Archive for the ‘Uncategorized’ Category

September 21, 2012

Ley de Equidad para Trabajadoras Embarazadas Presentado en el Senado

Escrito por Rachel. Traducido del orginial en inglés Sept. 21, 2012.

Los senadores Bob Casey (Demócrata, Pennsylvania) y Jean Shaheen (Demócrata, New Hampshire) presentaron introdujeron la Ley de Equidad para Trabajadoras Embarazadas esta semana para extender protecciones legales a trabajadoras embarazadas contra la discriminación, protecciones a las que provee el Acta de Americanos con Descapacidades (que no cubre el embarazo) .

Muchas mujeres embarazadas necesitan arreglos sencillos en el trabajo: el permiso de trabajar sentadas, o descansos de baño mas frecuentes. Pero estos arreglos no están protegidos bajo las leyes actuales. Como ejemplo, una trabajadora fue despedida después de cargar y beber agua de una botella, ya que el negocio donde trabajaba tenia una regla prohibiendo empleados de comer y beber durante el trabajo.

Dijo Casey:

Trabajadoras embarazadas enfrentan discriminación en el trabajo todo los días, lo que es un detrimento sin excusa a las mujeres y familias trabajadoras de Pennsylvania y por toda la nación.  Esta ley finalmente extenderá equidad a las mujeres embarazadas para que puedan continuar a contribuir a una economía productiva mientras que progresan con un embarazo sano.

La ley se presentó en la Cámara de Representantes previamente en este verano por el Rep. Jerry Nadler (Demócrata Nueva York) y tiene más de 100 copatrocinantes. Sin embargo, no ha progresado mucho, menos ser referida a varios comités– provocando el comentario de Sheila Bapat de RH Reality Check, “ la ley no estaba yendo a ningún lugar.”

Bapat también nos clarifica las razones por la cuales la Ley de Equidad para Trabajadoras Embarazadas tiene importancia, aunque una Acta contra Discriminación en el Embarazo ha existido desde 1978:

Ya existen leyes que protegen mujeres embarazadas contra la discriminación, pero no han sido interpretado en términos de proteger mujeres que buscan modificaciones a sus responsabilidades en el trabajo. El Acta contra Discriminación en el Embarazo (PDA) se aprobó hace 20 años, y previene la discriminación “a base de embarazo, parto, y condiciones médicas relacionadas.” Pero esta ley ha sido interpretada a proteger solamente a las mujeres que están embarazadas pero que no necesitan modificaciones en su trabajo para continuar, o mujeres embarazadas que ya no pueden seguir trabajando y que necesitan baja por maternidad.

Defensores Nacionales para Mujeres Embarazadas tiene una guía a las leyes que afectan la discriminación contra las mujeres embarazadas en el trabajo en la red  un buen punto de partida para comprender las protecciones que ya existen y los huecos en las leyes actuales, como el Acta de Americanos con Descapacidades y el Acta de Baja Médica y de Familia (“ADA” y “FMLA” en sus siglas ingleses”.

El Centro Nacional de Ley de Mujeres (National Women’s Law Center) está promoviendo la aprobación de la ley, y tiene varias entradas útiles en su blog para profundizar conocimiento sobre el tema. Entradas excelentes incluyen “It Shouldn’t Be A Heavy Lift: Pregnant Workers Fairness Act Introduced in Senate,” y “The Pregnant Workers Fairness Act: What It Means for Low-Wage Working Women.”


August 23, 2011

El CDC Dice que la Mayoría de Hospitales No Apoyan Adecuadamente el Amamantamiento

Escrito por Rachel. Traducido del orginial en inglés August 9, 2011.

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

La semana pasada, el Centro para el Control y la Prevención de Enfermedades dio a conocer un reporte que muestra una baja tasa de amamantamiento en los Estados Unidos, así como la importancia de tener hospitales que asuman un papel positivo en animar y apoyar esta práctica. La información del reportaje viene de una encuesta nacional sobre prácticas y políticas de maternidad.

