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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.

Planet

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via Pixabay

One of the most wonderful things about having a dog is how attached they become to their owners. I work from home and my Jack Russel terrier, Scout, lies next to me on his bed for most of the day. The only time he leaves my office is for a sip of water or to go outside and sun his belly on the porch.

That's why whenever I leave the house and can't take Scout with me, I wonder, "Does he miss me? Is he sad that he's alone?" Studies show that our dogs miss us the moment we leave the house and that feeling slowly intensifies until we are gone for about four hours and they have a "plateau of melancholy." That's why the longer you're away, the more excited your dog is when you return home.

The moment I pull up in my car Scout begins to howl like a wolf trying to contact someone who's miles away. It's like, "Dude, I'm 30 feet away. Give me a second to grab the groceries out of the trunk."

Researchers from the Universities of Pisa and Perugia, Italy have found that if you give your dog some affection before you leave the house they'll have less anxiety while you're away.

They conducted experiments with 10 dogs between the ages of one and 11 without attachment issues. The group was composed of seven mixed-breed dogs, one Labrador retriever, one Hovawart, and one Chihuahua.

Participants in the study walked their leashed dogs into a fenced area where they were greeted by a researcher who took their dog's heart rate. In the first test, after the owners walked their dogs into the area, they talked with a researcher for one minute then left without giving the dog any special attention.

In the second test, the dog owners petted the dog during their interaction with the researcher.

In both tests, the owners left the fenced area and hid far enough away so that the dog couldn't smell them.

After the owners left, the dogs looked for them for about three minutes on average. After the owners returned, the researchers measured the dogs' levels of the stress hormone cortisol as well as their heart rates.

The researchers found that whether the dogs were petted or not, their cortisol levels were unchanged. But their heart rate showed a marked decrease if the owners petted them before leaving. Researchers later watched videos of the dogs and found that the ones that were petted showed " behaviors indicative of calmness for a longer period while waiting for the owner's return."

Next time I'm ready to leave the house and Scout follows me to the front door after saying, "Sorry bud, you can't go with me on this trip," I'll kneel down and give him a little extra love and attention.

Maybe that way he won't howl like the house is on fire when I pull up in my car after a trip to the grocery store.

This article originally appeared four years ago.

Health

25-year-old U.S. mom is shocked after receiving an astronomical bill from baby's NICU stay

For starters, the hospital charged it cost $4,337 every time they moved the baby's room.

A woman looks at a massive medical bill.

Twenty-five-year-old Janice Hernandez, who goes by @JaniceHeartss on TikTok, has her hands and heart full after her baby, born in late October, was diagnosed with Prader-Willi syndrome (PWS). PWS is a rare genetic condition that leads to physical, mental, and behavioral problems. A key feature of Prader-Willi syndrome is a sense of always being hungry. It also results in poor muscle tone, distinct facial features, and a poor sucking reflex. It can also lead to behavioral problems down the line.

To make things worse for Hernandez, after her baby spent 7 weeks in the NICU, she received a bill in the mail, and it’s the cost of two to three houses in some parts of the United States. “I just got the bill for my daughter's NICU stay,” she said in a video with over 3.5 million views. "Do you guys wanna know how much it is? Do you wanna converse or have a conversation about the price? $738,360 freaking dollars. Almost a million dollars.”

That’s right, $738,360 freaking dollars.

@janiceheartss

Anyone actually pay their medical debt ooooorrrrrrrrr??? #nicumama #nicubaby #nicuwarrior

Hernandez then looked at the itemized bill and found she was charged astronomical amounts for everyday items and services. “For example, I noticed on the bill that there is a little tiny tube of Aquafor that they gave me that I actually still have $25. $25 for a tiny tube of Aquaphor that I thought the nurse was just giving me to be cute and give it for free. No, ma'am, they made sure to charge every single little thing,” Hernandez continued.

In a follow-up video, she shared that it cost $4,337 every time the staff switched her baby’s room. “Imagine if I didn't have insurance," she said according to Daily Mail, I'd have to pay all of this. 'Here in America, just to breathe costs money, and so, of course, when you step foot into a hospital, they start charging you automatically.”

