California Lawmakers Consider Allowing Nurse-Midwives to Practice Without Physician Supervision
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Since 2011, she's been writing and editing stories for the site. Before taking up blogging, she toiled for many years (more than we can count) producing health stories for television, including\u003cem> Dateline NBC\u003c/em> and San Francisco's CBS affiliate, KPIX-TV. She also wrote up a \u003ca title=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\">handy guide to the Affordable Care Act\u003c/a>, especially for Californians. Her work has been honored for many awards. Most recently she was a finalist for \"Best Topical Reporting\" from the Online News Association. 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KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/state-of-health"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal 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FM","link":"/"}},"stateofhealth_222385":{"type":"posts","id":"stateofhealth_222385","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"222385","score":null,"sort":[1470673667000]},"guestAuthors":[],"slug":"california-nurse-midwives-may-soon-be-allowed-to-practice-without-physician-supervision","title":"California Lawmakers Consider Allowing Nurse-Midwives to Practice Without Physician Supervision","publishDate":1470673667,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>A California \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1306\" target=\"_blank\">bill\u003c/a> that would allow certified nurse-midwives to practice independently is pitting the state’s doctors against its hospitals, even though both sides support the main goal of the legislation.\u003c/p>\n\u003cp>The California Hospital Association and the California Medical Association, which represents doctors, agree that nurse-midwives have the training and qualifications to practice without physician supervision.\u003c/p>\n\u003cp>But they differ sharply over whether hospitals should be able to employ midwives directly — a dispute the certified nurse-midwives fear could derail the proposed law.\u003c/p>\n\u003cp>“We are very much caught in the middle,” said Linda Walsh, president of the California Nurse-Midwives Association.\u003c/p>\n\u003cp>The bill would override an existing law that requires certified nurse-midwives to practice under the supervision of medical doctors. California is one of only six states that requires full supervision. Several other states mandate other forms of collaboration, such as in prescribing medications.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The American College of Nurse-Midwives has been chipping away for decades at state laws that require physician supervision, and it has finally passed the tipping point nationally, said Jesse Bushman, director of federal government affairs for the organization. Nurse-midwives aren’t seeking permission to go off and do whatever they want without consulting anyone, Bushman said. “They’re just asking to be able to do what they are trained to do.”\u003c/p>\n\u003cp>In states where nurse-midwives can practice independently, there is more access to care, he said, citing a \u003ca href=\"http://www.whijournal.com/article/S1049-3867%2816%2900025-6/fulltext\" target=\"_blank\">recent report\u003c/a> published by the George Washington University’s Jacobs Institute of Women’s Health.\u003c/p>\n\u003cp>There are more than 11,200 nurse-midwives around the nation, including about 1,200 in California. They provide maternity care, family planning services and other primary care for women.\u003c/p>\n\u003cp>In 2013, California eliminated the physician supervision requirement for licensed midwives, who require significantly less training than nurse-midwives. Unlike licensed midwives, certified nurse-midwives must become registered nurses and obtain a graduate degree in midwifery. They primarily deliver babies in hospitals, while licensed midwives usually work in homes or birth centers.\u003c/p>\n\u003cp>Walsh said her association is trying to make it easier for certified nurse-midwives to practice around the state, especially in areas where there may not be any obstetricians. It can be challenging to find physicians willing to oversee nurse-midwives, because of the responsibility and liability involved, she said.\u003c/p>\n\u003cp>“We have an access issue in California,” Walsh said. “Yet we have this supervisory language that prevents an increase in access for the people who need it most.”\u003c/p>\n\u003cp>Lisa Catterall, who works in a hospital-based midwifery practice at Feather River Hospital in Paradise, Calif., said getting physician supervision is not easy. For one thing, some nurse-midwives have to pay extra malpractice insurance in addition to paying doctors for their supervision. Even with the supervision, the doctors are not required to be present to oversee the care, added Catterall, who delivers about 100 babies a year and sees patients from throughout the rural region north of Sacramento where her hospital is located.\u003c/p>\n\u003cp>The debate between the doctors and the hospitals centers on the state’s prohibition of what’s known as the “corporate practice of medicine.” California does not allow corporations, including hospitals, to hire physicians, though there are several exceptions. The intent of the ban is to avoid undue corporate influence on doctors’ medical judgment and patient care. Under current law, hospitals can hire nurse-midwives, though many don’t.\u003c/p>\n\u003cp>One of the bill’s co-authors, Assemblywoman Autumn Burke, recently withdrew an amendment that would have mirrored the law applying to doctors by barring hospitals from hiring nurse-midwives. With that provision withdrawn, the California Medical Association now opposes the legislation and the California Hospital Association supports it.\u003c/p>\n\u003cp>The physicians’ group believes that the health care decisions of nurse-midwives employed directly by hospitals could be influenced by their administrators, and it says it will only back the bill if the amendment is reinstated.\u003c/p>\n\u003cp>Patients should have the same consumer protections whether they see a nurse-midwife or a doctor, said Juan Thomas, a lobbyist with the medical association. “It should be a level playing field,” he said. “We believe very strongly that the corporate practice of medicine bar language provides an important layer of patient protection.”\u003c/p>\n\u003cp>The California Hospital Association, meanwhile, won’t support the bill if the amendment is reinstated. The association believes hospitals need to retain the freedom to hire nurse-midwives.\u003c/p>\n\u003cp>A ban on hiring would make it more difficult for nurse-midwives to work in hospitals, forcing them into roundabout contracts that are “unduly cumbersome, unduly burdensome and unnecessary,” said Jackie Garman, a vice president of the hospital association.\u003c/p>\n\u003cp>In addition, Garman said, some nurse-midwives are already employed by hospitals. “What happens to them?” she asked.\u003c/p>\n\u003cp>The nonprofit Pacific Business Group on Health recently announced its support of the midwife bill, saying it would help expand women’s choices in pregnancy care and lead to better maternal health. In the spring, the group had sponsored a roundtable with more than 30 organizations from around California to discuss increasing access to nurse-midwives.\u003c/p>\n\u003cp>“It is really hard to argue with the evidence about the value that midwives offer pregnant women,” said Brynn Rubinstein, the group’s senior manager for transforming maternity care. “They are delivering more patient-friendly care, yielding better outcomes and saving money for purchasers,” she said. “But they are not always easy to find.”\u003c/p>\n\u003cp>Research shows that patients of certified nurse-midwives have fewer cesarean deliveries and \u003ca href=\"http://www.whijournal.com/article/S1049-3867(11)00160-5/abstract\" target=\"_blank\">lower epidural rates.\u003c/a>\u003c/p>\n\u003cp>Assemblywoman Burke’s office is continuing to talk to representatives of both the physicians and the hospitals to try and find a solution to the contentious issue of whether hospitals should be allowed to hire nurse-midwives, said Allison Ruff, a senior aide to Burke.\u003c/p>\n\u003cp>“For both of them, it is an issue they don’t want to compromise on,” she said. “The bill became a pawn in the fight between the hospitals and the physicians. It still is.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\u003csection class=\"meta-tags\">\u003c/section>\n\n","blocks":[],"excerpt":"In states where nurse-midwives can work independently, there is more access to care, experts say.","status":"publish","parent":0,"modified":1470675328,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":1045},"headData":{"title":"California Lawmakers Consider Allowing Nurse-Midwives to Practice Without Physician Supervision | KQED","description":"In states where nurse-midwives can work independently, there is more access to care, experts say.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California Lawmakers Consider Allowing Nurse-Midwives to Practice Without Physician Supervision","datePublished":"2016-08-08T16:27:47.000Z","dateModified":"2016-08-08T16:55:28.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"222385 http://ww2.kqed.org/stateofhealth/?p=222385","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/08/california-nurse-midwives-may-soon-be-allowed-to-practice-without-physician-supervision/","disqusTitle":"California Lawmakers Consider Allowing Nurse-Midwives to Practice Without Physician Supervision","nprByline":"Anna Gorman\u003cbr />\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>","path":"/stateofhealth/222385/california-nurse-midwives-may-soon-be-allowed-to-practice-without-physician-supervision","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A California \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1306\" target=\"_blank\">bill\u003c/a> that would allow certified nurse-midwives to practice independently is pitting the state’s doctors against its hospitals, even though both sides support the main goal of the legislation.\u003c/p>\n\u003cp>The California Hospital Association and the California Medical Association, which represents doctors, agree that nurse-midwives have the training and qualifications to practice without physician supervision.\u003c/p>\n\u003cp>But they differ sharply over whether hospitals should be able to employ midwives directly — a dispute the certified nurse-midwives fear could derail the proposed law.\u003c/p>\n\u003cp>“We are very much caught in the middle,” said Linda Walsh, president of the California Nurse-Midwives Association.\u003c/p>\n\u003cp>The bill would override an existing law that requires certified nurse-midwives to practice under the supervision of medical doctors. California is one of only six states that requires full supervision. Several other states mandate other forms of collaboration, such as in prescribing medications.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The American College of Nurse-Midwives has been chipping away for decades at state laws that require physician supervision, and it has finally passed the tipping point nationally, said Jesse Bushman, director of federal government affairs for the organization. Nurse-midwives aren’t seeking permission to go off and do whatever they want without consulting anyone, Bushman said. “They’re just asking to be able to do what they are trained to do.”\u003c/p>\n\u003cp>In states where nurse-midwives can practice independently, there is more access to care, he said, citing a \u003ca href=\"http://www.whijournal.com/article/S1049-3867%2816%2900025-6/fulltext\" target=\"_blank\">recent report\u003c/a> published by the George Washington University’s Jacobs Institute of Women’s Health.\u003c/p>\n\u003cp>There are more than 11,200 nurse-midwives around the nation, including about 1,200 in California. They provide maternity care, family planning services and other primary care for women.\u003c/p>\n\u003cp>In 2013, California eliminated the physician supervision requirement for licensed midwives, who require significantly less training than nurse-midwives. Unlike licensed midwives, certified nurse-midwives must become registered nurses and obtain a graduate degree in midwifery. They primarily deliver babies in hospitals, while licensed midwives usually work in homes or birth centers.\u003c/p>\n\u003cp>Walsh said her association is trying to make it easier for certified nurse-midwives to practice around the state, especially in areas where there may not be any obstetricians. It can be challenging to find physicians willing to oversee nurse-midwives, because of the responsibility and liability involved, she said.\u003c/p>\n\u003cp>“We have an access issue in California,” Walsh said. “Yet we have this supervisory language that prevents an increase in access for the people who need it most.”\u003c/p>\n\u003cp>Lisa Catterall, who works in a hospital-based midwifery practice at Feather River Hospital in Paradise, Calif., said getting physician supervision is not easy. For one thing, some nurse-midwives have to pay extra malpractice insurance in addition to paying doctors for their supervision. Even with the supervision, the doctors are not required to be present to oversee the care, added Catterall, who delivers about 100 babies a year and sees patients from throughout the rural region north of Sacramento where her hospital is located.\u003c/p>\n\u003cp>The debate between the doctors and the hospitals centers on the state’s prohibition of what’s known as the “corporate practice of medicine.” California does not allow corporations, including hospitals, to hire physicians, though there are several exceptions. The intent of the ban is to avoid undue corporate influence on doctors’ medical judgment and patient care. Under current law, hospitals can hire nurse-midwives, though many don’t.\u003c/p>\n\u003cp>One of the bill’s co-authors, Assemblywoman Autumn Burke, recently withdrew an amendment that would have mirrored the law applying to doctors by barring hospitals from hiring nurse-midwives. With that provision withdrawn, the California Medical Association now opposes the legislation and the California Hospital Association supports it.\u003c/p>\n\u003cp>The physicians’ group believes that the health care decisions of nurse-midwives employed directly by hospitals could be influenced by their administrators, and it says it will only back the bill if the amendment is reinstated.\u003c/p>\n\u003cp>Patients should have the same consumer protections whether they see a nurse-midwife or a doctor, said Juan Thomas, a lobbyist with the medical association. “It should be a level playing field,” he said. “We believe very strongly that the corporate practice of medicine bar language provides an important layer of patient protection.”\u003c/p>\n\u003cp>The California Hospital Association, meanwhile, won’t support the bill if the amendment is reinstated. The association believes hospitals need to retain the freedom to hire nurse-midwives.\u003c/p>\n\u003cp>A ban on hiring would make it more difficult for nurse-midwives to work in hospitals, forcing them into roundabout contracts that are “unduly cumbersome, unduly burdensome and unnecessary,” said Jackie Garman, a vice president of the hospital association.\u003c/p>\n\u003cp>In addition, Garman said, some nurse-midwives are already employed by hospitals. “What happens to them?” she asked.\u003c/p>\n\u003cp>The nonprofit Pacific Business Group on Health recently announced its support of the midwife bill, saying it would help expand women’s choices in pregnancy care and lead to better maternal health. In the spring, the group had sponsored a roundtable with more than 30 organizations from around California to discuss increasing access to nurse-midwives.\u003c/p>\n\u003cp>“It is really hard to argue with the evidence about the value that midwives offer pregnant women,” said Brynn Rubinstein, the group’s senior manager for transforming maternity care. “They are delivering more patient-friendly care, yielding better outcomes and saving money for purchasers,” she said. “But they are not always easy to find.”\u003c/p>\n\u003cp>Research shows that patients of certified nurse-midwives have fewer cesarean deliveries and \u003ca href=\"http://www.whijournal.com/article/S1049-3867(11)00160-5/abstract\" target=\"_blank\">lower epidural rates.\u003c/a>\u003c/p>\n\u003cp>Assemblywoman Burke’s office is continuing to talk to representatives of both the physicians and the hospitals to try and find a solution to the contentious issue of whether hospitals should be allowed to hire nurse-midwives, said Allison Ruff, a senior aide to Burke.\u003c/p>\n\u003cp>“For both of them, it is an issue they don’t want to compromise on,” she said. “The bill became a pawn in the fight between the hospitals and the physicians. It still is.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\u003csection class=\"meta-tags\">\u003c/section>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/222385/california-nurse-midwives-may-soon-be-allowed-to-practice-without-physician-supervision","authors":["byline_stateofhealth_222385"],"categories":["stateofhealth_11"],"tags":["stateofhealth_2808","stateofhealth_2839","stateofhealth_2519","stateofhealth_349"],"featImg":"stateofhealth_222388","label":"stateofhealth"},"stateofhealth_221121":{"type":"posts","id":"stateofhealth_221121","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"221121","score":null,"sort":[1470352029000]},"guestAuthors":[],"slug":"2-california-babies-born-with-zika-related-defects","title":"2 California Babies Born with Zika-Related Defects","publishDate":1470352029,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Two babies have been born with Zika-related birth defects in California to mothers who were infected in other countries, health officials said Thursday.