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Health

How abortion ban exceptions muddy ethical care for pregnant patients

"How imminent must death be?"

woman in a doctor's office getting an ultrasound

Obstetricians are facing impossible dilemmas with abortion care in some states.

When the Dobbs decision overturned Roe v. Wade in the summer of 2022, experts warned that there would be medical consequences. Politicians have made abortion a black-and-white issue when it's a vast ocean of gray, and doctors are now stuck in dilemma after dilemma in states like Tennessee, which enacted some of the strictest abortion laws in the nation in the wake of Dobbs.

In Tennessee, it is now a Class C felony to perform an abortion. Exceptions are made for rape and incest, ectopic pregnancy, molar pregnancy, and if "the abortion was necessary to prevent the death of the pregnant woman or to prevent serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman."

But as OB-GYN Sarah Osmundson explained on Radio Atlantic, that last exception is "very gray." Working as a maternal-fetal specialist at Vanderbilt University Medical Center, Osmundson serves on the abortion committee that decides whether a doctor has the green light to perform an abortion to save a mother's life or bodily function. In an interview with Hanna Rosin, Dr. Osmundson shared how making those calls can feel like an impossible task as providers walk the line between ethical care and the threat of legal action.

Osmundson explained that it's unclear what the exceptions to the law even mean because there's no predictable line for when a patient will cross over into imminent death or permanent injury. "It is a continuum of risk," she said. "Where is the cut point that we have to decide some aspect of risk is too high?"

Some cases are cut-and-dried, she said, but others present a conundrum for those who are tasked with assessing whether the risk to a mother's life or health is high enough to warrant an abortion. There are no clear thresholds, especially since risk assessment isn't an exact science.

She offered an example of a patient who has diabetes combined with an autoimmune condition, but they're both currently well managed, on top of kidney disease.

"You know, these are the kind of cases where we’re really trying to guess at: What is their risk of death or serious morbidity?" she said. "And even when I see these patients in the office, like, I can’t sit down with them and say, Your risk is X percent. I don’t have data to drive that individual case. Maybe their risk of serious problems in pregnancy is like 5 percent."

Osmundson pointed out that some patients choose not to screen for chromosomal abnormalities with an amniocentesis because there's a 0.1% risk of complication and they decide it's not worth the risk. "So we don’t do certain things because of very low risk. How am I to say that a risk of 5 percent is too low of a risk?" she asked.

Dr. Lisa Harris, an OB-GYN and professor at the University of Michigan, posed a similar questions to NPR shortly after the Dobbs decision was announced.

"How imminent must death be?" Harris asked. "There are many conditions that people have that when they become pregnant, they're OK in early pregnancy, but as pregnancy progresses, it puts enormous stress on all of the body's organ systems – the heart, the lungs, the kidneys. So they may be fine right now – there's no life-threatening emergency now – but three or four or five months from now, they may have life-threatening consequences."

Osmundson gave a specific example along those lines that posed a problem for some doctors on her committee. A woman was 14 weeks pregnant with a fetus that had no skull, which meant it had no chance of survival but an increased risk of excessive amniotic fluid, which could threaten the mother's life. Osmundson thought the case warranted an abortion, but others on the committee wouldn't commit, with one saying they weren't "brave enough."

The doctors were concerned about the way the decision would be scrutinized and the potential legal consequences if someone brought the case to court. Dr. Louise King, an OB-GYN at Boston's Brigham and Women's Hospital, had warned of this scenario when Roe v. Wade was overturned.

"Laws will exist that ask [physicians] to deprioritize the person in front of them and to act in a way that is medically harmful," King told NPR. "And the penalty for not doing so will be loss of license, money loss, potentially even criminal sanctions."

The reality Osmundson described in the Radio Atlantic interview demonstrates how prescient that warning truly was.

"I feel like I’m making a decision thinking about: How would our attorney general interpret this? How would the optics appear? And it makes me feel really uncomfortable, as a physician, that I’m considering care for the optics, rather than for what is right and best for the patient," she said.

Legal abortion ban exceptions like "to prevent the death of the pregnant woman or to prevent serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman" may sound straightforward to the average person, in the reality of medicine, it's not. Doctors aren't magicians or oracles, they don't have a crystal ball that tells them if a patient is going to live or die or be irreparably harmed—they make their best guesses based on their deep well of knowledge and experience, which lawyers and politicians deciding on legal boundaries don't have. Abortion restrictions and exceptions like Tennessee's force doctors to think as lawyers and lawyers to think as doctors when they don't have the training for it, all while people's lives hang in the balance.

