Showing posts with label women's health. Show all posts
Showing posts with label women's health. Show all posts
Nov 8, 2024
Nov 1, 2024
Today's Jessica
Women are dying because of all this fucked up Republican "policy" on abortion.
A Pregnant Teenager Died After Trying to Get Care in Three Visits to Texas Emergency Rooms
It took three ER visits and 20 hours before a hospital admitted Nevaeh Crain, 18, as her condition worsened. Doctors insisted on two ultrasounds to confirm “fetal demise.” She’s one of at least two Texas women who died under the state’s abortion ban.
Candace Fails screamed for someone in the Texas hospital to help her pregnant daughter. “Do something,” she pleaded, on the morning of Oct. 29, 2023.
Nevaeh Crain was crying in pain, too weak to walk, blood staining her thighs. Feverish and vomiting the day of her baby shower, the 18-year-old had gone to two different emergency rooms within 12 hours, returning home each time worse than before.
The first hospital diagnosed her with strep throat without investigating her sharp abdominal cramps. At the second, she screened positive for sepsis, a life-threatening and fast-moving reaction to an infection, medical records show. But doctors said her six-month fetus had a heartbeat and that Crain was fine to leave.
Now on Crain’s third hospital visit, an obstetrician insisted on two ultrasounds to “confirm fetal demise,” a nurse wrote, before moving her to intensive care.
By then, more than two hours after her arrival, Crain’s blood pressure had plummeted and a nurse had noted that her lips were “blue and dusky.” Her organs began failing.
Hours later, she was dead.
Fails, who would have seen her daughter turn 20 this Friday, still cannot understand why Crain’s emergency was not treated like an emergency.
But that is what many pregnant women are now facing in states with strict abortion bans, doctors and lawyers have told ProPublica.
“Pregnant women have become essentially untouchables,” said Sara Rosenbaum, a health law and policy professor emerita at George Washington University.
Texas’s abortion ban threatens prison time for interventions that end a fetal heartbeat, whether the pregnancy is wanted or not. It includes exceptions for life-threatening conditions, but still, doctors told ProPublica that confusion and fear about the potential legal repercussions are changing the way their colleagues treat pregnant patients with complications.
In states with abortion bans, such patients are sometimes bounced between hospitals like “hot potatoes,” with health care providers reluctant to participate in treatment that could attract a prosecutor, doctors told ProPublica. In some cases, medical teams are wasting precious time debating legalities and creating documentation, preparing for the possibility that they’ll need to explain their actions to a jury and judge.
Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University School of Medicine, said patients are left wondering: “Am I being sent home because I really am OK? Or am I being sent home because they’re afraid that the solution to what’s going on with my pregnancy would be ending the pregnancy, and they’re not allowed to do that?”
There is a federal law to prevent emergency room doctors from withholding lifesaving care.
Passed nearly four decades ago, it requires emergency rooms to stabilize patients in medical crises. The Biden administration argues this mandate applies even in cases where an abortion might be necessary.
No state has done more to fight this interpretation than Texas, which has warned doctors that its abortion ban supersedes the administration’s guidance on federal law, and that they can face up to 99 years in prison for violating it.
ProPublica condensed more than 800 pages of Crain’s medical records into a four-page timeline in consultation with two maternal-fetal medicine specialists; reporters reviewed it with nine doctors, including researchers at prestigious universities, OB-GYNs who regularly handle miscarriages, and experts in emergency medicine and maternal health.
Some said the first ER missed warning signs of infection that deserved attention. All said that the doctor at the second hospital should never have sent Crain home when her signs of sepsis hadn’t improved. And when she returned for the third time, all said there was no medical reason to make her wait for two ultrasounds before taking aggressive action to save her.
“This is how these restrictions kill women,” said Dr. Dara Kass, a former regional director at the Department of Health and Human Services and an emergency room physician in New York. “It is never just one decision, it’s never just one doctor, it’s never just one nurse.”
While they were not certain from looking at the records provided that Crain’s death could have been prevented, they said it may have been possible to save both the teenager and her fetus if she had been admitted earlier for close monitoring and continuous treatment.
There was a chance Crain could have remained pregnant, they said. If she had needed an early delivery, the hospital was well-equipped to care for a baby on the edge of viability. In another scenario, if the infection had gone too far, ending the pregnancy might have been necessary to save Crain.
Doctors involved in Crain’s care did not respond to several requests for comment. The two hospitals, Baptist Hospitals of Southeast Texas and Christus Southeast Texas St. Elizabeth, declined to answer detailed lists of questions about her treatment.
Fails and Crain believed abortion was morally wrong. The teen could only support it in the context of rape or life-threatening illness, she used to tell her mother. They didn’t care whether the government banned it, just how their Christian faith guided their own actions.
When they discovered Crain was pregnant with a girl, the two talked endlessly about the little dresses they could buy, what kind of mother she would be. Crain landed on the name Lillian. Fails could not wait to meet her.
But when her daughter got sick, Fails expected that doctors had an obligation to do everything in their power to stave off a potentially deadly emergency, even if that meant losing Lillian. In her view, they were more concerned with checking the fetal heartbeat than attending to Crain.
“I know it sounds selfish, and God knows I would rather have both of them, but if I had to choose,” Fails said, “I would have chosen my daughter.”
“I’m in a Lot of Pain”
Crain had just graduated from high school in her hometown of Vidor, Texas, in May of 2023 when she learned that she was pregnant.
She and her boyfriend of two years, Randall Broussard, were always hip to hip, wrestling over vapes or snuggling on the couch watching vampire movies. Crain was drawn to how gentle he was. He admired how easily she built friendships and how quickly she could make people laugh. Though they were young, they’d already imagined starting a family. Broussard, who has eight siblings, wanted many kids; Crain wanted a daughter and the kind of relationship she had with her mom. Earlier that year, Broussard had given Crain a small diamond ring — “a promise,” he told her, “that I will always love you.”
On the morning of their baby shower, Oct. 28, 2023, Crain woke with a headache. Her mom decorated the house with pink balloons and Crain laid out Halloween-themed platters. Soon, nausea set in. Crain started vomiting and was running a fever. When guests arrived, Broussard opened gifts — onesies and diapers and bows — while Crain kept closing her eyes.
Around 3 p.m., her family told her she needed to go to the hospital.
Broussard drove Crain to Baptist Hospitals of Southeast Texas. They sat in the waiting room for four hours. When Crain started vomiting, staff brought her a plastic pan. When she wasn’t retching, she lay her head in her boyfriend’s lap.
New here?
A nurse practitioner ordered a test for strep throat, which came back positive, medical records show. But in a pregnant patient, abdominal pain and vomiting should not be quickly attributed to strep, physicians told ProPublica; a doctor should have also evaluated her pregnancy.
Instead, Baptist Hospitals discharged her with a prescription for antibiotics. She was home at 9 p.m. and quickly dozed off, but within hours, she woke her mother up. “Mom, my stomach is still hurting,” she said into the dark bedroom at 3 a.m. “I’m in a lot of pain.”
Fails drove Broussard and Crain to another hospital in town, Christus Southeast Texas St. Elizabeth. Around 4:20 a.m., OB-GYN William Hawkins saw that Crain had a temperature of 102.8 and an abnormally high pulse, according to records; a nurse noted that Crain rated her abdominal pain as a seven out of 10.
Her vital signs pointed to possible sepsis, records show. It’s standard medical practice to immediately treat patients who show signs of sepsis, which can overtake and kill a person quickly, medical experts told ProPublica. These patients should be watched until their vitals improve. Through tests and scans, the goal is to find the source of the infection. If the infection was in Crain’s uterus, the fetus would likely need to be removed with a surgery.
In a room at the obstetric emergency department, a nurse wrapped a sensor belt around Crain’s belly to check the fetal heart rate. “Baby’s fine,” Broussard told Fails, who was sitting in the hallway.
After two hours of IV fluids, one dose of antibiotics, and some Tylenol, Crain’s fever didn’t go down, her pulse remained high, and the fetal heart rate was abnormally fast, medical records show. Hawkins noted that Crain had strep and a urinary tract infection, wrote up a prescription and discharged her.
Hawkins had missed infections before. Eight years earlier, the Texas Medical Board found that he had failed to diagnose appendicitis in one patient and syphilis in another. In the latter case, the board noted that his error “may have contributed to the fetal demise of one of her twins.” The board issued an order to have Hawkins’ medical practice monitored; the order was lifted two years later. (Hawkins did not respond to several attempts to reach him.)
All of the doctors who reviewed Crain’s vital signs for ProPublica said she should have been admitted. “She should have never left, never left,” said Elise Boos, an OB-GYN in Tennessee.
Kass, the New York emergency physician, put it in starker terms: When they discharged her, they were “pushing her down the path of no return.”
