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She specializes in covering altered states of mind, from postpartum depression to methamphetamine-induced psychosis to the insanity defense. Her investigative series on insurance companies sidestepping mental health laws won multiple awards, including first place in beat reporting from the national Association of Health Care Journalists. She is the recipient of numerous other prizes and fellowships, including a national Edward R. Murrow award for investigative reporting, a Society of Professional Journalists award for long-form storytelling, and a Carter Center Fellowship for Mental Health Journalism.\r\n\r\nDembosky reported and produced \u003cem>Soundtrack of Silence\u003c/em>, an audio documentary about music and memory that is currently being made into a feature film by Paramount Pictures.\r\n\r\nBefore joining KQED in 2013, Dembosky covered technology and Silicon Valley for \u003cem>The Financial Times of London,\u003c/em> and contributed business and arts stories to \u003cem>Marketplace \u003c/em>and \u003cem>The New York Times.\u003c/em> She got her undergraduate degree in philosophy from Smith College and her master's in journalism from the University of California, Berkeley. She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.","avatar":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twitter":"adembosky","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"April Dembosky | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/adembosky"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_331728":{"type":"posts","id":"stateofhealth_331728","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"331728","score":null,"sort":[1495191644000]},"guestAuthors":[],"slug":"womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape","title":"Women's Health Clinics in California Struggle in a Shifting Health Care Landscape","publishDate":1495191644,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Closures and consolidations have been increasing among community clinics that provide reproductive health services.\u003c/p>\n\u003cp>Two beloved women’s clinics in San Francisco are consolidating with outside partners in order to keep operating. Another two, in Santa Rosa and Sacramento, have shut their doors. All four were unintended casualties of the Affordable Care Act, which shifted payments and changed incentives throughout California's health industry.\u003c/p>\n\u003cp>Because of the health law, more women in California have coverage for a full range of health services through Medi-Cal. As a result, many of those women are now going to a regular doctor or primary care center for their family planning needs, instead of a dedicated women’s clinic. In addition, the state is paying these clinics \u003ca href=\"http://audio.californiareport.org/archive/R201401031630/c\">less money under Obamacare\u003c/a>.\u003c/p>\n\u003cp>“Of course, I love the Affordable Care Act, but it was very harmful to reproductive health clinics,” said \u003ca href=\"https://obgyn.ucsf.edu/san-francisco-general-hospital/rebecca-jackson-md\" target=\"_blank\" rel=\"noopener noreferrer\">Dr. Rebecca Jackson\u003c/a>, director of New Generation, a teen clinic in San Francisco's Mission neighborhood. New Generation announced last spring it would have to close, but then UCSF agreed to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/05/11/uc-san-francisco-drops-plans-to-close-mission-clinic/\">fund it one more year\u003c/a>.\u003c/p>\n\u003cp>This week, managers announced the next steps to ensure the clinic's ongoing survival. New Generation will move into a smaller, shared office; partner with the city’s Department of Public Health to cover administrative costs such as billing and medical records; and continue intensive and urgent fund-raising efforts in the private sector.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“That allows us to get long-term sustainability that we didn't have as a free-standing clinic,” Jackson said.\u003c/p>\n\u003cp>In Sacramento, \u003ca href=\"https://www.womenshealthspecialists.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Women’s Health Specialists\u003c/a> couldn’t get the numbers to work and shut down last month. Their Santa Rosa location closed two years ago. Outgoing director Shauna Heckert warned the same could happen to the three remaining clinics in Grass Valley, Chico, and Redding if the state doesn’t increase Medi-Cal reimbursements. That's something Governor Jerry Brown has \u003ca href=\"http://audio.californiareport.org/archive/R201509020850/b\">refused to do for years\u003c/a>.\u003c/p>\n\u003cp>“Number one, raising rates for poor people's health care is not popular,” Heckert explained. “Number two, raising rates for reproductive health — that includes abortion and chlamydia [and] gonorrhea — is certainly not something people even feel comfortable talking about.”\u003c/p>\n\u003cp>Women’s clinics are now lobbying state lawmakers, asking them to direct some of the revenues from the newly-passed tobacco tax specifically to them. The Legislature must pass the state budget by June 15th.\u003c/p>\n\u003cp>But the Women’s Community Clinic in San Francisco couldn’t wait to see what might happen with the state budget. The clinic, which had \u003ca href=\"http://womenscommunityclinic.org/who-we-are/history/\" target=\"_blank\" rel=\"noopener noreferrer\">previously suffered\u003c/a> a temporary closure and re-organization in 1999, announced a merger this week with\u003ca href=\"https://www.healthright360.org/\" target=\"_blank\" rel=\"noopener noreferrer\"> HealthRight360\u003c/a>, a statewide nonprofit health system.\u003c/p>\n\u003cp>Carlina Hansen, the clinic's executive director, explained that the Women’s Community Clinic had lost some federal grants. But she noted that the merger with HealthRight360 will also benefit her patients: in addition to family planning, they'll be able to access primary care, mental health services and addiction treatment.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It was not all about money,” said Hansen, who will step down from running the clinic after 17 years. “It was really also about adapting, to do better for our clients in the future.”