Los investigadores encontraron que aproximadamente el 90% de los hospitales reportan que proveen educación prenatal para el amamantamiento para enseñar técnicas para amamantar, pero menos de la mitad siguen el resto de las recomendaciones de Los Diez Pasos para Amamantar con Éxito, la lista de políticas y acciones requeridas para ser un hospital o un centro de natalidad adecuado para los recién nacidos. Solo alrededor del 3.5% de los hospitales implementan al menos 9 de las 10 prácticas, las cuales son consideradas como las causantes del aumento en la tasa del amamantamiento, gracias al apoyo que reciben las madres.

Entre los pasos menos seguidos están el tener una política modelo para el amamantamiento (14.4% lo hizo); limitar el uso de formula, agua, o suplementos de glucosa en bebes saludables y apropiadamente amamantados (21.5%); y proveer apoyo adecuado de amamantamiento para madres que están dando de lactar, cuando el hospital les da de alta (26.8%).

Información adiciónale sobre el tema:


July 5, 2011

Tonight: The Consequences of Choosing Boys Over Girls

Boston area readers may be interested in an event happening tonight at the Cambridge Hospital: Mara Hvistendahl, author of “Unnatural Selection: Choosing Boys Over Girls and the Consequences of a World Full of Men” will be speaking about her new book. Mara will be joined by OBOS executive director Judy Norsigian, who will be highlighting some of the reproductive rights-related work of OBOS’ global partners and speaking about the forthcoming edition of “Our Bodies, Ourselves.”

The event begins at 8 p.m. and will take place at the Learning Center A/B on the 3rd floor of The Cambridge Hospital, 1493 Cambridge Street. Hope to see some of you there!


June 29, 2011

UNFPA Releases Report on State of the World’s Midwifery

This month, the United Nations Population Fund (UNFPA) released a report, The State of World’s Midwifery 2011: Delivering Health, Saving Lives. The report stems from concerns about maternal and newborn deaths and lack of adequate health care in many countries. It builds on previous calls for increased midwifery care around the globe, and provides details about how many midwives there are working in various areas around the world. It echoes past calls for increasing access to well-trained midwives as part of a global effort “to realize the right of every woman to the best possible health care during pregnancy and childbirth.”

Parts I and II of the freely available report describe the current state of midwifery around the world, while part III outlines goals for moving forward, including growing midwifery skills and increasing their numbers, enhancing midwifery education, ensuring that proper regulation is in place to keep women safe, encouraging action from professional associations, and more.  It also outlines “Bold Steps” to be taken by governments, regulatory bodies, schools/training associations, professional associations, and international partners and organizations in order to “maximize the impact of investments, improve mutual accountability and strengthen midwifery services.”

The report includes country profiles for 58 nations on the midwifery workforce, education, and regulation, health indicators such as maternal and neonatal mortality, and where women give birth. According to the report, these countries account for 91% of global maternal mortality and 82% of global neonatal mortality, despite representing only 58% of the the world’s births, and have only 17% of the world’s trained midwives, physicians and nurses.

The report is available in English, French and Spanish – on the “Main Report” page, just choose “Change language.”

Also, check out our previous post linking to the UNFPA report from the Strengthening Midwifery conference.


March 30, 2011

Update on Availability of Compounded Progesterone for Preterm Birth

We wrote earlier this week about growing objections to the new, drastically increased price for a drug to prevent preterm birth, now branded as Makena.

One concern has been that cheaper versions of the drug compounded by pharmacies would no longer be available to patients. The company making Makena, KV Pharmaceuticals, previously sent letters to compounding pharmacies instructing them to stop compounding the drug lest they run afowl of FDA regulations. The FDA has now issued a statement in response indicating that the agency:

does not intend to take enforcement action against pharmacies that compound hydroxyprogesterone caproate based on a valid prescription for an individually identified patient unless the compounded products are unsafe, of substandard quality, or are not being compounded in accordance with appropriate standards for compounding sterile products.

The FDA also says the letters send out by KV Pharmaceuticals to pharmacies are “not correct” when they suggest that the agency plans to take action against compounding pharmacies.


December 15, 2010

Understanding Genetic Information and Privacy Concerns

If you follow much health news, you’ve probably noticed the expansion of genetic testing in recent years. Individuals with enough disposable income can now purchase packages of genetic tests focused on health and genealogy for their own personal use, in addition to genetic tests physicians might conduct, such as for BRCA1/2 mutations. All of this testing and information gathering naturally raises privacy concerns, as consumers wonder if their genetic information might be used against them, such as when shopping for a health insurance policy.