“It’s bullshit,” Fails said as Broussard rolled Crain out in a wheelchair; she was unable to walk on her own. Fails had expected the hospital to keep her overnight. Her daughter was breathing heavily, hunched over in pain, pale in the face. Normally talkative, the teen was quiet.
Back home, around 7 a.m., Fails tried to get her daughter comfortable as she cried and moaned. She told Fails she needed to pee, and her mother helped her into the bathroom. “Mom, come here,” she said from the toilet. Blood stained her underwear.
The blood confirmed Fails’ instinct: This was a miscarriage.
At 9 a.m, a full day after the nausea began, they were back at Christus St. Elizabeth. Crain’s lips were drained of color and she kept saying she was going to pass out. Staff started her on IV antibiotics and performed a bedside ultrasound.
Around 9:30 a.m., the OB on duty, Dr. Marcelo Totorica, couldn’t find a fetal heart rate, according to records; he told the family he was sorry for their loss.
Standard protocol when a critically ill patient experiences a miscarriage is to stabilize her and, in most cases, hurry to the operating room for delivery, medical experts said. This is especially urgent with a spreading infection. But at Christus St. Elizabeth, the OB-GYN just continued antibiotic care. A half-hour later, as nurses placed a catheter, Fails noticed her daughter’s thighs were covered in blood.
At 10 a.m., Melissa McIntosh, a labor and delivery nurse, spoke to Totorica about Crain’s condition. The teen was now having contractions. “Dr. Totorica states to not move patient,” she wrote after talking with him. “Dr. Totorica states there is a slight chance patient may need to go to ICU and he wants the bedside ultrasound to be done stat for sure before admitting to room.”
Though he had already performed an ultrasound, he was asking for a second.
The first hadn’t preserved an image of Crain’s womb in the medical record. “Bedside ultrasounds aren’t always set up to save images permanently,” said Abbott, the Boston OB-GYN.
The state’s laws banning abortion require that doctors record the absence of a fetal heartbeat before intervening with a procedure that could end a pregnancy. Exceptions for medical emergencies demand physicians document their reasoning. “Pretty consistently, people say, ‘Until we can be absolutely certain this isn’t a normal pregnancy, we can’t do anything, because it could be alleged that we were doing an abortion,’” said Dr. Tony Ogburn, an OB-GYN in San Antonio.
At 10:40 a.m, Crain’s blood pressure was dropping. Minutes later, Totorica was paging for an emergency team over the loudspeakers.
Around 11 a.m., two hours after Crain had arrived at the hospital, a second ultrasound was performed. A nurse noted: “Bedside ultrasound at this time to confirm fetal demise per Dr. Totorica’s orders.”
When doctors wheeled Crain into the ICU at 11:20 a.m., Fails stayed by her side, rubbing her head, as her daughter dipped in and out of consciousness. Crain couldn’t sign consent forms for her care because of “extreme pain,” according to the records, so Fails signed a release for “unplanned dilation and curettage” or “unplanned cesarean section.”
But the doctors quickly decided it was now too risky to operate, according to records. They suspected that she had developed a dangerous complication of sepsis known as disseminated intravascular coagulation; she was bleeding internally.
Frantic and crying, Fails locked eyes with her daughter. “You’re strong, Nevaeh,” she said. “God made us strong.”
“The Law Is on Our Side”
Crain is one of at least two pregnant Texas women who died after doctors delayed treating miscarriages, ProPublica found.
Texas Attorney General Ken Paxton has successfully made his state the only one in the country that isn’t required to follow the Biden administration’s efforts to ensure that emergency departments don’t turn away patients like Crain.
After the U.S. Supreme Court overturned the constitutional right to abortion, the administration issued guidance on how states with bans should follow the Emergency Medical Treatment and Labor Act. The federal law requires hospitals that receive funding through Medicare — which is virtually all of them — to stabilize or transfer anyone who arrives in their emergency rooms. That goes for pregnant patients, the guidance argues, even if that means violating state law and providing an abortion.
Paxton responded by filing a lawsuit in 2022, saying the federal guidance “forces hospitals and doctors to commit crimes,” and was an “attempt to use federal law to transform every emergency room in the country into a walk-in abortion clinic.”
Part of the battle has centered on who is eligible for abortion. The federal EMTALA guidelines apply when the health of the pregnant patient is in “serious jeopardy.” That’s a wider range of circumstances than the Texas abortion restriction, which only makes exceptions for a “risk of death” or “a serious risk of substantial impairment of a major bodily function.”
The lawsuit worked its way through three layers of federal courts, and each time it was met by judges nominated by former President Donald Trump, whose court appointments were pivotal to overturning Roe v. Wade.
After U.S. District Judge James Wesley Hendrix, a Trump appointee, quickly sided with Texas, Paxton celebrated the triumph over “left-wing bureaucrats in Washington.”
“The decision last night proves what we knew all along,” Paxton added. “The law is on our side.”
This year, the U.S. Court of Appeals for the 5th Circuit upheld the order in a ruling authored by Kurt D. Engelhardt, another judge nominated by Trump.
The Biden administration appealed to the U.S. Supreme Court, urging the justices to make it clear that some emergency abortions are allowed.
Even amid news of preventable deaths related to abortion bans, the Supreme Court declined to do so last month.
Paxton called this “a major victory” for the state’s abortion ban.
He has also made clear that he will bring charges against physicians for performing abortions if he decides that the cases don’t fall within Texas’ narrow medical exceptions.
Last year, he sent a letter threatening to prosecute a doctor who had received court approval to provide an emergency abortion for a Dallas woman. He insisted that the doctor and her patient had not proven how, precisely, the patient’s condition threatened her life.
Many doctors say this kind of message has encouraged doctors to “punt” patients instead of treating them.
Since the abortion bans went into effect, an OB-GYN at a major hospital in San Antonio has seen an uptick in pregnant patients being sent to them from across Southern Texas, as they suffer from complications that could easily be treated close to home.
The well-resourced hospital is perceived to have more institutional support to provide abortions and miscarriage management, the doctor said. Other providers “are transferring those patients to our centers because, frankly, they don’t want to deal with them.”
After Crain died, Fails couldn’t stop thinking about how Christus Southeast Hospital had ignored her daughter’s condition. “She was bleeding,” she said. “Why didn’t they do anything to help it along instead of wait for another ultrasound to confirm the baby is dead?”
It was the medical examiner, not the doctors at the hospital, who removed Lillian from Crain’s womb. His autopsy didn’t resolve Fails’ lingering questions about what the hospitals missed and why. He called the death “natural” and attributed it to “complications of pregnancy.” He did note, however, that Crain was “repeatedly seeking medical care for a progressive illness” just before she died.
It took three ER visits and 20 hours before a hospital admitted Nevaeh Crain, 18, as her condition worsened. Doctors insisted on two ultrasounds to confirm “fetal demise.” She’s one of at least two Texas women who died under the state’s abortion ban.
Candace Fails screamed for someone in the Texas hospital to help her pregnant daughter. “Do something,” she pleaded, on the morning of Oct. 29, 2023.
Nevaeh Crain was crying in pain, too weak to walk, blood staining her thighs. Feverish and vomiting the day of her baby shower, the 18-year-old had gone to two different emergency rooms within 12 hours, returning home each time worse than before.
The first hospital diagnosed her with strep throat without investigating her sharp abdominal cramps. At the second, she screened positive for sepsis, a life-threatening and fast-moving reaction to an infection, medical records show. But doctors said her six-month fetus had a heartbeat and that Crain was fine to leave.
Now on Crain’s third hospital visit, an obstetrician insisted on two ultrasounds to “confirm fetal demise,” a nurse wrote, before moving her to intensive care.
By then, more than two hours after her arrival, Crain’s blood pressure had plummeted and a nurse had noted that her lips were “blue and dusky.” Her organs began failing.
Hours later, she was dead.
Fails, who would have seen her daughter turn 20 this Friday, still cannot understand why Crain’s emergency was not treated like an emergency.
But that is what many pregnant women are now facing in states with strict abortion bans, doctors and lawyers have told ProPublica.
“Pregnant women have become essentially untouchables,” said Sara Rosenbaum, a health law and policy professor emerita at George Washington University.
Texas’s abortion ban threatens prison time for interventions that end a fetal heartbeat, whether the pregnancy is wanted or not. It includes exceptions for life-threatening conditions, but still, doctors told ProPublica that confusion and fear about the potential legal repercussions are changing the way their colleagues treat pregnant patients with complications.
In states with abortion bans, such patients are sometimes bounced between hospitals like “hot potatoes,” with health care providers reluctant to participate in treatment that could attract a prosecutor, doctors told ProPublica. In some cases, medical teams are wasting precious time debating legalities and creating documentation, preparing for the possibility that they’ll need to explain their actions to a jury and judge.
Dr. Jodi Abbott, an associate professor of obstetrics and gynecology at Boston University School of Medicine, said patients are left wondering: “Am I being sent home because I really am OK? Or am I being sent home because they’re afraid that the solution to what’s going on with my pregnancy would be ending the pregnancy, and they’re not allowed to do that?”