The ambiguity in risk thresholds also makes these legal questions impossible to navigate. As Osmundson pointed out, a 5% risk is actually quite high, especially when it's your own life on the line. That's a hard enough choice for a person to make for themselves, much less a choice we should expect a doctor to make for someone based on political decisions and legal judgments made by people with no experience in the intricacies of medicine.

The challenges are even causing some doctors to leave states where they feel they can't care for patients properly. Kylie Cooper, MD was a maternal-fetal specialist who moved from Idaho to Minnesota in the wake of the Dobbs decision.

“My husband and I would talk about this every day. It was consuming us,” she told the AAMC. “What if I lost my license? What would happen to our kids if I went to jail? What about my guilt if I didn’t help a sick patient to my fullest ability? It was a nightmare. I didn’t feel I could remain a health care provider in a place where I couldn’t help a patient sitting right in front of me. It was unbearable.”

And for many, it doesn't seem to be a matter of making the law clearer. There are simply too many factors on an individual patient basis for more clarity in the law to even be possible, much less helpful, while also preserving a doctor's ethical standards of care.

So what's the answer?

The simplest answer is medical privacy—the protection that was provided by Roe. v. Wade—which was argued for and passed by the majority of Republican-nominated Supreme Court Justices, by the way—for doctors and patients together to decide on healthcare decisions without government interference. We were warned by doctors of what would happen when abortion laws were left fully up to each state, and now we're seeing those consequences play out in state after state.

After going through various challenging scenarios, Osmundson summed up the crux of the issue with two questions that every person ought to consider: "Do you want your cancer doctor to be considering the opinion of an attorney general when they’re making recommendations about your cancer care? Why would you want those kind of external things involved in your care during pregnancy?"

Listen to Dr. Osmundson's enlightening Radio Atlantic interview here.

via Pixabay

A sad-looking Labrador Retriever

The sweet-faced, loveable Labrador Retriever is no longer America’s favorite dog breed. The breed best known for having a heart of gold has been replaced by the smaller, more urban-friendly French Bulldog.

According to the American Kennel Club, for the past 31 years, the Labrador Retriever was America’s favorite dog, but it was eclipsed in 2022 by the Frenchie. The rankings are based on nearly 716,500 dogs newly registered in 2022, of which about 1 in 7 were Frenchies. Around 108,000 French Bulldogs were recorded in the U.S. in 2022, surpassing Labrador Retrievers by over 21,000.


The French Bulldog’s popularity has grown exponentially over the past decade. They were the #14 most popular breed in 2012, and since then, registrations have gone up 1,000%, bringing them to the top of the breed popularity rankings.

The AKC says that the American Hairless Terrier, Gordon Setter, Italian Greyhound and Anatolian Shepherd Dog also grew in popularity between 2021 and 2022.

The French Bulldog was famous among America’s upper class around the turn of the 20th century but then fell out of favor. Their resurgence is partly based on several celebrities who have gone public with their Frenchie love. Leonardo DiCaprio, Megan Thee Stallion, Alexandra Ocasio-Cortez, Reese Witherspoon and Lady Gaga all own French Bulldogs.

The breed earned a lot of attention as show dogs last year when a Frenchie named Winston took second place at the Westminster Kennel Club Dog Show and first in the National Dog Show.

The breed made national news in early 2021 when Gaga’s dog walker was shot in the chest while walking two of her Frenchies in a dog heist. He recovered from his injuries, and the dogs were later returned.

They’ve also become popular because of their unique look and personalities.

“They’re comical, friendly, loving little dogs,” French Bull Dog Club of America spokesperson Patty Sosa told the AP. She said they are city-friendly with modest grooming needs and “they offer a lot in a small package.”

They are also popular with people who live in apartments. According to the AKC, Frenchies don’t bark much and do not require a lot of outdoor exercise.

The French Bulldog stands out among other breeds because it looks like a miniature bulldog but has large, expressive bat-like ears that are its trademark feature. However, their popularity isn’t without controversy. “French bulldogs can be a polarizing topic,” veterinarian Dr. Carrie Stefaniak told the AP.

american kennel club, french bulldog, most popular dog

An adorable French Bulldog

via Pixabay

French Bulldogs have been bred to have abnormally large heads, which means that large litters usually need to be delivered by C-section, an expensive procedure that can be dangerous for the mother. They are also prone to multiple health problems, including skin, ear, and eye infections. Their flat face means they often suffer from respiratory problems and heat intolerance.

