Louisiana health care deserts put women and babies at risk, advocates and doctors say | 60 minutes

A Louisiana hospital sent a mother home “with a prayer” as she miscarried, she said.

Caitlin Joshua had an ultrasound at Women’s Hospital in Baton Rouge. They examined her and observed her. There she says that the treatment is over.

“So I said, ‘Okay – so is this a miscarriage?’ And the young lady, she said, “I–I can’t tell you that right now. I don’t know.” And I said, “Well, what do you mean you don’t know? We did the ultrasound,” Joshua said. “I remember her saying ‘we’re just sending you home with a prayer, we’ll hope for the best.’

Women’s Hospital told 60 Minutes, “It’s complicated…when the diagnosis of early pregnancy loss is unclear, the standard of care is to wait.”

The next day, when the bleeding and cramping became unbearable, Joshua sought help from a second hospital, Baton Rouge General, where a doctor scheduled another ultrasound

“She just said, ‘That doesn’t look like a baby at all.’ Are you sure you’ve ever been pregnant? It just looks like a cyst,” Joshua told 60 Minutes correspondent Sharyn Alfonsi.

Caitlin Joshua with her family

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At both hospitals, Joshua said health care providers avoided directly answering her questions about whether she had miscarried. Joshua said her discharge papers noted only a “potential” miscarriage.

“I just have to believe, and I know that it’s just the vagueness of the abortion ban in this state that’s the reason there’s so much fear among doctors doing their jobs,” Joshua said.

A spokesperson for Baton Rouge General said every patient is different. They said that since the abortion ban began, “they have not changed the way they deal with miscarriages or the options available” for their treatment. Discharge instructions from the hospital left Joshua with one option – take Tylenol and watch for worsening symptoms

Since the new law was enacted, banning abortions in most cases, many doctors in Louisiana have been afraid to provide care commonly used to treat miscarriages — such as D-and-Cs, a surgical procedure or the pill — because those same methods are used in abortions and could now be seen as illegal in Louisiana – potentially landing health care providers in jail.

Getting maternity care in the state was already a challenge before the law was passed. The US has the sad distinction of having one of the highest rates of pregnancy-related deaths in the developed world, according to the World Health Organization. Women in the US are 10 or more times more likely to die from pregnancy-related causes than mothers in Poland, Spain or Norway. Some of the worst statistics come from the South, where deep pockets of poverty, health care deserts and racial discrimination have long put women and their babies at greater risk.

Where you live can increase your risk. A third of Louisiana’s 64 parishes are maternal health deserts without a single midwifery provider, according to the March of Dimes. More than 51,000 women in the state are left without easy access to care. They are three times more likely to die from pregnancy-related causes, according to a Tulane University study published in Women’s Health Issues

Doctors are scarce in Assumption Parish, a rural county of 21,000. Mothers Teresa DuBois and Brittany Cavalier, who are expecting their third child, have to travel 45 minutes to the nearest pediatrician and up to an hour and 35 minutes to get to the nearest OB-GYN.

Sharyn Alfosni walks with Brittany Cavalier and Theresa Dubois

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“Oh, it’s a nightmare,” DuBois said. “It’s a lot. It’s very emotional. It’s a lot in the car. It’s just a lot on your body just waiting so long to get help.”

The only hospital in Assumption is not equipped to deliver babies. Mothers would have to drive more than an hour to reach hospitals in Baton Rouge to give birth.

“I mean, we’re supposed to be one of the best countries in the world. And you’re just leaving women out to dry,” Cavalier said.

Doctors, advocates and mothers are leading the charge to improve maternal health conditions across the state. Dr. Rebecca Gee, OB/GYN, former Secretary of Health and founder of Nest Health, a primary health care service for families, has spent her career advocating for better maternal care in Louisiana.

As Secretary of Health, Gee works with the state board that reviews every maternal death in Louisiana. The board found that 80 percent of all pregnancy-related deaths in Louisiana are potentially preventable. Thirty-nine out of every 100,000 mothers die during or shortly after childbirth in the state, according to the Centers for Disease Control and Prevention.

“High caesarean section rates have contributed, lack of access to care for women before and after pregnancy,” she said. “Fifty percent of the time, women don’t get that postpartum care, which means they have untreated hypertension, untreated diabetes, untreated depression. The fact that we have racial bias in health care. And so all of these things are compounded and especially worse for low-income women.”

Black women are among the most endangered; they are up to four times more likely than white women to die during or after childbirth in Louisiana, according to the state Department of Health. Dr. Gee said that when she was medical director, workers were told they were not allowed to show medical records that showed health discrepancies.

“Because the political elite didn’t want to admit there were inconsistencies,” she said.

These discrepancies are why birth nurse Latona Giwa co-founded the New Orleans-based Birthmark Doula Collective in 2011. Last year, they worked with 2,000 mothers.

“We live in a country that does not guarantee insurance coverage and health care for all, there is disparate and discriminatory care,” Giwa said. “Black and brown people are more likely to be on Medicaid. They go to practices that are busier, that see more patients. And here comes the doula.”

Birth nurse Latona Giwa co-founded the Birthmark Doula Collective in New Orleans in 2011.

Recent studies have shown better birth outcomes in black women who have had doula care. Birthmark’s work in Louisiana has caught the attention of the advocacy group Every Mother Counts, which was founded by model Christy Turlington. Turlington became an advocate for mothers after her own complications during childbirth. Her organization focuses resources on countries that have high maternal mortality rates, she said.

“The United States is one of eight countries that has actually had an increase in maternal mortality,” Turlington said. “So we’re certainly on the bottom rung.”

Last year, Every Mother Counts gave away more than $1 million to groups focused on strengthening maternal care in the US. It’s a mission that became even more difficult last summer. After Roe v. Wade was overturned by the Supreme Court in June, Louisiana enacted a broad abortion ban. The ban caused a domino effect across the state.

Organizations that advocate for mothers face difficult challenges. Last summer, Louisiana Attorney General Jeff Landry sent a letter to doctors about the new abortion ban, leaving many maternal care providers in the state feeling paralyzed.

Dr. Jennifer Aveno, an emergency physician and current director of the New Orleans Health Department, said Landry’s letter made doctors afraid to act. When 60 Minutes reached out to multiple providers across the state about maternal care, officials said they were afraid to talk. Dr. Aveño felt that her voice should be heard on the matter.

“We cannot afford to compromise on maternal morbidity and mortality,” Aveño said. “If we can’t support mothers and they have adverse outcomes or die, it affects the family throughout its life. I worry that we’re going to see a deterioration in our morbidity and mortality rates—simply because of access and simply because of fear.”

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