There is a federal law to prevent emergency room doctors from withholding lifesaving care.
Passed nearly four decades ago, it requires emergency rooms to stabilize patients in medical crises. The Biden administration argues this mandate applies even in cases where an abortion might be necessary.
No state has done more to fight this interpretation than Texas, which has warned doctors that its abortion ban supersedes the administration’s guidance on federal law, and that they can face up to 99 years in prison for violating it.
ProPublica condensed more than 800 pages of Crain’s medical records into a four-page timeline in consultation with two maternal-fetal medicine specialists; reporters reviewed it with nine doctors, including researchers at prestigious universities, OB-GYNs who regularly handle miscarriages, and experts in emergency medicine and maternal health.
Some said the first ER missed warning signs of infection that deserved attention. All said that the doctor at the second hospital should never have sent Crain home when her signs of sepsis hadn’t improved. And when she returned for the third time, all said there was no medical reason to make her wait for two ultrasounds before taking aggressive action to save her.
“This is how these restrictions kill women,” said Dr. Dara Kass, a former regional director at the Department of Health and Human Services and an emergency room physician in New York. “It is never just one decision, it’s never just one doctor, it’s never just one nurse.”
While they were not certain from looking at the records provided that Crain’s death could have been prevented, they said it may have been possible to save both the teenager and her fetus if she had been admitted earlier for close monitoring and continuous treatment.
There was a chance Crain could have remained pregnant, they said. If she had needed an early delivery, the hospital was well-equipped to care for a baby on the edge of viability. In another scenario, if the infection had gone too far, ending the pregnancy might have been necessary to save Crain.
Doctors involved in Crain’s care did not respond to several requests for comment. The two hospitals, Baptist Hospitals of Southeast Texas and Christus Southeast Texas St. Elizabeth, declined to answer detailed lists of questions about her treatment.
Fails and Crain believed abortion was morally wrong. The teen could only support it in the context of rape or life-threatening illness, she used to tell her mother. They didn’t care whether the government banned it, just how their Christian faith guided their own actions.
When they discovered Crain was pregnant with a girl, the two talked endlessly about the little dresses they could buy, what kind of mother she would be. Crain landed on the name Lillian. Fails could not wait to meet her.
But when her daughter got sick, Fails expected that doctors had an obligation to do everything in their power to stave off a potentially deadly emergency, even if that meant losing Lillian. In her view, they were more concerned with checking the fetal heartbeat than attending to Crain.
“I know it sounds selfish, and God knows I would rather have both of them, but if I had to choose,” Fails said, “I would have chosen my daughter.”
“I’m in a Lot of Pain”
Crain had just graduated from high school in her hometown of Vidor, Texas, in May of 2023 when she learned that she was pregnant.
She and her boyfriend of two years, Randall Broussard, were always hip to hip, wrestling over vapes or snuggling on the couch watching vampire movies. Crain was drawn to how gentle he was. He admired how easily she built friendships and how quickly she could make people laugh. Though they were young, they’d already imagined starting a family. Broussard, who has eight siblings, wanted many kids; Crain wanted a daughter and the kind of relationship she had with her mom. Earlier that year, Broussard had given Crain a small diamond ring — “a promise,” he told her, “that I will always love you.”
On the morning of their baby shower, Oct. 28, 2023, Crain woke with a headache. Her mom decorated the house with pink balloons and Crain laid out Halloween-themed platters. Soon, nausea set in. Crain started vomiting and was running a fever. When guests arrived, Broussard opened gifts — onesies and diapers and bows — while Crain kept closing her eyes.
Around 3 p.m., her family told her she needed to go to the hospital.
Broussard drove Crain to Baptist Hospitals of Southeast Texas. They sat in the waiting room for four hours. When Crain started vomiting, staff brought her a plastic pan. When she wasn’t retching, she lay her head in her boyfriend’s lap.
New here?
A nurse practitioner ordered a test for strep throat, which came back positive, medical records show. But in a pregnant patient, abdominal pain and vomiting should not be quickly attributed to strep, physicians told ProPublica; a doctor should have also evaluated her pregnancy.
Instead, Baptist Hospitals discharged her with a prescription for antibiotics. She was home at 9 p.m. and quickly dozed off, but within hours, she woke her mother up. “Mom, my stomach is still hurting,” she said into the dark bedroom at 3 a.m. “I’m in a lot of pain.”
Fails drove Broussard and Crain to another hospital in town, Christus Southeast Texas St. Elizabeth. Around 4:20 a.m., OB-GYN William Hawkins saw that Crain had a temperature of 102.8 and an abnormally high pulse, according to records; a nurse noted that Crain rated her abdominal pain as a seven out of 10.
Her vital signs pointed to possible sepsis, records show. It’s standard medical practice to immediately treat patients who show signs of sepsis, which can overtake and kill a person quickly, medical experts told ProPublica. These patients should be watched until their vitals improve. Through tests and scans, the goal is to find the source of the infection. If the infection was in Crain’s uterus, the fetus would likely need to be removed with a surgery.
In a room at the obstetric emergency department, a nurse wrapped a sensor belt around Crain’s belly to check the fetal heart rate. “Baby’s fine,” Broussard told Fails, who was sitting in the hallway.
After two hours of IV fluids, one dose of antibiotics, and some Tylenol, Crain’s fever didn’t go down, her pulse remained high, and the fetal heart rate was abnormally fast, medical records show. Hawkins noted that Crain had strep and a urinary tract infection, wrote up a prescription and discharged her.
Hawkins had missed infections before. Eight years earlier, the Texas Medical Board found that he had failed to diagnose appendicitis in one patient and syphilis in another. In the latter case, the board noted that his error “may have contributed to the fetal demise of one of her twins.” The board issued an order to have Hawkins’ medical practice monitored; the order was lifted two years later. (Hawkins did not respond to several attempts to reach him.)
All of the doctors who reviewed Crain’s vital signs for ProPublica said she should have been admitted. “She should have never left, never left,” said Elise Boos, an OB-GYN in Tennessee.
Kass, the New York emergency physician, put it in starker terms: When they discharged her, they were “pushing her down the path of no return.”
“It’s bullshit,” Fails said as Broussard rolled Crain out in a wheelchair; she was unable to walk on her own. Fails had expected the hospital to keep her overnight. Her daughter was breathing heavily, hunched over in pain, pale in the face. Normally talkative, the teen was quiet.
Back home, around 7 a.m., Fails tried to get her daughter comfortable as she cried and moaned. She told Fails she needed to pee, and her mother helped her into the bathroom. “Mom, come here,” she said from the toilet. Blood stained her underwear.
The blood confirmed Fails’ instinct: This was a miscarriage.
At 9 a.m, a full day after the nausea began, they were back at Christus St. Elizabeth. Crain’s lips were drained of color and she kept saying she was going to pass out. Staff started her on IV antibiotics and performed a bedside ultrasound.
Around 9:30 a.m., the OB on duty, Dr. Marcelo Totorica, couldn’t find a fetal heart rate, according to records; he told the family he was sorry for their loss.
Standard protocol when a critically ill patient experiences a miscarriage is to stabilize her and, in most cases, hurry to the operating room for delivery, medical experts said. This is especially urgent with a spreading infection. But at Christus St. Elizabeth, the OB-GYN just continued antibiotic care. A half-hour later, as nurses placed a catheter, Fails noticed her daughter’s thighs were covered in blood.
At 10 a.m., Melissa McIntosh, a labor and delivery nurse, spoke to Totorica about Crain’s condition. The teen was now having contractions. “Dr. Totorica states to not move patient,” she wrote after talking with him. “Dr. Totorica states there is a slight chance patient may need to go to ICU and he wants the bedside ultrasound to be done stat for sure before admitting to room.”
Though he had already performed an ultrasound, he was asking for a second.
The first hadn’t preserved an image of Crain’s womb in the medical record. “Bedside ultrasounds aren’t always set up to save images permanently,” said Abbott, the Boston OB-GYN.
The state’s laws banning abortion require that doctors record the absence of a fetal heartbeat before intervening with a procedure that could end a pregnancy. Exceptions for medical emergencies demand physicians document their reasoning. “Pretty consistently, people say, ‘Until we can be absolutely certain this isn’t a normal pregnancy, we can’t do anything, because it could be alleged that we were doing an abortion,’” said Dr. Tony Ogburn, an OB-GYN in San Antonio.
At 10:40 a.m, Crain’s blood pressure was dropping. Minutes later, Totorica was paging for an emergency team over the loudspeakers.
Around 11 a.m., two hours after Crain had arrived at the hospital, a second ultrasound was performed. A nurse noted: “Bedside ultrasound at this time to confirm fetal demise per Dr. Totorica’s orders.”
