NEW YORK - The number of out-of-hospital births, including home births and birthing-center deliveries, are up in New York and nationwide.

According to data from the Centers for Disease Control and Prevention, more than 1 percent of deliveries in New York in 2012 were out-of-hospital births, up from just 0.75 percent in 2004. Meanwhile, nationally, the risk profile for non-hospital births was lower than hospital births.

Michele Giordano, executive director of the nonprofit advisory group Choices in Childbirth, said women increasingly are seeking more control in the birth process, such as how, when and where the baby is delivered and by whom.

"Women aren't getting the level of care they want." she said, "and the reason why women are making a wide range of choices and seeking doulas and seeking home births and seeking options outside of the medical model is because they want to be treated with respect. They want to be at the center of their health care decision-making."

Giordano warned that all non-hospital births are not reactions to a hospital experience but sometimes simply reflect a desire for a safe and comfortable birthing experience. The CDC also found that nationally, more than 50,000 babies were born at home in 2012, the highest since 1975, and far fewer out-of-hospital births were born preterm or low birth weight than hospital births.

Giordano said few birthing centers providing alternative childbirth options exist in New York. And while many critics view non-hospital births as unsafe, Katherine Morrison, medical director for the Birthing Center of Buffalo, said hospitals actually have become less safe as the U.S. maternal mortality rate is now higher than in any other developed country.

"In 1987, our maternal mortality rate was nine per 100,000 births, and now it's 18.8 per 100,000 births," she said. "So we are unnecessarily intervening and killing mothers in the hospital. and nobody in the hospital wants to discuss that."

The CDC found that in 2012, out-of-hospital births had a lower risk profile than hospital births. About four percent of non-hospital births were born preterm, compared with more than 11 percent of hospital births - and about three percent of non-hospital births were low birth weight compared with about eight percent of hospital births.

More information about out-of-hospital births can be found online at cdc.gov. International non-hospital birth information can be found at savethechildren.org.


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ST. PAUL, Minn. -- High blood pressure among Americans was already a concern before the pandemic. Researchers now say the crisis has created greater risk for certain individuals.

The findings were issued today by the American Heart Association. They compare blood-pressure data of participants between April and December of last year to the same period in 2019.

In 2020, nearly 27% moved to a higher blood pressure category, while only 22% were downgraded.

Dr. Haitham Hussein, associate professor of neurology at the University of Minnesota and a board member with the American Heart Association Twin Cities, said the results show there's real concern that more people will suffer from adverse health effects.

"High blood pressure is the most common cause of heart attack, and stroke, kidney disease," said Hussein. "And it's silent. People will have high blood pressure and not know."

Researchers cited factors as the pandemic took shape - including more stress, people eating less healthy foods, consuming more alcohol, and not getting enough physical activity.

According to the study, the highest blood-pressure measures were found among women and older adults. And Hussein noted that traditionally, there are also racial disparities when it comes to hypertension.

In communities of color, factors such as social determinants of health play a role in seeing more of these cases. Hussein said the way the crisis affected some areas versus others could make the problem worse.

"And then when the pandemic hit, and the economic issues [were] more significant in ethnic and racial minorities," said Hussein, "lack of access to health care, the living situation, the job - all that hit harder."

Hussein said health leaders, public agencies and others need to join forces to ramp up prevention work so that high-risk individuals aren't trying to correct hypertension later in life.

In Minnesota, the American Heart Association is providing grants to Federally Qualified Health Centers to help get a handle on declining control rates for blood pressure due to the crisis.

"These efforts are very much needed," said Hussein, "along with improving the knowledge about high blood pressure, needing to know your numbers."

By Claire Carlson for The Daily Yonder.
Broadcast version by Emily Scott for Big Sky Connection reporting for The Daily Yonder-Public News Service Collaboration

Reproductive rights activists who are fighting abortion restrictions in Montana say new state laws will have a disproportionate impact on reproductive care in rural communities.

The laws, currently awaiting a Montana Supreme Court decision, prohibit abortions after 20 weeks, require providers to offer ultrasounds to patients, and prohibit medication abortions via telehealth and mail prescriptions.