\u003c/p>\n\u003cp>The newborns survived. One of the mothers returned to her home country with her baby while the other remains in the state, according to the California Department of Public Health.\u003c/p>\n\u003cp>Health officials declined to release additional details about the cases, citing patient privacy.\u003c/p>\n\u003cp>Nineteen other pregnant women in California who contracted Zika while traveling abroad were being monitored by doctors.\u003c/p>\n\u003cp>[contextly_sidebar id=\"shIj3mZGWqg2l3o67ngbxdV3kzI8cSTt\"]Babies born to Zika-infected mothers will be followed for up to a year. Health officials will check their hearing, vision and development, said Dr. Connie Mitchell, deputy director of the Center for Family Health.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.cdc.gov/zika/geo/pregnancy-outcomes.html\" target=\"_blank\">15 babies\u003c/a> have been born with Zika-related birth defects, according to the federal Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The CDC has advised pregnant women not to travel to parts of Latin America and the Caribbean where Zika transmission is active. The virus is usually spread by mosquitoes, but it can also be passed through sex.\u003c/p>\n\u003cp>Most people infected with Zika experience mild symptoms such as fever, rash and joint pain. Zika infection during pregnancy can cause babies to be born with unusually small heads, called microcephaly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Aedes aegypti mosquito which can transmit Zika \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/06/30/map-where-zika-mosquitoes-are-likely-found-in-california/\" target=\"_blank\">is present in a handful of California counties\u003c/a>. But Florida is the only U.S. state so far that has reported homegrown Zika transmission by mosquitoes. One square-mile neighborhood in Miami-Dade County is affected. The CDC has urged expectant mothers to avoid Miami's Wynwood neighborhood, where at least 15 people are believed to have been infected with the Zika virus through mosquito bites.\u003c/p>\n\n","blocks":[],"excerpt":" 21 pregnant women in California have confirmed cases of Zika infection.","status":"publish","parent":0,"modified":1470352474,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":11,"wordCount":288},"headData":{"title":"2 California Babies Born with Zika-Related Defects | KQED","description":" 21 pregnant women in California have confirmed cases of Zika infection.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"2 California Babies Born with Zika-Related Defects","datePublished":"2016-08-04T23:07:09.000Z","dateModified":"2016-08-04T23:14:34.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"221121 http://ww2.kqed.org/stateofhealth/?p=221121","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/04/2-california-babies-born-with-zika-related-defects/","disqusTitle":"2 California Babies Born with Zika-Related Defects","path":"/stateofhealth/221121/2-california-babies-born-with-zika-related-defects","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two babies have been born with Zika-related birth defects in California to mothers who were infected in other countries, health officials said Thursday.\u003c/p>\n\u003cp>The newborns survived. One of the mothers returned to her home country with her baby while the other remains in the state, according to the California Department of Public Health.\u003c/p>\n\u003cp>Health officials declined to release additional details about the cases, citing patient privacy.\u003c/p>\n\u003cp>Nineteen other pregnant women in California who contracted Zika while traveling abroad were being monitored by doctors.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Babies born to Zika-infected mothers will be followed for up to a year. Health officials will check their hearing, vision and development, said Dr. Connie Mitchell, deputy director of the Center for Family Health.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nationwide, \u003ca href=\"http://www.cdc.gov/zika/geo/pregnancy-outcomes.html\" target=\"_blank\">15 babies\u003c/a> have been born with Zika-related birth defects, according to the federal Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The CDC has advised pregnant women not to travel to parts of Latin America and the Caribbean where Zika transmission is active. The virus is usually spread by mosquitoes, but it can also be passed through sex.\u003c/p>\n\u003cp>Most people infected with Zika experience mild symptoms such as fever, rash and joint pain. Zika infection during pregnancy can cause babies to be born with unusually small heads, called microcephaly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Aedes aegypti mosquito which can transmit Zika \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/06/30/map-where-zika-mosquitoes-are-likely-found-in-california/\" target=\"_blank\">is present in a handful of California counties\u003c/a>. But Florida is the only U.S. state so far that has reported homegrown Zika transmission by mosquitoes. One square-mile neighborhood in Miami-Dade County is affected. The CDC has urged expectant mothers to avoid Miami's Wynwood neighborhood, where at least 15 people are believed to have been infected with the Zika virus through mosquito bites.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/221121/2-california-babies-born-with-zika-related-defects","authors":["237"],"categories":["stateofhealth_1"],"tags":["stateofhealth_2519","stateofhealth_349","stateofhealth_2653"],"featImg":"stateofhealth_221126","label":"stateofhealth"},"stateofhealth_219980":{"type":"posts","id":"stateofhealth_219980","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"219980","score":null,"sort":[1470086876000]},"guestAuthors":[],"slug":"cdc-tells-pregnant-women-to-avoid-parts-of-miami-hit-by-zika","title":"CDC Tells Pregnant Women to Avoid Parts of Miami Hit by Zika","publishDate":1470086876,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Government health officials warned pregnant women Monday to avoid a Zika-stricken part of Miami and told couples who have been there recently to put off having children for at least two months, after the number of people feared infected through mosquito bites in the U.S. climbed to 14.\u003c/p>\n\u003caside class=\"pullquote alignright\">The travel warning is highly unusual. Officials cannot remember another warning against travel within the U.S. in the CDC's 70-year history.\u003c/aside>\n\u003cp>In its highly unusual and perhaps unprecedented \u003ca href=\"http://www.cdc.gov/zika/intheus/florida-update.html\" target=\"_blank\">travel warning\u003c/a>, the Centers for Disease Control and Prevention also said expectant mothers should get tested for the virus if they have visited the neighborhood since mid-June.\u003c/p>\n\u003cp>All 14 cases are thought to have occurred in Miami's Wynwood arts district, a trendy, fast-gentrifying neighborhood of warehouses, art galleries, restaurants and boutiques.\u003c/p>\n\u003cp>Florida Gov. Rick Scott asked for a CDC emergency response team to help the state combat Zika, which after sweeping Latin America and the Caribbean, is beginning to spread in the U.S. The White House said a team will be sent quickly.\u003c/p>\n\u003cp>Health officials\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/29/4-zika-cases-in-florida-are-likely-from-mosquitoes/\" target=\"_blank\"> last Friday announced\u003c/a> that mosquitoes have apparently started spreading Zika on the U.S. mainland, citing four cases they strongly believe were caused by bites. Ten more cases were announced Monday, even though Florida authorities have yet to find any mosquitoes actually carrying the virus.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Zika infections in pregnant women can cause severe brain-related birth defects, including extremely small skulls. The global outbreak has led to more than 1,800 serious defects.\u003c/p>\n\u003cp>CDC officials said they could not remember another time in the 70-year history of the disease-fighting agency when it told members of the public not to travel someplace in the U.S.\u003c/p>\n\u003cp>The virus can linger in the blood and urine for weeks, and has been found in sperm for months. As a result, the CDC said men and women who have recently been in the affected area should wait at least eight weeks before trying to conceive a child.\u003c/p>\n\u003cp>The travel warning covers an area of about 1 square mile in Wynwood, to the east of Interstate 95 and south of I-195. It's large enough, health officials said, to provide a buffer around the suspected hot zone. The tropical mosquito that spreads Zika travels less than 200 yards in its lifetime.\u003c/p>\n\u003cp>Yet some experts said that's far too small a radius. Dr. Peter Hotez, a tropical medicine expert at the Baylor College of Medicine in Texas, said the CDC should be more cautious and expand the travel advisory to all of Miami-Dade County.\u003c/p>\n\u003cp>\"If you're pregnant or think you might be pregnant, avoid travel to Miami, and possible elsewhere in South Florida,\" he said. \"I'm guessing most women who are pregnant are doing that. I don't think they're sitting around for the CDC to split hairs and fine-tune it to a specific area.\"\u003c/p>\n\u003cp>CDC Director Dr. Tom Frieden said the narrowly drawn warning was dictated by science and not by any concern for Florida's crucial tourism industry. He said it was based on the nation's ability to contain outbreaks of other diseases carried by the same mosquito.\u003c/p>\n\u003cp>\"There wouldn't be a technical or scientific basis to give a broader recommendation,\" Frieden said.\u003c/p>\n\u003cp>U.S. health officials have said all along that while isolated clusters of Zika may occur in this country, they do not expect major outbreaks like those seen in Latin America, because of better sanitation and mosquito control and widespread use of air conditioners and window screens.\u003c/p>\n\u003cp>At the same time, health officials expressed concern that they continue to see \"moderately high\" numbers of the type of mosquito that carries Zika, despite aggressive use of insecticides.\u003c/p>\n\u003cp>\"This is a very difficult mosquito to control,\" Frieden said.\u003c/p>\n\u003cp>Florida health officials said they have tested more than 200 people in Miami-Dade and Broward Counties since early July. The CDC emergency team will help Florida officials investigate the outbreak, collect samples and control mosquitoes.\u003c/p>\n\u003cp>Of the 14 people infected, two are women and 12 are men. Eight patients showed symptoms of Zika, which can include fever, rash, joint pain and red eyes. The others had no symptoms. The disease is often so mild that most people don't know they are infected.\u003c/p>\n\u003cp>\"We will continue to keep our residents and visitors safe utilizing constant surveillance and aggressive strategies, such as increased mosquito spraying, that have allowed our state to fight similar viruses,\" the governor said in a statement.\u003c/p>\n\u003cp>Rosemary LeBranch was doing laundry in Wynwood when health officials came to her house a few days ago and took urine samples from her, her daughter and her father. Her father, Gabriel Jean, tested positive, she said Monday.\u003c/p>\n\u003cp>He had already spoken with a doctor and was advised to wear long shirts and pants outdoors.\u003c/p>\n\u003cp>\"He said nothing hurts, he doesn't have any pain. He doesn't feel anything,\" she said.\u003c/p>\n\u003cp>Jordan Davison and Melissa Felix work for a cruise line and were enjoying their day off Monday looking at Wynwood's spray-painted murals.\u003c/p>\n\u003cp>\"It's not like a big thing, right?\" the 25-year-old Davidson said. \"It's kind of freaky — there's so much going on we didn't know, didn't really think about it. ... I might wear bug spray going forward.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>More than 1,650 cases of Zika have been reported in U.S. states, nearly all the result of travel to a Zika-stricken country or sex with someone who was infected abroad.\u003c/p>\n\n","blocks":[],"excerpt":"The travel warning is unprecedented. Officials cannot remember another warning against travel within the U.S. in the CDC's 70-year history.","status":"publish","parent":0,"modified":1470179659,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":930},"headData":{"title":"CDC Tells Pregnant Women to Avoid Parts of Miami Hit by Zika | KQED","description":"The travel warning is unprecedented. Officials cannot remember another warning against travel within the U.S. in the CDC's 70-year history.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"CDC Tells Pregnant Women to Avoid Parts of Miami Hit by Zika","datePublished":"2016-08-01T21:27:56.000Z","dateModified":"2016-08-02T23:14:19.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"219980 http://ww2.kqed.org/stateofhealth/?p=219980","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/01/cdc-tells-pregnant-women-to-avoid-parts-of-miami-hit-by-zika/","disqusTitle":"CDC Tells Pregnant Women to Avoid Parts of Miami Hit by Zika","nprByline":"Kelli Kennedy and Josh Replogle\u003cbr />Associated Press","path":"/stateofhealth/219980/cdc-tells-pregnant-women-to-avoid-parts-of-miami-hit-by-zika","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Government health officials warned pregnant women Monday to avoid a Zika-stricken part of Miami and told couples who have been there recently to put off having children for at least two months, after the number of people feared infected through mosquito bites in the U.S. climbed to 14.\u003c/p>\n\u003caside class=\"pullquote alignright\">The travel warning is highly unusual. Officials cannot remember another warning against travel within the U.S. in the CDC's 70-year history.\u003c/aside>\n\u003cp>In its highly unusual and perhaps unprecedented \u003ca href=\"http://www.cdc.gov/zika/intheus/florida-update.html\" target=\"_blank\">travel warning\u003c/a>, the Centers for Disease Control and Prevention also said expectant mothers should get tested for the virus if they have visited the neighborhood since mid-June.\u003c/p>\n\u003cp>All 14 cases are thought to have occurred in Miami's Wynwood arts district, a trendy, fast-gentrifying neighborhood of warehouses, art galleries, restaurants and boutiques.\u003c/p>\n\u003cp>Florida Gov. Rick Scott asked for a CDC emergency response team to help the state combat Zika, which after sweeping Latin America and the Caribbean, is beginning to spread in the U.S. The White House said a team will be sent quickly.\u003c/p>\n\u003cp>Health officials\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/07/29/4-zika-cases-in-florida-are-likely-from-mosquitoes/\" target=\"_blank\"> last Friday announced\u003c/a> that mosquitoes have apparently started spreading Zika on the U.S. mainland, citing four cases they strongly believe were caused by bites. Ten more cases were announced Monday, even though Florida authorities have yet to find any mosquitoes actually carrying the virus.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Zika infections in pregnant women can cause severe brain-related birth defects, including extremely small skulls. The global outbreak has led to more than 1,800 serious defects.\u003c/p>\n\u003cp>CDC officials said they could not remember another time in the 70-year history of the disease-fighting agency when it told members of the public not to travel someplace in the U.S.\u003c/p>\n\u003cp>The virus can linger in the blood and urine for weeks, and has been found in sperm for months. As a result, the CDC said men and women who have recently been in the affected area should wait at least eight weeks before trying to conceive a child.\u003c/p>\n\u003cp>The travel warning covers an area of about 1 square mile in Wynwood, to the east of Interstate 95 and south of I-195. It's large enough, health officials said, to provide a buffer around the suspected hot zone. The tropical mosquito that spreads Zika travels less than 200 yards in its lifetime.\u003c/p>\n\u003cp>Yet some experts said that's far too small a radius. Dr. Peter Hotez, a tropical medicine expert at the Baylor College of Medicine in Texas, said the CDC should be more cautious and expand the travel advisory to all of Miami-Dade County.\u003c/p>\n\u003cp>\"If you're pregnant or think you might be pregnant, avoid travel to Miami, and possible elsewhere in South Florida,\" he said. \"I'm guessing most women who are pregnant are doing that. I don't think they're sitting around for the CDC to split hairs and fine-tune it to a specific area.\"\u003c/p>\n\u003cp>CDC Director Dr. Tom Frieden said the narrowly drawn warning was dictated by science and not by any concern for Florida's crucial tourism industry. He said it was based on the nation's ability to contain outbreaks of other diseases carried by the same mosquito.\u003c/p>\n\u003cp>\"There wouldn't be a technical or scientific basis to give a broader recommendation,\" Frieden said.\u003c/p>\n\u003cp>U.S. health officials have said all along that while isolated clusters of Zika may occur in this country, they do not expect major outbreaks like those seen in Latin America, because of better sanitation and mosquito control and widespread use of air conditioners and window screens.\u003c/p>\n\u003cp>At the same time, health officials expressed concern that they continue to see \"moderately high\" numbers of the type of mosquito that carries Zika, despite aggressive use of insecticides.\u003c/p>\n\u003cp>\"This is a very difficult mosquito to control,\" Frieden said.\u003c/p>\n\u003cp>Florida health officials said they have tested more than 200 people in Miami-Dade and Broward Counties since early July. The CDC emergency team will help Florida officials investigate the outbreak, collect samples and control mosquitoes.