The Council for Responsible Genetics has created an online “Consumer Genetic Privacy Manual” to help people understand this relatively new technology and its implications, providing information for the public about the basic science of genetics, genetic discrimination (including existing nondiscrimination acts related to health insurance), current privacy concerns, gene-associated diseases, genetic tests, informed consent, and other issues. The material seems intended for a U.S. audience, and much of it is somewhat technical, but it may be a good starting point for individuals seeking to understand these issues.

For those interested in policy, Genome.gov has more information on genetic discrimination, including legislation, White House statements, and reports. For those who would like to learn more about genes and associated conditions, Genetics Home Reference is a good resource, and the Talking Glossary of Genetic Terms may be a useful reference for understanding and pronouncing the relevant terminology.


October 21, 2010

New Report Details Abuses of HIV-Positive Chilean Women

The Center for Reproductive Rights and Vivo Positivo have released a new report, “Dignity Denied: Violations of the Rights of HIV-Positive Women in Chilean Health Facilities.” The report is the result of 2009-2010 study that included interviews with 27 HIV-positive Chilean women and health care providers, visits to public health facilities, and a review of relevant policies on HIV/AIDS and reproductive rights.

The report provides accounts of coerced and forced sterilization of HIV-positive women, negative attitudes from care providers, including pressure not to have children, and structural barriers to care.

The organizations had previously filed a case before the Inter-American Commission on Human Rights, an international human rights body, on behalf of a Chilean woman who was sterilized without her consent during a cesarean. More information on her story is provided here; she explains:

I was in the recovery room of the Hospital of Curicó when [the nurse] entered and… told me that I was sterilized… It was not my decision to end my fertility; they took it away from me.

Unfortunately her story is not uncommon. For more information, check out the full report.


October 19, 2010

Letters Respond to Lancet Home Birth Editorial With Feminist Perspective

In July, The Lancet published an editorial, “Home Births: Proceed with Caution,” in which the editors discussed the apparent safety of home birth for most low-risk women, contradictory or low-quality evidence on infant outcomes, and the recent, controversial Wax meta-analysis.

Perhaps most likely to cause feminist double-takes was the following comment:

Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.

New letters to the editor in the October 16 issue take on this comment (alongside other letter-writers who describe their perspectives on the Wax methods and conclusions). Susan Bewley et al respond:

Why does The Lancet perpetuate the misuse of language, irresponsible reporting, and paternalism that dog the home birth debate? “Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk:” what humbug! There is no risk-free birth. Life and parenting consist of complex choices and tradeoffs, preferably made with impartial information. “Rights-talk”…becomes a stick to beat “non-compliant” women.

They go on to ask, “Even if home birth was objectively inadvisable, what remedy is proposed-barring the familiar guilt trip and cultural misogyny?”

Another writer comments that if improvements in home birth safety is desired,

The most effective solution would be a call to action for professional organizations and health-care institutions to remedy the problems for both hospital and home births, although it is not as headline-catching as a solution that suggests that women’s informed decision making, and indeed their rights, be curtailed.

For more information about the problems with the Wax meta-analysis, see Planned home birth and neonatal death: Who do we believe?, a post by Science and Sensibility’s Amy Romano.


October 5, 2010

A Letter to “Time” on Home Birth

Last month, Time magazine published an article, American Women: Birthing Babies at Home, which covered the small but increasing number of women choosing home birth, the legal status for providers, safety issues, and the debate over home birth in general. It included commentary on the Wax meta-analysis, summarizing the controversy thusly:

The authors of the paper, which consists of a review of 12 previous studies, acknowledged significant benefits associated with home birth: fewer maternal interventions, including epidurals, episiotomies and C-sections; and fewer cases of premature birth and low birth weight.

But the finding that made headlines was that planned home births led to a two-to-three-times higher risk of neonatal death than planned hospital deliveries among healthy, low-risk women.

Time reporter Catherine Elton notes that the study’s lead author Dr. Joseph Wax “cautions against alarm,” quoting him as stating: “Home birth is quite safe for the baby. But not as safe as a hospital birth.”