The telehealth and mail-prescription bans could have the biggest direct impact on the state's dispersed and remote rural populations, but all three laws work together to limit abortion services statewide, especially for underserved and rural populations, abortion rights advocates say.

"Each of these bills have their individual impacts, but together, they do what I call the 'squeeze,'" said Martha Stahl, CEO and president of Planned Parenthood of Montana. "They work together to make it a much more difficult process to access care early in pregnancy, which, for abortion patients, is something that people need in a timely manner."

Republican Governor Greg Gianforte signed four abortion bills into law in April. The only one currently in effect prohibits health insurance plans that are covered by the state's health insurance exchange from paying abortion expenses.

Planned Parenthood of Montana is suing the state of Montana over the bills, arguing that they breach Montanans' constitutional right of privacy.

"Legal precedent exists in a couple of places that actually show the court's belief that that right to privacy is directly applicable to access to sexual and reproductive care and to abortion," said Stahl.

District Judge Michael Moses put the three laws on hold just hours before they would have gone into effect in October to give the court time to consider Planned Parenthood's legal challenge.

The bill that most clearly affects rural communities is HB 171. Medication abortion by mail and telehealth consultation is often the only way an abortion seeker can receive care if they live in remote areas and don't have the ability to travel long distances for medical care.

However, abortion providers do recognize that this option doesn't guarantee access for everyone.

"Telehealth isn't always the amazing solution that it seems for rural America, simply because people's lack of broadband can get in the way," said Stahl. "But now that providers can actually bill insurance for these services, it really has changed the face of access for a lot of folks."

Telehealth services also include site-to-site patient care, which allows a patient to go to their nearest health center and connect via telehealth with an abortion clinic elsewhere to be prescribed medication abortion. This brings telehealth to people without broadband, but along with medication abortion by mail, this site-to-site patient care would also be banned under HB 171.

According to Planned Parenthood, medication abortion provides two medicines: mifepristone and misoprostol. These pills are taken within two days of one another and induce cramping in the uterus, creating a process similar to an early miscarriage. In Montana, medication abortion can be given up to 11 weeks after the last day of the person's period. The process is safe, effective, and common.

Between July 1, 2020 and June 30, 2021, Planned Parenthood of Montana provided 935 medication abortions and 255 procedural abortions, according to data from the organization. Of these medication abortions, 140 were direct-to-patient, meaning they were mailed. Had these patients been required to show up in person, 56% would have had to drive one to two hours one-way to reach the clinic, and 18% would have had to drive two to five hours one-way, according to Planned Parenthood.

In a state as large as Montana, being required to drive to a clinic can be a significant obstacle, which is why many patients use telehealth and direct-to-patient mailing services. Snow and icy road conditions in the winter can make drives even longer, which is another reason abortion providers say telehealth services have revolutionized abortion access for rural communities in the state.

There are just three abortion providers in Montana: Blue Mountain Clinic, All Families Healthcare, and Planned Parenthood. Their clinics are primarily concentrated in the western part of the state, which means that if patients were required to drive to an abortion clinic for in-person care, those living on the far eastern side of Montana could be forced to travel between seven and eight hours one-way.

(The Daily Yonder driving-time analysis at the top of this article is based on Google Maps estimates, which do not account well for terrain or road conditions in many rural areas. The Daily Yonder found that residents of eastern Montana were likely to drive five to 10 times longer to reach abortion services than residents of unserved counties in western Montana.)

By banning direct-to-patient medication abortion by mail and site-to-site care, people in rural areas without reliable transportation are left with few options.

This is where support from abortion organizations like the Susan Wicklund Fund can help.

The Susan Wicklund Fund is one of only two abortion funds providing financial support to people in Montana - the other is Indigenous Women Rising's fund, which supports Indigenous and undocumented people. Both of these funds rely on donations, usually from individuals, and the Susan Wicklund Fund is fully volunteer-run.

According to Kate Kujawa, chair of the Susan Wicklund Fund, the organization provides their callers with support with transportation costs and medical expenses. The fund provides support to anyone in Montana, even if they travel out of state to go to an abortion clinic. Activists say this might become increasingly common, even if the bans aren't enforced.