\u003c/p>\n\n","blocks":[],"excerpt":"The Affordable Care Act has meant lower payments and fewer patients for independent clinics that specialize in family planning and reproductive health. ","status":"publish","parent":0,"modified":1495237719,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":562},"headData":{"title":"Women's Health Clinics in California Struggle in a Shifting Health Care Landscape | KQED","description":"The Affordable Care Act has meant lower payments and fewer patients for independent clinics that specialize in family planning and reproductive health. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Women's Health Clinics in California Struggle in a Shifting Health Care Landscape","datePublished":"2017-05-19T11:00:44.000Z","dateModified":"2017-05-19T23:48:39.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"331728 https://ww2.kqed.org/stateofhealth/?p=331728","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/","disqusTitle":"Women's Health Clinics in California Struggle in a Shifting Health Care Landscape","path":"/stateofhealth/331728/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Closures and consolidations have been increasing among community clinics that provide reproductive health services.\u003c/p>\n\u003cp>Two beloved women’s clinics in San Francisco are consolidating with outside partners in order to keep operating. Another two, in Santa Rosa and Sacramento, have shut their doors. All four were unintended casualties of the Affordable Care Act, which shifted payments and changed incentives throughout California's health industry.\u003c/p>\n\u003cp>Because of the health law, more women in California have coverage for a full range of health services through Medi-Cal. As a result, many of those women are now going to a regular doctor or primary care center for their family planning needs, instead of a dedicated women’s clinic. In addition, the state is paying these clinics \u003ca href=\"http://audio.californiareport.org/archive/R201401031630/c\">less money under Obamacare\u003c/a>.\u003c/p>\n\u003cp>“Of course, I love the Affordable Care Act, but it was very harmful to reproductive health clinics,” said \u003ca href=\"https://obgyn.ucsf.edu/san-francisco-general-hospital/rebecca-jackson-md\" target=\"_blank\" rel=\"noopener noreferrer\">Dr. Rebecca Jackson\u003c/a>, director of New Generation, a teen clinic in San Francisco's Mission neighborhood. New Generation announced last spring it would have to close, but then UCSF agreed to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/05/11/uc-san-francisco-drops-plans-to-close-mission-clinic/\">fund it one more year\u003c/a>.\u003c/p>\n\u003cp>This week, managers announced the next steps to ensure the clinic's ongoing survival. New Generation will move into a smaller, shared office; partner with the city’s Department of Public Health to cover administrative costs such as billing and medical records; and continue intensive and urgent fund-raising efforts in the private sector.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“That allows us to get long-term sustainability that we didn't have as a free-standing clinic,” Jackson said.\u003c/p>\n\u003cp>In Sacramento, \u003ca href=\"https://www.womenshealthspecialists.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Women’s Health Specialists\u003c/a> couldn’t get the numbers to work and shut down last month. Their Santa Rosa location closed two years ago. Outgoing director Shauna Heckert warned the same could happen to the three remaining clinics in Grass Valley, Chico, and Redding if the state doesn’t increase Medi-Cal reimbursements. That's something Governor Jerry Brown has \u003ca href=\"http://audio.californiareport.org/archive/R201509020850/b\">refused to do for years\u003c/a>.\u003c/p>\n\u003cp>“Number one, raising rates for poor people's health care is not popular,” Heckert explained. “Number two, raising rates for reproductive health — that includes abortion and chlamydia [and] gonorrhea — is certainly not something people even feel comfortable talking about.”\u003c/p>\n\u003cp>Women’s clinics are now lobbying state lawmakers, asking them to direct some of the revenues from the newly-passed tobacco tax specifically to them. The Legislature must pass the state budget by June 15th.\u003c/p>\n\u003cp>But the Women’s Community Clinic in San Francisco couldn’t wait to see what might happen with the state budget. The clinic, which had \u003ca href=\"http://womenscommunityclinic.org/who-we-are/history/\" target=\"_blank\" rel=\"noopener noreferrer\">previously suffered\u003c/a> a temporary closure and re-organization in 1999, announced a merger this week with\u003ca href=\"https://www.healthright360.org/\" target=\"_blank\" rel=\"noopener noreferrer\"> HealthRight360\u003c/a>, a statewide nonprofit health system.\u003c/p>\n\u003cp>Carlina Hansen, the clinic's executive director, explained that the Women’s Community Clinic had lost some federal grants. But she noted that the merger with HealthRight360 will also benefit her patients: in addition to family planning, they'll be able to access primary care, mental health services and addiction treatment.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It was not all about money,” said Hansen, who will step down from running the clinic after 17 years. “It was really also about adapting, to do better for our clients in the future.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/331728/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape","authors":["3205"],"categories":["stateofhealth_11","stateofhealth_15"],"tags":["stateofhealth_160","stateofhealth_2969","stateofhealth_2808","stateofhealth_99","stateofhealth_2519","stateofhealth_365","stateofhealth_2753","stateofhealth_397"],"featImg":"stateofhealth_180898","label":"stateofhealth"},"stateofhealth_215059":{"type":"posts","id":"stateofhealth_215059","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"215059","score":null,"sort":[1469032968000]},"guestAuthors":[],"slug":"anti-abortion-forces-regroup-in-wake-of-supreme-court-decision","title":"Anti-Abortion Forces Regroup In Wake Of Supreme Court Decision","publishDate":1469032968,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Delegates at the Republican convention in Cleveland have approved the strongest anti-abortion platform in the party’s history. But groups that oppose abortion — and that lobbied for the strong language — are far from unified.