\u003c/p>\n\u003cp>Of the 14 people infected, two are women and 12 are men. Eight patients showed symptoms of Zika, which can include fever, rash, joint pain and red eyes. The others had no symptoms. The disease is often so mild that most people don't know they are infected.\u003c/p>\n\u003cp>\"We will continue to keep our residents and visitors safe utilizing constant surveillance and aggressive strategies, such as increased mosquito spraying, that have allowed our state to fight similar viruses,\" the governor said in a statement.\u003c/p>\n\u003cp>Rosemary LeBranch was doing laundry in Wynwood when health officials came to her house a few days ago and took urine samples from her, her daughter and her father. Her father, Gabriel Jean, tested positive, she said Monday.\u003c/p>\n\u003cp>He had already spoken with a doctor and was advised to wear long shirts and pants outdoors.\u003c/p>\n\u003cp>\"He said nothing hurts, he doesn't have any pain. He doesn't feel anything,\" she said.\u003c/p>\n\u003cp>Jordan Davison and Melissa Felix work for a cruise line and were enjoying their day off Monday looking at Wynwood's spray-painted murals.\u003c/p>\n\u003cp>\"It's not like a big thing, right?\" the 25-year-old Davidson said. \"It's kind of freaky — there's so much going on we didn't know, didn't really think about it. ... I might wear bug spray going forward.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>More than 1,650 cases of Zika have been reported in U.S. states, nearly all the result of travel to a Zika-stricken country or sex with someone who was infected abroad.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/219980/cdc-tells-pregnant-women-to-avoid-parts-of-miami-hit-by-zika","authors":["byline_stateofhealth_219980"],"categories":["stateofhealth_2746"],"tags":["stateofhealth_2519","stateofhealth_349","stateofhealth_2653"],"featImg":"stateofhealth_220001","label":"stateofhealth"},"stateofhealth_177017":{"type":"posts","id":"stateofhealth_177017","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"177017","score":null,"sort":[1461695800000]},"guestAuthors":[],"slug":"how-a-birth-at-stanford-50-years-ago-launched-search-for-down-syndrome-test","title":"How A Birth at Stanford 50 Years Ago Launched Search for Down Syndrome Test","publishDate":1461695800,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cem>This story comes to us via\u003c/em> Only Human, \u003cem>a new podcast from WNYC Studios. Hosted by Mary Harris, \u003c/em>\u003ca href=\"http://www.wnyc.org/shows/onlyhuman/\" target=\"_blank\">Only Human\u003c/a>\u003cem> tells stories we all can relate to. Because every body has a story. Subscribe to \u003c/em>Only Human\u003cem> on iTunes or wherever you like to get your podcasts. \u003c/em>\u003c/p>\n\u003chr>\n\u003cp>When Lee Herzenberg remembers the day her son Michael was born, she laughs and calls it a \"cool birth.\" Her obstetrician was a friend, and she describes it almost like a party — \"a little bit painful, but that you forget very quickly.\" Lee even got a kick out of the fact that a resident learned to do an episiotomy on her.\u003c/p>\n\u003cp>It was November 1961, and she was at the newly christened Palo Alto-Stanford Hospital Center; her husband, Len, was a biology professor on campus. Like most fathers at the time, he didn't attend the birth, which meant he wasn't there when Michael started turning blue.\u003c/p>\n\u003cp>The nurses whisked the newborn off to the nursery without telling Lee anything was wrong.\u003c/p>\n\u003cp>It was then that a doctor noticed the characteristic features of Down syndrome: floppy muscles, eyes that slanted upward. They got Michael breathing again, but doctors thought his prognosis was grim. They gave Michael just a few months to live. A daisy chain of physicians was called, and Lee says it was a pediatrics professor who told her husband what had happened. Then Len was dispatched to tell Lee.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She remembers the moment with uncharacteristic emotion. \"We hugged each other, and it was a terrible conversation to realize that you'd lost the baby, but the baby was lost,\" Lee says now. \"We knew immediately what we'd do. We had already made the decision that it was not a good thing to take the baby home, and so we didn't.\"\u003c/p>\n\u003cp>In the 1960s — an era before neurodiversity movements and early intervention programs — many people still called people with Down syndrome \"mongoloids.\" Playwright Arthur Miller institutionalized his son, Daniel, in 1966. A few years later, \u003ca href=\"https://repository.library.georgetown.edu/handle/10822/1031271\" target=\"_blank\">an article\u003c/a> in \u003cem>The Atlantic Monthly\u003c/em> argued that \"a Down's is not a person.\"\u003c/p>\n\u003cp>Lee and Len Herzenberg had seen friends struggle with the birth of a child with Down syndrome and had even gone with a colleague to an institution, where he dropped off his own infant daughter.\u003c/p>\n\u003cp>So, they decided Michael would never come home.\u003c/p>\n\u003cp>But Michael wasn't absolutely lost to them. Michael's birth sparked their search for a blood test that has revolutionized prenatal care in this country.\u003c/p>\n\u003cp>I made the mistake of telling one scientist I was reporting about \"Len Herzenberg's lab.\" He corrected me instantly: \"Len \u003cem>and Lee's\u003c/em> lab.\" Because Lee Herzenberg was \"leaning in\" decades before Sheryl Sandberg coined the phrase. At 81, Lee, a professor of genetics, is still running the lab she and her husband founded more than 50 years ago. Len died in 2013.\u003c/p>\n\u003cp>The lab is a quirky place, even by Stanford standards. Lee rarely sits on chairs, preferring cushions on the floor. She's often accompanied by her bichon frise, Gigi. Researchers can often be found working in this basement office well into the night.\u003c/p>\n\u003cp>But Lee Herzenberg isn't just quirky. She is one of the few professors at Stanford — possibly the only one — never to have officially graduated from college. Instead, she trained by her husband's side, auditing courses while he got his Ph.D. at Caltech (women weren't allowed to attend at the time) and working at his labs at the Pasteur Institute in Paris and the National Institutes of Health.\u003c/p>\n\u003cp>And the science that's been done here has changed the course of medicine.\u003c/p>\n\u003cp>The Herzenbergs are best known as the creators of the modern-day \u003ca href=\"http://www.bio.umass.edu/micro/immunology/facs542/facswhat.htm\" target=\"_blank\">fluorescence-activated flow cytometer\u003c/a>, or FACS. It was a machine born out of frustration: Len couldn't stand squinting down a microscope looking at cells.\u003c/p>\n\u003cp>Before the FACS, a biologist peering at slides could feel like he was playing a really intense round of \"Where's Waldo,\" staring at crowds of all kinds of cells, trying to pinpoint the exact ones he was looking for. Not only was it annoying — Len Herzenberg worried it wasn't particularly scientific. He wanted a way to find and describe cells that didn't rely on his worn-out eyes.\u003c/p>\n\u003cp>The FACS allows you to pour cells in, program the machine to find whatever it is you're looking for, and then it will spit out a little tube of just those cells alone. And the FACS gives you all kinds of information, too: how big the cells are and how much DNA they have inside.\u003c/p>\n\u003cp>The FACS was used to diagnose AIDS because the technology can quickly and easily sort out T cells. The FACS was used to find the first stem cells. When Len Herzenberg died, one colleague \u003ca href=\"http://www.nytimes.com/2013/11/11/us/leonard-herzenberg-immunologist-who-revolutionized-research-dies-at-81.html?_r=0\" target=\"_blank\">told\u003c/a> \u003cem>T\u003c/em>\u003cem>he New York Times\u003c/em> that \"without Len, tens of thousands of people now alive would not be.\"\u003c/p>\n\u003cp>But in the 1970s, the Herzenbergs were still proving the value of this machine. That's when they started thinking about using it to create a blood test for Down syndrome.\u003c/p>\n\u003cfigure id=\"attachment_177037\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-full wp-image-177037\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/herzenberg-2-8b2c93f342bef3820866b27fb8d5fb69f300d149-s800-c85.jpg\" alt=\"One of Michael's albums, with a photo of his birth parents, Lee and Len Herzenberg. \" width=\"800\" height=\"599\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/herzenberg-2-8b2c93f342bef3820866b27fb8d5fb69f300d149-s800-c85.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/herzenberg-2-8b2c93f342bef3820866b27fb8d5fb69f300d149-s800-c85-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/herzenberg-2-8b2c93f342bef3820866b27fb8d5fb69f300d149-s800-c85-768x575.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">One of Michael's albums, with a photo of his birth parents, Lee and Len Herzenberg. \u003ccite>(Mary Harris/WNYC)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Len had seen research from Finland claiming it was possible to see a fetus's cells in a mother's blood. It was hard to believe. But he figured that FACS, with its nearly magical sorting capabilities, could figure it out. So he took on a medical student named Diana Bianchi as a research associate and made sorting out these cells her project.\u003c/p>\n\u003cp>If they could isolate these cells, he could learn a lot about the developing fetus, including whether the fetus had chromosomal abnormalities.\u003c/p>\n\u003cp>\"They had a very personal reason for doing this, because of their son Michael,\" Bianchi says now. \"They wanted to have a test that could be offered to any pregnant woman — that would be noninvasive and would allow them to know if a child had Down syndrome. The first step, however, was to show that you could pull out fetal cells.\"\u003c/p>\n\u003cp>Scientists now estimate that for every 200 billion cells in a mother's bloodstream, about 10 of those are fetal cells. Bianchi was one of the first people to see them.\u003c/p>\n\u003cp>\u003cem>The New York Times\u003c/em> quoted Len saying the work was a \"first step\" toward a blood test for Down syndrome for all pregnant women. But it would take 30 years for a practical test to become a reality.\u003c/p>\n\u003cp>As it turned out, Len's FACS wasn't the right tool for prenatal diagnosis. There weren't very many fetal cells to be sorted, and if a pregnant woman already had children, scientists couldn't be sure if the cells in her blood came from the current fetus or one of her older kids.\u003c/p>\n\u003cp>But in 2008, Len helped ensure the right tool was found.\u003c/p>\n\u003cp>A researcher named Stephen Quake had discovered a way to sequence chunks of fetal DNA floating in expectant mothers' blood. As a member of the National Academy of Sciences, Len made sure the \u003ca href=\"http://www.pnas.org/content/early/2008/10/03/0808319105\" target=\"_blank\">paper was published\u003c/a> in the academy's journal. Another researcher, Dennis Lo, confirmed Quake's findings. Three years later, the tests were on the market.\u003c/p>\n\u003cp>Now, at just 10 weeks into a pregnancy, a whole range of things can be revealed with this test. Not just Down syndrome, but a host of other chromosomal abnormalities as well as the sex of the child to be.\u003c/p>\n\u003cp>Until this test, doctors had to rely on amniocentesis, an invasive procedure that involves inserting a needle in the womb to sample amniotic fluid, or biopsying the placenta, to tell them with any reliability whether a fetus had a chromosomal abnormality. These tests aren't just uncomfortable; they come with a risk of miscarriage. By some estimates, in the past five years the number of these procedures performed in this country \u003ca href=\"http://www.npr.org/sections/health-shots/2015/01/26/368449371/dna-blood-test-gives-women-a-new-option-for-prenatal-screening\" target=\"_blank\">has plummeted\u003c/a> by more than 50 percent.\u003c/p>\n\u003cp>To some parents, this knowledge can be alarming. Advocates in Ohio are trying to pass a law preventing abortions if Down syndrome is the reason (North Dakota and \u003ca href=\"http://www.npr.org/sections/thetwo-way/2016/03/25/471842196/indiana-governor-signs-new-abortion-restrictions-into-law\" target=\"_blank\">Indiana\u003c/a> have already passed similar laws).\u003c/p>\n\u003cp>Lee Herzenberg is honest about what she would have done if she'd known early on in her pregnancy that Michael had Down syndrome.\u003c/p>\n\u003cp>\"I'd say if I had the choice of not pushing Michael into this life — if I at that time would know I was carrying a Down syndrome child — I would have aborted the child,\" she says. \"I see no reason Michael has to live the life he leads. The fact that we've made it very happy for him or that he's made it very happy for us — all of that is adapting to a situation, but I don't think it's fair or proper.\"\u003c/p>\n\u003cp>But Lee is alarmed that these tests are now being used to determine the sex of unborn babies. She worries about parents choosing to abort girls.\u003c/p>\n\u003cp>Diana Bianchi, that medical student from the Herzenberg lab, is now a professor at Tufts, where she founded the \u003ca href=\"https://www.tuftsmedicalcenter.org/Research-Clinical-Trials/Institutes-Centers-Labs/Mother-Infant-Research-Institute/Laboratories/Bianchi-Laboratory.aspx\" target=\"_blank\">Mother Infant Research Institute\u003c/a>. She's still working in prenatal testing. In fact, perfecting these tests has become her life's work.\u003c/p>\n\u003cp>But her focus has shifted. Now that she can detect Down syndrome so early, she wants to treat it early, too — in the womb. Because finding this chromosomal abnormality at 10 weeks means there's a window of opportunity: The brain changes associated with Down syndrome don't occur until a month or so later. Theoretically, you could treat a fetus before some brain changes occur at all.\u003c/p>\n\u003cp>Bianchi's work is still early. She's experimenting with mice, giving them existing drugs in utero to see if she can forestall brain damage.\u003c/p>\n\u003cp>There's an often-quoted statistic, that 90 percent of parents who find out that their fetus has Down syndrome will abort. But that statistic is from a study done in the United Kingdom. In the U.S., far fewer women terminate.\u003c/p>\n\u003cp>\"We have to unpack this connection between prenatal testing and abortion,\" she says. \"We have good data to suggest that approximately 40 plus percent of women who know their fetus has Down syndrome continue their pregnancy. There are many women who speak very highly of the fact that this allows them to prepare.\"\u003c/p>\n\u003cp>The Down syndrome baby who kicked off the search for this blood test is now a 54-year-old man. He lives in a squat house in Redwood City, Calif., just a 30-minute drive from his birth mother's home.\u003c/p>\n\u003cp>For years, Michael lived with a local woman named Barbara Jennings, who raised a number of children with developmental challenges. The Herzenbergs' pediatrician helped them find her when Michael was a newborn. The Herzenbergs would visit Michael every month or so, but they never felt they should bring him home. When Barbara died, Michael moved to this group home.\u003c/p>\n\u003cp>It's hard to know how much Michael understands when I speak to him, though he has learned to read and use a cellphone. And he's stubborn. A lot like his mother, actually. \"Michael has the hardest head in the whole world,\" says Janet Thomas, the caretaker who runs this house. \"He does whatever he wants to do. He does not care whatever you say. He's going to do whatever it is he wants to do — that's Michael.\"\u003c/p>\n\u003cp>I asked Lee if she ever regretted not raising Michael, and she said no. \"It was a decision that was selfish, if you like, because we had things we wanted to do. In retrospect, a lot of things would never have gotten done. There would be no FACS had we decided to do this. Because it would have been a very intensive kind of upbringing.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>As for Michael, he clearly loves his mother, no matter what she decided. In Michael's room, there are photos on almost every surface, with snapshots of his biological and adopted families. In the corner is a huge poster of his father, celebrating when \u003ca href=\"//www.the-scientist.com/?articles.view/articleNo/24076/title/Herzenberg-wins-Kyoto-Prize/\" target=\"_blank\">he won the Kyoto Prize\u003c/a> for his contributions to biotechnology. And deep in one album, there's a picture of Len and Lee together. The caption reads: \"Michael's Other Mom + Dad.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 WNYC Radio. To see more, visit \u003ca href=\"http://www.wnyc.org/\" target=\"_blank\">WNYC Radio\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Only+Human%3A+A+Birth+That+Launched+The+Search+For+A+Down+Syndrome+Test&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"After Stanford scientist Lee Herzenberg gave birth to a son with Down syndrome, she and her husband worked to find a noninvasive prenatal test.","status":"publish","parent":0,"modified":1461705498,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":45,"wordCount":2086},"headData":{"title":"How A Birth at Stanford 50 Years Ago Launched Search for Down Syndrome Test | KQED","description":"After Stanford scientist Lee Herzenberg gave birth to a son with Down syndrome, she and her husband worked to find a noninvasive prenatal test.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"How A Birth at Stanford 50 Years Ago Launched Search for Down Syndrome Test","datePublished":"2016-04-26T18:36:40.000Z","dateModified":"2016-04-26T21:18:18.