Below is an unpublished letter to the editor of Time coordinated by OBOS’s Judy Norsigian:

Catherine Elton’s recent article is a thoughtful analysis of the the fragmented and sometimes underground system of home birth care in the United States, and the reasons women access it in spite of these shortcomings. However, in her discussion of the recent high-profile meta-analysis showing a significantly higher neonatal death rate in home birth compared with hospital birth, Elton states that the meta-analysis included hundreds of thousands of births, but fails to make it clear that the researchers’ calculation of neonatal mortality risk was not based on hundreds of thousands of births…not by a long shot. For reasons that are unclear, the researchers excluded from their neonatal mortality analysis a study that included over a half-million births, leaving fewer than 10,000 planned home births in their calculations of newborn death rates. The large Dutch study that was excluded found identical, very low rates of newborn deaths in the first week of life in both the planned home birth and planned hospital birth groups, and these data come from much more reliable databases than the Washington study, which the meta-analysis researchers included and which Elton acknowledged was flawed. All reliable data on home birth midwifery in regulated and integrated systems like the Netherlands and Canada suggest that home birth is safe for the baby and associated with significant health benefits for the mother.

Sincerely,

Marjorie Greenfield MD, FACOG
Professor, Obstetrics and Gynecology
Division Director, General Obstetrics and Gynecology MacDonald Hospital for Women University
Hospitals Case Medical Center Case Western Reserve University School of Medicine, Cleveland Ohio

Mark Nichols, MD, FACOG, Professor, Chief of General Gynecology & Obstetrics, Oregon Health and
Science University

Elizabeth Allemann, MD, Family Physician, Columbia, MO

Lucy Candib, MD, Professor, Department of Family Medicine and Community Health, University of
Massachusetts Medical School, and Family Health Center of Worcester, MA.

Eugene Declercq, PhD, Professor of Maternal and Child Health, Boston University School
of Public Health Daniel Grossman, MD, FACOG Senior Associate, Ibis Reproductive Health

Michael C. Klein, MD, CCFP, FAAP (Neonatal-Perinatal), FCFP, ABFP, FCPS, Emeritus Professor
Family Practice & Pediatrics, University British Columbia, Sr. Scientist Emeritus, Child and Family
Research Institute, BC Children’s & Women’s Health Centre Vancouver, BC Canada

Michael C. Lu, MD, MPH, Associate Professor of Obstetrics, Gynecology and Public Health, UCLA (Los
Angeles, CA).

Lauren Plante, MD, MPH, FACOG, Associate Professor, Obstetrics & Gynecology, Thomas Jefferson
University (Philadelphia, PA)

Amy Romano, MSN, CNM Author, Science and Sensibility blog: www.scienceandsensibility.org/

Judith Rooks, CNM, MS, MPH, midwife and epidemiologist, Portland, OR

Sara G. Shields, M.D., M.S., FAAFP
Clinical Associate Professor of Family Medicine and Community Health University of Massachusetts
Family Health Center of Worcester, Worcester, MA 01610

Mark Sloan, MD, pediatrician and author of Birth Day: A Pediatrician Explores the Science, the History,
and the Wonder of Childbirth,

Naomi E. Stotland MD, FACOG
Associate Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences University of
California, San Francisco, San Francisco General Hospital

Cornelia van der Ziel, MD, FACOG, obstetrician, Harvard Vanguard Medical Associates, Cambridge,
MA

OBOS urges all readers to share this letter with maternity care providers who may not have had time to fully read or consider potential limitations of the Wax study.


August 23, 2010

Keeping Up With Recalls, the Egg Edition

While it’s not strictly women’s health, I wanted to pass along these resources on keeping up with food recalls (especially in light of the current egg recall estimated to affect around half a million eggs). The resources below can help keep you informed about product safety in this and future recall events.

First, some good resources for keeping up with product recalls in general:

If you have access to a mobile device, there are also apps for tracking recalls, such as these from the U.S. government.

Now, some egg recall-specific resources:


June 28, 2010

The Rising Rate of C-Sections Exemplifies What’s Wrong With U.S. Healthcare

Judy Norsigian, executive director of Our Bodies Ourselves, and Timothy R. B. Johnson, MD, chair of the Department of Obstetrics and Gynecology at the University of Michigan and an OBOS advisory board member, have penned an op-ed in today’s Boston Globe on the high cost of medically unnecessary caesarean sections, both in terms of a mother’s health and rising medical costs:

Even though caesareans are associated with higher rates of complications than vaginal births, they are becomingly increasingly common. Problems range from infections, including the more serious antibiotic-resistant ones, to blood clots, prematurity, respiratory problems for the baby, and more complications with subsequent pregnancies. There is even a small but measurably higher risk of death for the mother.