\u003c/p>\n\u003cp>In fact, in the wake of last month’s Supreme Court decision reaffirming a woman’s right to abortion, leaders of a movement known for speaking largely with one voice are showing some surprising disagreement.\u003c/p>\n\u003cp>For the past several years, anti-abortion groups have pushed an agenda aimed at imposing much stricter regulation on abortion facilities. The groups said it was to promote the health and safety of women; abortion-rights supporters said it was an effort to \u003ca href=\"http://www.reproductiverights.org/project/targeted-regulation-of-abortion-providers-trap\" target=\"_blank\">regulate the clinics out of existence\u003c/a>.\u003c/p>\n\u003cp>At least for now, the Supreme Court is siding with abortion-rights backers. Neither of the portions of Texas’ omnibus abortion law that were up for review “offers medical benefits sufficient to justify the burdens upon access that each imposes,” wrote Justice Stephen Breyer in the \u003ca href=\"https://www.supremecourt.gov/opinions/15pdf/15-274_p8k0.pdf\" target=\"_blank\">majority opinion\u003c/a>.\u003c/p>\n\u003cp>The provisions that were struck down required abortion clinics in the state to meet the much higher safety standards for facilities that do much more advanced surgical procedures and required doctors who perform abortions to have admitting privileges at a hospital within 30 miles of the clinic.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In hindsight, “maybe it was a mistake for us to champion safeguards for women,” said Marjorie Dannenfelser, president of the \u003ca href=\"https://www.sba-list.org/about-susan-b-anthony-list\" target=\"_blank\">Susan B. Anthony List\u003c/a>, whose goal is to elect more anti-abortion candidates to public office. “Maybe we shouldn’t have done that.”\u003c/p>\n\u003cp>At a media briefing, Dannenfelser said her group will instead rally around legislation that has passed in more than a dozen states to \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_PLTA.pdf\" target=\"_blank\">ban abortion at roughly 20 weeks\u003c/a> of pregnancy. Similar legislation \u003ca href=\"https://www.congress.gov/bill/114th-congress/house-bill/36\" target=\"_blank\">passed the U.S. House\u003c/a> but not the Senate.\u003c/p>\n\u003cp>The 20-week ban is “our top priority,” she said.\u003c/p>\n\u003cp>But Clarke Forsythe, acting president and senior counsel for Americans United for Life, said his group plans no fundamental change in strategy.\u003c/p>\n\u003cp>“It is more important than ever to focus on the risks to women and negative consequences,” he said in an interview. “The justices can’t sweep away the public health vacuum that they created with a few pen strokes.”\u003c/p>\n\u003cp>Forsythe said that while the court’s ruling has “put some roadblocks in the way, and we will have to take those into consideration,” there are still plenty of opportunities to regulate abortion providers that could pass constitutional muster, particularly if they are more narrowly targeted than the Texas law was.\u003c/p>\n\u003cp>The nation’s oldest anti-abortion group, the National Right to Life Committee, has never embraced the push for health and safety regulations aimed at women.\u003c/p>\n\u003cp>“Our focus has always been on the humanity of the unborn,” said its president, Carol Tobias, rather than potential risks to women seeking abortions.\u003c/p>\n\u003cp>Her group has instead been pushing state and federal bills to ban abortions after 20 weeks and ban “\u003ca href=\"http://www.webmd.com/women/dilation-and-evacuation-de-for-abortion\" target=\"_blank\">dilation and evacuation\u003c/a>” abortions, which are the most common procedure performed after the first trimester of pregnancy.\u003c/p>\n\u003cp>“I don’t think the Texas decision is necessarily going to impact those types of legislation, and I know it’s not going to affect us,” she said.\u003c/p>\n\u003cp>But there is one thing they all seem to agree on: The future makeup of the Supreme Court, and with it the future of abortion rights, hangs in the balance with the upcoming election.\u003c/p>\n\u003cp>Because of the vacancy left by the death of Justice Antonin Scalia last winter, “it is so obvious, so simple to make the case” about the importance of who controls the White House and Senate when it comes to Supreme Court appointments, said Dannenfelser.\u003c/p>\n\u003cp>“We say the court’s always important,” said Tobias. “But this time we have solid proof.”\u003c/p>\n\u003cp>The groups also agree on something else — that despite the victory at the Supreme Court, abortion-rights forces are not winning the fight.\u003c/p>\n\u003cp>“The pro-life cause has never been stronger,” said Dannenfelser. “And our opponents’ position has never been weaker.”\u003c/p>\n\u003cp>Immediately after the court’s ruling, said Tobias, “Planned Parenthood came out and said they were going to pass pro-abortion legislation and repeal pro-life legislation.”\u003c/p>\n\u003cp>That is true. “Today’s victory means we can fight state by state, legislature by legislature, law by law, and restore women’s access to reproductive health care,” said Planned Parenthood Action Fund Executive Vice President Dawn Laguens in a statement.\u003c/p>\n\u003cp>But in fact, said Tobias, “they haven’t been able to do that in 40 years. The only way they make advances is through the courts. They don’t have the people” on their side.\u003c/p>\n\u003cp>In an interview, Laguens agreed that her side has more work to do. “We’ve got to change hearts and minds,” she said. But Laguens insists it is abortion opponents who are “out of sync with America and out of sync with the new generation.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With a more “social justice minded” generation of millennials now coming of age, she said, it is abortion foes on the defensive. “They’re in a last gasp moment,” she said. “They feel it slipping away.”