When doctors wheeled Crain into the ICU at 11:20 a.m., Fails stayed by her side, rubbing her head, as her daughter dipped in and out of consciousness. Crain couldn’t sign consent forms for her care because of “extreme pain,” according to the records, so Fails signed a release for “unplanned dilation and curettage” or “unplanned cesarean section.”
But the doctors quickly decided it was now too risky to operate, according to records. They suspected that she had developed a dangerous complication of sepsis known as disseminated intravascular coagulation; she was bleeding internally.
Frantic and crying, Fails locked eyes with her daughter. “You’re strong, Nevaeh,” she said. “God made us strong.”
“The Law Is on Our Side”
Crain is one of at least two pregnant Texas women who died after doctors delayed treating miscarriages, ProPublica found.
Texas Attorney General Ken Paxton has successfully made his state the only one in the country that isn’t required to follow the Biden administration’s efforts to ensure that emergency departments don’t turn away patients like Crain.
After the U.S. Supreme Court overturned the constitutional right to abortion, the administration issued guidance on how states with bans should follow the Emergency Medical Treatment and Labor Act. The federal law requires hospitals that receive funding through Medicare — which is virtually all of them — to stabilize or transfer anyone who arrives in their emergency rooms. That goes for pregnant patients, the guidance argues, even if that means violating state law and providing an abortion.
Paxton responded by filing a lawsuit in 2022, saying the federal guidance “forces hospitals and doctors to commit crimes,” and was an “attempt to use federal law to transform every emergency room in the country into a walk-in abortion clinic.”
Part of the battle has centered on who is eligible for abortion. The federal EMTALA guidelines apply when the health of the pregnant patient is in “serious jeopardy.” That’s a wider range of circumstances than the Texas abortion restriction, which only makes exceptions for a “risk of death” or “a serious risk of substantial impairment of a major bodily function.”
The lawsuit worked its way through three layers of federal courts, and each time it was met by judges nominated by former President Donald Trump, whose court appointments were pivotal to overturning Roe v. Wade.
After U.S. District Judge James Wesley Hendrix, a Trump appointee, quickly sided with Texas, Paxton celebrated the triumph over “left-wing bureaucrats in Washington.”
“The decision last night proves what we knew all along,” Paxton added. “The law is on our side.”
This year, the U.S. Court of Appeals for the 5th Circuit upheld the order in a ruling authored by Kurt D. Engelhardt, another judge nominated by Trump.
The Biden administration appealed to the U.S. Supreme Court, urging the justices to make it clear that some emergency abortions are allowed.
Even amid news of preventable deaths related to abortion bans, the Supreme Court declined to do so last month.
Paxton called this “a major victory” for the state’s abortion ban.
He has also made clear that he will bring charges against physicians for performing abortions if he decides that the cases don’t fall within Texas’ narrow medical exceptions.
Last year, he sent a letter threatening to prosecute a doctor who had received court approval to provide an emergency abortion for a Dallas woman. He insisted that the doctor and her patient had not proven how, precisely, the patient’s condition threatened her life.
Many doctors say this kind of message has encouraged doctors to “punt” patients instead of treating them.
Since the abortion bans went into effect, an OB-GYN at a major hospital in San Antonio has seen an uptick in pregnant patients being sent to them from across Southern Texas, as they suffer from complications that could easily be treated close to home.
The well-resourced hospital is perceived to have more institutional support to provide abortions and miscarriage management, the doctor said. Other providers “are transferring those patients to our centers because, frankly, they don’t want to deal with them.”
After Crain died, Fails couldn’t stop thinking about how Christus Southeast Hospital had ignored her daughter’s condition. “She was bleeding,” she said. “Why didn’t they do anything to help it along instead of wait for another ultrasound to confirm the baby is dead?”
It was the medical examiner, not the doctors at the hospital, who removed Lillian from Crain’s womb. His autopsy didn’t resolve Fails’ lingering questions about what the hospitals missed and why. He called the death “natural” and attributed it to “complications of pregnancy.” He did note, however, that Crain was “repeatedly seeking medical care for a progressive illness” just before she died.
Last November, Fails reached out to medical malpractice lawyers to see about getting justice through the courts. A different legal barrier now stood in her way.
If Crain had experienced these same delays as an inpatient, Fails would have needed to establish that the hospital violated medical standards. That, she believed, she could do. But because the delays and discharges occurred in an area of the hospital classified as an emergency room, lawyers said that Texas law set a much higher burden of proof: “willful and wanton negligence.”
No lawyer has agreed to take the case.
If Crain had experienced these same delays as an inpatient, Fails would have needed to establish that the hospital violated medical standards. That, she believed, she could do. But because the delays and discharges occurred in an area of the hospital classified as an emergency room, lawyers said that Texas law set a much higher burden of proof: “willful and wanton negligence.”
No lawyer has agreed to take the case.
Sep 25, 2024
Womenfolk
note: there may be some major problems with the way the numbers are reported, the data is processed, and then what the studies actually are able to conclude.
But that doesn't change the facts on the ground in most instances:
Between 2019 and 2022, the death rate among pregnant women in Texas went up 56%, compared with 11% across the US.
Again, there are discrepancies, etc. But we know the number of women dying during pregnancy is up in a state where there have been some pretty shitty changes in how pregnant women are treated when they present with health problems.
So the question is: How bad does it have to get before we kick in a few doors and make some of these assholes change the fucking law?
Aug 7, 2022
Here It Comes
Women taking it into their own hands could pose a whole set of dangers, but there's some possibility that it just might be the "good news" part of this whole fucked up mess.
NYT: (pay wall)
Some Women ‘Self-Manage’ Abortions as Access Recedes
Information and medications needed to end a pregnancy are increasingly available outside the health care system.
Hannah, a woman in Oklahoma, self-managed her abortion last year, when local clinics were overwhelmed with patients from Texas.
In states that have banned abortion, some women with unwanted pregnancies are pursuing an unconventional workaround: They are “self-managing” their abortions, seeking out the necessary know-how online and obtaining the medications without the supervision of a clinic or a doctor.
At first glance, the practice may recall the days before Roe v. Wade, when women too often were forced to take risky measures to end an unwanted pregnancy. But the advent of medication abortion — accomplished with drugs, rather than in-office procedures — has transformed reproductive care, posing a significant challenge to anti-abortion legislation.
Even before the Supreme Court's decision to overturn Roe v. Wade, medication abortions accounted for more than half of abortions in the United States. Federal regulators made access to the pills even easier during the pandemic by dropping the requirement for an in-person visit and allowing the drugs to be mailed to patients after a virtual appointment.
But many states never allowed telehealth abortion, and new laws prohibiting abortion apply to all forms of the procedure, including medications. So women in increasingly restrictive parts of the country are procuring the pills any way they can, often online, despite state prohibitions.
There are no reliable estimates of the number of women who undertake their own medication abortions, according to the Guttmacher Institute, which researches and supports abortion access.
With the overturning of Roe v. Wade, abortion is now banned in at least 10 states, according to a database maintained by The New York Times. Voters in Kansas on Tuesday rejected a ballot measure that would have removed abortion rights protections from the state constitution.
Limits of one sort or another are nonetheless expected in at least half of U.S. states, and so both sides of the divide are bracing for an increase in self-managed abortions.
Critics of abortion in any form insist that medication abortions are riskier than claimed, and even more so without medical supervision. The procedure should not be undertaken beyond 10 weeks gestation, they note, or performed without a doctor’s visit, because dating a pregnancy accurately is not always possible.
Other medical complications can be missed, they say — including ectopic pregnancy, in which the fertilized egg implants outside the uterus.
Claims that medication abortion is safe “are based on flawed and incomplete data, which prioritize convenience and cost over the health and safety of patients,” said Dr. Christina Francis, chair of the American Association of Pro-Life Obstetricians and Gynecologists, which opposes all abortions except to prevent permanent harm or death to the mother.
Physicians who support abortion tell a different story: There is plentiful evidence that medication abortion is safe, and women already carry out the procedure almost entirely alone at home, even if they do see a doctor to obtain the drugs. Self-management is not so different, supporters argue.
“It’s quite safe and effective based on studies we’ve done, national data provided by the states and the Guttmacher Institute, and the experience of other countries,” said Dr. Beverly Winikoff, the founder of Gynuity Health Projects, who performed much of the research on medication abortion that led to its approval in the United States more than 20 years ago.
The procedure typically involves taking two drugs: mifepristone, which stops the pregnancy by blocking a hormone called progesterone, followed a day or two later by misoprostol, which causes the uterus to contract.
More than half a million women had medication abortions in 2020 in the United States, and fewer than half of 1 percent experience serious complications, studies show. Medical interventions like hospitalizations or blood transfusions were needed by fewer than 0.4 percent of patients, according to a 2013 review of dozens of studies involving tens of thousands of patients.
A 2018 review by the National Academies of Sciences, Engineering and Medicine found that abortion medication ended pregnancies 96.7 percent of the time in gestations of up to nine weeks. The World Health Organization endorses self-managed abortion and says it can be used up to 12 weeks gestation.