Frenchies are also more prone to spine deformations and nerve pain as they age.

Here are the AKC’s top ten most popular dog breeds for 2022.

1 French Bulldogs

2 Labrador Retrievers

3 Golden Retrievers

4 German Shepherd Dogs

5 Poodles

6 Bulldogs

7 Rottweilers

8 Beagles

9 Dachshunds

10 German Shorthaired Pointers


This article originally appeared on 03.17.23

Representative Image from Canva

There's no way they didn't understand what she was saying.

Okay, so maybe dogs don’t understand everything we tell them exactly as a human would. But is that gonna stop us from having full blown conversations with them? Of course not. And the times they do seem to comprehend what’s being communicated—pure comedy.

Take this dog mom’s hilarious pre-grooming pep talk with Shih-Tzus Branston, Pickle and Gizmo. She minced no words telling them exactly how this trip was gonna go. And the message seemed to be received.

Branston (the troublemaker, apparently) got a firm warning of what not to do, including telling white lies about his upbringing.

“I don’t need you running in telling the first dog you see that this is what this is what your hair used to look like when you lived in the Bronx running up and down the block, cause I know for a fact, Branston, that you live in a rural village,” she tells him.

Viewers, however, seemed on board with Branston’s Bronx-affiliation, even if it was a little white lie. One person joked, “don’t be mad at the treats that I got, I’m still Branny from the block.”

In the video, Branston is also instructed to not tell everyone that he “identifies as a BUll Mastiff,” which gets the most adorable look of disappointment for wee little Branston.

As for Gizmo and Pickle—mom’s best advice is to pretend like they don’t know Branston.

Perhaps the best part is mom’s British accent, which makes the entire clip feel like something pulled straight outta “Ted Lasso.” That, or the complete shock the Shih-tzu trio has at being informed of their weight class.

Watch:

@branstonandpickle01 Your NOT from the Bronx and you never ran up and down the block!! #dogsoftiktok #peptalktoyourdog #branstonwehavearrived #shihtzusoftiktok #peptalkbranston #funnydogvideos #funnyvideos #nyc #bronx #funny #dogs #dogtok ♬ original sound - Branston,Pickle&Gizmo

Perhaps Branston, Pickle, and Gizmo’s mom isn’t totally off-base by giving them a talking to. According to the website allshihtzu.com, this breed had a “unique intelligence,” which gets best demonstrated by their attuned, empathic connection to their human families. Meaning that while they might not have the same kind of smarts as border collies or other herding dogs, their super power is picking up social cues.

And, again, even if they had no earthly idea what their mom was saying, odds are she’d still be talking to them anyway. Why? Because pets are our babies. And baby talk is fun.jk

Island School Class, circa 1970s.

Parents, do you think your child would be able to survive if they were transported back to the '70s or '80s? Could they live at a time before the digital revolution put a huge chunk of our lives online?

These days, everyone has a phone in their pocket, but before then, if you were in public and needed to call someone, you used a pay phone. Can you remember the last time you stuck 50 cents into one and grabbed the grubby handset?

According to the U.S. Federal Communications Commission, roughly 100,000 pay phones remain in the U.S., down from 2 million in 1999.

Do you think a 10-year-old kid would have any idea how to use a payphone in 2022? Would they be able to use a Thomas Guide map to find out how to get somewhere? If they stepped into a time warp and wound up in 1975, could they throw a Led Zeppelin album on the record player at a party?


Another big difference between now and life in the '70s and '80s has been public attitudes toward smoking cigarettes. In 1965, 42.4% of Americans smoked and now, it’s just 12.5%. This sea change in public opinion about smoking means there are fewer places where smoking is deemed acceptable.

But in the early '80s, you could smoke on a bus, on a plane, in a movie theater, in restaurants, in the classroom and even in hospitals. How would a child of today react if their third grade teacher lit up a heater in the middle of math class?

Dan Wuori, senior director of early learning at the Hunt Institute, tweeted that his high school had a smoking area “for the kids.” He then asked his followers to share “something you experienced as a kid that would blow your children’s minds.”


A lot of folks responded with stories of how ubiquitous smoking was when they were in school. While others explained that life was perilous for a kid, whether it was the school playground equipment or questionable car seats.

Here are a few responses that’ll show today’s kids just how crazy life used to be in the '70s and '80s.

First of all, let’s talk about smoking.

