the maternity care providers expect that their cooperation, which will target low-to-moderate risk pregnancies, will reduce readmissions and complications, thanks in part to data analysis."

If the clinics can reduce costs of a pregnancy below a target set in the contract, they can get part of the savings as a bonus — if patient outcomes improve. "For example, if the providers reduce costs, but quality declines — based on measures including the share of patients who make it to full term and the share of patients who require a C-section — the providers will not eligible for the bonus," Ladwig reports.

Brent Stice, director of value-based strategies for Humana, told Ladwig, “We don’t just want them to reduce cost if it doesn’t increase quality.”

Maternity-care providers who are participating in the plan are Ob/Gyn Associates of Southern Indiana, in New Albany; TriHealth and Seven Hills Women’s Health Centers, both of Cincinnati; and two providers in Kansas and Texas.

The Centers for Medicare and Medicaid Services has said bundled payments “may lead to higher quality and more coordinated care at a lower cost to Medicare,” Ladwig notes. "Government agencies and insurers are moving away from the fee-for-service model because they say it incentivizes providers to see as many patients and perform as many procedures as possible without focusing on health outcomes, which increases health-care costs both in the short and long terms. However, they say bundled payment and capitation models incentivize providers to perform as few procedures as necessary and to focus more on long-term health outcomes, which benefits patients and lowers costs."

Humana is making bundled payments to 40 orthopedic practices in 13 states for Medicare Advantage customers who get total hip or knee replacement, Ladwig reports: "Stice said the company is in conversations with other medical providers about such agreements, and he expects Humana’s push away from the fee-for-service model will continue."

Bill to certify professional midwives passes Senate, but no time remains to pass it through the House by normal means

By Melissa Patrick and Al Cross
Kentucky Health News

FRANKFORT, Ky. -- A bill to give midwives professional recognition in Kentucky made it out of the Senate March 27 on a 29-8 vote, over opposition from doctors. It is all but dead, with only two days left in the legislative session, though the bill's sponsor refused to declare it so.

Sen. Tom Buford

"It's not too late, but as one might say, we are at the finish line and it will be close if it does," Sen. Tom Buford said in a telephone interview. "The General Assembly always has their barrels loaded until the last day after the veto session." Legislators' final day, Saturday, April 14, is scheduled to reconsider any legislation Gov. Matt Bevin may veto.

Since the legislature postponed its last pre-veto session day to Monday, April 2, it only has that day and the veto-override day left, and the constitution requires a bill to be read in a chamber on three separate days before passage. The House would have to add the bill's contents to a Senate bill pending in the House, pass it and return it to the Senate for final approval.

Kentucky has no rules or regulations for midwives. Buford's Senate Bill 134 would create a Certified Professional Midwife Advisory Council under the Kentucky Board of Nursing, which would be responsible for setting care standards for midwives to follow and issue permits to those who qualify.

Buford said Kentucky needs a law on midwifery "because you and I, believe it or not, we could go and be midwives tonight without any training or anything. That's a scary thought."

The Nicholasville Republican said opposition to the bill comes from the Kentucky Hospital Association and the doctors' lobby, the Kentucky Medical Association, even though he has tried to accommodate them with several changes to it. He said the groups voice safety concerns, but their opposition is more likely a "turf battle," adding that "it's usually about the money."

"Remember that a midwife might perform a home-birth delivery for free, or she might charge $3,000 to $6,000 -- and at a hospital, if everything goes right, it's $20,000 if you are in and out in two to three days with no complications," Buford said.

Mary Kathryn DeLodder, a leader of the Kentucky Home Birth Coalition, told the Senate Health and Welfare Committee March 19 that the coalition has been seeking the legislation since 2012. She said Kentucky has more than 700 home deliveries a year, and 33 states already have certified professional midwife programs.

"This bill is about increasing access to the only category of care providers who are clinically trained to attend births in the home settings, and that is the certified professional midwife," she said. She later added, "Families don't rely on Facebook groups to verify if their dentist or their pediatrician is legitimate, and they shouldn't have to do that for their midwife either. . . . Opposing this bill doesn't make anyone safer."

Buford told the Senate that his bill isn't about whether or not Kentucky will have home births, "because we are," he said. "This is a question of whether you want those home births to be safe. To be a somewhat certified individual that comes into that house, knows what they are doing."

Republican Sen. Ralph Alvarado, a Winchester physician who spoke strongly against the bill during the committee meeting, filed a floor amendment with a long list of conditions that would prohibit a certified midwife from attending a home birth, prohibit midwives from performing abortions and require them to have a transfer agreement with hospitals that deliver babies. Any violation of the law would result in a Class D felony.