Bags of medical abortion medication and follow-up instructions for patients were readied at the Trust Women clinic in Oklahoma City in December.Credit...Evelyn Hockstein/Reuters
Medication abortion “is noninvasive, doesn’t cause sepsis and doesn’t cause ruptures of internal organs,” like the illegal abortions of the pre-Roe era, Dr. Winikoff said.
“It doesn’t mean people can’t have excessive bleeding and need to get care occasionally, but those are not the dire circumstances of people from 50 years ago,” she added.
The drugs are regulated by the Food and Drug Administration, however, and are intended to be taken under a doctor’s supervision. The agency discourages internet purchases of mifepristone because patients will be “bypassing important safeguards,” officials said in a statement.
But the F.D.A. does not advise against online purchases of misoprostol (brand name Cytotec), which is used to treat a number of medical conditions. Misoprostol can terminate pregnancies by itself, recent studies have shown.
While no treatment is 100 percent safe, taking the pills “on your own at home does not affect your risk of complications,” said Dr. Carolyn Westhoff, an obstetrician gynecologist and professor at Columbia University and the editor in chief of the journal Contraception.
But self-management also means a woman does not have a familiar health care professional nearby to call in case of an emergency or complications. Dr. Westhoff and other experts fear that women performing their own abortions may be reluctant to seek medical help in states that have criminalized abortion.
Cassie, 20, who uses the pronouns they and them and asked that only a first name be used because they reside in Texas, where most abortions are banned after about six weeks of pregnancy, managed their own abortion in January.
Cassie, who already had a child and was struggling financially, filled out an online request form for abortion pills from Aid Access, which is based in Europe. The drugs took longer to arrive than expected, and when they did, Cassie’s pregnancy was already 12 weeks along.
“I just took them and prayed for the best,” Cassie said. They experienced heavy bleeding, nausea and “the worst cramps I’ve had in my entire life.”
“I was crying, curled up in a ball of pain in the middle of my bed,” they said.
When the bleeding did not subside, Cassie’s partner drove them to the hospital, where the remaining tissue was removed.
“That was its own horrifying experience of praying that they wouldn’t know or suspect I’d caused it myself,” Cassie said.
Both the know-how and the tools to perform an abortion are increasingly easy to access.
Women who live in states where abortion is legal can turn to U.S.-based telehealth providers like Abortion on Demand and Hey Jane, which offer detailed information to women seeking abortions and provide pills by mail after a video visit in states where these services are legal.
MYA Network provides physicians who answer questions about self-managed abortion, and Abortion Pill Info offers tips on keeping online research private.
For women in states with abortion bans, Plan C offers a number of workarounds, including a list of online pharmacies selling abortion drugs that the organization has tested and tutorials on setting up mail forwarding in another state to receive the drugs.
The site also refers people to Aid Access, which screens women online and orders abortion pills from overseas pharmacies that are sent in envelopes without return addresses, even to states where abortion is illegal. The group charges $150 or less, depending on income.
Hannah, a 26-year-old in Oklahoma, said she managed her own abortion with pills from Aid Access late last year, when local clinics, overwhelmed with patients from Texas, could not accommodate her.
Hannah, who asked to not be identified because abortion is now banned in her state, said she suffered from depression at times before she became pregnant, but had plummeted to a new low and was suicidal.
“I couldn’t afford a pregnancy and was not well enough, physically or mentally, to carry a pregnancy,” she said. Her self-managed abortion was “no worse than a normal period for me.”
A medication abortion cannot be distinguished from a miscarriage, and traces of the pills cannot be discovered if they are taken orally, said Dr. Rebecca Gomperts, a Dutch physician who founded Aid Access.
If a woman needs care after taking the pills, “we always tell people to say they had a miscarriage,” she said. “It’s exactly the same symptoms, and the treatment is exactly the same.”
A study of thousands of women in the United States who received abortion pills from a provider without an in-person visit during the pandemic found that the practice was safe.
Complications are the rare exception. Another recent study looked at self-managed abortions in Argentina and Nigeria, where abortion is banned except to save the life of the mother (and, in Argentina, in cases of rape).
Twenty percent of the nearly 1,000 women who participated in the study sought care at hospitals after the procedure, but most only wanted to confirm the abortion was complete. About 4 percent reported ongoing pain, fever or bleeding. Seventeen required procedures to complete the abortion, 12 stayed in the hospital overnight, and six needed blood transfusions, according to the study, which was published in The Lancet Global Health in late 2021.
The surprise finding was that while some of the women took the mifepristone-misoprostol combination, the success rate for those taking misoprostol alone — a widely used drug that can be purchased in countries like Mexico without a prescription and is fairly inexpensive — was higher than that of the two-drug combination.
Most state laws that restrict abortion make performing an abortion a crime for doctors, not patients. Only three states — South Carolina, Oklahoma and Nevada — have laws that explicitly make it a crime to end one’s own pregnancy.
Other states, however, have wielded child endangerment statutes or other laws against women suspected of terminating their pregnancies.
In Indiana, Purvi Patel was sentenced to 20 years in prison in 2015 for inducing a self-managed abortion; her conviction was overturned in 2016. In Texas, murder charges were brought against Lizelle Herrera earlier this year in relation to a self-managed abortion, but prosecutors said they would not pursue the case.
At least six states have introduced legislation establishing a fetus as a person, which will make it easier to prosecute women who terminate their own pregnancies, said Dana Sussman, the deputy executive director of National Advocates for Pregnant Women.
Both the American Medical Association and the American College of Obstetricians and Gynecologists, which support abortion as an essential component of health care, oppose criminalizing self-managed abortion, as they say doing so will deter women from seeking medical attention.
At the moment, health care providers are not legally required by any state to report patients they suspect of self-managing an abortion, according to If/When/How, an abortion-rights advocacy group. But laws are in flux.
“We’re operating in an area of complete uncertainty,” Ms. Sussman said.
Abortion Access in the United States![]()
Medication Abortions:
Limits of one sort or another are nonetheless expected in at least half of U.S. states, and so both sides of the divide are bracing for an increase in self-managed abortions.
Critics of abortion in any form insist that medication abortions are riskier than claimed, and even more so without medical supervision. The procedure should not be undertaken beyond 10 weeks gestation, they note, or performed without a doctor’s visit, because dating a pregnancy accurately is not always possible.
Other medical complications can be missed, they say — including ectopic pregnancy, in which the fertilized egg implants outside the uterus.
Claims that medication abortion is safe “are based on flawed and incomplete data, which prioritize convenience and cost over the health and safety of patients,” said Dr. Christina Francis, chair of the American Association of Pro-Life Obstetricians and Gynecologists, which opposes all abortions except to prevent permanent harm or death to the mother.
Physicians who support abortion tell a different story: There is plentiful evidence that medication abortion is safe, and women already carry out the procedure almost entirely alone at home, even if they do see a doctor to obtain the drugs. Self-management is not so different, supporters argue.
“It’s quite safe and effective based on studies we’ve done, national data provided by the states and the Guttmacher Institute, and the experience of other countries,” said Dr. Beverly Winikoff, the founder of Gynuity Health Projects, who performed much of the research on medication abortion that led to its approval in the United States more than 20 years ago.
The procedure typically involves taking two drugs: mifepristone, which stops the pregnancy by blocking a hormone called progesterone, followed a day or two later by misoprostol, which causes the uterus to contract.
More than half a million women had medication abortions in 2020 in the United States, and fewer than half of 1 percent experience serious complications, studies show. Medical interventions like hospitalizations or blood transfusions were needed by fewer than 0.4 percent of patients, according to a 2013 review of dozens of studies involving tens of thousands of patients.
A 2018 review by the National Academies of Sciences, Engineering and Medicine found that abortion medication ended pregnancies 96.7 percent of the time in gestations of up to nine weeks. The World Health Organization endorses self-managed abortion and says it can be used up to 12 weeks gestation.
Bags of medical abortion medication and follow-up instructions for patients were readied at the Trust Women clinic in Oklahoma City in December.Credit...Evelyn Hockstein/Reuters
Medication abortion “is noninvasive, doesn’t cause sepsis and doesn’t cause ruptures of internal organs,” like the illegal abortions of the pre-Roe era, Dr. Winikoff said.
“It doesn’t mean people can’t have excessive bleeding and need to get care occasionally, but those are not the dire circumstances of people from 50 years ago,” she added.
The drugs are regulated by the Food and Drug Administration, however, and are intended to be taken under a doctor’s supervision. The agency discourages internet purchases of mifepristone because patients will be “bypassing important safeguards,” officials said in a statement.
But the F.D.A. does not advise against online purchases of misoprostol (brand name Cytotec), which is used to treat a number of medical conditions. Misoprostol can terminate pregnancies by itself, recent studies have shown.