Want to call someone? Need to get picked up from baseball practice? You can’t text mom or dad, you’ll have to grab a quarter and use a pay phone.

People had little regard for their kids’ safety or health.

You could buy a soda in school.

Things were a lot different before the internet.

Remember pen pals?

A lot of people bemoan the fact that the children of today aren’t as tough as they were a few decades back. But that’s probably because the parents of today are better attuned to their kids’ needs so they don't have to cheat death to make it through the day.

But just imagine how easy parenting would be if all you had to do was throw your kids a bag of Doritos and a Coke for lunch and you never worried about strapping them into a car seat?


This article originally appeared on 06.08.22

What is Depression?

In the United States, close to 10% of the population has depression, but sometimes it can take a long time for someone to even understand that they have it.

One difficulty in diagnosis is trying to distinguish between feeling down and experiencing clinical depression. This TED-Ed video from December 2015 can help make the distinction. With simple animation, the video explains how clinical depression lasts longer than two weeks with a range of symptoms that can include changes in appetite, poor concentration, restlessness, sleep disorders (either too much or too little), and suicidal ideation. The video briefly discusses the neuroscience behind the illness, outlines treatments, and offers advice on how you can help a friend or loved one who may have depression.


Unlike the many pharmaceutical ads out there with their cute mascots and vague symptoms, the video uses animation to provide clarity about the mental disorder. It's similar in its poignant simplicity to the HBO short documentary "My Depression," based on Liz Swados' book of the same name.


This article originally appeared on 08.17.19

New baby and a happy dad.


When San Francisco photographer Lisa Robinson was about to have her second child, she was both excited and nervous.

Sure, those are the feelings most moms-to-be experience before giving birth, but Lisa's nerves were tied to something different.

She and her husband already had a 9-year-old son but desperately wanted another baby. They spent years trying to get pregnant again, but after countless failed attempts and two miscarriages, they decided to stop trying.


Of course, that's when Lisa ended up becoming pregnant with her daughter, Anora. Since it was such a miraculous pregnancy, Lisa wanted to do something special to commemorate her daughter's birth.

So she turned to her craft — photography — as a way to both commemorate the special day, and keep herself calm and focused throughout the birthing process.

Normally, Lisa takes portraits and does wedding photography, so she knew the logistics of being her own birth photographer would be a somewhat precarious new adventure — to say the least.

pregnancy, hospital, giving birth, POV

She initially suggested the idea to her husband Alec as a joke.

Photo by Lisa Robinson/Lisa Robinson Photography.

"After some thought," she says, "I figured I would try it out and that it could capture some amazing memories for us and our daughter."

In the end, she says, Alec was supportive and thought it would be great if she could pull it off. Her doctors and nurses were all for Lisa taking pictures, too, especially because it really seemed to help her manage the pain and stress.

In the hospital, she realized it was a lot harder to hold her camera steady than she initially thought it would be.

tocodynamometer, labor, selfies

She had labor shakes but would periodically take pictures between contractions.

Photo by Lisa Robinson/Lisa Robinson Photography.

"Eventually when it was time to push and I was able to take the photos as I was pushing, I focused on my daughter and my husband and not so much the camera," she says.

"I didn't know if I was in focus or capturing everything but it was amazing to do.”

The shots she ended up getting speak for themselves:

nurse, strangers, medical care,

Warm and encouraging smiles from the nurse.

Photo by Lisa Robinson/Lisa Robinson Photography.

experiment, images, capture, document, record

Newborn Anora's first experience with breastfeeding.

Photo by Lisa Robinson/Lisa Robinson Photography.

"Everybody was supportive and kind of surprised that I was able to capture things throughout. I even remember laughing along with them at one point as I was pushing," Lisa recalled.

In the end, Lisa was so glad she went through with her experiment. She got incredible pictures — and it actually did make her labor easier.

Would she recommend every mom-to-be document their birth in this way? Absolutely not. What works for one person may not work at all for another.

However, if you do have a hobby that relaxes you, figuring out how to incorporate it into one of the most stressful moments in your life is a pretty good way to keep yourself calm and focused.

Expecting and love the idea of documenting your own birthing process?

Take some advice from Lisa: "Don't put pressure on yourself to get 'the shot'" she says, "and enjoy the moment as much as you can.”

Lisa's mom took this last one.

grandma, hobby, birthing process

Mom and daughter earned the rest.

Photo via Lisa Robinson/Lisa Robinson Photography.

This article originally appeared on 06.30.16