Alvarado's amendment got 18 votes, all from Republicans, except Senate Democratic Leader Ray Jones of Pikeville; 19 senators, half the Senate, supported it. Democratic Sen. Perry Clark of Louisville did not vote. (See roll call here.)

Buford said afterward that if the legislation becomes law, the advisory council could add some of the same requirements in the "crushing amendment," but he would prefer to leave these decisions to the Board of Nursing and not allow "men to make the decision on how a woman will have a baby."

Ban of most common type of 2nd-trimester abortions nears passage; foes say it's part of larger strategy to ban abortion

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A House bill to ban the most common method of second-trimester abortion is near final passage after passing out of the Senate Judiciary Committee and the Senate on the same day, despite warnings that its passage would lead to a legal fight.

Committee Chair Whitney Westerfield, R-Hopkinsville, said concerns about being sued over a bill that protects an unborn child and the potential legal cost to taxpayers shouldn't be a consideration in voting for this bill. "It's worth challenging precedent," he said.

Rep. Addia Wuchner

House Bill 454, sponsored by Rep. Addia Wuchner, R-Florence, would prohibit an abortion procedure known as dilation and evacuation, or D&E, after roughly 11 weeks of pregnancy except in medical emergencies. The procedure involves dilating the cervix and removing the fetus using suction and surgical tools.

If the bill becomes law, abortion providers found in violation of it would be guilty of a felony that carries a prison sentence. The women undergoing the procedure would not be prosecuted.

A federal court has struck down a ban on the procedure in Texas, and similar bans have been temporarily blocked in Alabama, Arkansas, Kansas, Louisiana, and Oklahoma while litigation proceeds. Mississippi and West Virginia have similar bans that haven't been challenged in court, because the bans aren't expected to have an impact on abortion services, according to the American Civil Liberties Union of Kentucky.

Sen. Wil Schroder, R-Wilder, told both the committee and the full Senate that no federal judge from the Sixth Circuit of the U.S. Court of Appeals, which covers Kentucky, has ever ruled on such a law.

Wuchner said at the March 22 committee meeting that the bill did not prohibit all abortion methods after the 11-week mark in Kentucky because Kentucky women would still be able to get a second-trimester abortion through the induction of labor or a procedure called dilation and curettage, or D&C, which involves dilating the cervix and removing the contents of the uterus by scraping and scooping.

In presenting the bill on the floor, Sen. Stephen Meredith, R-Leitchfield, said, “Abortions by dismemberment, crushing or suction are brutal procedures which are and should be considered repulsive, barbaric and inhumane by any society standards. “This bill upholds basic human dignity.”

Opponents of the bill said that without access to legal D&E procedures, Kentucky women will be limited to undergoing more expensive abortions that takes longer and involve a hospital stay.

Marcie Crim, executive director at Kentucky Health Justice Network, told the committee that Kentucky Revised Statute 311.800 will make getting an abortion after 11 weeks near impossible because it says that no publicly owned hospital or publicly owned healthcare facility can perform abortions, except to save the life of the pregnant woman -- and most of Kentucky's hospitals are either publicly owned or owned by a religious organization.

The bill passed the Senate 31-5, with Democrats Julian Carroll of Frankfort, Reginald Thomas of Lexington and Perry Clark, Denise Harper Angel and Morgan McGarvey of Louisville voting against it. Sens. Gerald Neal of Louisville and Robin Webb of Grayson did not vote.

The bill returned to the House for consideration of a change made in the Senate to add a definition for "unborn child." The bill passed the House March 12 on a 71-11 vote.

Tamarra Wieder, director of external affairs for Planned Parenthood Advocates of Indiana and Kentucky, told the committee that experts from the American Congress of Obstetricians and Gynecologists oppose such laws.

"This bill is part of a larger anti-abortion strategy to ban abortion law by law, method by method," she said. "House bill 454, which uses inflammatory, non-medical language to ban abortion, is further proof of this bill's intent."

In 2016, the state's "informed consent" law was amended to require women seeking an abortion to have a face-to-face or live-chat consultation before the procedure.

In 2017, when Republicans took full control of the General Assembly, it passed two abortion bills that were signed into law by Republican Gov. Matt Bevin, who was elected in 2015. One banned abortions after 20 weeks of pregnancy, unless the mother's life is in danger. The other required women to get an ultrasound before an abortion that included an audible heartbeat, and required the doctor to show and describe the image of the fetus to the patient before performing the abortion. This law was struck down in court, but the state has appealed.