"We wouldn't be shocked if privacy and medical privacy is stripped in Montana," said Kujawa. "And if that happens, we do believe that abortion will become harder to obtain, and at that point, we are prepared to help people get out of state or out of country depending on what is easiest and best in order to help them retain their access to choice."

If the bans do go into effect, Kujawa believes they will only magnify financial and social disparities between abortion seekers. "If you don't have access to a car, if you can't coordinate childcare with family or friends, you're really just left without options," said Kujawa.

Requiring in-person care isn't the only issue activists believe will affect rural communities.

Stahl, of Planned Parenthood, is also concerned about HB 171's requirement for abortion providers to make public the demographics of their patients. The law would require clinics to report the patients' age, race, and number of previous pregnancies.

"If you think about Montana that has rural counties of less than 1,000 people, [being able to identify] a patient who's, say, been pregnant three times and is 24-years-old is not going to be that difficult for the people living in that county," said Stahl.

While HB 171 has the most direct impact on rural communities, all three bans work in concert to restrict rural access, according to Stahl. HB 140 requires in-person appointments so people can be given the opportunity for an ultrasound, and HB 136's 20-week ban decreases the amount of time a person has to get an abortion. If a person has to get an abortion before they are 20 weeks pregnant and they are required to drive to multiple appointments across state for in-person care, the process is challenging.

Some argue that complicating this process is the goal for Republican lawmakers who are closer to restricting abortion in Montana than they have been in years. This is thanks to Republican Governor Greg Gianforte, who was elected in 2020 after 16 consecutive years of Democratic governors.

"Republicans have the majority and are using these abortion access restrictions to demonstate their power and to fire up their voting base," said Helen Weems, nurse practitioner of All Families Healthcare, one of the three abortion providers in Montana, in an email.

Supporters of the bills believe these restrictions are a step in opposing Planned Parenthood as a whole, which has long been targeted by anti-abortion Republicans. Along with abortion services, Planned Parenthood provides other affordable reproductive health services - many to low-income or underserved communities - such as STD screening, contraception, and preventive reproductive care.

A state lawmaker who supports the restrictions said the measures would not affect health care services for rural areas.

"How can you call aborticide a health issue?" said state Representative John Fuller (R-8) from Whitefish, in northern Montana. "Banning aborticide through mail or through telehealth is not reducing health care to rural America [or to] rural Montana."

Reproductive rights activists say that these bills wouldn't stop abortion but would only stigmatize the procedure and put undue burden on low-income and rural communities.

There is no end date to the court injunction that halted the bills in October, which means that until the Montana Supreme Court makes a decision, abortion seekers won't face the restrictions the bills would enact.

"These laws do not represent the will of the majority," said Weems. "We will keep fighting and keep caring for our patients. We aren't going anywhere."

Claire Carlson wrote this article for The Daily Yonder.



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CARSON CITY, Nev. -- Eye exams can help determine your risk of dying from COVID, according to experts, because optometrists are often the first medical professionals to notice symptoms of diabetes.

A 2020 study in the Journal of Diabetes Science and Technology found people with diabetes are more than four times more likely to succumb to COVID than non-diabetics.

Dr. Scott Edmonds, optometrist and chief eye care officer at UnitedHealthcare, said getting treatment for diabetes will improve the odds against COVID.

"A well-controlled diabetic will fare better in the face of COVID infection than someone who is an uncontrolled diabetic," Edmonds explained. "And often that difference between controlled and uncontrolled is seen in the eye exam, as opposed to other tests."

Optometrists will suspect diabetes if a person is obese, or has a family history of diabetes, and if a younger person's prescription changes suddenly, if the patient starts to develop cataracts before age 60, or if small hemorrhages are visible under a microscope.

Edmonds noted if a patient is diagnosed as diabetic or pre-diabetic, the optometrist can recommend they take preventive measures against COVID.

"Then we can have that person take more precautions," Edmonds advised. "Being more careful with their masks, maybe talk them into getting a vaccine if they weren't otherwise inclined because now they're at higher risk."

He added so-called "long-haul" COVID can cause neurological changes that result in double vision, blur and eye strain, especially when someone is sitting in front of a computer screen.