Between 2000 and 2006, while the Massachusetts caesarean rate climbed from 16th to 10th highest among all states, the state’s ranking on neonatal mortality has slipped from 4th best to a tie for 9th. Six hospitals in the state have caesarean rates greater than 40 percent for first time mothers, yet none of these hospitals is designated as a high-risk center. So much for the argument that high-risk pregnancies are the reason for these rates.

There are also cost consequences for taxpayers — the caesarean rate for Massachusetts mothers on Medicaid is increasing at a faster pace than among privately insured mothers. Nationally, in 2008, average hospital charges for an uncomplicated caesarean section were $14,894, while such charges for an uncomplicated vaginal birth were $8,919.

In the United States, about one in three births are via c-section, and in some communities the rate is much higher.  Childbirth Connection explains the myriad conditions that have led to the increase, including: low priority of enhancing women’s own abilities to give birth; side effects of common labor interventions; refusal to offer the informed choice of vaginal birth; casual attitudes about surgery and cesarean sections in particular; limited awareness of harms that are more likely with cesarean section; providers’ fears of malpractice claims and lawsuits; and incentives to practice in a manner that is efficient for providers.

In the op-ed, Norsigian and Johnson argue that while the media often focuses on how extreme obesity can raise the risk of having a caesarean, more emphasis is needed on “system-based approaches” — steps that hospitals and obstetricians can take, such as instituting policies that restrict the induction of labor, unless there is a good medical reason, and following the new National Institute of Health recommendations to offer the option of vaginal birth after a caesarean for women who want to avoid repeat surgery.

Finally, they note, hospitals should expand access to nurse-midwifery care:

Enhancing access to midwifery care might well be the most effective approach to safely reducing the overall caesarean rate — and could lead to significant cost savings and improvement in other priority areas such as breastfeeding. It would also address the impending shortage of obstetric providers. The Legislature should pass a bill to expand access to midwifery care in Massachusetts. We must finally make midwives more central in maternity care — as do all other countries whose birth outcomes are superior to ours.

Read the full op-ed here.

Related:
* Vaginal Birth after Cesarean — What the NIH has to say

* ACOG on VBAC: In Their Own Words


June 1, 2010

Debate Ensues on Over-the-Counter Genetic Testing

Earlier this month, a company announced its plan to offer over-the-counter genetic testing kits. The news generated considerable debate, as this would be the first time an over-the-counter genetic test has been available directly to the public.

The FDA, though, responded to this plan with a letter to the company indicating that their product met the definition of a medical device and would therefore require FDA approval. The agency indicated that they could find no such approval on file, and asked the company to respond within 15 days with either an FDA approval number or an argument for why one shouldn’t be needed.

The House Committee on Energy and Commerce has also jumped into the fray. In a letter [PDF] to the company planning to offer OTC kits, the committee asked for, among other things “All documents relating to the ability of your genetic testing products to accurately identify consumer risk,” and “All documents regarding your policies for processing and use of individual DNA samples collected from consumers.”

This is not the first time, however, that genetic testing has been available to consumers – other companies have been offering what is essentially mail order genetic testing, including testing for BRCA mutations. The Committee also sent letters to two other companies which have been offering these services, such as 23andme.

Aside from issues of FDA approval, the presence or absence of mutations does not tell the whole story of an individual’s health risk. For example, in the case of BRCA1 and BRCA2 mutations, a positive or negative test cannot specifically predict whether or when an individual woman might develop cancer (or determine that she will not develop cancer). As Merrill Goozner of Gooznews on Health explains:

…Mary Claire King discovered that women in families with a history of breast cancer had common mutations of the BRCA1 and BRCA2 genes. But it’s important to remember that you can have the relevant mutations and not develop the disease.