\u003c/p>\n\n","blocks":[],"excerpt":"Anti-abortion groups are rethinking their approach following a U.S. Supreme Court decision last month. But they don't all agree on strategy.","status":"publish","parent":0,"modified":1469034831,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":930},"headData":{"title":"Anti-Abortion Forces Regroup In Wake Of Supreme Court Decision | KQED","description":"Anti-abortion groups are rethinking their approach following a U.S. Supreme Court decision last month. But they don't all agree on strategy.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Anti-Abortion Forces Regroup In Wake Of Supreme Court Decision","datePublished":"2016-07-20T16:42:48.000Z","dateModified":"2016-07-20T17:13:51.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"215059 http://ww2.kqed.org/stateofhealth/?p=215059","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/20/anti-abortion-forces-regroup-in-wake-of-supreme-court-decision/","disqusTitle":"Anti-Abortion Forces Regroup In Wake Of Supreme Court Decision","nprByline":"Julie Rovner\u003cbr />\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>","path":"/stateofhealth/215059/anti-abortion-forces-regroup-in-wake-of-supreme-court-decision","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Delegates at the Republican convention in Cleveland have approved the strongest anti-abortion platform in the party’s history. But groups that oppose abortion — and that lobbied for the strong language — are far from unified.\u003c/p>\n\u003cp>In fact, in the wake of last month’s Supreme Court decision reaffirming a woman’s right to abortion, leaders of a movement known for speaking largely with one voice are showing some surprising disagreement.\u003c/p>\n\u003cp>For the past several years, anti-abortion groups have pushed an agenda aimed at imposing much stricter regulation on abortion facilities. The groups said it was to promote the health and safety of women; abortion-rights supporters said it was an effort to \u003ca href=\"http://www.reproductiverights.org/project/targeted-regulation-of-abortion-providers-trap\" target=\"_blank\">regulate the clinics out of existence\u003c/a>.\u003c/p>\n\u003cp>At least for now, the Supreme Court is siding with abortion-rights backers. Neither of the portions of Texas’ omnibus abortion law that were up for review “offers medical benefits sufficient to justify the burdens upon access that each imposes,” wrote Justice Stephen Breyer in the \u003ca href=\"https://www.supremecourt.gov/opinions/15pdf/15-274_p8k0.pdf\" target=\"_blank\">majority opinion\u003c/a>.\u003c/p>\n\u003cp>The provisions that were struck down required abortion clinics in the state to meet the much higher safety standards for facilities that do much more advanced surgical procedures and required doctors who perform abortions to have admitting privileges at a hospital within 30 miles of the clinic.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In hindsight, “maybe it was a mistake for us to champion safeguards for women,” said Marjorie Dannenfelser, president of the \u003ca href=\"https://www.sba-list.org/about-susan-b-anthony-list\" target=\"_blank\">Susan B. Anthony List\u003c/a>, whose goal is to elect more anti-abortion candidates to public office. “Maybe we shouldn’t have done that.”\u003c/p>\n\u003cp>At a media briefing, Dannenfelser said her group will instead rally around legislation that has passed in more than a dozen states to \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_PLTA.pdf\" target=\"_blank\">ban abortion at roughly 20 weeks\u003c/a> of pregnancy. Similar legislation \u003ca href=\"https://www.congress.gov/bill/114th-congress/house-bill/36\" target=\"_blank\">passed the U.S. House\u003c/a> but not the Senate.\u003c/p>\n\u003cp>The 20-week ban is “our top priority,” she said.\u003c/p>\n\u003cp>But Clarke Forsythe, acting president and senior counsel for Americans United for Life, said his group plans no fundamental change in strategy.\u003c/p>\n\u003cp>“It is more important than ever to focus on the risks to women and negative consequences,” he said in an interview. “The justices can’t sweep away the public health vacuum that they created with a few pen strokes.”\u003c/p>\n\u003cp>Forsythe said that while the court’s ruling has “put some roadblocks in the way, and we will have to take those into consideration,” there are still plenty of opportunities to regulate abortion providers that could pass constitutional muster, particularly if they are more narrowly targeted than the Texas law was.\u003c/p>\n\u003cp>The nation’s oldest anti-abortion group, the National Right to Life Committee, has never embraced the push for health and safety regulations aimed at women.\u003c/p>\n\u003cp>“Our focus has always been on the humanity of the unborn,” said its president, Carol Tobias, rather than potential risks to women seeking abortions.\u003c/p>\n\u003cp>Her group has instead been pushing state and federal bills to ban abortions after 20 weeks and ban “\u003ca href=\"http://www.webmd.com/women/dilation-and-evacuation-de-for-abortion\" target=\"_blank\">dilation and evacuation\u003c/a>” abortions, which are the most common procedure performed after the first trimester of pregnancy.\u003c/p>\n\u003cp>“I don’t think the Texas decision is necessarily going to impact those types of legislation, and I know it’s not going to affect us,” she said.\u003c/p>\n\u003cp>But there is one thing they all seem to agree on: The future makeup of the Supreme Court, and with it the future of abortion rights, hangs in the balance with the upcoming election.\u003c/p>\n\u003cp>Because of the vacancy left by the death of Justice Antonin Scalia last winter, “it is so obvious, so simple to make the case” about the importance of who controls the White House and Senate when it comes to Supreme Court appointments, said Dannenfelser.\u003c/p>\n\u003cp>“We say the court’s always important,” said Tobias. “But this time we have solid proof.”\u003c/p>\n\u003cp>The groups also agree on something else — that despite the victory at the Supreme Court, abortion-rights forces are not winning the fight.\u003c/p>\n\u003cp>“The pro-life cause has never been stronger,” said Dannenfelser. “And our opponents’ position has never been weaker.”\u003c/p>\n\u003cp>Immediately after the court’s ruling, said Tobias, “Planned Parenthood came out and said they were going to pass pro-abortion legislation and repeal pro-life legislation.”