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"177017 http://ww2.kqed.org/stateofhealth/?p=177017","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/04/26/how-a-birth-at-stanford-50-years-ago-launched-search-for-down-syndrome-test/","disqusTitle":"How A Birth at Stanford 50 Years Ago Launched Search for Down Syndrome Test","nprByline":"Mary Harris\u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","nprImageAgency":"Mary Harris/WNYC","nprStoryId":"475637228","nprApiLink":"http://api.npr.org/query?id=475637228&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/04/26/475637228/only-human-a-birth-that-launched-the-search-for-a-down-syndrome-test?ft=nprml&f=475637228","nprRetrievedStory":"1","nprPubDate":"Tue, 26 Apr 2016 11:49:00 -0400","nprStoryDate":"Tue, 26 Apr 2016 07:17:00 -0400","nprLastModifiedDate":"Tue, 26 Apr 2016 11:49:16 -0400","path":"/stateofhealth/177017/how-a-birth-at-stanford-50-years-ago-launched-search-for-down-syndrome-test","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This story comes to us via\u003c/em> Only Human, \u003cem>a new podcast from WNYC Studios. Hosted by Mary Harris, \u003c/em>\u003ca href=\"http://www.wnyc.org/shows/onlyhuman/\" target=\"_blank\">Only Human\u003c/a>\u003cem> tells stories we all can relate to. Because every body has a story. Subscribe to \u003c/em>Only Human\u003cem> on iTunes or wherever you like to get your podcasts. \u003c/em>\u003c/p>\n\u003chr>\n\u003cp>When Lee Herzenberg remembers the day her son Michael was born, she laughs and calls it a \"cool birth.\" Her obstetrician was a friend, and she describes it almost like a party — \"a little bit painful, but that you forget very quickly.\" Lee even got a kick out of the fact that a resident learned to do an episiotomy on her.\u003c/p>\n\u003cp>It was November 1961, and she was at the newly christened Palo Alto-Stanford Hospital Center; her husband, Len, was a biology professor on campus. Like most fathers at the time, he didn't attend the birth, which meant he wasn't there when Michael started turning blue.\u003c/p>\n\u003cp>The nurses whisked the newborn off to the nursery without telling Lee anything was wrong.\u003c/p>\n\u003cp>It was then that a doctor noticed the characteristic features of Down syndrome: floppy muscles, eyes that slanted upward. They got Michael breathing again, but doctors thought his prognosis was grim. They gave Michael just a few months to live. A daisy chain of physicians was called, and Lee says it was a pediatrics professor who told her husband what had happened. Then Len was dispatched to tell Lee.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She remembers the moment with uncharacteristic emotion. \"We hugged each other, and it was a terrible conversation to realize that you'd lost the baby, but the baby was lost,\" Lee says now. \"We knew immediately what we'd do. We had already made the decision that it was not a good thing to take the baby home, and so we didn't.\"\u003c/p>\n\u003cp>In the 1960s — an era before neurodiversity movements and early intervention programs — many people still called people with Down syndrome \"mongoloids.\" Playwright Arthur Miller institutionalized his son, Daniel, in 1966. A few years later, \u003ca href=\"https://repository.library.georgetown.edu/handle/10822/1031271\" target=\"_blank\">an article\u003c/a> in \u003cem>The Atlantic Monthly\u003c/em> argued that \"a Down's is not a person.\"\u003c/p>\n\u003cp>Lee and Len Herzenberg had seen friends struggle with the birth of a child with Down syndrome and had even gone with a colleague to an institution, where he dropped off his own infant daughter.\u003c/p>\n\u003cp>So, they decided Michael would never come home.\u003c/p>\n\u003cp>But Michael wasn't absolutely lost to them. Michael's birth sparked their search for a blood test that has revolutionized prenatal care in this country.\u003c/p>\n\u003cp>I made the mistake of telling one scientist I was reporting about \"Len Herzenberg's lab.\" He corrected me instantly: \"Len \u003cem>and Lee's\u003c/em> lab.\" Because Lee Herzenberg was \"leaning in\" decades before Sheryl Sandberg coined the phrase. At 81, Lee, a professor of genetics, is still running the lab she and her husband founded more than 50 years ago. Len died in 2013.\u003c/p>\n\u003cp>The lab is a quirky place, even by Stanford standards. Lee rarely sits on chairs, preferring cushions on the floor. She's often accompanied by her bichon frise, Gigi. Researchers can often be found working in this basement office well into the night.\u003c/p>\n\u003cp>But Lee Herzenberg isn't just quirky. She is one of the few professors at Stanford — possibly the only one — never to have officially graduated from college. Instead, she trained by her husband's side, auditing courses while he got his Ph.D. at Caltech (women weren't allowed to attend at the time) and working at his labs at the Pasteur Institute in Paris and the National Institutes of Health.\u003c/p>\n\u003cp>And the science that's been done here has changed the course of medicine.\u003c/p>\n\u003cp>The Herzenbergs are best known as the creators of the modern-day \u003ca href=\"http://www.bio.umass.edu/micro/immunology/facs542/facswhat.htm\" target=\"_blank\">fluorescence-activated flow cytometer\u003c/a>, or FACS. It was a machine born out of frustration: Len couldn't stand squinting down a microscope looking at cells.\u003c/p>\n\u003cp>Before the FACS, a biologist peering at slides could feel like he was playing a really intense round of \"Where's Waldo,\" staring at crowds of all kinds of cells, trying to pinpoint the exact ones he was looking for. Not only was it annoying — Len Herzenberg worried it wasn't particularly scientific. He wanted a way to find and describe cells that didn't rely on his worn-out eyes.\u003c/p>\n\u003cp>The FACS allows you to pour cells in, program the machine to find whatever it is you're looking for, and then it will spit out a little tube of just those cells alone. And the FACS gives you all kinds of information, too: how big the cells are and how much DNA they have inside.\u003c/p>\n\u003cp>The FACS was used to diagnose AIDS because the technology can quickly and easily sort out T cells. The FACS was used to find the first stem cells. When Len Herzenberg died, one colleague \u003ca href=\"http://www.nytimes.com/2013/11/11/us/leonard-herzenberg-immunologist-who-revolutionized-research-dies-at-81.html?_r=0\" target=\"_blank\">told\u003c/a> \u003cem>T\u003c/em>\u003cem>he New York Times\u003c/em> that \"without Len, tens of thousands of people now alive would not be.\"\u003c/p>\n\u003cp>But in the 1970s, the Herzenbergs were still proving the value of this machine. That's when they started thinking about using it to create a blood test for Down syndrome.\u003c/p>\n\u003cfigure id=\"attachment_177037\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-full wp-image-177037\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/herzenberg-2-8b2c93f342bef3820866b27fb8d5fb69f300d149-s800-c85.jpg\" alt=\"One of Michael's albums, with a photo of his birth parents, Lee and Len Herzenberg. \" width=\"800\" height=\"599\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/herzenberg-2-8b2c93f342bef3820866b27fb8d5fb69f300d149-s800-c85.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/herzenberg-2-8b2c93f342bef3820866b27fb8d5fb69f300d149-s800-c85-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/herzenberg-2-8b2c93f342bef3820866b27fb8d5fb69f300d149-s800-c85-768x575.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">One of Michael's albums, with a photo of his birth parents, Lee and Len Herzenberg. \u003ccite>(Mary Harris/WNYC)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Len had seen research from Finland claiming it was possible to see a fetus's cells in a mother's blood. It was hard to believe. But he figured that FACS, with its nearly magical sorting capabilities, could figure it out. So he took on a medical student named Diana Bianchi as a research associate and made sorting out these cells her project.\u003c/p>\n\u003cp>If they could isolate these cells, he could learn a lot about the developing fetus, including whether the fetus had chromosomal abnormalities.\u003c/p>\n\u003cp>\"They had a very personal reason for doing this, because of their son Michael,\" Bianchi says now. \"They wanted to have a test that could be offered to any pregnant woman — that would be noninvasive and would allow them to know if a child had Down syndrome. The first step, however, was to show that you could pull out fetal cells.\"\u003c/p>\n\u003cp>Scientists now estimate that for every 200 billion cells in a mother's bloodstream, about 10 of those are fetal cells. Bianchi was one of the first people to see them.\u003c/p>\n\u003cp>\u003cem>The New York Times\u003c/em> quoted Len saying the work was a \"first step\" toward a blood test for Down syndrome for all pregnant women. But it would take 30 years for a practical test to become a reality.\u003c/p>\n\u003cp>As it turned out, Len's FACS wasn't the right tool for prenatal diagnosis. There weren't very many fetal cells to be sorted, and if a pregnant woman already had children, scientists couldn't be sure if the cells in her blood came from the current fetus or one of her older kids.\u003c/p>\n\u003cp>But in 2008, Len helped ensure the right tool was found.\u003c/p>\n\u003cp>A researcher named Stephen Quake had discovered a way to sequence chunks of fetal DNA floating in expectant mothers' blood. As a member of the National Academy of Sciences, Len made sure the \u003ca href=\"http://www.pnas.org/content/early/2008/10/03/0808319105\" target=\"_blank\">paper was published\u003c/a> in the academy's journal. Another researcher, Dennis Lo, confirmed Quake's findings. Three years later, the tests were on the market.\u003c/p>\n\u003cp>Now, at just 10 weeks into a pregnancy, a whole range of things can be revealed with this test. Not just Down syndrome, but a host of other chromosomal abnormalities as well as the sex of the child to be.\u003c/p>\n\u003cp>Until this test, doctors had to rely on amniocentesis, an invasive procedure that involves inserting a needle in the womb to sample amniotic fluid, or biopsying the placenta, to tell them with any reliability whether a fetus had a chromosomal abnormality. These tests aren't just uncomfortable; they come with a risk of miscarriage. By some estimates, in the past five years the number of these procedures performed in this country \u003ca href=\"http://www.npr.org/sections/health-shots/2015/01/26/368449371/dna-blood-test-gives-women-a-new-option-for-prenatal-screening\" target=\"_blank\">has plummeted\u003c/a> by more than 50 percent.\u003c/p>\n\u003cp>To some parents, this knowledge can be alarming. Advocates in Ohio are trying to pass a law preventing abortions if Down syndrome is the reason (North Dakota and \u003ca href=\"http://www.npr.org/sections/thetwo-way/2016/03/25/471842196/indiana-governor-signs-new-abortion-restrictions-into-law\" target=\"_blank\">Indiana\u003c/a> have already passed similar laws).\u003c/p>\n\u003cp>Lee Herzenberg is honest about what she would have done if she'd known early on in her pregnancy that Michael had Down syndrome.\u003c/p>\n\u003cp>\"I'd say if I had the choice of not pushing Michael into this life — if I at that time would know I was carrying a Down syndrome child — I would have aborted the child,\" she says. \"I see no reason Michael has to live the life he leads. The fact that we've made it very happy for him or that he's made it very happy for us — all of that is adapting to a situation, but I don't think it's fair or proper.\"\u003c/p>\n\u003cp>But Lee is alarmed that these tests are now being used to determine the sex of unborn babies. She worries about parents choosing to abort girls.\u003c/p>\n\u003cp>Diana Bianchi, that medical student from the Herzenberg lab, is now a professor at Tufts, where she founded the \u003ca href=\"https://www.tuftsmedicalcenter.org/Research-Clinical-Trials/Institutes-Centers-Labs/Mother-Infant-Research-Institute/Laboratories/Bianchi-Laboratory.aspx\" target=\"_blank\">Mother Infant Research Institute\u003c/a>. She's still working in prenatal testing. In fact, perfecting these tests has become her life's work.\u003c/p>\n\u003cp>But her focus has shifted. Now that she can detect Down syndrome so early, she wants to treat it early, too — in the womb. Because finding this chromosomal abnormality at 10 weeks means there's a window of opportunity: The brain changes associated with Down syndrome don't occur until a month or so later. Theoretically, you could treat a fetus before some brain changes occur at all.\u003c/p>\n\u003cp>Bianchi's work is still early. She's experimenting with mice, giving them existing drugs in utero to see if she can forestall brain damage.\u003c/p>\n\u003cp>There's an often-quoted statistic, that 90 percent of parents who find out that their fetus has Down syndrome will abort. But that statistic is from a study done in the United Kingdom. In the U.S., far fewer women terminate.\u003c/p>\n\u003cp>\"We have to unpack this connection between prenatal testing and abortion,\" she says. \"We have good data to suggest that approximately 40 plus percent of women who know their fetus has Down syndrome continue their pregnancy. There are many women who speak very highly of the fact that this allows them to prepare.\"\u003c/p>\n\u003cp>The Down syndrome baby who kicked off the search for this blood test is now a 54-year-old man. He lives in a squat house in Redwood City, Calif., just a 30-minute drive from his birth mother's home.\u003c/p>\n\u003cp>For years, Michael lived with a local woman named Barbara Jennings, who raised a number of children with developmental challenges. The Herzenbergs' pediatrician helped them find her when Michael was a newborn. The Herzenbergs would visit Michael every month or so, but they never felt they should bring him home. When Barbara died, Michael moved to this group home.\u003c/p>\n\u003cp>It's hard to know how much Michael understands when I speak to him, though he has learned to read and use a cellphone. And he's stubborn. A lot like his mother, actually. \"Michael has the hardest head in the whole world,\" says Janet Thomas, the caretaker who runs this house. \"He does whatever he wants to do. He does not care whatever you say. He's going to do whatever it is he wants to do — that's Michael.\"\u003c/p>\n\u003cp>I asked Lee if she ever regretted not raising Michael, and she said no. \"It was a decision that was selfish, if you like, because we had things we wanted to do. In retrospect, a lot of things would never have gotten done. There would be no FACS had we decided to do this. Because it would have been a very intensive kind of upbringing.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As for Michael, he clearly loves his mother, no matter what she decided. In Michael's room, there are photos on almost every surface, with snapshots of his biological and adopted families. In the corner is a huge poster of his father, celebrating when \u003ca href=\"//www.the-scientist.com/?articles.view/articleNo/24076/title/Herzenberg-wins-Kyoto-Prize/\" target=\"_blank\">he won the Kyoto Prize\u003c/a> for his contributions to biotechnology. And deep in one album, there's a picture of Len and Lee together. The caption reads: \"Michael's Other Mom + Dad.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 WNYC Radio. To see more, visit \u003ca href=\"http://www.wnyc.org/\" target=\"_blank\">WNYC Radio\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Only+Human%3A+A+Birth+That+Launched+The+Search+For+A+Down+Syndrome+Test&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/177017/how-a-birth-at-stanford-50-years-ago-launched-search-for-down-syndrome-test","authors":["byline_stateofhealth_177017"],"categories":["stateofhealth_2407","stateofhealth_13"],"tags":["stateofhealth_2519","stateofhealth_349","stateofhealth_461"],"featImg":"stateofhealth_177018","label":"stateofhealth"},"stateofhealth_174355":{"type":"posts","id":"stateofhealth_174355","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"174355","score":null,"sort":[1461002177000]},"guestAuthors":[],"slug":"newly-pregnant-you-may-not-want-to-tell-covered-california","title":"Newly Pregnant? You May Not Want to Tell Covered California","publishDate":1461002177,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Lynn Kersey has some advice for pregnant women who bought health insurance policies from Covered California and want to keep them: Don’t report your pregnancy to the agency.\u003c/p>\n\u003caside class=\"pullquote alignright\">1,900 pregnant women across the state were automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California\u003c/aside>\n\u003cp>“It’s not a requirement ... and it’s actually worse to do so,” said Kersey, executive director of Maternal and Child Health Access, an advocacy group based in Los Angeles County.\u003c/p>\n\u003cp>Why? Two of Kersey’s clients with Covered California health plans recently were thrown into Medi-Cal -- the state’s health program for low-income residents -- without their consent or prior notice after they reported their pregnancies to the state’s health insurance exchange.\u003c/p>\n\u003cp>The two women are among about 1,900 across the state who were automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California. The snafu was triggered by a recent policy change in Medi-Cal eligibility.\u003c/p>\n\u003cp>“One of the women missed a month of prenatal care,” Kersey said. “She was told she couldn’t be seen when she went to see her doctor.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Covered California acknowledged the problem, casting part of the blame on its computer system.\u003c/p>\n\u003cp>\u003cstrong>Similar Problem with Healthcare.gov\u003c/strong>\u003c/p>\n\u003cp>“We didn’t implement this as well as it should have been implemented,” said Amy Palmer, the agency’s director of communications.\u003c/p>\n\u003cp>That computer glitch will be fixed, but not until September, Palmer said.