BOSTON – A new program in Boston is trying to improve the labor and delivery experience for expectant Black mothers and mothers of color, who often find their voices aren’t always heard by hospital staff.

Harder for Black moms to advocate

At 35, Latoya Baskin was thrilled to be pregnant with her first child, Jason, but she had concerns about giving birth.

“I’ve definitely heard and seen stories about how it’s just harder or just more you have to advocate for yourself a little more as an African-American,” said Baskin.

“We know that there are inequities or differences in the way that Black individuals or individuals of many different backgrounds either experience their labor and delivery care or their ultimate outcomes,” said Dr. Allison Bryant, the Associate Chief Health Equity Officer for Mass General Brigham.

Professional support person

Bryant said having a doula or a professional support person can help decrease c-section rates, improve the patient experience and promote breastfeeding but they can be expensive. So Mass General Brigham started a program called Birth Partners, which pairs a doula with an expectant parent of color free of charge. The Birth Partners program now serves about 130 expectant moms a year.

Baskin was matched Ieshia Lee, who has been a doula in the Boston area for 30 years.

“When I advocate, I’m advocating to the patient, not to the nurses,” said Lee. “So I’m guiding her, telling her, if she’s not liking what’s going on, how do you feel about that? I don’t like this, I don’t like this. Once she tells me what she don’t like, I then guide her how to tell them what she doesn’t like about it. So her voice is being heard.”

Lee met with Bryant before, during and after delivery and quickly became a member of her birthing team.

“Another person in my village to help me along the way, said Baskin.

Four women suing over Idaho’s strict abortion ban told a judge Tuesday how excitement over their pregnancies turned to grief and fear after they learned their fetuses were not likely to survive to birth — and how they had to leave the state to get abortions amid fears that pregnancy complications would put their own health in danger.

“We felt like we were being made refugees, medical refugees,” said Jennifer Adkins, one of the plaintiffs in the case.

The women, represented by the Center for Reproductive Rights, aren’t asking for the state’s abortion ban to be overturned. Instead, they want the judge to clarify and expand the exceptions to the strict ban so that people facing serious pregnancy complications can receive abortions before they are at death’s door.

Currently, the state’s near-total ban makes performing an abortion a felony at any stage of pregnancy unless it is “necessary to prevent the death of the pregnant woman.”

Adkins’ fetus had a severe medical condition that meant the fetus would not survive the pregnancy. The illness also put Adkins at risk of developing “mirror syndrome,” a dangerous syndrome that can cause fatally high blood pressure and other issues, she said.

Adkins and her husband, John, decided to seek an abortion, and learned, after another ultrasound showed the fetus still had a heartbeat, that they would have to go out of state to get one.

Idaho law prohibits a woman from getting an abortion when a fetal heartbeat is detected, with the exception of cases of rape, incest or a “medical emergency,” defined by the law as “a condition that, in reasonable medical judgment, so complicates the medical condition of a pregnant woman as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible impairment of a major bodily function.” 

“No parent wants to wish that when they look at an ultrasound they don’t see their baby’s heartbeat, yet here I was hoping that I wouldn’t,” Adkins said. “I wanted the decision to be made for us, and I wanted to end her suffering, so it was really hard to see that and know that we had the challenges ahead of us that we did.”

“I was not willing to watch my son suffer”

Kayla Smith cried as she told the judge how she found out she was pregnant for a second time on Mother’s Day of 2022, and how she and her husband chose the name “Brooks” for their son. She was around 18 or 20 weeks along in her pregnancy when the sonographer grew quiet during a routine anatomy scan, Smith said.

Brooks’ heart had fatal anomalies, and the young family could not find a pediatric cardiologist willing to attempt an operation. The veins supplying Brooks’ lungs were also abnormal, Smith said, and he would not survive birth.

Smith had developed dangerously high blood pressure during a previous pregnancy, and she was at risk of developing the condition called preeclampsia again.

“If I were to continue pregnancy not only would I risk my life with preeclampsia, I was not willing to watch my son suffer and potentially gasp for air,” Smith said, crying.

Idaho’s abortion ban went into effect two days before Brooks’ diagnosis, she said, making it impossible for her to get an abortion in her home state.

“We wanted to meet our son — that was really important to us — so we needed to do it in a hospital,” she said. 

They took out a loan to cover the estimated $16,000 to $20,000 out-of-network cost for the procedure and drove more than eight hours to a hospital where doctors induced labor.