\u003c/p>\n\u003cp>That is true. “Today’s victory means we can fight state by state, legislature by legislature, law by law, and restore women’s access to reproductive health care,” said Planned Parenthood Action Fund Executive Vice President Dawn Laguens in a statement.\u003c/p>\n\u003cp>But in fact, said Tobias, “they haven’t been able to do that in 40 years. The only way they make advances is through the courts. They don’t have the people” on their side.\u003c/p>\n\u003cp>In an interview, Laguens agreed that her side has more work to do. “We’ve got to change hearts and minds,” she said. But Laguens insists it is abortion opponents who are “out of sync with America and out of sync with the new generation.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With a more “social justice minded” generation of millennials now coming of age, she said, it is abortion foes on the defensive. “They’re in a last gasp moment,” she said. “They feel it slipping away.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/215059/anti-abortion-forces-regroup-in-wake-of-supreme-court-decision","authors":["byline_stateofhealth_215059"],"categories":["stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_160","stateofhealth_2519","stateofhealth_397"],"featImg":"stateofhealth_215061","label":"stateofhealth"},"stateofhealth_214392":{"type":"posts","id":"stateofhealth_214392","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"214392","score":null,"sort":[1468881238000]},"guestAuthors":[],"slug":"got-dense-breasts-that-can-depend-on-who-is-reading-the-mammogram","title":"Got Dense Breasts? That Can Depend On Who Is Reading The Mammogram","publishDate":1468881238,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>If you're a woman who gets screening mammograms, you may have received a letter telling you that your scan was clear, but that you have dense breasts, a risk factor for breast cancer. About half of U.S. states, including \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">California\u003c/a>, require providers to \u003ca href=\"http://www.npr.org/sections/health-shots/2016/04/26/475624010/letters-telling-women-about-breast-density-are-often-too-darn-dense\" target=\"_blank\">notify women\u003c/a> if they fall into that category.\u003c/p>\n\u003cp>But what you may not know is that gauging breast density isn't a clear-cut process. Researchers reporting in \u003cem>Annals of Internal Medicine\u003c/em> Monday found that density assessments varied widely from one radiologist to another. That means you shouldn't let one finding freak you out too much, nor should you assume something's wrong if your reported density changes from year to year.\u003c/p>\n\u003cp>\"Women and providers should keep in mind that density is a subjective measure,\" says \u003ca href=\"https://www.uvm.edu/medicine/surgery/?Page=profile.php&bioID=22952\" target=\"_blank\">Brian Sprague\u003c/a>, a cancer epidemiologist at the University of Vermont and an author of the study. And, he says, breast density is only one factor contributing to a woman's \u003ca href=\"http://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm\" target=\"_blank\">individual risk of getting breast cancer\u003c/a>.\u003c/p>\n\u003cp>About 40 percent of women between 40 and 74 years old have dense breasts — meaning they have more breast tissue (that is, ducts and glands) and connective tissue and less fatty tissue than women whose breasts aren't dense. You can't know your status by how the breasts feel; it only shows up on a mammogram.\u003c/p>\n\u003cp>Dense breasts make it harder for radiologists to detect possible abnormalities on a mammogram, and the presence of the tissue itself is an independent risk factor for breast cancer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers looked at 216,783 mammograms from more than 145,000 women, interpreted by 83 radiologists in Pennsylvania, Vermont, New Hampshire and Massachusetts. The average proportion of mammograms that fell into the \"extremely dense\" or \"heterogeneously dense\" categories was 38.7 percent. But the proportion of mammograms assigned to those two categories by individual radiologists ranged from 6.3 percent to 84.5 percent.\u003c/p>\n\u003cp>Even when adjusting for each patient's age, race and \u003ca href=\"http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm\" target=\"_blank\">body mass index\u003c/a> — since, after all, the patient population in Philadelphia isn't the same as in rural Vermont — the variation continued, the authors say.\u003c/p>\n\u003cp>And among women who had consecutive mammograms read by different radiologists, 17.2 percent got different assessments of whether they fell into the dense or nondense category.\u003c/p>\n\u003cp>The findings aren't too surprising, says \u003ca href=\"http://www.bidmc.org/Centers-and-Departments/Departments/Radiology/Data/Clinical-Faculty/Breast-Imaging/Priscilla-Slanetz.aspx\" target=\"_blank\">Dr. Priscilla Slanetz\u003c/a>, a radiologist at Beth Israel Deaconess Medical Center. \"There's agreement usually in the extremes, but a lot of variation in the middle,\" she says.\u003c/p>\n\u003cp>The guidelines for assessing density have also changed since the study was conducted, Slanetz points out, though it's not yet clear how that will affect the percentage of women assessed as having dense breasts.\u003c/p>\n\u003cp>At a policy level, the researchers say, the results mean that authors of state legislation requiring that women be notified of breast density — and in some cases, offered extra screening using other methods — need to be aware that this variation exists. If all women classified as having dense breasts are referred for an ultrasound based on that factor alone (\u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/16/399946509/letters-about-dense-breasts-can-lead-to-more-questions-than-answers\" target=\"_blank\">as they are in some states\u003c/a>), that could make for a lot of unnecessary tests and false positive results without an offsetting benefit.\u003c/p>\n\u003cp>Slanetz's advice for women is to use the density report as a jumping-off point for a broader discussion about their individual breast cancer risk. Authors of a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25984843\" target=\"_blank\">large study published last year\u003c/a> said that density alone shouldn't be the only criterion for getting extra screening. Nor should women whose breasts aren't dense assume that they have a low risk of breast cancer.