\u003c/p>\n\u003cp>A similar problem is affecting some pregnant women who purchased their plans through \u003ca href=\"https://www.healthcare.gov/\" target=\"_blank\">HealthCare.gov\u003c/a>, the federal health insurance exchange that serves people in 38 states, said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities in Washington, D.C.\u003c/p>\n\u003cp>“The computer system was basically immediately transitioning them to Medicaid when they reported their pregnancies to HealthCare.gov,\" Solomon said. “They should have the choice and they’re not getting it.”\u003c/p>\n\u003cp>Plan cancellations without notice or consent have been a persistent problem for some Covered California enrollees since 2014. In some cases, people are terminated from their plans unexpectedly. In others, they are transferred to Medi-Cal without prior notice. It’s unclear -- even to Covered California -- how widespread the problem is.\u003c/p>\n\u003cp>The situation for the pregnant California women can be traced to a recent policy change.\u003c/p>\n\u003cp>Usually, consumers are placed in either Covered California or Medi-Cal based on their income, with no choice in the matter, even though they can enroll in Medi-Cal via the Covered California website.\u003c/p>\n\u003cp>But the rules are different for some pregnant women whose household income falls between 138 percent and 213 percent of the federal poverty level, or roughly $22,100 to $34,100 for a family of two.\u003c/p>\n\u003cp>Before last October pregnant women in that income range technically had a choice between Medi-Cal and Covered California, though often they were not informed of the choice, said Lucy Quacinella, a San Francisco attorney and health care advocate for working families.\u003c/p>\n\u003cp>Now, under an October 2015 policy change, \u003cem>women who are pregnant at the time they apply\u003c/em> for health coverage and fall into this income bracket will automatically be placed into Medi-Cal, she said.\u003c/p>\n\u003cp>Women in the income range who already have Covered California plans \u003cem>before they become pregnant\u003c/em> are now supposed to be given the choice to remain in their subsidized plans -- which have out-of-pocket costs such as co-pays and deductibles -- or move to Medi-Cal, which is free.\u003c/p>\n\u003cp>The idea is to allow them to keep their existing Covered California providers if they want, Quacinella said.\u003c/p>\n\u003cp>But the Covered California computer system wasn’t programmed to give them the choice, and some pregnant women were moved immediately into Medi-Cal.\u003c/p>\n\u003cp>“They didn’t receive notice. They just knew from one day to the next that their Covered California insurance didn’t work anymore,” Quacinella said. “It’s very stressful, very confusing.”\u003c/p>\n\u003cp>\u003cstrong>May Be Easier to Find a Doctor with Covered California...\u003c/strong>\u003c/p>\n\u003cp>Although Medi-Cal is free, some women find it’s easier to get a doctor if they have private insurance. And because Covered California and Medi-Cal provider networks don’t always overlap, some of the women could no longer see the doctors with whom they had established relationships, Quacinella said.\u003c/p>\n\u003cp>“For some women, continuity of care is critical,” she said. “They don’t want to lose their providers.”\u003c/p>\n\u003cp>\u003cstrong>... But Medi-Cal is Free to Consumers\u003c/strong>\u003c/p>\n\u003cp>But after the initial shock, some women will consider the move to Medi-Cal a “blessing” because it’s cheaper, Quacinella said.\u003c/p>\n\u003cp>“Even with tax credits and cost-sharing reductions, it’s really hard for some families to afford the Covered California premiums or for pregnant women to afford a hospital’s labor and delivery charge,” she said.\u003c/p>\n\u003cp>That was the case for Kersey’s clients, who initially were distressed by the sudden loss of their Covered California plans but later decided to stay in Medi-Cal.\u003c/p>\n\u003cp>“One of our clients desperately wanted to get back into Covered California, but ultimately was fine with Medi-Cal, knowing there’s no delivery cost,” Kersey said.\u003c/p>\n\u003cp>Covered California has trained its customer service reps, insurance agents and other enrollers to explain to pregnant consumers that reporting a pregnancy could trigger a switch to Medi-Cal, Palmer said.\u003c/p>\n\u003cp>However, until the computer fix later this year, some women who report their pregnancy through the Covered California website still will be moved without a choice, she confirmed. These women can get their Covered California plans back, retroactive to the date they reported their pregnancies by calling Covered California’s customer service center at 800-300-1506.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Consumers should feel confident that their coverage continues,” Palmer said. “No consumer should be concerned about accessing care while they are pregnant for fear they do not have health coverage. They do.”\u003c/p>\n\n","blocks":[],"excerpt":"1,900 women across the state were automatically transferred from the exchange to Medi-Cal since last October with no notice.","status":"publish","parent":0,"modified":1461022235,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":34,"wordCount":1053},"headData":{"title":"Newly Pregnant? You May Not Want to Tell Covered California | KQED","description":"1,900 women across the state were automatically transferred from the exchange to Medi-Cal since last October with no notice.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Newly Pregnant? You May Not Want to Tell Covered California","datePublished":"2016-04-18T17:56:17.000Z","dateModified":"2016-04-18T23:30:35.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"174355 http://ww2.kqed.org/stateofhealth/?p=174355","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/04/18/newly-pregnant-you-may-not-want-to-tell-covered-california/","disqusTitle":"Newly Pregnant? You May Not Want to Tell Covered California","nprByline":"Emily Bazar\u003cbr />\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>","path":"/stateofhealth/174355/newly-pregnant-you-may-not-want-to-tell-covered-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lynn Kersey has some advice for pregnant women who bought health insurance policies from Covered California and want to keep them: Don’t report your pregnancy to the agency.\u003c/p>\n\u003caside class=\"pullquote alignright\">1,900 pregnant women across the state were automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California\u003c/aside>\n\u003cp>“It’s not a requirement ... and it’s actually worse to do so,” said Kersey, executive director of Maternal and Child Health Access, an advocacy group based in Los Angeles County.\u003c/p>\n\u003cp>Why? Two of Kersey’s clients with Covered California health plans recently were thrown into Medi-Cal -- the state’s health program for low-income residents -- without their consent or prior notice after they reported their pregnancies to the state’s health insurance exchange.\u003c/p>\n\u003cp>The two women are among about 1,900 across the state who were automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California. The snafu was triggered by a recent policy change in Medi-Cal eligibility.\u003c/p>\n\u003cp>“One of the women missed a month of prenatal care,” Kersey said. “She was told she couldn’t be seen when she went to see her doctor.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Covered California acknowledged the problem, casting part of the blame on its computer system.\u003c/p>\n\u003cp>\u003cstrong>Similar Problem with Healthcare.gov\u003c/strong>\u003c/p>\n\u003cp>“We didn’t implement this as well as it should have been implemented,” said Amy Palmer, the agency’s director of communications.\u003c/p>\n\u003cp>That computer glitch will be fixed, but not until September, Palmer said.\u003c/p>\n\u003cp>A similar problem is affecting some pregnant women who purchased their plans through \u003ca href=\"https://www.healthcare.gov/\" target=\"_blank\">HealthCare.gov\u003c/a>, the federal health insurance exchange that serves people in 38 states, said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities in Washington, D.C.\u003c/p>\n\u003cp>“The computer system was basically immediately transitioning them to Medicaid when they reported their pregnancies to HealthCare.gov,\" Solomon said. “They should have the choice and they’re not getting it.”\u003c/p>\n\u003cp>Plan cancellations without notice or consent have been a persistent problem for some Covered California enrollees since 2014. In some cases, people are terminated from their plans unexpectedly. In others, they are transferred to Medi-Cal without prior notice. It’s unclear -- even to Covered California -- how widespread the problem is.\u003c/p>\n\u003cp>The situation for the pregnant California women can be traced to a recent policy change.\u003c/p>\n\u003cp>Usually, consumers are placed in either Covered California or Medi-Cal based on their income, with no choice in the matter, even though they can enroll in Medi-Cal via the Covered California website.\u003c/p>\n\u003cp>But the rules are different for some pregnant women whose household income falls between 138 percent and 213 percent of the federal poverty level, or roughly $22,100 to $34,100 for a family of two.\u003c/p>\n\u003cp>Before last October pregnant women in that income range technically had a choice between Medi-Cal and Covered California, though often they were not informed of the choice, said Lucy Quacinella, a San Francisco attorney and health care advocate for working families.\u003c/p>\n\u003cp>Now, under an October 2015 policy change, \u003cem>women who are pregnant at the time they apply\u003c/em> for health coverage and fall into this income bracket will automatically be placed into Medi-Cal, she said.\u003c/p>\n\u003cp>Women in the income range who already have Covered California plans \u003cem>before they become pregnant\u003c/em> are now supposed to be given the choice to remain in their subsidized plans -- which have out-of-pocket costs such as co-pays and deductibles -- or move to Medi-Cal, which is free.\u003c/p>\n\u003cp>The idea is to allow them to keep their existing Covered California providers if they want, Quacinella said.\u003c/p>\n\u003cp>But the Covered California computer system wasn’t programmed to give them the choice, and some pregnant women were moved immediately into Medi-Cal.\u003c/p>\n\u003cp>“They didn’t receive notice. They just knew from one day to the next that their Covered California insurance didn’t work anymore,” Quacinella said. “It’s very stressful, very confusing.”\u003c/p>\n\u003cp>\u003cstrong>May Be Easier to Find a Doctor with Covered California...\u003c/strong>\u003c/p>\n\u003cp>Although Medi-Cal is free, some women find it’s easier to get a doctor if they have private insurance. And because Covered California and Medi-Cal provider networks don’t always overlap, some of the women could no longer see the doctors with whom they had established relationships, Quacinella said.\u003c/p>\n\u003cp>“For some women, continuity of care is critical,” she said. “They don’t want to lose their providers.”\u003c/p>\n\u003cp>\u003cstrong>... But Medi-Cal is Free to Consumers\u003c/strong>\u003c/p>\n\u003cp>But after the initial shock, some women will consider the move to Medi-Cal a “blessing” because it’s cheaper, Quacinella said.\u003c/p>\n\u003cp>“Even with tax credits and cost-sharing reductions, it’s really hard for some families to afford the Covered California premiums or for pregnant women to afford a hospital’s labor and delivery charge,” she said.\u003c/p>\n\u003cp>That was the case for Kersey’s clients, who initially were distressed by the sudden loss of their Covered California plans but later decided to stay in Medi-Cal.\u003c/p>\n\u003cp>“One of our clients desperately wanted to get back into Covered California, but ultimately was fine with Medi-Cal, knowing there’s no delivery cost,” Kersey said.\u003c/p>\n\u003cp>Covered California has trained its customer service reps, insurance agents and other enrollers to explain to pregnant consumers that reporting a pregnancy could trigger a switch to Medi-Cal, Palmer said.\u003c/p>\n\u003cp>However, until the computer fix later this year, some women who report their pregnancy through the Covered California website still will be moved without a choice, she confirmed. These women can get their Covered California plans back, retroactive to the date they reported their pregnancies by calling Covered California’s customer service center at 800-300-1506.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Consumers should feel confident that their coverage continues,” Palmer said. “No consumer should be concerned about accessing care while they are pregnant for fear they do not have health coverage. They do.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/174355/newly-pregnant-you-may-not-want-to-tell-covered-california","authors":["byline_stateofhealth_174355"],"categories":["stateofhealth_15"],"tags":["stateofhealth_368","stateofhealth_2519","stateofhealth_349","stateofhealth_397"],"featImg":"stateofhealth_174373","label":"stateofhealth"},"stateofhealth_172730":{"type":"posts","id":"stateofhealth_172730","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"172730","score":null,"sort":[1460668270000]},"guestAuthors":[],"slug":"fda-to-permit-folic-acid-in-corn-masa-to-prevent-birth-defects","title":"FDA to Permit Folic Acid in Corn Masa to Prevent Birth Defects","publishDate":1460668270,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>It's been almost 20 years since the Food and Drug Administration (FDA) required that folic acid, a B vitamin that can prevent a serious birth defect when taken by pregnant women, be added to certain enriched grains like breads and pasta. In the decade after, the rate of these neural tube defects plummeted and is estimated to have prevented 10,000 cases in a decade.\u003c/p>\n\u003cp>But corn masa was not included in the FDA's recommendation back in the '90s, and since then the Hispanic population of the U.S. has grown dramatically. Now a quarter of all babies are born to Hispanic mothers, and they have a \u003ca href=\"http://www.cdc.gov/mmWR/pdf/wk/mm6401.pdf\" target=\"_blank\">much higher risk \u003c/a>of neural tube defects than their white counterparts.\u003c/p>\n\u003cp>On Thursday, \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm496104.htm\" target=\"_blank\">the FDA announced \u003c/a>that folic acid may be added to corn masa flour, a staple for many Hispanic families, with a goal of reducing the risk of neural tube defects.\u003c/p>\n\u003cp>Advocacy groups, including the March of Dimes, have been lobbying the FDA for years to make the recommendation. They applauded the move.\u003c/p>\n\u003cp>\u003ca href=\"http://www.prnewswire.com/news-releases/advocates-hail-fda-decision-to-improve-infant-health-prevent-birth-defects-300251337.html#continue-jump\" target=\"_blank\">In a statement\u003c/a>, March of Dimes president Dr. Jennifer Howse called the announcement a \"major victory for maternal and child health, especially in our Hispanic communities.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In a developing fetus, the neural tube starts as a flat ribbon and develops into a tube by the end of the first month of pregnancy. The tube goes on to develop into the brain and spinal cord. \u003ca href=\"http://www.marchofdimes.org/complications/neural-tube-defects.aspx#\" target=\"_blank\">Serious defects \u003c/a>can happen if the tube does not close completely. That can lead to conditions such as spina bifida.\u003c/p>\n\u003cp>But if a woman consumes appropriate amounts of folic acid -- 400 micrograms a day -- before becoming pregnant, it can prevent many cases of neural tube defects, \u003ca href=\"http://www.cdc.gov/features/folicacidbenefits/\" target=\"_blank\">according to the Centers for Disease Control and Prevention\u003c/a>. Most multivitamins contain the recommended amount of folic acid, and many fortified cereals -- now soon to include masa flour -- also can provide the amount of folic acid women need each day.\u003c/p>\n\u003cp>The only question is if the FDA delayed in making the recommendation, reports the\u003ca href=\"http://www.seattletimes.com/seattle-news/health/fda-to-allow-folic-acid-in-corn-masa-to-stop-birth-defects/\" target=\"_blank\"> Seattle Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Adding folic acid to corn masa could prevent an average of 40 neural-tube defects in Hispanic women each year, and as many as 120 annually across the nation, \u003ca class=\"content-link external\" href=\"http://onlinelibrary.wiley.com/doi/10.1111/nyas.12325/abstract\" target=\"_blank\">according to research\u003c/a> by the Centers for Disease Control and Prevention (CDC).\u003c/p>\n\u003cp>Critics, including a former director of the CDC’s birth-defects division, said about 800 defects could have been prevented if the action had been taken earlier.\u003c/p>\n\u003cp>“That’s great news,” said Dr. Godfrey Oakley, director of the Center for Spina Bifida Research, Prevention and Policy at Emory University. “It’s only about 20 years too late.”\u003c/p>\n\u003cp>Susan Mayne [director of the FDA Center for Food Safety and Applied Nutrition], said the agency was required to follow the rules governing additives in the food supply.\u003c/p>\n\u003cp>“The big hitch, obviously, is that we need data,” she said. “Once we had the data, the process went very quickly.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>The Times also reported that Gruma, the world's largest maker of corn masa flour already adds folic acid to masa flour in other countries, and will begin adding the vitamin to its U.S. products as soon as manufacturing plants can be reconfigured.