“All four of these women were overjoyed to be pregnant with their second child and all four of them received the worst news a mother can imagine,” attorney Gail Deady, with the Center for Reproductive Rights, told 4th District Judge Jason D. Scott during opening arguments. All of them sought abortions “to protect their health, to spare their babies from pain and suffering, and to remain alive and healthy to protect their young children.”

James Craig, a division chief with the Idaho Attorney General’s office, said the women and their attorneys are relying on hypotheticals rather than concrete facts to make their case. Under their proposal, a pregnant woman could receive her abortion for something as minor as stepping on a rusty nail — even though the risk of infection in that scenario could be easily treated by receiving a tetanus booster shot, Craig said.

“Unborn children have a fundamental right to life, and protecting the lives of children is a legitimate and fundamental government interest,” Craig said.

The state also has the same interest in protecting the lives of women, Craig said — and the abortion ban laws do both, he contended.

In the “rare circumstances where abortion is necessary” to prevent the death of the mother, Idaho law allows that to occur, Craig said. The women suing are trying to “usurp the role of the Legislature” by asking the judge to rewrite the law, he said, and that is not the proper role of the court.

Dr. Emily Corrigan, an ob-gyn who works in emergency medicine at Saint Alphonsus Regional Medical Center who is also a plaintiff in the case, told the judge how Idaho’s multiple abortion bans have created confusion for physicians and made it difficult to treat pregnant patients who need emergency care.

Doctors have had to “basically guess which pregnancy conditions would fall under the state medical exception,” Corrigan said.

“I have had other hospital staff refuse to participate in the care of my patients because of the lack of understanding of the laws, and this has caused patient care delays,” she said. “I have personally cared for several patients who have been denied stabilizing abortion care at other hospitals in Idaho. By the time they arrive at my institution, their conditions have deteriorated and have lead to increased complications that I need to manage.”

Several conditions can put the health of pregnant people at risk, she said. Some are caused by pregnancy like preeclampsia, and others — including some chronic illnesses and cancers — can be made worse by pregnancy, she said. In those cases, delaying an abortion might not cause immediate death but can cause a shortened life span or have dramatic effects on a person’s health, Corrigan said.

“We are not trained to wait until things become urgent or emergent. We are trained to prevent harm to our patients,” she said.

An ectopic pregnancy is a serious medical condition that occurs when a fertilized egg implants outside the uterus, most commonly in one of the fallopian tubes. This abnormal placement means that the pregnancy cannot proceed normally, and without immediate medical intervention, it can pose life-threatening risks, such as rupture of the fallopian tube and internal bleeding. With timely diagnosis and treatment, however, severe complications can often be avoided. Insights from leading specialists—Dr. Suma Varsha, Dr. Komal Bhadu, and Dr. Rajendra Shitole—help deepen our understanding of this condition and how it can be managed.

What is an Ectopic Pregnancy?

As explained by Dr. Rajendra Shitole, IVF Consultant and Endoscopic Surgeon at DPU Super Specialty Hospital, an ectopic pregnancy happens when a fertilized egg implants outside the uterus, most frequently in the fallopian tube. This type of pregnancy is referred to as a “tubal pregnancy.” However, it can also occur in less common locations like the ovary, abdominal cavity, or cervix. In any case, these areas are not designed to support the development of a pregnancy, which means the condition is non-viable and requires medical attention.

The fallopian tubes, the most common site for ectopic pregnancies, are delicate and unable to stretch or accommodate a growing pregnancy. As the fertilized egg grows, it can cause the tube to rupture, leading to severe internal bleeding—a life-threatening emergency. Other potential locations for an ectopic pregnancy, like the abdomen or cervix, are also not equipped to sustain pregnancy growth and can result in serious complications if left untreated.

Risk Factors

Several factors can increase the likelihood of an ectopic pregnancy. Dr. Suma Varsha, an IVF Specialist at Ferty9 Fertility Center in Vijayawada, points out that women with a family history of ectopic pregnancies may be at greater risk, suggesting that screening for these women might help in early detection and preventive steps. Health conditions affecting the fallopian tubes—such as pelvic inflammatory disease (PID) or scarring from endometriosis—are also significant risk factors. PID is an infection in the reproductive organs that can lead to scarring, while endometriosis causes tissue similar to the uterine lining to grow outside the uterus, both of which can damage the fallopian tubes and increase the risk.

Lifestyle factors also play a role in the likelihood of developing an ectopic pregnancy. Smoking and a high body mass index (BMI) have both been associated with a higher risk. Additionally, fertility treatments like IVF may occasionally increase the chances of ectopic implantation.