How much money do Americans owe in medical debt?

Hernandez’s piece struck a chord with many Americans who have also received huge medical bills. A 2021 study found that Americans owe at least $220 billion in medical debt. Approximately 14 million people (6% of adults) owe at least $1,000, and 3 million (1% of adults) owe more than $10,000.

"Damn, how long was she in for? Our daughter was in the NICU for three weeks, and ours was $147k," Kristina asked in the comments. "My son died in the NICU after 4.5 months, and our bill was $6 million," Kaori added. "They charged me $2500 a night for the nursery that my baby never even went to. They also didn’t have a nursery," another user wrote.

Many people who live in developed countries where healthcare is free found the three-quarters-of-a-million-dollar bill astonishing. "In Saudi Arabia, all medical bills are covered by the government," one user wrote. "As a Canadian, I genuinely can not understand this," another added. "Genuine question from someone not located in the US: How on Earth do people pay these massive costs? What happens if you need medical care but have no insurance? Do you just not get treated?" Lola K asked.

media1.giphy.com

In another follow-up video, Hernandez shared that she got an update from her insurance company, and her daughter’s stay may not be fully covered. Insurance said it would pay $442,2918.75 of the $739,416.00 bill, leaving her owing $302,741.51. But she hopes that insurance will eventually kick in more. “They don't know if they're gonna be able to cover it yet,” Hernandez said. “It literally says pending or not payable. Charges that are either not covered or need more review by us.”

@janiceheartss

Replying to @Roman BIGGGG update! Guess it’s time for more waiting 🚶‍♀️🚶‍♀️#hospitalbill #insurance #nicu #hospital

Peter Dinklage on "Game of Thrones?

When it comes to actors doing accents across the pond, some Americans are known for their great British accents, such as Natalie Portman ("The Other Boleyn Girl"), Robert Downey, Jr. ("Sherlock Homes"), and Meryl Streep ("The Iron Lady").

Some have taken a lot of heat for their cartoonish or just plain weird-sounding British accents, Dick Van Dyke ("Mary Poppins"), Kevin Costner ("Robin Hood: Prince of Thieves") and Keanu Reeves ("Bram Stoker's Dracula").

Some actors, such as Tom Hardy (“The Drop”) and Hugh Laurie (“House”), have American accents so good that people have no idea they are British.

Benedict Townsend, a London-based comedian and host of the “Scroll Deep” podcast, says there is one word that American actors playing characters with a British accent never get right. And no, it’s not the word “Schedule,” which British people pronounce the entire first 3 letters, and Americans boil down to 2. And it’s not “aluminum,” which British and American people seem to pronounce every stinking letter differently.

@benedicttown

The one word American actors aways get wrong when doing an English accent

What word do American actors always get wrong when they do British accents?

“There is one word that is a dead giveaway that an English character in a movie or a TV show is being played by an American. One word that always trips them up. And once you notice it, you can't stop noticing it,” Townsend says. “You would see this lot in ‘Game of Thrones’ and the word that would always trip them up was ‘daughter.’”

Townsend adds that when British people say “daughter,” they pronounce it like the word “door” or “door-tah.” Meanwhile, Americans, even when they are putting on a British accent, say it like “dah-ter.”

“So top tip if you are an actor trying to do an English accent, daughter like a door. Like you're opening a door,” Townsend says.



What word do British actors always get wrong when doing American accents?

Some American commenters returned the favor by sharing the word that British actors never get right when using American accents: “Anything.”

"I can always tell a Brit playing an American by the word anything. An American would say en-ee-thing. Brits say it ena-thing,” Dreaming_of_Gaea wrote. "The dead giveaway for English people playing Americans: ‘Anything.’ Brits always say ‘EH-nuh-thin,’” marliemagill added.

"I can always tell an actor is English playing an American when they say ‘anything.’ English people always say it like ‘enny-thin,’” mkmason wrote.



What is the cot-caught merger?

One commenter noted that the problem goes back to the cot-caught merger, when Americans in the western US and Canadians began to merge different sounds into one. People on the East Coast and in Britain pronounce them as different sounds.