While no treatment is 100 percent safe, taking the pills “on your own at home does not affect your risk of complications,” said Dr. Carolyn Westhoff, an obstetrician gynecologist and professor at Columbia University and the editor in chief of the journal Contraception.
But self-management also means a woman does not have a familiar health care professional nearby to call in case of an emergency or complications. Dr. Westhoff and other experts fear that women performing their own abortions may be reluctant to seek medical help in states that have criminalized abortion.
Cassie, 20, who uses the pronouns they and them and asked that only a first name be used because they reside in Texas, where most abortions are banned after about six weeks of pregnancy, managed their own abortion in January.
Cassie, who already had a child and was struggling financially, filled out an online request form for abortion pills from Aid Access, which is based in Europe. The drugs took longer to arrive than expected, and when they did, Cassie’s pregnancy was already 12 weeks along.
“I just took them and prayed for the best,” Cassie said. They experienced heavy bleeding, nausea and “the worst cramps I’ve had in my entire life.”
“I was crying, curled up in a ball of pain in the middle of my bed,” they said.
When the bleeding did not subside, Cassie’s partner drove them to the hospital, where the remaining tissue was removed.
“That was its own horrifying experience of praying that they wouldn’t know or suspect I’d caused it myself,” Cassie said.
Both the know-how and the tools to perform an abortion are increasingly easy to access.
Women who live in states where abortion is legal can turn to U.S.-based telehealth providers like Abortion on Demand and Hey Jane, which offer detailed information to women seeking abortions and provide pills by mail after a video visit in states where these services are legal.
MYA Network provides physicians who answer questions about self-managed abortion, and Abortion Pill Info offers tips on keeping online research private.
For women in states with abortion bans, Plan C offers a number of workarounds, including a list of online pharmacies selling abortion drugs that the organization has tested and tutorials on setting up mail forwarding in another state to receive the drugs.
The site also refers people to Aid Access, which screens women online and orders abortion pills from overseas pharmacies that are sent in envelopes without return addresses, even to states where abortion is illegal. The group charges $150 or less, depending on income.
Hannah, a 26-year-old in Oklahoma, said she managed her own abortion with pills from Aid Access late last year, when local clinics, overwhelmed with patients from Texas, could not accommodate her.
Hannah, who asked to not be identified because abortion is now banned in her state, said she suffered from depression at times before she became pregnant, but had plummeted to a new low and was suicidal.
“I couldn’t afford a pregnancy and was not well enough, physically or mentally, to carry a pregnancy,” she said. Her self-managed abortion was “no worse than a normal period for me.”
A medication abortion cannot be distinguished from a miscarriage, and traces of the pills cannot be discovered if they are taken orally, said Dr. Rebecca Gomperts, a Dutch physician who founded Aid Access.
If a woman needs care after taking the pills, “we always tell people to say they had a miscarriage,” she said. “It’s exactly the same symptoms, and the treatment is exactly the same.”
A study of thousands of women in the United States who received abortion pills from a provider without an in-person visit during the pandemic found that the practice was safe.
Complications are the rare exception. Another recent study looked at self-managed abortions in Argentina and Nigeria, where abortion is banned except to save the life of the mother (and, in Argentina, in cases of rape).
Twenty percent of the nearly 1,000 women who participated in the study sought care at hospitals after the procedure, but most only wanted to confirm the abortion was complete. About 4 percent reported ongoing pain, fever or bleeding. Seventeen required procedures to complete the abortion, 12 stayed in the hospital overnight, and six needed blood transfusions, according to the study, which was published in The Lancet Global Health in late 2021.
The surprise finding was that while some of the women took the mifepristone-misoprostol combination, the success rate for those taking misoprostol alone — a widely used drug that can be purchased in countries like Mexico without a prescription and is fairly inexpensive — was higher than that of the two-drug combination.
Most state laws that restrict abortion make performing an abortion a crime for doctors, not patients. Only three states — South Carolina, Oklahoma and Nevada — have laws that explicitly make it a crime to end one’s own pregnancy.
Other states, however, have wielded child endangerment statutes or other laws against women suspected of terminating their pregnancies.
In Indiana, Purvi Patel was sentenced to 20 years in prison in 2015 for inducing a self-managed abortion; her conviction was overturned in 2016. In Texas, murder charges were brought against Lizelle Herrera earlier this year in relation to a self-managed abortion, but prosecutors said they would not pursue the case.
At least six states have introduced legislation establishing a fetus as a person, which will make it easier to prosecute women who terminate their own pregnancies, said Dana Sussman, the deputy executive director of National Advocates for Pregnant Women.
Both the American Medical Association and the American College of Obstetricians and Gynecologists, which support abortion as an essential component of health care, oppose criminalizing self-managed abortion, as they say doing so will deter women from seeking medical attention.
At the moment, health care providers are not legally required by any state to report patients they suspect of self-managing an abortion, according to If/When/How, an abortion-rights advocacy group. But laws are in flux.
“We’re operating in an area of complete uncertainty,” Ms. Sussman said.
Abortion Access in the United States
- Indiana Governor Signs First Post-Roe Abortion Ban, With Limited Exceptions
Republicans Begin Adjusting to a Fierce Abortion Backlash
- Biden Issues Executive Order on Abortion Access, Calling for More Study
- Kansas Votes to Preserve Abortion Rights Protections in Its Constitution
- They Had Miscarriages, and New Abortion Laws Obstructed Treatment
- Tracking the States Where Abortion Is Now Banned
Medication Abortions:
Demand for abortion pills is surging, setting the stage for new legal battles. For now, it is still legal in most states to receive abortion medication by mail and pharmacies risk violating federal civil rights law if they refuse to fill a prescription for abortion pills.
Plan B:
Plan B:
In the wake of the Supreme Court’s ruling, many women are stocking up on so-called morning-after pills. Here’s how these differ from abortion pills.
I.V.F.:
I.V.F.:
Legal experts say the end of Roe could make it easier to place restrictions on genetic testing, storage and disposal of the embryos created outside the womb.
Contraceptive Pills:
Contraceptive Pills:
The Food and Drug Administration’s first application for a birth control pill that would not require a prescription has taken on new meaning after the Supreme Court decision.
Sep 30, 2021
Nobody Has Rights
... until everybody has rights.
Equal rights. Not more. Not almost. Not maybe some day if you're really good - have a little patience - you're moving too fast and that scares people.
The Constitution of The United States was ratified more than 230 years ago, and we have yet to make sure everybody enjoys the same rights and protections under the law.
Democrats are fighting for us - to secure those rights - while Republicans are always fighting against us - trying to take those rights away.
Sep 5, 2021
Another Thought
An aspect that had never entered my mind: What about the kids who never were because a young woman was forced to have an unwanted child, and never got the chance to have kids she did want?
via Lexington Chapter - Kentucky Religious Coalition for Reproductive Choice:
They asked me to tell you what it was like to be twenty and pregnant in 1950 and when you tell your boyfriend you’re pregnant, he tells you about a friend of his in the army whose girl told him she was pregnant, so he got all his buddies to come and say, “We all f*cked her, so who knows who the father is?” And he laughs at the good joke….
What was it like, if you were planning to go to graduate school and get a degree and earn a living so you could support yourself and do the work you loved—what it was like to be a senior at Radcliffe and pregnant and if you bore this child, this child which the law demanded you bear and would then call “unlawful,” “illegitimate,” this child whose father denied it … What was it like? […]
They asked me to tell you what it was like to be twenty and pregnant in 1950 and when you tell your boyfriend you’re pregnant, he tells you about a friend of his in the army whose girl told him she was pregnant, so he got all his buddies to come and say, “We all f*cked her, so who knows who the father is?” And he laughs at the good joke….
What was it like, if you were planning to go to graduate school and get a degree and earn a living so you could support yourself and do the work you loved—what it was like to be a senior at Radcliffe and pregnant and if you bore this child, this child which the law demanded you bear and would then call “unlawful,” “illegitimate,” this child whose father denied it … What was it like? […]
It’s like this: if I had dropped out of college, thrown away my education, depended on my parents … if I had done all that, which is what the anti-abortion people want me to have done, I would have borne a child for them, … the authorities, the theorists, the fundamentalists; I would have born a child for them, their child.
But I would not have born my own first child, or second child, or third child. My children.
The life of that fetus would have prevented, would have aborted, three other fetuses … the three wanted children, the three I had with my husband—whom, if I had not aborted the unwanted one, I would never have met … I would have been an “unwed mother” of a three-year-old in California, without work, with half an education, living off her parents….
But it is the children I have to come back to, my children Elisabeth, Caroline, Theodore, my joy, my pride, my loves. If I had not broken the law and aborted that life nobody wanted, they would have been aborted by a cruel, bigoted, and senseless law. They would never have been born. This thought I cannot bear.