The only remaining abortion clinic in Kentucky, EMW Women's Surgical Center in Louisville, is in a legal battle with the state over licensing issues.

Bill to ban most common type of second-trimester abortion heads to House; foes say it would further limit safe access to procedure

A bill to ban the most common method of second-trimester abortion passed out of the House Judiciary Committee March 7, with opponents saying the legislation would severely limit Kentucky women's access to safe abortions.

Rep. Addia Wuchner

House Bill 454, sponsored by Rep. Addia Wuchner, R-Florence, would prohibit an abortion procedure known as dilation and evacuation, or D&E, after roughly 11 weeks of pregnancy except in medical emergencies. The procedure involves dilating the cervix and removing the fetus using suction and surgical tools.

The committee heard testimony on the bill several days before it took the vote, with opponents of it warning that its passage would result in a legal challenge, pointing out that identical measures had been struck down in several states, Morgan Watkins reports for the Courier Journal..

Wuchner, who chairs the House Health and Family Services Committee, said her bill would be able to withstand a legal challenge if it becomes law, reports Bruce Schreiner of The Associated Press.

But Tamarra Wieder, a spokeswoman for Planned Parenthood Advocates of Indiana and Kentucky, told the committee, "Let’s be honest here: House Bill 454 is attempting to curtail full access to abortion in the commonwealth, which is unconstitutional and dangerous."

Several others — including two women who've had abortions, a physician and a minister — also testified against the proposal.

Marcie Crim, executive director of the Kentucky Health Justice Network, told the committee that if this bill passes, pregnant women may go to "extreme and unsafe lengths" to end unwanted pregnancies, Watkins reports. “We don’t want more Kentuckians scared and alone in the dark, desperately googling 'How to give myself an abortion',” she said.

Wuchner argued that the bill would not prohibit all abortion methods after the 11-week mark in Kentucky, but instead would outlaw a procedure that is "gruesome, brutal and not necessary."

Lexington physician Lynda Sanders spoke in support of the bill, emotionally telling the committee that Kentucky wasn't providing unborn children some degree of dignity in how their lives ended. She said dismemberment is inhumane and it is better to do second-trimester abortions by inducing labor, to provide "as much dignity as we can for this unborn child."

Dr. Jennifer Hoffman, an obstetrician/gynecologist, spoke against the legislation and said that "without access to legal D&E procedures, some women would be limited to undergoing a more expensive abortion that takes longer and involves a hospital stay — barriers that can especially impact women with little money or other resources." She said the bill "would put women in desperate situations" and "lead to women dying en masse."

Watkins reports, "Two states ban the D&E procedure: West Virginia and Mississippi, according to the Guttmacher Institute, a research group that supports abortion rights. Several other states have approved similar bans but have had those policies temporarily or permanently halted by a court challenge.

If the bill becomes law, abortion providers found in violation of it would be guilty of a felony that carries a prison sentence. The women undergoing the procedure would not be prosecuted.

Top leaders in the House told Schreinerthat the bill is expected to pass out of the Republican-led chamber.

Since 2016, when Republicans took over General Assembly and Republican Gov. Matt Bevin was elected, the General Assembly has passed three abortion measures that were signed into law.

In 2016, the informed consent law was amended to require women seeking an abortion to have a face-to-face or live-chat consultation before an abortion. And two abortion laws were passed in 2017. One required women to get an ultrasound before an abortion that included an audible heartbeat. It also required the doctor to show and describe the image of the fetus to the patient before performing the abortion. This law was struck down in court. The state appealed. The other one bans abortions after 20 weeks of pregnancy, unless the mother's life is in danger.

The only remaining abortion clinic in Kentucky, EMW Women's Surgical Center in Louisville, is in a legal battle with the state over licensing issues.

Appalachian smoking cessation studies suggest changes in tactics, such as being blunter with pregnant smokers

Two long-term smoking cessation projects in Appalachia have prompted researchers to change to a more direct approach with pregnant smokers, telling them the risks to their babies, and to look at the mental health and work history of other smokers.

Beth Bailey, director of the Primary Care Research Department of Family Medicine at East Tennessee University, reported on her research in the fall newsletter of the Appalachian Translational Research Network.

The first project Bailey directed attempted to address the high rates of pregnancy smoking in the region and the consequent poor child health and development outcomes, writes Bailey, who is also a professor of medicine at ETSU's James H. Quillen College of Medicine.

This project, implemented in obstetric practices, found that "rural Appalachian women prefer detailed information about the significant fetal harm and long-term developmental effects that can result from smoking during pregnancy" instead of the current approach of providing a positive message with specific tips and techniques to stop smoking.