\u003c/p>\n\n","blocks":[],"excerpt":"The new fortification could prevent birth defects mostly in Hispanic babies. The vitamin has been added to other grains for decades.","status":"publish","parent":0,"modified":1460671372,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":547},"headData":{"title":"FDA to Permit Folic Acid in Corn Masa to Prevent Birth Defects | KQED","description":"The new fortification could prevent birth defects mostly in Hispanic babies. The vitamin has been added to other grains for decades.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"FDA to Permit Folic Acid in Corn Masa to Prevent Birth Defects","datePublished":"2016-04-14T21:11:10.000Z","dateModified":"2016-04-14T22:02:52.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"172730 http://ww2.kqed.org/stateofhealth/?p=172730","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/04/14/fda-to-permit-folic-acid-in-corn-masa-to-prevent-birth-defects/","disqusTitle":"FDA to Permit Folic Acid in Corn Masa to Prevent Birth Defects","path":"/stateofhealth/172730/fda-to-permit-folic-acid-in-corn-masa-to-prevent-birth-defects","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's been almost 20 years since the Food and Drug Administration (FDA) required that folic acid, a B vitamin that can prevent a serious birth defect when taken by pregnant women, be added to certain enriched grains like breads and pasta. In the decade after, the rate of these neural tube defects plummeted and is estimated to have prevented 10,000 cases in a decade.\u003c/p>\n\u003cp>But corn masa was not included in the FDA's recommendation back in the '90s, and since then the Hispanic population of the U.S. has grown dramatically. Now a quarter of all babies are born to Hispanic mothers, and they have a \u003ca href=\"http://www.cdc.gov/mmWR/pdf/wk/mm6401.pdf\" target=\"_blank\">much higher risk \u003c/a>of neural tube defects than their white counterparts.\u003c/p>\n\u003cp>On Thursday, \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm496104.htm\" target=\"_blank\">the FDA announced \u003c/a>that folic acid may be added to corn masa flour, a staple for many Hispanic families, with a goal of reducing the risk of neural tube defects.\u003c/p>\n\u003cp>Advocacy groups, including the March of Dimes, have been lobbying the FDA for years to make the recommendation. They applauded the move.\u003c/p>\n\u003cp>\u003ca href=\"http://www.prnewswire.com/news-releases/advocates-hail-fda-decision-to-improve-infant-health-prevent-birth-defects-300251337.html#continue-jump\" target=\"_blank\">In a statement\u003c/a>, March of Dimes president Dr. Jennifer Howse called the announcement a \"major victory for maternal and child health, especially in our Hispanic communities.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In a developing fetus, the neural tube starts as a flat ribbon and develops into a tube by the end of the first month of pregnancy. The tube goes on to develop into the brain and spinal cord. \u003ca href=\"http://www.marchofdimes.org/complications/neural-tube-defects.aspx#\" target=\"_blank\">Serious defects \u003c/a>can happen if the tube does not close completely. That can lead to conditions such as spina bifida.\u003c/p>\n\u003cp>But if a woman consumes appropriate amounts of folic acid -- 400 micrograms a day -- before becoming pregnant, it can prevent many cases of neural tube defects, \u003ca href=\"http://www.cdc.gov/features/folicacidbenefits/\" target=\"_blank\">according to the Centers for Disease Control and Prevention\u003c/a>. Most multivitamins contain the recommended amount of folic acid, and many fortified cereals -- now soon to include masa flour -- also can provide the amount of folic acid women need each day.\u003c/p>\n\u003cp>The only question is if the FDA delayed in making the recommendation, reports the\u003ca href=\"http://www.seattletimes.com/seattle-news/health/fda-to-allow-folic-acid-in-corn-masa-to-stop-birth-defects/\" target=\"_blank\"> Seattle Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Adding folic acid to corn masa could prevent an average of 40 neural-tube defects in Hispanic women each year, and as many as 120 annually across the nation, \u003ca class=\"content-link external\" href=\"http://onlinelibrary.wiley.com/doi/10.1111/nyas.12325/abstract\" target=\"_blank\">according to research\u003c/a> by the Centers for Disease Control and Prevention (CDC).\u003c/p>\n\u003cp>Critics, including a former director of the CDC’s birth-defects division, said about 800 defects could have been prevented if the action had been taken earlier.\u003c/p>\n\u003cp>“That’s great news,” said Dr. Godfrey Oakley, director of the Center for Spina Bifida Research, Prevention and Policy at Emory University. “It’s only about 20 years too late.”\u003c/p>\n\u003cp>Susan Mayne [director of the FDA Center for Food Safety and Applied Nutrition], said the agency was required to follow the rules governing additives in the food supply.\u003c/p>\n\u003cp>“The big hitch, obviously, is that we need data,” she said. “Once we had the data, the process went very quickly.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>The Times also reported that Gruma, the world's largest maker of corn masa flour already adds folic acid to masa flour in other countries, and will begin adding the vitamin to its U.S. products as soon as manufacturing plants can be reconfigured.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/172730/fda-to-permit-folic-acid-in-corn-masa-to-prevent-birth-defects","authors":["240"],"categories":["stateofhealth_12","stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_96","stateofhealth_349","stateofhealth_2552"],"featImg":"stateofhealth_172748","label":"stateofhealth"},"stateofhealth_91285":{"type":"posts","id":"stateofhealth_91285","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"91285","score":null,"sort":[1444758521000]},"guestAuthors":[],"slug":"pregnant-and-uninsured-here-are-your-options","title":"Pregnant and Uninsured? Here Are Your Options","publishDate":1444758521,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{},"content":"\u003cp>Did you recently have or adopt a baby, get married, or move to California from another state? Perhaps you lost your job – and your health insurance with it.\u003c/p>\n\u003cp>These are some of life’s common events that trigger special health insurance enrollment opportunities, which allow you to buy or switch plans outside of limited open enrollment periods.\u003c/p>\n\u003cp>But one common life event is missing from that list: Pregnancy.\u003c/p>\n\u003cp>Attempts to add it this year have failed. At the same time, recent changes have expanded coverage options for some uninsured, pregnant Californians.\u003c/p>\n\u003cp>\u003cstrong>Q: Do you know any solution to get health insurance now that \u003c/strong>\u003cstrong>my\u003c/strong>\u003cstrong> friend’s wife is pregnant and there are no health plans accepting applications? For some reason, they say it’s not a qualifying event.\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A: Jay of Rancho Cucamonga isn’t alone in wondering why pregnancy doesn’t trigger a special enrollment period for most commercial health insurance plans, whether purchased from the individual market or obtained from your employer.\u003c/p>\n\u003cp>In March, 37 Democratic U.S. Senators urged the secretary of the U.S. Department of Health and Human Services (HHS) to include pregnancy as a qualifying life event. Within days, California’s two Democratic U.S. Senators, Barbara Boxer and Dianne Feinstein, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/03/11/feinstein-and-boxer-say-pregnant-women-should-get-special-obamacare-enrollment/\" target=\"_blank\">asked California’s health insurance exchange, Covered California,\u003c/a> to do the same. In their letter, they said that doing so could save lives and reduce health costs.\u003c/p>\n\u003cp>“Especially since having a child is a qualifying life event, it makes sense to ensure that access to care is granted prior to birth,” they wrote.\u003c/p>\n\u003cp>HHS Secretary Sylvia Burwell responded in April that the department can’t make pregnancy a qualifying life event because “we do not have the legal authority to” do so.\u003c/p>\n\u003cp>(Which of course raises the question of who does have the authority. I asked HHS, but the agency declined to comment further.)\u003c/p>\n\u003cp>As a result of Burwell’s response, Covered California, too, said it couldn’t make pregnancy a qualifying event.\u003c/p>\n\u003cp>So what options are available for women who get pregnant while uninsured?\u003c/p>\n\u003cp>[contextly_sidebar id=\"98MRboitTJQrj3cwlOCCOBJ5XuRbYCsF\"]After all, nearly half of pregnancies are unintended, says Alina Salganicoff, director of Women’s Health Policy at the Kaiser Family Foundation.\u003c/p>\n\u003cp>In California, \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/documents/pregnancy_fact_sheet_chart.pdf\" target=\"_blank\">you may qualify \u003c/a>for a publicly-funded health program depending on your income. The thresholds can be relatively generous and include middle-income families.\u003c/p>\n\u003cp>And as long as you’re eligible, you can sign up anytime of year.\u003c/p>\n\u003cp>The first is \u003ca href=\"http://mcap.dhcs.ca.gov/my_mcap/important_information_applicants.aspx\" target=\"_blank\">Medi-Cal\u003c/a>, which is the state’s version of the federal Medicaid program for low-income residents. On Aug. 1, it increased the income limit for pregnant women to qualify for full-scope benefits to \u003ca href=\"http://aspe.hhs.gov/2015-poverty-guidelines#threshholds\" target=\"_blank\">138 percent of the Federal Poverty Level\u003c/a> (FPL).\u003c/p>\n\u003cp>This year, that’s up to roughly $22,000 for a family of two. (There’s a twist here. I’ll explain more below.)\u003c/p>\n\u003cp>The higher income threshold means that more pregnant women will qualify for comprehensive coverage, says Lucy Quacinella, a San Francisco attorney who advocates for health coverage options for working families.\u003c/p>\n\u003cp>“They won’t have to worry about whether something outside of a routine prenatal visit, like a referral to a specialist, will be covered,” she says.\u003c/p>\n\u003cp>Pregnant women who make between 138 percent and 213 percent of FPL may qualify for Pregnancy-Related Medi-Cal. This coverage includes “all medically necessary Medi-Cal services related to pregnancy and/or any complications that may pose a risk to the woman or her unborn child,” says Tony Cava of the state Department of Health Care Services.\u003c/p>\n\u003cp>(No matter how much their income is, pregnant women who are not in the country legally are not eligible for full Medi-Cal benefits. However, they are eligible for Pregnancy-Related Medi-Cal up to 213 percent of FPL, Quacinella says.)\u003c/p>\n\u003cp>Coverage in full-scope Medi-Cal and Pregnancy-Related Medi-Cal is free for those who qualify.\u003c/p>\n\u003cp>Plus, while you’re waiting for your Medi-Cal application to be processed, there’s a program called \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/pages/pe.aspx\" target=\"_blank\">Presumptive Eligibility for Pregnant Women\u003c/a>, which allows you to access temporary prenatal care. Call 800-824-0088 for more information.\u003c/p>\n\u003cp>Pregnant women who make between 213 percent and 322 percent of FPL (up to roughly $51,300 for a family of two), may qualify for different coverage called the \u003ca href=\"http://mcap.dhcs.ca.gov/home/default.aspx\">Medi-Cal Access Program\u003c/a>, formerly known as AIM.\u003c/p>\n\u003cp>Earlier this year, the state removed the requirement that women sign up by their 30\u003csup>th\u003c/sup> week of gestation, allowing them to apply anytime during pregnancy, says Lynn Kersey, executive director of Maternal and Child Health Access.\u003c/p>\n\u003cp>This program costs 1.5 percent of annual household income (after some adjustments) but does not have deductibles or copayments.\u003c/p>\n\u003cp>You can apply for Medi-Cal or the Medi-Cal Access Program by visiting \u003ca href=\"http://www.coveredca.com\" target=\"_blank\">www.CoveredCA.com \u003c/a>or by calling 800-300-1506. You can apply in person at your \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/pages/countyoffices.aspx\" target=\"_blank\">county human services office.\u003c/a>\u003c/p>\n\u003cp>Now, here’s the twist: For Medi-Cal and the Medi-Cal Access Program, a pregnant woman counts not just as one person when calculating income, but one person plus the number of fetuses she’s carrying.\u003c/p>\n\u003cp>“That means you can make more money and still qualify for these programs,” Kersey says.\u003c/p>\n\u003cp>For instance, a single mom who has one child and is expecting another would have a family size of three instead of two, which means she would be eligible for the Medi-Cal Access Program up to an annual income of nearly $65,000 instead of $51,300.\u003c/p>\n\u003cp>If you make too much money to qualify for these programs, you still have options.\u003c/p>\n\u003cul>\n\u003cli>Community health clinics won’t turn you away and offer care on a sliding-scale based on your income, Salganicoff says.\u003c/li>\n\u003cli>Talk to your doctor and hospital (ask to speak with a medical social worker) to see if you can receive reduced-cost care or work out a payment plan, she adds.\u003c/li>\n\u003cli>Check with your county health agency to see what programs, if any, might be available to you, Kersey says. For instance, she says \u003ca href=\"https://dhs.lacounty.gov/wps/portal/dhs/healthcoverageoptions/lacountynocost/prepayment\" target=\"_blank\">Los Angeles County offers some services.\u003c/a>\u003c/li>\n\u003cli>Open-enrollment season is upon us. For Covered California and the open market, it starts Nov. 1 and ends Jan. 31, 2016. If you’re pregnant and uninsured –- or you’re planning to get pregnant –- now’s the time to sign up.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cem>Questions for Emily: \u003c/em>\u003cem>\u003ca href=\"http://AskEmily@usc.edu\">AskEmily@usc.edu\u003c/a>\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>The \u003ca href=\"http://centerforhealthreporting.org\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a> partners with news organizations to cover California health policy. Located at the \u003ca href=\"http://annenberg.usc.edu\" target=\"_blank\">USC Annenberg School for Communication and Journalism\u003c/a>, it is funded by the nonpartisan \u003ca href=\"http://www.chcf.org\" target=\"_blank\">California HealthCare Foundation\u003c/a>\u003c/em>.\u003c/p>\n\n","blocks":[],"excerpt":"In California, you may qualify for a publicly-funded health program. The thresholds can be relatively generous and include middle-income families.","status":"publish","parent":0,"modified":1444758521,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1137},"headData":{"title":"Pregnant and Uninsured? Here Are Your Options | KQED","description":"In California, you may qualify for a publicly-funded health program. The thresholds can be relatively generous and include middle-income families.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Pregnant and Uninsured? Here Are Your Options","datePublished":"2015-10-13T17:48:41.000Z","dateModified":"2015-10-13T17:48:41.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"91285 http://ww2.kqed.org/stateofhealth/?p=91285","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/10/13/pregnant-and-uninsured-here-are-your-options/","disqusTitle":"Pregnant and Uninsured? Here Are Your Options","source":"CHCF Center for Health Reporting","sourceUrl":"http://centerforhealthreporting.org","nprByline":"Emily Bazar","path":"/stateofhealth/91285/pregnant-and-uninsured-here-are-your-options","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Did you recently have or adopt a baby, get married, or move to California from another state? Perhaps you lost your job – and your health insurance with it.\u003c/p>\n\u003cp>These are some of life’s common events that trigger special health insurance enrollment opportunities, which allow you to buy or switch plans outside of limited open enrollment periods.\u003c/p>\n\u003cp>But one common life event is missing from that list: Pregnancy.\u003c/p>\n\u003cp>Attempts to add it this year have failed. At the same time, recent changes have expanded coverage options for some uninsured, pregnant Californians.\u003c/p>\n\u003cp>\u003cstrong>Q: Do you know any solution to get health insurance now that \u003c/strong>\u003cstrong>my\u003c/strong>\u003cstrong> friend’s wife is pregnant and there are no health plans accepting applications? For some reason, they say it’s not a qualifying event.\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A: Jay of Rancho Cucamonga isn’t alone in wondering why pregnancy doesn’t trigger a special enrollment period for most commercial health insurance plans, whether purchased from the individual market or obtained from your employer.\u003c/p>\n\u003cp>In March, 37 Democratic U.S. Senators urged the secretary of the U.S. Department of Health and Human Services (HHS) to include pregnancy as a qualifying life event. Within days, California’s two Democratic U.S. Senators, Barbara Boxer and Dianne Feinstein, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/03/11/feinstein-and-boxer-say-pregnant-women-should-get-special-obamacare-enrollment/\" target=\"_blank\">asked California’s health insurance exchange, Covered California,\u003c/a> to do the same. In their letter, they said that doing so could save lives and reduce health costs.\u003c/p>\n\u003cp>“Especially since having a child is a qualifying life event, it makes sense to ensure that access to care is granted prior to birth,” they wrote.\u003c/p>\n\u003cp>HHS Secretary Sylvia Burwell responded in April that the department can’t make pregnancy a qualifying life event because “we do not have the legal authority to” do so.\u003c/p>\n\u003cp>(Which of course raises the question of who does have the authority. I asked HHS, but the agency declined to comment further.)\u003c/p>\n\u003cp>As a result of Burwell’s response, Covered California, too, said it couldn’t make pregnancy a qualifying event.