The life of that fetus would have prevented, would have aborted, three other fetuses … the three wanted children, the three I had with my husband—whom, if I had not aborted the unwanted one, I would never have met … I would have been an “unwed mother” of a three-year-old in California, without work, with half an education, living off her parents….
But it is the children I have to come back to, my children Elisabeth, Caroline, Theodore, my joy, my pride, my loves. If I had not broken the law and aborted that life nobody wanted, they would have been aborted by a cruel, bigoted, and senseless law. They would never have been born. This thought I cannot bear.
What was it like, in the Dark Ages when abortion was a crime, for the girl whose dad couldn’t borrow cash, as my dad could? What was it like for the girl who couldn’t even tell her dad, because he would go crazy with shame and rage? Who couldn’t tell her mother? Who had to go alone to that filthy room and put herself body and soul into the hands of a professional criminal? – because that is what every doctor who did an abortion was, whether he was an extortionist or an idealist.
You know what it was like for her. You know and I know; that is why we are here. We are not going back to the Dark Ages. We are not going to let anybody in this country have that kind of power over any girl or woman. There are great powers, outside the government and in it, trying to legislate the return of darkness. We are not great powers. But we are the light. Nobody can put us out. May all of you shine very bright and steady, today and always.
Jun 24, 2019
On Women And Sexual Health
NYT: (pay wall - please consider subscribing - keep journalism alive)
By Jen Gunter
May 16, 2019
I used to be able to orgasm easily, but now it is very difficult. I have to hit the exact spot in exactly the right way. Is there anything I can do to improve this? I can orgasm when I masturbate, but not usually with my partner. I’m 60+. Help!
— Anonymous, DallasAs women age, some report a decrease in orgasm intensity as well as difficulty achieving orgasm. This phenomenon can be age-related, though low estrogen may also play a role. Other factors may include medical conditions or their treatments. The good news is there is often help.
Tell me more
There could be many reasons a woman’s ability to orgasm changes with age. Before determining the cause of age-related sexual problems, a doctor should first rule out that there are no libido issues or previous difficulties achieving orgasm, and establish that everything is solid relationship-wise.
After that, a woman could consider that she may simply need a little “help” achieving orgasm. Age-related changes happen in many organ systems, and the clitoris is no exception; after all, many people need reading glasses or a hearing aid as they age. For women who do not experience pain with sex and simply find it takes more effort to achieve orgasm, incorporating a vibrator for clitoral stimulation into sexual play — while masturbating or with a partner — may be all that is needed. There are many vibrator options with different levels of intensity and construction types to hit different “spots.” Some also provide more of a suction sensation versus traditional vibration.
Another factor in orgasm may be a decrease in strength in the levator ani muscles. These are the muscles that support the vagina, bladder and rectum, and they also produce the physical contractions of orgasm. Your orgasms may be affected if these muscles are weak because of age or childbirth. A doctor — typically a gynecologist or urogynecologist — can examine these muscles to determine if you have a pelvic floor disorder. If they are weak, you may be offered Kegel exercises to strengthen them. You may even be referred to a physical therapist who specializes in treating the pelvic floor muscles.
For women in menopause, low estrogen levels can have sexual consequences because of a decrease in blood flow, tissue elasticity and lubrication. Low estrogen can also lead to pain with sex, which can definitely affect orgasm. The changes caused by low estrogen can sometimes be managed with over-the-counter lubricants and vaginal moisturizers, but often a prescription product, most commonly topical estrogen, is needed.
Medical conditions, such as depression and diabetes, can also affect sexual response as can some medications, such as antidepressants and opioids. Antidepressants and anti-seizure medications that are often prescribed for hot flashes during menopause can negatively affect orgasm, so consider the potential sexual side effects when deciding to start or stay on these medications. Sorting out how medical conditions and medications may affect a woman’s sexual response can be challenging, so working with an experienced practitioner is essential.
Another factor to consider:
Women whose male partners have erectile dysfunction sometimes tell me this condition can have an impact on their own sexual response. This phenomenon is not well-studied, but I hear it often enough that I can’t dismiss it. Not knowing if a partner will be able to achieve a full erection can be stressful. And if sex has to move quickly to catch the moment for penetration, it may bypass what some women need emotionally and physically to reach orgasm. If a woman’s orgasm is normal when she masturbates, but not with her male partner, erectile dysfunction may be a factor to consider. There are a variety of treatments for erectile dysfunction that a male partner can discuss with his own health care provider.
Dr. Jen Gunter, often called Twitter’s resident gynecologist, is teaming up with our editors to answer your questions about all things women’s health. From what’s normal for your anatomy to healthy sex and clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called The Cycle, promises to handle your questions with respect, forthrightness and honesty.see also: Walker Thornton
May 20, 2016
Today's Chart
I think it's worth noting that there's a fairly obvious connection here: a rapist being able to deny his victim's right to abort "his" "child", and then to sue for his "right" to be involved in that kid's life is coming almost straight outa the really shitty parts of The Bible that have god telling certain Israelites that it's OK to kidnap and rape women as a means of obtaining a family.
That's pretty fucked up right there, buy hey - it's what the TheoCons do.
Allow me to reiterate Mike's Manifesto on this particular subject:
Abortion is very serious, and so it MUST be closely restricted -
...to women
...who are pregnant
...and decide not to be pregnant
No exceptions
If you're not the one who's pregnant
(and especially if you were born with that Y chromosome)
then your opinion is duly noted
and you can shut the fuck up now
Mar 2, 2016
Sam B Brings It
Let's review:
- Eggs ain't chickens
- Tadpoles ain't frogs
- Ain't nuthin' goin' on in my daughter's uterus that's any of your goddamned business
So fuck off, motherfucker. And then fuck off some more. And keep fucking off until you get all the way back here - and then fuck off again.
And let's try to remember that abortion restrictions have almost no effect on any woman living at or above the basic Middle Class level. The women in Jagoff Dan Flynn's life will hop on a plane to Montreal or Vancouver (to visit an old friend - or to attend an important Jesus-ey thing), and be back all spiffed up, and in plenty of time to make Sunday services where I'm sure they'll be praying for re-election and for a god-sent firebomb to mysteriously destroy whatever's left of those evil Planned Parenthood clinics.
This shit has nothing to do with health - women's or otherwise - it has everything to do with power.
Jan 22, 2016
Today's Anniversary
Roe v Wade - Jan 22, 1973
Also, I have a penis, so whatever I say on this subject may be safely disregarded entirely.
Thank you.
And may I say for the record:
I am pro-life.
I believe strongly that abortion should be tightly restricted
to women
who are pregnant
and don't wanna be pregnant anymore.
Also, I have a penis, so whatever I say on this subject may be safely disregarded entirely.
Thank you.
Jun 26, 2015
Today's Cheap Shot
hat tip = Little Green Footballs
Bristol Palin, who’s been advocating abstinence as a spokeswoman for the National Campaign to Prevent Teen and Unplanned Pregnancy, announced today that she’s pregnant out of wedlock for the second time.
And she doesn’t want any lectures from you people.
OK - no lecture, but c'mon - Abstinence Only didn't even work for GOD.
What the fuck is wrong with you?
Nov 21, 2014
Next Up at UVa
The story continues. And it just gets weirder as UVa appoints former Deputy US AG Mark Filip to head up the investigation into the total fucked-up-edness of a party culture (this time centering around Phi Kappa Psi) bordering on straight-up Caligula.
From our "local" rag The Daily Progress:
First, from the Daily Progress article:
Second, Mark Filip is a Phi Kappa Psi alum. Let that one sink in for a bit. I'm not saying there's no value in the guy being somebody who knows his way around a fraternity. But when there's an obvious problem with foxes in the chicken coop, I hafta be just a little skeptical about hiring a coyote to look into it for me.
To be real clear here, I don't want anybody throwing shit at the Frat House or at the little Frat Rats living there.
This kinda nonsense might feel OK at the time, but it just makes it easier for some people to rationalize sympathy for the perps:
That said, it's not gonna hurt my feelings one little bit if we find a way to put an end to the elitist entitlement legacy bullshit that persists in the continuation of anything so obviously toxic to a democracy as The Greek System is.
So, take whatever action against PKP necessary to facilitate its demise. I'd like nothing better than to sue the fuck out of 'em, and then bulldoze the house.
Use the money from the lawsuit to build a brand new Women's Health and Crisis Intervention Center - right there in the heart of Frat-boy Fuck-around Central.
Require every Fraternity and Sorority to contribute half of their dues (and whatever other income they get) to the maintenance and support and perpetuation of the thing until time itself crumbles into the dust.
EvilleMike has spoken. So let it be written. So let it be done.
From our "local" rag The Daily Progress:
Late in a day of unrest Thursday on Grounds, University of Virginia officials announced the appointment of former U.S. Deputy Attorney General Mark Filip to lead a review of the school’s policy and procedures for dealing with sexual assaults.