"These findings led us to revise our intervention efforts, better tailoring them to the needs of Appalachian women, increasing success rates," Bailey writes.

Kentucky leads the nation in smoking by pregnant mothers, with 22.5 percent of Kentucky women reporting that they smoked during pregnancy; and nearly one in every 10 Kentucky babies are born at low-birth-weight, to which smoking during pregnancy contributes, according to the the annual Kentucky Kids Count report.

Graph from Ky. State Innovation Model report

The second project, also led by Bailey, examined the differences between those who successfully quit smoking following intervention by primary-care providers, and those who didn't.

In Kentucky, 26.5 percent of adults smoke, but this rate is much higher in Eastern Kentucky with rates of 30.4 percent in the Big Sandy Area Development District, 30.5 percent in the Kentucky River Area Development District and 33.6 percent in the Cumberland Valley Area Development District , according to the Kentucky State Innovation Model Draft Population Health Improvement Plan.

This examination found that the presence of chronic health conditions related to smoking did not make a difference in whether a person quit smoking, and people with depression or other mental-health problems, or who were disabled and unable to work, were more than twice as likely to fail to quit smoking.

These findings have led to a modification of primary-care smoking intervention, to include a kook at mental health and work history, as well as advsing such patients to stay busy when trying to quit.

Bailey writes that she hopes these findings will help others in the region to "benefit from this knowledge and enhance smoking cessation efforts in other areas of Appalachia, where the burden from this health behavior is substantial."

Anthem gives hospital group grant to improve perinatal care, including discouraging early, medically unnecessary deliveries

The foundation of Anthem Blue Cross Blue Shield has awarded nearly $259,000 to an arm of the Kentucky Hospital Association to improve perinatal care and outcomes for mothers and their babies by discouraging early, medically unnecessary deliveries and encouraging breastfeeding.

Perinatal care, provided in the time around childbirth, is critical to ensure the good health of newborns, Anthem notes in a news release, pointing out that Kentucky's infant mortality rate is 6.6 deaths per 1,000 births, while the national rate is 6.1, and the state's rate of premature births, almost 14 percent, is well above the 9.6 percent goal set by the March of Dimes.

"The closer the baby is to full term, the better; but sometimes babies are born before they fully develop, weighing only a few pounds," the release notes. "When this occurs, long stays in the hospital neonatal intensive care unit (NICU) are necessary as these babies fight health complications while learning to breathe on their own without the use of a ventilator."

NICU stays are usually expensive. In 2012, Kentucky hospitals charged about $400 million for such treatment.

The hospital association says it has been working to reduce early, elective deliveries, with the Anthem foundation's help, and the latest grant is designed to build on that work. It says the grant to its subsidiary, the Kentucky Institute for Patient Safety and Quality, will also promote breastfeeding, reducing blood infections in the hospital, and reducing complications related to inducing labor, including Cesarean sections.

"KIPSQ will work with all Kentucky hospitals that deliver babies to assure the best care during delivery and the best outcomes for mothers and babies," the KHA release says. "KIPSQ will collect data to measure progress and provide resources, tools and technical assistance in quality improvement techniques to reduce prematurity, unnecessary Cesareans and improve the long-term health of newborns.

KHA says 76 of Kentucky’s 131 hospitals are members of KIPSQ, which is expanding its membership to include long-term care facilities and physicians' practices. "The Anthem grant will improve the delivery of perinatal health care to all of the state’s birthing/neonatal hospitals, regardless of their participation in KIPSQ," the release says.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, an independent licensee of the Blue Cross Blue Shield Association. The Anthem Foundation Inc. is a private, non-profit foundation.

After several groups say Pap smears aren't needed every year, ob/gyns recommend an annual 'well-woman' visit

Though several groups have said women don't need a Pap smear every year, obstetricians and gynecologists still recommend an annual "well-woman" visit and annual pelvic exams for all females over 21.

These new recommendations by the American College of Obstetricians and Gynecologists were published Monday. They come a few months after the American Cancer Society, the U.S. Preventive Services Task Force and other groups said most women only need a Pap smear every three years starting at age 21. After the age of 30, they can get them less often if they also get tests for the human papillomavirus, known to cause cervical and other cancers.

The visit "can be used to check blood pressure and weight, update immunizations, counsel patients on healthy lifestyles, screen for sexually transmitted infections and other health problems, perform breast exams and build relationships between doctors and patients," reports Kim Painter for USA Today.

But some critics question if these visits are just a way to make money. "We estimate that about $8 billion a year is spent on preventive yearly physicals of all kinds," said Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine. "The question is whether we could spend those $8 billion more wisely." (Read more)