\u003c/p>\n\u003cp>That personal discussion with a doctor or other health care provider should cover risk factors such as personal history of breast abnormalities and family history of breast cancer, as well as density, Slanetz says.\u003c/p>\n\u003cp>She also recommends that women with dense breasts seek out digital mammography, which improves detection of cancers.\u003c/p>\n\u003cp>Ultrasound, \u003ca href=\"http://www.npr.org/sections/health-shots/2014/06/24/325216641/3-d-mammography-finds-more-tumors-but-questions-remain\" target=\"_blank\">digital breast tomosynthesis\u003c/a> and MRI have all been suggested as additional screening options for women with dense breasts. But the \u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/20/401006116/federal-panel-revisits-contested-recommendation-on-mammograms\" target=\"_blank\">U.S. Preventive Services Task Force says\u003c/a> there's not yet enough evidence to know whether they should be used for screening.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/katherinehobson\" target=\"_blank\">\u003cem>@katherinehobson\u003c/em>\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Got+Dense+Breasts%3F+That+Can+Depend+On+Who+Is+Reading+The+Mammogram&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"A large study suggests that radiologists vary widely in their assessment of density, a risk factor for breast cancer. ","status":"publish","parent":0,"modified":1468881283,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":731},"headData":{"title":"Got Dense Breasts? That Can Depend On Who Is Reading The Mammogram | KQED","description":"A large study suggests that radiologists vary widely in their assessment of density, a risk factor for breast cancer. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Got Dense Breasts? That Can Depend On Who Is Reading The Mammogram","datePublished":"2016-07-18T22:33:58.000Z","dateModified":"2016-07-18T22:34:43.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"214392 http://ww2.kqed.org/stateofhealth/?p=214392","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/18/got-dense-breasts-that-can-depend-on-who-is-reading-the-mammogram/","disqusTitle":"Got Dense Breasts? That Can Depend On Who Is Reading The Mammogram","nprImageCredit":"Lester Lefkowitz","nprByline":"Katherine Hobson\u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","nprImageAgency":"Getty Images","nprStoryId":"486473548","nprApiLink":"http://api.npr.org/query?id=486473548&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/07/18/486473548/got-dense-breasts-that-can-depend-on-whos-reading-the-mammogram?ft=nprml&f=486473548","nprRetrievedStory":"1","nprPubDate":"Mon, 18 Jul 2016 18:14:00 -0400","nprStoryDate":"Mon, 18 Jul 2016 17:01:00 -0400","nprLastModifiedDate":"Mon, 18 Jul 2016 18:14:47 -0400","path":"/stateofhealth/214392/got-dense-breasts-that-can-depend-on-who-is-reading-the-mammogram","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you're a woman who gets screening mammograms, you may have received a letter telling you that your scan was clear, but that you have dense breasts, a risk factor for breast cancer. About half of U.S. states, including \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/29/californias-breast-density-notification-law-goes-into-effect/\" target=\"_blank\">California\u003c/a>, require providers to \u003ca href=\"http://www.npr.org/sections/health-shots/2016/04/26/475624010/letters-telling-women-about-breast-density-are-often-too-darn-dense\" target=\"_blank\">notify women\u003c/a> if they fall into that category.\u003c/p>\n\u003cp>But what you may not know is that gauging breast density isn't a clear-cut process. Researchers reporting in \u003cem>Annals of Internal Medicine\u003c/em> Monday found that density assessments varied widely from one radiologist to another. That means you shouldn't let one finding freak you out too much, nor should you assume something's wrong if your reported density changes from year to year.\u003c/p>\n\u003cp>\"Women and providers should keep in mind that density is a subjective measure,\" says \u003ca href=\"https://www.uvm.edu/medicine/surgery/?Page=profile.php&bioID=22952\" target=\"_blank\">Brian Sprague\u003c/a>, a cancer epidemiologist at the University of Vermont and an author of the study. And, he says, breast density is only one factor contributing to a woman's \u003ca href=\"http://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm\" target=\"_blank\">individual risk of getting breast cancer\u003c/a>.\u003c/p>\n\u003cp>About 40 percent of women between 40 and 74 years old have dense breasts — meaning they have more breast tissue (that is, ducts and glands) and connective tissue and less fatty tissue than women whose breasts aren't dense. You can't know your status by how the breasts feel; it only shows up on a mammogram.\u003c/p>\n\u003cp>Dense breasts make it harder for radiologists to detect possible abnormalities on a mammogram, and the presence of the tissue itself is an independent risk factor for breast cancer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers looked at 216,783 mammograms from more than 145,000 women, interpreted by 83 radiologists in Pennsylvania, Vermont, New Hampshire and Massachusetts. The average proportion of mammograms that fell into the \"extremely dense\" or \"heterogeneously dense\" categories was 38.7 percent. But the proportion of mammograms assigned to those two categories by individual radiologists ranged from 6.3 percent to 84.5 percent.\u003c/p>\n\u003cp>Even when adjusting for each patient's age, race and \u003ca href=\"http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm\" target=\"_blank\">body mass index\u003c/a> — since, after all, the patient population in Philadelphia isn't the same as in rural Vermont — the variation continued, the authors say.\u003c/p>\n\u003cp>And among women who had consecutive mammograms read by different radiologists, 17.2 percent got different assessments of whether they fell into the dense or nondense category.