\u003c/p>\n\u003cp>So what options are available for women who get pregnant while uninsured?\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>After all, nearly half of pregnancies are unintended, says Alina Salganicoff, director of Women’s Health Policy at the Kaiser Family Foundation.\u003c/p>\n\u003cp>In California, \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/documents/pregnancy_fact_sheet_chart.pdf\" target=\"_blank\">you may qualify \u003c/a>for a publicly-funded health program depending on your income. The thresholds can be relatively generous and include middle-income families.\u003c/p>\n\u003cp>And as long as you’re eligible, you can sign up anytime of year.\u003c/p>\n\u003cp>The first is \u003ca href=\"http://mcap.dhcs.ca.gov/my_mcap/important_information_applicants.aspx\" target=\"_blank\">Medi-Cal\u003c/a>, which is the state’s version of the federal Medicaid program for low-income residents. On Aug. 1, it increased the income limit for pregnant women to qualify for full-scope benefits to \u003ca href=\"http://aspe.hhs.gov/2015-poverty-guidelines#threshholds\" target=\"_blank\">138 percent of the Federal Poverty Level\u003c/a> (FPL).\u003c/p>\n\u003cp>This year, that’s up to roughly $22,000 for a family of two. (There’s a twist here. I’ll explain more below.)\u003c/p>\n\u003cp>The higher income threshold means that more pregnant women will qualify for comprehensive coverage, says Lucy Quacinella, a San Francisco attorney who advocates for health coverage options for working families.\u003c/p>\n\u003cp>“They won’t have to worry about whether something outside of a routine prenatal visit, like a referral to a specialist, will be covered,” she says.\u003c/p>\n\u003cp>Pregnant women who make between 138 percent and 213 percent of FPL may qualify for Pregnancy-Related Medi-Cal. This coverage includes “all medically necessary Medi-Cal services related to pregnancy and/or any complications that may pose a risk to the woman or her unborn child,” says Tony Cava of the state Department of Health Care Services.\u003c/p>\n\u003cp>(No matter how much their income is, pregnant women who are not in the country legally are not eligible for full Medi-Cal benefits. However, they are eligible for Pregnancy-Related Medi-Cal up to 213 percent of FPL, Quacinella says.)\u003c/p>\n\u003cp>Coverage in full-scope Medi-Cal and Pregnancy-Related Medi-Cal is free for those who qualify.\u003c/p>\n\u003cp>Plus, while you’re waiting for your Medi-Cal application to be processed, there’s a program called \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/pages/pe.aspx\" target=\"_blank\">Presumptive Eligibility for Pregnant Women\u003c/a>, which allows you to access temporary prenatal care. Call 800-824-0088 for more information.\u003c/p>\n\u003cp>Pregnant women who make between 213 percent and 322 percent of FPL (up to roughly $51,300 for a family of two), may qualify for different coverage called the \u003ca href=\"http://mcap.dhcs.ca.gov/home/default.aspx\">Medi-Cal Access Program\u003c/a>, formerly known as AIM.\u003c/p>\n\u003cp>Earlier this year, the state removed the requirement that women sign up by their 30\u003csup>th\u003c/sup> week of gestation, allowing them to apply anytime during pregnancy, says Lynn Kersey, executive director of Maternal and Child Health Access.\u003c/p>\n\u003cp>This program costs 1.5 percent of annual household income (after some adjustments) but does not have deductibles or copayments.\u003c/p>\n\u003cp>You can apply for Medi-Cal or the Medi-Cal Access Program by visiting \u003ca href=\"http://www.coveredca.com\" target=\"_blank\">www.CoveredCA.com \u003c/a>or by calling 800-300-1506. You can apply in person at your \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/pages/countyoffices.aspx\" target=\"_blank\">county human services office.\u003c/a>\u003c/p>\n\u003cp>Now, here’s the twist: For Medi-Cal and the Medi-Cal Access Program, a pregnant woman counts not just as one person when calculating income, but one person plus the number of fetuses she’s carrying.\u003c/p>\n\u003cp>“That means you can make more money and still qualify for these programs,” Kersey says.\u003c/p>\n\u003cp>For instance, a single mom who has one child and is expecting another would have a family size of three instead of two, which means she would be eligible for the Medi-Cal Access Program up to an annual income of nearly $65,000 instead of $51,300.\u003c/p>\n\u003cp>If you make too much money to qualify for these programs, you still have options.\u003c/p>\n\u003cul>\n\u003cli>Community health clinics won’t turn you away and offer care on a sliding-scale based on your income, Salganicoff says.\u003c/li>\n\u003cli>Talk to your doctor and hospital (ask to speak with a medical social worker) to see if you can receive reduced-cost care or work out a payment plan, she adds.\u003c/li>\n\u003cli>Check with your county health agency to see what programs, if any, might be available to you, Kersey says. For instance, she says \u003ca href=\"https://dhs.lacounty.gov/wps/portal/dhs/healthcoverageoptions/lacountynocost/prepayment\" target=\"_blank\">Los Angeles County offers some services.\u003c/a>\u003c/li>\n\u003cli>Open-enrollment season is upon us. For Covered California and the open market, it starts Nov. 1 and ends Jan. 31, 2016. If you’re pregnant and uninsured –- or you’re planning to get pregnant –- now’s the time to sign up.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cem>Questions for Emily: \u003c/em>\u003cem>\u003ca href=\"http://AskEmily@usc.edu\">AskEmily@usc.edu\u003c/a>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>The \u003ca href=\"http://centerforhealthreporting.org\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a> partners with news organizations to cover California health policy. Located at the \u003ca href=\"http://annenberg.usc.edu\" target=\"_blank\">USC Annenberg School for Communication and Journalism\u003c/a>, it is funded by the nonpartisan \u003ca href=\"http://www.chcf.org\" target=\"_blank\">California HealthCare Foundation\u003c/a>\u003c/em>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/91285/pregnant-and-uninsured-here-are-your-options","authors":["byline_stateofhealth_91285"],"categories":["stateofhealth_2442"],"tags":["stateofhealth_368","stateofhealth_99","stateofhealth_349","stateofhealth_397"],"featImg":"stateofhealth_91902","label":"source_stateofhealth_91285"},"stateofhealth_81576":{"type":"posts","id":"stateofhealth_81576","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"81576","score":null,"sort":[1442878481000]},"guestAuthors":[],"slug":"pregnancy-complications-may-signal-heart-disease-risk-later-in-life","title":"Pregnancy Complications May Signal Heart Disease Risk Later in Life","publishDate":1442878481,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Certain complications during pregnancy may increase a woman's risk of dying from heart disease later in life, according to a new analysis.\u003c/p>\n\u003cp>That increased risk can be dramatic, more than 7-fold, if a woman experiences combinations of problems.\u003c/p>\n\u003cp>The analysis is from Oakland's Public Health Institute and was \u003ca href=\"http://circ.ahajournals.org/content/early/2015/09/14/CIRCULATIONAHA.113.003901.abstract?sid=07de4322-6ada-4d01-9f5b-513f74251791\" target=\"_blank\">published Monday\u003c/a> in the American Heart Association journal, Circulation.\u003c/p>\n\u003cp>Heart disease is the number one killer of women in America, responsible for \u003ca href=\"http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm\" target=\"_blank\">one in every four deaths\u003c/a> among women, according to the Centers for Disease Control.\u003c/p>\n\u003cp>While doctors have long known that pregnancy puts real stress on a woman's cardiovascular system, this study confirms and quantifies some known risks and identifies new ones.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The women followed and assessed were part of a unique group of more than 15,000 pregnant women who enrolled in the Oakland metropolitan area Child Health and Development Studies between 1959 and 1967. Researchers have been following these women for decades since.\u003c/p>\n\u003cp>The 7.1 times increased risk of death from heart disease happened in women who had pre-pregnancy or early-pregnancy high blood pressure in combination with a pre-term delivery of the baby.\u003c/p>\n\u003cp>If a woman had pre-existing high blood pressure and\u003ca href=\"http://www.webmd.com/baby/guide/preeclampsia-eclampsia\" target=\"_blank\"> pre-eclampsia\u003c/a>, which is characterized by high blood pressure after 20 weeks of pregnancy and protein in the urine, her risk of later heart disease death increased 5.6 times.\u003c/p>\n\u003cp>Senior author Barbara Cohn with Oakland's Public Health Institute said she was surprised by the some of the findings.\u003c/p>\n\u003cp>\"Knowing additional information about the combinations of complications ... led to higher risk of cardiovascular disease than we expected.\u003c/p>\n\u003cp>Cohn and her colleagues also identified statistically significant differences for African-American women. They made up 22 percent of the enrollees in the study, but were 1.7 times more likely to die of heart disease, if they developed high blood pressure after 20 weeks of pregnancy. Women in other ethnic groups -- Hispanic, Asian, and Caucasian -- did not appear to be at significant increased risk from this development.\u003c/p>\n\u003cp>Cohn argued that doctors could save lives simply by taking a woman's pregnancy history.\u003c/p>\n\u003cp>\"If she has had these complications, (doctors) can begin surveillance early, recommend prevention measures that the patient can take to address factors they can control,\" Cohn said. \"It's really not expensive to get this history. It doesn't require an intervention like a blood test or a special medical test.\u003c/p>\n\u003cp>UC San Francisco professor Dr. Rita Redberg, who directs women's cardiovascular services, was not involved in the study. In an interview with \u003ca href=\"http://consumer.healthday.com/cardiovascular-health-information-20/misc-stroke-related-heart-news-360/complicated-pregnancy-linked-to-later-heart-disease-703466.html\" target=\"_blank\">HealthDay \u003c/a>she said that the study reveals an opportunity to identify the at-risk population at a younger age.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Obviously, we're catching women younger when we're doing it during pregnancy,\" Redberg said. \"While it's never too late, we like to start young.\"\u003c/p>\n\n","blocks":[],"excerpt":"Some combinations of complications during pregnancy put women at risk of a 7-fold increase in death from heart disease.","status":"publish","parent":0,"modified":1442878570,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":476},"headData":{"title":"Pregnancy Complications May Signal Heart Disease Risk Later in Life | KQED","description":"Some combinations of complications during pregnancy put women at risk of a 7-fold increase in death from heart disease.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Pregnancy Complications May Signal Heart Disease Risk Later in Life","datePublished":"2015-09-21T23:34:41.000Z","dateModified":"2015-09-21T23:36:10.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"81576 http://ww2.kqed.org/stateofhealth/?p=81576","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/09/21/pregnancy-complications-may-signal-heart-disease-risk-later-in-life/","disqusTitle":"Pregnancy Complications May Signal Heart Disease Risk Later in Life","path":"/stateofhealth/81576/pregnancy-complications-may-signal-heart-disease-risk-later-in-life","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Certain complications during pregnancy may increase a woman's risk of dying from heart disease later in life, according to a new analysis.\u003c/p>\n\u003cp>That increased risk can be dramatic, more than 7-fold, if a woman experiences combinations of problems.\u003c/p>\n\u003cp>The analysis is from Oakland's Public Health Institute and was \u003ca href=\"http://circ.ahajournals.org/content/early/2015/09/14/CIRCULATIONAHA.113.003901.abstract?sid=07de4322-6ada-4d01-9f5b-513f74251791\" target=\"_blank\">published Monday\u003c/a> in the American Heart Association journal, Circulation.\u003c/p>\n\u003cp>Heart disease is the number one killer of women in America, responsible for \u003ca href=\"http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm\" target=\"_blank\">one in every four deaths\u003c/a> among women, according to the Centers for Disease Control.\u003c/p>\n\u003cp>While doctors have long known that pregnancy puts real stress on a woman's cardiovascular system, this study confirms and quantifies some known risks and identifies new ones.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The women followed and assessed were part of a unique group of more than 15,000 pregnant women who enrolled in the Oakland metropolitan area Child Health and Development Studies between 1959 and 1967. Researchers have been following these women for decades since.\u003c/p>\n\u003cp>The 7.1 times increased risk of death from heart disease happened in women who had pre-pregnancy or early-pregnancy high blood pressure in combination with a pre-term delivery of the baby.\u003c/p>\n\u003cp>If a woman had pre-existing high blood pressure and\u003ca href=\"http://www.webmd.com/baby/guide/preeclampsia-eclampsia\" target=\"_blank\"> pre-eclampsia\u003c/a>, which is characterized by high blood pressure after 20 weeks of pregnancy and protein in the urine, her risk of later heart disease death increased 5.6 times.\u003c/p>\n\u003cp>Senior author Barbara Cohn with Oakland's Public Health Institute said she was surprised by the some of the findings.\u003c/p>\n\u003cp>\"Knowing additional information about the combinations of complications ... led to higher risk of cardiovascular disease than we expected.\u003c/p>\n\u003cp>Cohn and her colleagues also identified statistically significant differences for African-American women. They made up 22 percent of the enrollees in the study, but were 1.7 times more likely to die of heart disease, if they developed high blood pressure after 20 weeks of pregnancy. Women in other ethnic groups -- Hispanic, Asian, and Caucasian -- did not appear to be at significant increased risk from this development.\u003c/p>\n\u003cp>Cohn argued that doctors could save lives simply by taking a woman's pregnancy history.\u003c/p>\n\u003cp>\"If she has had these complications, (doctors) can begin surveillance early, recommend prevention measures that the patient can take to address factors they can control,\" Cohn said. \"It's really not expensive to get this history. It doesn't require an intervention like a blood test or a special medical test.\u003c/p>\n\u003cp>UC San Francisco professor Dr. Rita Redberg, who directs women's cardiovascular services, was not involved in the study. In an interview with \u003ca href=\"http://consumer.healthday.com/cardiovascular-health-information-20/misc-stroke-related-heart-news-360/complicated-pregnancy-linked-to-later-heart-disease-703466.html\" target=\"_blank\">HealthDay \u003c/a>she said that the study reveals an opportunity to identify the at-risk population at a younger age.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Obviously, we're catching women younger when we're doing it during pregnancy,\" Redberg said. \"While it's never too late, we like to start young.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/81576/pregnancy-complications-may-signal-heart-disease-risk-later-in-life","authors":["240"],"categories":["stateofhealth_12","stateofhealth_13"],"tags":["stateofhealth_167","stateofhealth_349","stateofhealth_461","stateofhealth_397"],"featImg":"stateofhealth_81627","label":"stateofhealth"},"stateofhealth_23634":{"type":"posts","id":"stateofhealth_23634","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"23634","score":null,"sort":[1422466049000]},"guestAuthors":[],"slug":"call-the-midwife-a-home-birth-story","title":"Call the Midwife: A Home Birth Story","publishDate":1422466049,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_23671\" class=\"wp-caption aligncenter\" style=\"max-width: 632px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Screen-Shot-2015-01-27-at-5.09.55-PM.png\">\u003cimg class=\"size-full wp-image-23671\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Screen-Shot-2015-01-27-at-5.09.55-PM.png\" alt=\"The author's wife, Pippa, and their daughter, Caitlin, who was born at home, in 1982. (Courtesy: Nick Allen)\" width=\"632\" height=\"568\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/01/Screen-Shot-2015-01-27-at-5.09.55-PM.png 632w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Screen-Shot-2015-01-27-at-5.09.55-PM-400x359.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Screen-Shot-2015-01-27-at-5.09.55-PM-320x288.png 320w\" sizes=\"(max-width: 632px) 100vw, 632px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The author's wife, Pippa, and their daughter, Caitlin, who was born at home, in 1982. (Courtesy: Nick Allen)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Stephen Talbot\u003c/strong>\u003c/p>\n\u003cp>My wife, Pippa, gave birth like a giraffe, standing up.\u003c/p>\n\u003cp>I was astonished. This wasn’t quite the nativity scene I’d imagined. Then again, I should not have been too shocked. Pippa grew up in South Africa, she’s very keen on giraffes, and she likes doing things unconventionally.\u003c/p>\n\u003cp>I should also mention that this was happening at home, in our bedroom, in the middle of the night, and that no one else was around. Except for our two-year-old son asleep in another room.