A statement from Rector George Keith Martin released just after 8 p.m. broke a nearly daylong silence from university leaders, including President Teresa A. Sullivan, in the wake of allegations of a September 2012 gang rape at the Phi Kappa Psi house at UVa.
An account of the attack detailed in a nearly 9,000-word story in Rolling Stone ignited a storm of scrutiny Wednesday.
Earlier in a day when hundreds of students rallied and vandals shattered windows and spray-painted messages of protest on the walls of the house on Madison Lane, Phi Kappa Psi voluntarily surrendered its fraternal agreement with UVa and suspended all chapter activities. Charlottesville police are investigating the rape allegations at Sullivan’s request.In case you missed them - here's a coupla details I find interesting.
First, from the Daily Progress article:
The Governing Board of the Inter-Fraternity Council at UVa released a statement saying members were “horrified, disgusted, and viscerally saddened” by the story.BTW - a member of that Council was interviewed at length by Rolling Stone (weeks if not months before publication), so translation: "We are shocked - shocked - to find there's rape going on here!"
“That some fraternity men commit sexual assault is irreconcilable with everything we hope our community to be, and we are mortified that any fraternity member is responsible for perpetrating such a heinous crime,” they said in the statement.
Second, Mark Filip is a Phi Kappa Psi alum. Let that one sink in for a bit. I'm not saying there's no value in the guy being somebody who knows his way around a fraternity. But when there's an obvious problem with foxes in the chicken coop, I hafta be just a little skeptical about hiring a coyote to look into it for me.
To be real clear here, I don't want anybody throwing shit at the Frat House or at the little Frat Rats living there.
This kinda nonsense might feel OK at the time, but it just makes it easier for some people to rationalize sympathy for the perps:
That said, it's not gonna hurt my feelings one little bit if we find a way to put an end to the elitist entitlement legacy bullshit that persists in the continuation of anything so obviously toxic to a democracy as The Greek System is.
So, take whatever action against PKP necessary to facilitate its demise. I'd like nothing better than to sue the fuck out of 'em, and then bulldoze the house.
Use the money from the lawsuit to build a brand new Women's Health and Crisis Intervention Center - right there in the heart of Frat-boy Fuck-around Central.
Require every Fraternity and Sorority to contribute half of their dues (and whatever other income they get) to the maintenance and support and perpetuation of the thing until time itself crumbles into the dust.
EvilleMike has spoken. So let it be written. So let it be done.
Sep 12, 2014
Standards
Allowing somebody else to impose any kind of arbitrary "standards of beauty" on us is at least a little iffy. Buying into the manipulative bullshit of advertising and manufactured opinion, and then remaining apathetic about it is dangerous for a society and too often deadly for individuals.
Just the way you are, ladies. Honest.
Just the way you are, ladies. Honest.
Jul 8, 2014
Kaili's Pissed
One observation - the Hobby Lobby decision is a near-perfect metaphor for exactly the kind of botched abortions that are prob'ly headed our way because of this mis-guided and poorly- informed, deliberately ignorant "conservative movement" that seems bent on pulling down American Democracy and replacing it with Christian Sharia.
But here's Kaili Joy Gray to girlsplain it to us from a perspective that's only shared by - oh I dunno - a few gazillion other women:
SCOTUS just found another way to push the envelope, using the 1st amendment for cover - Corporations are people who now have the right to free speech (Citizens United) and (the right to nullify federal law by claiming) religious freedom (Hobby Lobby)...and at some point I think we can look forward to a lawsuit on behalf of some poor mistreated corporation whose 'freedom of association' is being denied by the mean ol' bureaucrats at SEC and DoJ et al - so we can say good-bye to Anti-Trust laws and every trace of rules and regulations that prohibit the use of important business tools like Collusion and Price-Fixing and Market Manipulation, and all the other elements of a Libertarian Free Market Utopia.
So let's go ahead and fuss at each other about Church and State, and Bodily Integrity, and Red Team vs Blue Team - all of which are plenty important btw - just let's be sure we're paying attention to what's behind the curtain too.
But here's Kaili Joy Gray to girlsplain it to us from a perspective that's only shared by - oh I dunno - a few gazillion other women:
Of course I am mad. My vagina is getting uncomfortably crowded, what with all of that compelling government interest to protect me from myself, and those sincerely held religious beliefs, and the counseling, and the men telling me JUST DON’T HAVE SEX. There’s hardly room for my doctor to even get up in there to make sure my oh-so-important vagina is actually in fine working order, which I know is beside the point to everyone else taking up space for freedom and liberty and Jesus. But it’s really the only point that should matter.But also too - keeping in mind my first basic tenet (it's never about what they tell us it's about): This decision is being sold to us as if it's Rep vs Dem, or Librul vs Conservadope, or Godless Big Gubmint vs Holy Little Guy Business Owner - that's bullshit - or mostly bullshit anyway. This ends up being about furthering the cause of establishing and reinforcing the primacy of Corporation-as-Citizen.
SCOTUS just found another way to push the envelope, using the 1st amendment for cover - Corporations are people who now have the right to free speech (Citizens United) and (the right to nullify federal law by claiming) religious freedom (Hobby Lobby)...and at some point I think we can look forward to a lawsuit on behalf of some poor mistreated corporation whose 'freedom of association' is being denied by the mean ol' bureaucrats at SEC and DoJ et al - so we can say good-bye to Anti-Trust laws and every trace of rules and regulations that prohibit the use of important business tools like Collusion and Price-Fixing and Market Manipulation, and all the other elements of a Libertarian Free Market Utopia.
So let's go ahead and fuss at each other about Church and State, and Bodily Integrity, and Red Team vs Blue Team - all of which are plenty important btw - just let's be sure we're paying attention to what's behind the curtain too.
Jul 6, 2014
Jul 3, 2014
Dear Rush
So if them wimmins could just not "do the one thing that makes birth control necessary..." - funny how guys like Limbaugh can't quite bring themselves to talk about sex in any way that's not coded and secretive and laced with the adolescent snickering that reinforces the stilted manipulating notion that sex is dirty, and that a total slut is the only kind of woman who'd actually want to have sex - especially with an emotionally crippled bucket of pus like Rush Limbaugh.
But anyway, it does kinda pop into my brain that given the facts emerging now about sexual assault being lots more of a frequent and widespread problem, maybe birth control needs to be considered just another tool in the Self Defense Kit for every woman - right along with the whistle and the mace and the pocket .38, which of course, can be yours now for the low low price of $289.99 - available online!
It's just a pure wonderment the NRA hasn't hired me on as a marketing consultant. I got truly great ideas.
Mar 13, 2014
Today In Absurdity
Ms Forlano mentions something about mammography and a recent study that the authors have said suggests annual screening isn't as vital as we've been told. I haven't found a lot about that study, so I'm kinda talking out my ass here, but when you're trying to make a judgement call on practically anything medical ya gotta look at the outcomes first, and then work your way back thru all the treatment options. Outcome is what matters, and evidence - what you can prove - is what has to drive those treatment decisions.
The study, which included nearly 90,000 women ages 40 to 59, is the latest to question the value of routine mammography. The researchers found the same number of women died of breast cancer over 25 years, regardless of whether they underwent yearly mammograms or not.I'm always gonna start from a skeptical viewpoint. eg: The Cancer Treatment Industry has a dog in this fight, so there's some probability for us to see at least a little self-promotion on their part when they push back.
Of course, it's all a shitload more complex than that. Take a ride thru The Placebo Effect some time and tell me it didn't make you just a tiny bit dizzy. (Try this one too)
The more we learn, the more we understand how little we know.
Feb 17, 2014
Cosmo Strikes Out
This appeared on Cosmo's Facebook page, and reaffirms what most of us have known for a while about dumfuk magazines "for women".
(paraphrasing a favorite comment):
Dear Cosmo -
Kindly take your ridiculous, arbitrary dictates of what women should want to look like and shove 'em back up your ass.
Sincerely,
Every guy on the planet who's had to spend hours reassuring a wife, girlfriend or daughter (ie: any real-world-perfect-for-me woman) that she's not fat and grotesque, all because assholes like you insist on undermining her confidence by playing on her fears just so you can sell her a load of shit she doesn't need in the first fucking place.
Jan 5, 2014
Today's PSA
"Sorry, we didn't agree to this - this wasn't in the script..."
75% of all Americans know someone who is (or was) a victim of Domestic Violence - that's 232,500,000 of us.
Every day, 4 Americans are murdered by their intimate partners. Four. Every. Fucking. Day.
Worth a visit - RAINN
75% of all Americans know someone who is (or was) a victim of Domestic Violence - that's 232,500,000 of us.
Every day, 4 Americans are murdered by their intimate partners. Four. Every. Fucking. Day.
Worth a visit - RAINN
Oct 29, 2013
Yo, Texas
Judges in the lower courts keep knocking down these attempts to deny women their rights, but I don't believe it has anything to do with anything short of getting an appeal up to SCOTUS in an attempt to blow up Roe v Wade.
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