Similarly, the National Cancer Institute explains the limitations of what can be known from a positive or negative test:

A positive test result generally indicates that a person has inherited a known harmful mutation in BRCA1 or BRCA2 and, therefore, has an increased risk of developing certain cancers… However, a positive test result provides information only about a person’s risk of developing cancer. It cannot tell whether an individual will actually develop cancer or when. Not all women who inherit a harmful BRCA1 or BRCA2 mutation will develop breast or ovarian cancer… Having a true negative test result does not mean that a person will not develop cancer; it means that the person’s risk of cancer is probably the same as that of people in the general population.

The Institute also recommends genetic counseling prior to testing in order to discuss the risks and benefits of such testing and the implications of a positive or negative result. The debate over whether over-the-counter genetic testing is appropriate without such counseling is likely, I think, to follow along similar lines as the debate over the elimination of required counseling for HIV testing since the availability of over-the-counter testing. Although the specifics and rationale are a little different, both discussions include a component of whether consumers can fully utilize or react to results without further counseling or intervention.

The bloggers at Genetic Future and Genomics Law Report have more.


May 19, 2010

Quick Hit: Campaign To End Chronic Pain in Women Site Launched

Last week we noted that a new Campaign to End Chronic Pain In Women would be launching today, led by the Overlapping Conditions Alliance. The site for the campaign is now available at http://endwomenspain.org.


May 4, 2010

Quick Hit: Disaster Preparedness Tips for Women

As some of you may know, I’m based in Nashville, TN, where we have had significant flood damage over the past several days. This seems like a good time, then, to share some resources about disaster/emergency preparedness.

Some resources specific to women:

  • womenshealth.gov: Disaster or Emergency Preparedness Plan for Women (includes information on breastfeeding during an emergency)
  • National Library of Medicine: Special Populations: Emergency and Disaster Preparedness (includes information for women and on pregnancy, as well as for individuals with disabilities, materials in Spanish, and other resources)
  • Association of Women’s Health, Obstetric and Neonatal Nurses: Emergency Preparedness for Women & Infants (round-up of links to relevant CDC and other materials, clinical advisories, and journal articles)
  • CDC: Emergency Planning Tips If You’re Pregnant or Have Young Children

  • February 26, 2010

    Calls for Support of Birth-Related Legislation at State and Federal Levels

    A bill has passed in the Mississippi House that could effectively make  midwives who are not also trained as nurses illegal in the state. The bill states that “the practice of midwifery shall only be conducted by Certified Nurse Midwives; to provide that any person who is not a Certified Nurse Midwife who engages in the practice of midwifery shall be subject to criminal penalties and injunctive relief.”

    The bill would make it illegal for Certified Professional Midwives — midwives who who are specially trained to deliver babies in out-of-hospital settings– to practice.

    Right now, the Midwives Alliance of North America (MANA) categorizes the current situation in Mississippi for non-nurse midwives as “Legal by Judicial Interpretation or Statutory Inference” – in other words, interpreted to be legal but not explicitly provided for in the current law.

    The organization provides some documentation from the previous MS Attorney General who concluded in 1991 that, “By its express terms, the practice of medicine as defined in Miss. Code Ann. Section 73-25-33 specifically excludes the practice of midwifery. Thus, it is the opinion of this office that those persons otherwise not licensed as nurses may engage in the practice of midwifery without licensure as a physician and for compensation.”

    The current bill, which would add language to explicitly make non-CNM midwives illegal, passed the state House on February 9th and has been referred to Public Health and Welfare committee in the state Senate, whose members bill opponents are contacting. That committee consists of: Hob Bryan, Chairman; Alan Nunnelee, Vice-Chairman; Terry C. Burton; Eugene S. Clarke;Bob M. Dearing; Joey Fillingane; Hillman Terome Frazier; Billy Hewes; W. Briggs Hopson III; John Horhn; Cindy Hyde-Smith; Gary Jackson; Kenneth Wayne Jones; Tom King; Chris McDaniel; Nolan Mettetal; Willie Simmons; Bennie L. Turner; Lee Yancey. Contact information for each Senator is linked from this Senate roster.

    MANA is encouraging supporters of Certified Professional Midwives who live in Mississippi to contact their state Senators. Tell them that you do NOT support making Certified Professional Midwives illegal, and ask them to vote NO on HB 695.

    In other birth-related legislative news, the American Association of Birth Centers is asking supporters to contact their Senators and Representatives to support the Medicaid Birth Center Reimbursement Act (H.R. 2358 / S. 1423). For further information, see our previous post and information provided by AABC.