\u003c/p>\n\u003cp>The findings aren't too surprising, says \u003ca href=\"http://www.bidmc.org/Centers-and-Departments/Departments/Radiology/Data/Clinical-Faculty/Breast-Imaging/Priscilla-Slanetz.aspx\" target=\"_blank\">Dr. Priscilla Slanetz\u003c/a>, a radiologist at Beth Israel Deaconess Medical Center. \"There's agreement usually in the extremes, but a lot of variation in the middle,\" she says.\u003c/p>\n\u003cp>The guidelines for assessing density have also changed since the study was conducted, Slanetz points out, though it's not yet clear how that will affect the percentage of women assessed as having dense breasts.\u003c/p>\n\u003cp>At a policy level, the researchers say, the results mean that authors of state legislation requiring that women be notified of breast density — and in some cases, offered extra screening using other methods — need to be aware that this variation exists. If all women classified as having dense breasts are referred for an ultrasound based on that factor alone (\u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/16/399946509/letters-about-dense-breasts-can-lead-to-more-questions-than-answers\" target=\"_blank\">as they are in some states\u003c/a>), that could make for a lot of unnecessary tests and false positive results without an offsetting benefit.\u003c/p>\n\u003cp>Slanetz's advice for women is to use the density report as a jumping-off point for a broader discussion about their individual breast cancer risk. Authors of a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25984843\" target=\"_blank\">large study published last year\u003c/a> said that density alone shouldn't be the only criterion for getting extra screening. Nor should women whose breasts aren't dense assume that they have a low risk of breast cancer.\u003c/p>\n\u003cp>That personal discussion with a doctor or other health care provider should cover risk factors such as personal history of breast abnormalities and family history of breast cancer, as well as density, Slanetz says.\u003c/p>\n\u003cp>She also recommends that women with dense breasts seek out digital mammography, which improves detection of cancers.\u003c/p>\n\u003cp>Ultrasound, \u003ca href=\"http://www.npr.org/sections/health-shots/2014/06/24/325216641/3-d-mammography-finds-more-tumors-but-questions-remain\" target=\"_blank\">digital breast tomosynthesis\u003c/a> and MRI have all been suggested as additional screening options for women with dense breasts. But the \u003ca href=\"http://www.npr.org/sections/health-shots/2015/04/20/401006116/federal-panel-revisits-contested-recommendation-on-mammograms\" target=\"_blank\">U.S. Preventive Services Task Force says\u003c/a> there's not yet enough evidence to know whether they should be used for screening.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/katherinehobson\" target=\"_blank\">\u003cem>@katherinehobson\u003c/em>\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Got+Dense+Breasts%3F+That+Can+Depend+On+Who+Is+Reading+The+Mammogram&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/214392/got-dense-breasts-that-can-depend-on-who-is-reading-the-mammogram","authors":["byline_stateofhealth_214392"],"categories":["stateofhealth_13"],"tags":["stateofhealth_46","stateofhealth_2808","stateofhealth_2824","stateofhealth_397"],"featImg":"stateofhealth_214393","label":"stateofhealth"},"stateofhealth_210214":{"type":"posts","id":"stateofhealth_210214","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"210214","score":null,"sort":[1467991607000]},"guestAuthors":[],"slug":"dont-cut-me-episiotomies-now-discouraged-still-too-common","title":"'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common","publishDate":1467991607,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Since it was uploaded to YouTube, \u003ca href=\"https://youtu.be/lCfXxtoAN-I\" target=\"_blank\">the video of Kimberly Turbin’s 2013 episiotomy \u003c/a>has been viewed more than 430,000 times. In the video, Turbin lies on her back in a hospital bed. Her knees are bent, her legs and feet are elevated above her in stirrups. She is trying to push the baby out.\u003c/p>\n\u003cp>“Push, push, push. Go, go, go,” the nurse says.\u003c/p>\n\u003cp>A doctor walks into her room in Providence Tarzana Medical Center in California’s San Fernando Valley. He pulls out a pair of sharp scissors.\u003c/p>\n\u003cp>“What are you doing?” Turbin asks, breathless, between contractions.\u003c/p>\n\u003cp>He tells her he is going to cut her perineum, a procedure known as an episiotomy.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“What? Why? We haven’t even tried,” Turbin cries. “No, don’t cut me!”\u003c/p>\n\u003cp>“What do you mean, ‘Why?’” the doctor responds, sounding increasingly irritated as Turbin continues to protest. “That’s my reason. Listen: I am the expert here.”\u003c/p>\n\u003cp>“You cannot fight with the doctor,” Turbin’s mother tells her daughter. “Just do it, doctor. Don’t worry.”\u003c/p>\n\u003cp>Then comes the audible sound of him snipping Turbin’s flesh.\u003c/p>\n\u003cp>Episiotomy, a once-common childbirth procedure that involves cutting tissue between the vagina and anus to enlarge the vaginal opening, has been officially discouraged in most cases for a decade. Yet it is still being performed at much higher than recommended rates in certain hospitals and by certain doctors.\u003c/p>\n\u003cp>In 2006, the American College of Obstetricians and Gynecologists released a \u003ca href=\"http://www.acog.org/About-ACOG/News-Room/News-Releases/2006/ACOG-Recommends-Restricted-Use-of-Episiotomies\" target=\"_blank\">recommendation against routine use of episiotomy, \u003c/a>finding that it benefited neither mothers nor babies. In 2008, the \u003ca href=\"http://www.qualityforum.org/Home.aspx\">National Quality Forum\u003c/a> also endorsed \u003ca href=\"http://www.npic.org/services/Sample_V093_Incidence_of_Episiotomy_Analysis.pdf\">limiting the routine use\u003c/a> of episiotomies. The procedure is still supported for use in certain emergency situations.\u003c/p>\n\u003cp>Nationally, and throughout California, the use of episiotomies has dropped significantly since the official recommendations came out — from 21 percent of all vaginal births in the state in 2005 to less than 12 percent in 2014.