Symptoms of Ectopic Pregnancy

In the early stages, the symptoms of an ectopic pregnancy often mimic those of a normal pregnancy. According to Dr. Komal Bhadu, Obstetrics & Gynaecology specialist at Ruby Hall Clinic, Pune, women might initially experience missed periods, nausea, and breast tenderness, making it harder to identify the condition early. However, there are distinct symptoms that should raise alarm. Sharp or stabbing pain in the abdomen or pelvis, abnormal vaginal bleeding, dizziness, fainting, and shoulder pain (caused by internal bleeding irritating the diaphragm) are all warning signs of an ectopic pregnancy.

Dr. Shitole adds that these symptoms usually occur as the ectopic tissue grows, and early diagnosis is essential to prevent life-threatening complications like tube rupture and severe internal bleeding. Immediate medical attention is critical when these symptoms present during early pregnancy.

Diagnosis and Advancements in Detection

Diagnosing an ectopic pregnancy has significantly improved with advancements in medical technology. Dr. Varsha explains that high-resolution 3D transvaginal ultrasounds, combined with blood tests measuring the pregnancy hormone beta-hCG, can detect ectopic pregnancies early, often before symptoms worsen. A lower-than-expected level of hCG can indicate an ectopic pregnancy, prompting doctors to investigate further using ultrasound imaging to confirm the location of the pregnancy.

Dr. Bhadu emphasizes that pelvic examinations, along with transvaginal ultrasound, are critical for pinpointing the exact location of the pregnancy, allowing for faster diagnosis and intervention. In some cases, especially in asymptomatic patients, these advanced diagnostic techniques can identify an ectopic pregnancy before it causes significant damage.

Treatment Options

The treatment for an ectopic pregnancy depends on how far along the pregnancy is and the woman’s overall health. Dr. Shitole describes the common approach of using medication like methotrexate to stop cell growth in early-stage ectopic pregnancies. This drug allows the body to absorb the pregnancy tissue naturally, avoiding the need for surgery. However, if the pregnancy is more advanced, or if there is a risk of rupture, surgical intervention may be necessary.

In some cases, surgery is performed laparoscopically, which is minimally invasive and reduces recovery time while preserving fertility. In more severe cases, where a rupture has occurred, emergency surgery may be required to remove the ectopic pregnancy and control internal bleeding.

Prevention and Awareness

While it is not always possible to prevent an ectopic pregnancy, awareness of risk factors and early detection can help reduce the likelihood of severe complications. Dr. Bhadu underscores the importance of recognizing the symptoms and seeking prompt medical care, as timely treatment significantly improves outcomes. Dr. Varsha recommends regular gynecological checkups, managing risk factors like smoking, and early treatment of infections like PID to lower the chances of developing an ectopic pregnancy.

Ectopic pregnancies, though rare, require swift medical intervention to prevent life-threatening complications. Understanding the symptoms, risk factors, and treatment options is critical for both patients and healthcare providers. With advances in early diagnosis and treatment methods, the risks associated with ectopic pregnancy can be mitigated, improving maternal health outcomes. By raising awareness and encouraging timely medical attention, specialists like Dr Varsha, Dr Bhadu, and Dr Shitole are helping to ensure better care for women facing this challenging condition.

MINNEAPOLIS — In Minnesota, around 290,000 people are in need of treatment for addiction, according to the Minnesota Department of Health. Some of those people happen to be women who are pregnant. 

An unconventional program is saving those babies and their moms. The program meets weekly in a Hennepin County classroom.

“It’s the reason why I have my kid right now,” Tara Weibenbach of Minneapolis said.

Sofia is her 12-week-old baby. Weibenbach has birthed 10 kids but lost her rights to nine of them as addiction took over her life.

“It was just going to continue to be the way it was until we did something. Then that’s when I was —  I give up. I gave up and got sober,” Weibenbach said.

She found respite at Project Child, a group for pregnant women who’ve been fighting addiction. 

“After just losing three children and having my rights terminated and finding myself pregnant again, I didn’t think there was hope for me,” Sarah Bruder said.

Bruder found hope at Project Child —  she got resources and got sober while carrying her fourth and now that little boy lives with her.

“He’s my little life changer boy. And I say that with a heavy heart because often I think about my other children and why couldn’t I get it together. But I’ve come to the realization that I didn’t love them, but it was because I didn’t love me,” Bruder said.

Dar Swanson is an instructor and leader at Project Child.

“Just because they become pregnant, doesn’t mean addiction stops. Addiction will stop at nothing so they need love and compassion and not to be judged,” Swanson said.

She says the results say it all. 

“Over the past five years, we have hit a 93% rate of women having substance-free babies, so that’s so exciting,” Swanson said.

Project Child is a free program through Hennepin County.