“Depending on where you live, you might be thinking one of two things right now: Of course, ‘cot’ and ‘caught’ sound exactly the same! or There’s no way that ‘cot’ and ‘caught’ sound the same!” Laura McGrath writes at DoYouReadMe. “As a result, although the different spellings remain, the vowel sounds in the words cot/caught, nod/gnawed, stock/stalk are identical for some English speakers and not for others.”

American actors owe Townsend a debt of gratitude for pointing out the one thing that even the best can’t seem to get right. He should also give the commenters a tip of the cap for sharing the big word that British people have trouble with when doing an American accent. Now, if we could just get through to Ewan McGregor and tell him that even though he is fantastic in so many films, his American accent still needs a lot of work.

This article originally appeared last year.

Unsplash

Conflict between parents and grandparents is hard to avoid. A lot of the time, it comes down to generational differences. When our parents were raising us, there weren't smartphones and there was no Disney+ or Netflix (well, at least not the streaming version). In general, kids had more freedom and less supervision in the 80s and 90s. Parenting styles like gentle parenting or conscious parenting weren't things people thought about as frequently. Again, there was no Instagram shoving it in your face over and over! In some cases, research and data gathered over time have shown us a better way, even though previous generations of parents were doing the best with the information they had.

So it's natural for grandparents to have, um, opinions about how their grandchildren are being raised at times. According to the AARP, most disagreements center on how children are disciplined, what they eat, and how much screen time they get. The sad thing is that when these conflicts become too common, or escalate too far, grandparents can start to miss out on time with their grandkids. There's got to be a way to avoid or mediate these conflicts before they get to that point.

One grandma just laid out her three simple rules for new grandparents who want better relationships with their kids and grandkids.

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Maria, who goes by MomMom Maria online, took to Instagram to offer the blunt advice for new or expecting grandmas — though they can definitely apply to any grandparent.

Rule number one. You are not the parent.

"That is crucial. You're not this child's parent," Maria says in a selfie-style video filmed in her car. "You're privileged to be a grandmother. You're not the mother."

It sounds obvious, but Maria's absolutely right about this one. The parents get to make the decisions on how their kids are raised, how they are disciplined, what they eat, what they can and can't watch on TV, and more. As a grandparent you're not the decision-maker and you're not the one who's ultimately responsible. You can have your own thoughts and opinions, but you don't really get a say. Harsh but true!

Rule number two: Respect the parents' boundaries.

"And guess what? You don't have to understand them," says Maria. "'I don't understand why she doesn't want us to kiss the baby!' You don't have to understand, respect their boundaries."

Conflict doesn't have to come from disagreements about parenting. Some parents butt heads with grandparents over their kids being spoiled and showered with gifts (and other junk that parents then have to find a place for in crowded houses). It can be tough for grandparents to understand or agree with a boundary like "Please don't buy them anything without asking me first," but Maria argues that grandparents must respect boundaries even if they don't understand or agree with them.

Number three, a corollary to rule number two: It's not about you.

"You're not a victim," Maria says. “You're not a pushover. You're just being respectful of their role as parents and realizing that your role is a grandmother. I love it."

Just because you're keeping critical thoughts and opinions and disagreements on how the children are being parented to yourself doesn't mean you're being weak. That's just being respectful of the parents' boundaries and decisions. It's a good thing that you're working to ensure a positive relationship with your children and grandchildren! That's an investment that will reap more and more dividends as the kids get older.

Maria's tips united people from across the aisle — both parents and grandparents agreed the guidelines could make for better relationships.

Maria's video struck a cord with a huge audience of over 300,000 viewers on Instagram. Most were fully on board with the 'new rules.'

"Grandmother to a 7-month-old and two-week-old. Absolutely agree. And I remember how it was when I was a young mother and my MIL made unsolicited comments," one fellow grandma chimed in.

"And remember things have changed since you were a mom: swaddling, no blankets, back sleeping, etc. Just nod and say ok!" offered another user.

Another user mentioned that she'd had a similar conversation with their therapist, who said: "grandparents are used to being *the* parents in the room. They often times don’t know how to or otherwise refuse to fall into a secondary role.” ... "And that hit hard," the user added. "I think a lot of these grandparents are not understanding that they don’t get to parent our kids. They need to step back and let us parent. It’s time for them to relax and step into that secondary role."