\u003c/p>\n\u003cp>Not to worry. Women have been giving birth in their homes, in their own fashion, for centuries, right? Well, actually, not so much these days, at least not in this country. A mere \u003ca title=\"http://www.cdc.gov/nchs/data/databriefs/db144.htm\" href=\"http://www.cdc.gov/nchs/data/databriefs/db144.htm\" target=\"_blank\">1.36 percent of births in the United States\u003c/a> in 2012 took place outside a hospital.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But this was 1982; we lived in a more freewheeling San Francisco, and home births with midwives were not so rare. In fact, our son Dashiell had been born in the very same bedroom, in then funky Bernal Heights, ushered into the world by his mother and a full cast of attendants. Led by a very experienced (if unlicensed) midwife, the birth team included her assistant, her back-up doctor complete with a traveling medical kit and oxygen tank, and three other doctors, all women, who happened to be relatives or close friends. I even had a bit role as a labor coach. There was little need for this full entourage, but it was reassuring.\u003c/p>\n\u003cp>Dash was three weeks past his due date — these days two weeks is the usual maximum before labor is induced. But Pippa had been intent on a home delivery and at the last possible moment, after a spicy dinner and some strong tea, she went into labor. With the midwife’s expert help, all went well. In just under three hours, from start to finish, our son slid into the world in that small room full of people.\u003c/p>\n\u003cp>This time, however, the room was empty, except for Pippa, me and our rapidly approaching second child. My only reassuring thought was that I’d been through this before, and I hadn’t passed out.\u003c/p>\n\u003cp>Frankly, I would have opted for a hospital delivery, but I wasn’t the one having the baby.\u003c/p>\n\u003cp>Pippa had been born at home in Johannesburg, and in those days, especially for a privileged family, the doctor came to you. Even though Pippa was a social worker in a San Francisco medical clinic, she still preferred to avoid hospitals unless absolutely necessary. For a pregnant American, this attitude was considered rebellious, even ill-advised. And the U.S. medical establishment still discourages home birth.\u003c/p>\n\u003cp>But the British national health service \u003ca title=\"http://www.nytimes.com/2014/12/04/world/british-regulator-urges-home-births-over-hospitals-for-uncomplicated-pregnancies.html\" href=\"http://www.nytimes.com/2014/12/04/world/british-regulator-urges-home-births-over-hospitals-for-uncomplicated-pregnancies.html\" target=\"_blank\">now agrees\u003c/a> with Pippa, declaring late last year that it’s safer in the UK for healthy women with uncomplicated pregnancies to give birth at home or in a birthing clinic than in a hospital. Naturally, “\u003ca title=\"http://www.kqed.org/tv/programs/archive/index.jsp?pgmid=20957\" href=\"http://www.kqed.org/tv/programs/archive/index.jsp?pgmid=20957\" target=\"_blank\">Call the Midwife\u003c/a>” on KQED is one of Pippa’s favorite British import shows.\u003c/p>\n\u003cp>For this second pregnancy, Pippa had chosen a team of licensed midwives affiliated with a local San Francisco hospital.\u003c/p>\n\u003cp>When her first labor cramps woke her around midnight, she promptly called the midwife on duty. They timed the contractions over the phone. The midwife advised her to take a warm bath to slow down the labor and give her a call later.\u003c/p>\n\u003cp>Pippa drew the bath and I started vacuuming. It’s a habit I picked up from my mother. She vacuumed with great vigor before any major event at home. It’s the one household chore I’ve never minded. It's something about operating machinery and making myself useful. Very appealing.\u003c/p>\n\u003cp>But before I could finish the carpeting in our living room, Pippa emerged — starkers — from the bath, saying, “Bloody hell, this baby won’t wait.” Wrapping herself in a robe, grabbing the phone, she notified the midwife, “This is it, ready or not.”\u003c/p>\n\u003cp>I was not feeling quite so ready myself. The midwife was now on her way, but she lived in Marin County, north of the Golden Gate Bridge. She wouldn't be here anytime soon. I encouraged Pippa to relax. But as the contractions came stronger and faster, relaxation was not much of an option. With mounting anxiety, I called the nearest doctor I could think of, our friend Kathy, who lived in our neighborhood. She’s a gerontologist, but at that moment I was not particularly picky.\u003c/p>\n\u003cp>Pippa began pacing, insisting that our child’s arrival was imminent. I implored her to hold back. She informed me this was no longer possible. A brief “I Love Lucy” scene ensued in which I kept yelling, “Not yet!” and Pippa kept moaning, “Yes, now.” Then she pressed her hands against the wall and pushed and I saw the undeniable validity of her argument. Our child’s head was emerging.\u003c/p>\n\u003cp>In a flash, she was born. I had just enough sense to reach over and let her slide out into my hands. It was a basket catch, Willie Mays-style. She was slippery, and she was blue. Wrong color, I thought. I stuck my finger in her little mouth, she gagged, coughed, and instantly turned a proper pink. I was euphoric with relief.\u003c/p>\n\u003cp>The doorbell rang. I handed our gurgling baby to her joyous, exhausted mother, and raced downstairs to admit a breathless Kathy. Upstairs, she quickly ascertained that everyone was alive and breathing and apparently healthy. She started to ask how this happened, but I interrupted to ask, “Aren’t we supposed to cut the umbilical cord?”\u003c/p>\n\u003cp>Scissors were promptly sterilized in boiling water; the deed was done.\u003c/p>\n\u003cp>The next hour or so passed in a daze, but we were all smiling now, temporarily delirious, as this newborn child, Caitlin, began to nurse. By dawn the house was full of relatives and friends, including the midwife who, apologizing for her late arrival, made certain all was well. It had been chaotic, but successful. A delivery in less than an hour. Mother and daughter doing fine.\u003c/p>\n\u003cp>When he awoke, our son Dash walked out of his room, saw all the people, yawned, and wondered aloud, “What’s happening?”\u003c/p>\n\u003cp>“You have a baby sister,” I said, “born right here at home.” And he wandered into our bedroom to see for himself.\u003c/p>\n\u003cp>Caitlin was not the only baby born at home in San Francisco that year. But over time, Pippa and I noticed that home births were going out of fashion. Our own son and his wife chose to have their first baby last year in a hospital in Santa Monica, where they were very happy with the way things went. Deliveries at home or in birthing clinics aren’t for everyone.\u003c/p>\n\u003cp>But now, 30 years after the home birth of my daughter, and after much debate over the soaring frequency of hospital C-sections, I wonder if this \u003ca title=\"http://www.nice.org.uk/guidance/CG190\" href=\"http://www.nice.org.uk/guidance/CG190\" target=\"_blank\">new endorsement by British medical authorities\u003c/a> of non-hospital births will lead to a resurgence in midwifery, even in the U.S.\u003c/p>\n\u003cp>My advice to prospective parents? Hospital or not, just in case, be prepared to handle that delivery yourselves.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Stephen Talbot was a staff reporter and producer at KQED from 1980-89. He has written and produced over 40 documentaries for public television, including the PBS series FRONTLINE and his music show, SOUND TRACKS. He’s a proud new grandfather.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"My wife, Pippa, gave birth like a giraffe, standing up. I should also mention that this was happening at home.","status":"publish","parent":0,"modified":1422669655,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":29,"wordCount":1304},"headData":{"title":"Call the Midwife: A Home Birth Story | KQED","description":"My wife, Pippa, gave birth like a giraffe, standing up. I should also mention that this was happening at home.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Call the Midwife: A Home Birth Story","datePublished":"2015-01-28T17:27:29.000Z","dateModified":"2015-01-31T02:00:55.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"23634 http://blogs.kqed.org/stateofhealth/?p=23634","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/01/28/call-the-midwife-a-home-birth-story/","disqusTitle":"Call the Midwife: A Home Birth Story","path":"/stateofhealth/23634/call-the-midwife-a-home-birth-story","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23671\" class=\"wp-caption aligncenter\" style=\"max-width: 632px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Screen-Shot-2015-01-27-at-5.09.55-PM.png\">\u003cimg class=\"size-full wp-image-23671\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Screen-Shot-2015-01-27-at-5.09.55-PM.png\" alt=\"The author's wife, Pippa, and their daughter, Caitlin, who was born at home, in 1982. (Courtesy: Nick Allen)\" width=\"632\" height=\"568\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/01/Screen-Shot-2015-01-27-at-5.09.55-PM.png 632w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Screen-Shot-2015-01-27-at-5.09.55-PM-400x359.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Screen-Shot-2015-01-27-at-5.09.55-PM-320x288.png 320w\" sizes=\"(max-width: 632px) 100vw, 632px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The author's wife, Pippa, and their daughter, Caitlin, who was born at home, in 1982. (Courtesy: Nick Allen)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Stephen Talbot\u003c/strong>\u003c/p>\n\u003cp>My wife, Pippa, gave birth like a giraffe, standing up.\u003c/p>\n\u003cp>I was astonished. This wasn’t quite the nativity scene I’d imagined. Then again, I should not have been too shocked. Pippa grew up in South Africa, she’s very keen on giraffes, and she likes doing things unconventionally.\u003c/p>\n\u003cp>I should also mention that this was happening at home, in our bedroom, in the middle of the night, and that no one else was around. Except for our two-year-old son asleep in another room.\u003c/p>\n\u003cp>Not to worry. Women have been giving birth in their homes, in their own fashion, for centuries, right? Well, actually, not so much these days, at least not in this country. A mere \u003ca title=\"http://www.cdc.gov/nchs/data/databriefs/db144.htm\" href=\"http://www.cdc.gov/nchs/data/databriefs/db144.htm\" target=\"_blank\">1.36 percent of births in the United States\u003c/a> in 2012 took place outside a hospital.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But this was 1982; we lived in a more freewheeling San Francisco, and home births with midwives were not so rare. In fact, our son Dashiell had been born in the very same bedroom, in then funky Bernal Heights, ushered into the world by his mother and a full cast of attendants. Led by a very experienced (if unlicensed) midwife, the birth team included her assistant, her back-up doctor complete with a traveling medical kit and oxygen tank, and three other doctors, all women, who happened to be relatives or close friends. I even had a bit role as a labor coach. There was little need for this full entourage, but it was reassuring.\u003c/p>\n\u003cp>Dash was three weeks past his due date — these days two weeks is the usual maximum before labor is induced. But Pippa had been intent on a home delivery and at the last possible moment, after a spicy dinner and some strong tea, she went into labor. With the midwife’s expert help, all went well. In just under three hours, from start to finish, our son slid into the world in that small room full of people.\u003c/p>\n\u003cp>This time, however, the room was empty, except for Pippa, me and our rapidly approaching second child. My only reassuring thought was that I’d been through this before, and I hadn’t passed out.\u003c/p>\n\u003cp>Frankly, I would have opted for a hospital delivery, but I wasn’t the one having the baby.\u003c/p>\n\u003cp>Pippa had been born at home in Johannesburg, and in those days, especially for a privileged family, the doctor came to you. Even though Pippa was a social worker in a San Francisco medical clinic, she still preferred to avoid hospitals unless absolutely necessary. For a pregnant American, this attitude was considered rebellious, even ill-advised. And the U.S. medical establishment still discourages home birth.\u003c/p>\n\u003cp>But the British national health service \u003ca title=\"http://www.nytimes.com/2014/12/04/world/british-regulator-urges-home-births-over-hospitals-for-uncomplicated-pregnancies.html\" href=\"http://www.nytimes.com/2014/12/04/world/british-regulator-urges-home-births-over-hospitals-for-uncomplicated-pregnancies.html\" target=\"_blank\">now agrees\u003c/a> with Pippa, declaring late last year that it’s safer in the UK for healthy women with uncomplicated pregnancies to give birth at home or in a birthing clinic than in a hospital. Naturally, “\u003ca title=\"http://www.kqed.org/tv/programs/archive/index.jsp?pgmid=20957\" href=\"http://www.kqed.org/tv/programs/archive/index.jsp?pgmid=20957\" target=\"_blank\">Call the Midwife\u003c/a>” on KQED is one of Pippa’s favorite British import shows.\u003c/p>\n\u003cp>For this second pregnancy, Pippa had chosen a team of licensed midwives affiliated with a local San Francisco hospital.\u003c/p>\n\u003cp>When her first labor cramps woke her around midnight, she promptly called the midwife on duty. They timed the contractions over the phone. The midwife advised her to take a warm bath to slow down the labor and give her a call later.\u003c/p>\n\u003cp>Pippa drew the bath and I started vacuuming. It’s a habit I picked up from my mother. She vacuumed with great vigor before any major event at home. It’s the one household chore I’ve never minded. It's something about operating machinery and making myself useful. Very appealing.\u003c/p>\n\u003cp>But before I could finish the carpeting in our living room, Pippa emerged — starkers — from the bath, saying, “Bloody hell, this baby won’t wait.” Wrapping herself in a robe, grabbing the phone, she notified the midwife, “This is it, ready or not.”\u003c/p>\n\u003cp>I was not feeling quite so ready myself. The midwife was now on her way, but she lived in Marin County, north of the Golden Gate Bridge. She wouldn't be here anytime soon. I encouraged Pippa to relax. But as the contractions came stronger and faster, relaxation was not much of an option. With mounting anxiety, I called the nearest doctor I could think of, our friend Kathy, who lived in our neighborhood. She’s a gerontologist, but at that moment I was not particularly picky.\u003c/p>\n\u003cp>Pippa began pacing, insisting that our child’s arrival was imminent. I implored her to hold back. She informed me this was no longer possible. A brief “I Love Lucy” scene ensued in which I kept yelling, “Not yet!” and Pippa kept moaning, “Yes, now.” Then she pressed her hands against the wall and pushed and I saw the undeniable validity of her argument. Our child’s head was emerging.\u003c/p>\n\u003cp>In a flash, she was born. I had just enough sense to reach over and let her slide out into my hands. It was a basket catch, Willie Mays-style. She was slippery, and she was blue. Wrong color, I thought. I stuck my finger in her little mouth, she gagged, coughed, and instantly turned a proper pink. I was euphoric with relief.\u003c/p>\n\u003cp>The doorbell rang. I handed our gurgling baby to her joyous, exhausted mother, and raced downstairs to admit a breathless Kathy. Upstairs, she quickly ascertained that everyone was alive and breathing and apparently healthy. She started to ask how this happened, but I interrupted to ask, “Aren’t we supposed to cut the umbilical cord?”\u003c/p>\n\u003cp>Scissors were promptly sterilized in boiling water; the deed was done.\u003c/p>\n\u003cp>The next hour or so passed in a daze, but we were all smiling now, temporarily delirious, as this newborn child, Caitlin, began to nurse. By dawn the house was full of relatives and friends, including the midwife who, apologizing for her late arrival, made certain all was well. It had been chaotic, but successful. A delivery in less than an hour. Mother and daughter doing fine.\u003c/p>\n\u003cp>When he awoke, our son Dash walked out of his room, saw all the people, yawned, and wondered aloud, “What’s happening?”\u003c/p>\n\u003cp>“You have a baby sister,” I said, “born right here at home.” And he wandered into our bedroom to see for himself.\u003c/p>\n\u003cp>Caitlin was not the only baby born at home in San Francisco that year. But over time, Pippa and I noticed that home births were going out of fashion. Our own son and his wife chose to have their first baby last year in a hospital in Santa Monica, where they were very happy with the way things went. Deliveries at home or in birthing clinics aren’t for everyone.\u003c/p>\n\u003cp>But now, 30 years after the home birth of my daughter, and after much debate over the soaring frequency of hospital C-sections, I wonder if this \u003ca title=\"http://www.nice.org.uk/guidance/CG190\" href=\"http://www.nice.org.uk/guidance/CG190\" target=\"_blank\">new endorsement by British medical authorities\u003c/a> of non-hospital births will lead to a resurgence in midwifery, even in the U.S.\u003c/p>\n\u003cp>My advice to prospective parents? Hospital or not, just in case, be prepared to handle that delivery yourselves.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Stephen Talbot was a staff reporter and producer at KQED from 1980-89. He has written and produced over 40 documentaries for public television, including the PBS series FRONTLINE and his music show, SOUND TRACKS. He’s a proud new grandfather.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/23634/call-the-midwife-a-home-birth-story","authors":["8344"],"categories":["stateofhealth_11","stateofhealth_12"],"tags":["stateofhealth_96","stateofhealth_349","stateofhealth_397"],"featImg":"stateofhealth_23671","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. 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