Giphy

But not everyone agreed with Maria's advice. Some grandparents, in particular, resented the fact that they should feel privileged just to be involved in a child's life at all, or they lamented not feeling connected to the family when their wisdom and experience wasn't being valued.

"I had one child. He grew up , got married, and is now a dad. I have one grandson," one person commented. "They live on the other side of the country. I keep my mouth shut about EVERYTHING. I text to get permission to call or be lucky enough to FT. I don’t send my grandson ANYTHING , not even so much as a cookie, unless I get their permission first. I struggle to have any conversation with him or his wife because I am not a part of their life. I keep my mouth shut, offer no opinions on anything . It is very hard to be so disconnected from them and it hurts but there is nothing I can do about."

Another commenter was upset by feeling like they knew better, but not being able to voice it:

"This is so hard to do as a GP. I want all organic. . Parents do not care. I want no sugar. They give lots of sugar . I want no screen time . Parents do lots of screen time . I want no cell phone scrolling. Parents scrolll constantly in front of baby. I’m trying so hard to not say anything."

Parents aren't "always right" when it comes to these conflicts, for the record. Ideally, there would be open and honest communication, and a relationship where grandparents' experience and wisdom was valued and taken into consideration, while also allowing space and boundaries for the parents to make the final decisions. Of course, communication is hard. It takes a lot of work and it requires multiple different parties to manage their emotions and egos. Learning to communicate about boundaries, rules, and differences in philosophy takes time — but Maria's three rules are a pretty good starting point for new grandparents who want to get off on the right foot.

Pets

The biggest fan of Kendrick Lamar's halftime show is a cockatoo, and he is rocking out

Even if you couldn't care less about this Lamar & Drake beef, this is so fun to watch.

NFL/Youtube, @banditthecockatoo/TikTok

Bandit is a Lamar fan through and through.

While there were certainly many folks at home bopping along to Kendrick Lamar’s epic halftime show, no one did it quite like an internet famous white cockatoo named Bandit—who seriously needs to be hired as one of Lamar’s back-up dancers post haste.

In the video below, we get to see the entire journey Bandit takes while listening to the performance— curiosity, intrigue, trying to find the beat, feather-raised excitement as he attempts his own dance moves, followed by full on hand banging, the works!

One thing is abundantly clear. In this infamous feud between Lamar and Drake, Bandit is definitely “Team Lamar.” Watch:

Of course, this spurred a lot of fun comments from viewers, especially folks referencing said feud.

“Even animals are feeling this diss track,” one person wrote, while another said “He’s feeling the power of KDot!” referencing one of Lamar’s earlier stage names.

Another commented, “I was waiting for him to yell MUSSSSSSTARRRRD!” which Lamar himself yelled in the song "TV Off" as a nod to Mustard, his co-producer, which also became a rather famous internet meme.

While Bandit had no actuarial awareness of the diss lyrics Lamar was spitting out, he, like many avians in the parrot family, was responding to the rhythm and beat of the music. Much about how and why these birds react to music remains a bit of a mystery, but they do seem to have their individual preferences. While Bandit clearly enjoys hip hop and rap, another might prefer classical music. One funny thing to note however—it’s been said that on the whole, parrots aren’t electronica fans. So no raves for them.

Of course, cockatoos and parrots can have eclectic tastes too! As we can see below, Bandit also has a soft spot for Billy Idol.

This charming bird has been a TikTok star for years now, entering his 300K followers with dance moves, food antics, and his own beef with “mean ol’ dad,” who has the audacity to touch his stuff. But Upworthy has encountered other cheeky cockatoos before, including one that maniacally chased its family around the house and a feathered anarchist who made headlines after uprooting anti-bird spikes.

All of these stories make sense, considering the cockatoos general penchant for attention seeking, which can lead to erratic and destructive behavior when ignored. But, as we can see, they are also incredibly intelligent, playful, and loyal to boot, making them excellent pets…as well as entertaining content creators, apparently. So bird parents, keep those video comin’.