\u003c/p>\n\u003cp>That overall drop masks some giant disparities. A majority of the state’s hospitals now have rates under 10 percent, according to state data. But a few, including Whittier Hospital Medical Center and Beverly Hospital, in Los Angeles, are performing the procedure in more than 60 percent of vaginal births. Neither hospital returned calls for comment.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-210233\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png\" alt=\"Screen Shot 2016-07-08 at 8.12.48 AM\" width=\"1386\" height=\"904\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png 1386w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-400x261.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-800x522.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-768x501.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-1180x770.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-960x626.png 960w\" sizes=\"(max-width: 1386px) 100vw, 1386px\">“If you perform an episiotomy, you’re more likely than not going to cause more postpartum pain and discomfort,” said Dr. Alexander Friedman, an assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center.\u003c/p>\n\u003cp>Friedman was the lead author of a 2015 \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2089343\" target=\"_blank\">JAMA report about the variation in episiotomy rates\u003c/a>among hospitals nationally. While it’s difficult to determine precisely what that rate should be, he said, it should likely be less than 10 percent.\u003c/p>\n\u003cp>As recently as the late 1970s, episiotomy was used in more than 60 percent of vaginal deliveries because doctors believed a clean incision made it easier to stitch up a woman and prevented overstretching of the muscles surrounding the vagina. In the past few decades, though, research began showing that the cuts were sometimes causing serious pain and injuries, including third and fourth degree lacerations, incontinence and sexual dysfunction. The cuts often proved slower to heal than a natural tear.\u003c/p>\n\u003cp>Armed with this information, many pregnant women started refusing the procedure, and most obstetricians stopped doing it routinely.\u003c/p>\n\u003cp>But some doctors are going against that trend.\u003c/p>\n\u003cp>Dr. Emiliano Chavira, a maternal and fetal medicine specialist at Dignity Health’s California Hospital Medical Center in Los Angeles, lists three main reasons why he suspects some providers continue to perform routine episiotomies: They’ve always done them, they lack awareness of best practices or they want to speed up deliveries.\u003c/p>\n\u003cp>“Certain segments of the obstetric community are very slow to modernize the practice,” he said. “They’re very slow to abandon procedures that are not a benefit and, in fact, may be harmful. And it’s really disappointing.”\u003c/p>\n\u003cp>Such variation exists not only among providers, but among hospitals. Case in point: The Los Angeles hospital chain, AHMC Healthcare Inc. Each of its six hospitals have continued to do episiotomies in more than 29 percent of vaginal births, according to state data. Two of them — Garfield Medical Center and Whittier Hospital Medical Center — have episiotomy rates close to 60 percent. Representatives of the chain and its hospitals did not return repeated calls and emails requesting comment.\u003c/p>\n\u003cp>By contrast, Kaiser hospitals have seen huge reductions in use of the procedure since the Oakland-based managed care organization undertook an intentional effort to address overuse.\u003c/p>\n\u003cp>Dr. Tracy Flanagan, director of women’s health and maternity at Kaiser Permanente in Northern California, said her office began examining episiotomy rates at different hospitals four or five years ago. They first looked at rates at the hospital level, then at the physician level, she said.\u003c/p>\n\u003cp>“When we generated the data, we saw a lot of the variation and got to work on it,” she said.\u003c/p>\n\u003cp>They sent the data to the individual hospitals. Then, doctors at each hospital who rarely performed episiotomies educated their colleagues about the appropriate use and risks.\u003c/p>\n\u003cp>Physicians tend to respond best if other physicians present them with a compelling argument to change their practices, Flanagan said. Reliable data, transparency and peer-to-peer education is a good recipe for narrowing variation, she said.\u003c/p>\n\u003cp>The average episiotomy rate for the Northern California Kaiser hospitals is now about 3 percent, she said. Zero percent would be too low, she added, since there are some cases where the procedure’s use is indicated — if a baby’s shoulder is stuck, if a baby’s heart rate drops, or if the mother is exhausted and wants an episiotomy, for instance.\u003c/p>\n\u003cp>Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative at Stanford University, says the episiotomy data offers a lesson on how quickly practices can change. It also highlights the hospitals where doctors refuse to alter their ways, he said.\u003c/p>\n\u003cp>In the case of C-sections, doctors may be motivated to perform the procedures because they allow for faster deliveries or better pay, he said. But the main reason most doctors still perform episiotomies is because they always have done so, he said.\u003c/p>\n\u003cp>“It is always hard for people to relearn,” Main said.\u003c/p>\n\u003cp>His organization is leading an effort to provide doctors and hospitals with data on certain childbirth practices to show them how they compare with their peers around the state. Beginning in 2010, they \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/toolkits/early-elective-deliveries-toolkit\" target=\"_blank\">partnered with the March of Dimes to educate providers\u003c/a> about the dangers of elective delivery prior to 39 weeks. Within three years, that practice had dropped off rapidly, he said. They are currently undertaking similar efforts related to C-sections.\u003c/p>\n\u003cp>Chavira, the maternal and fetal medicine specialist at California Hospital in Los Angeles, said he would like to see similar transparency with episiotomies.\u003c/p>\n\u003cp>“If you have a hospital where people are doing 5 percent episiotomies and one guy is doing 60 percent episiotomies, all of a sudden he sticks out like a sore thumb,” he said.\u003c/p>\n\u003cp>A lot of women don’t want the procedure, he noted, and doctors are supposed to honor their patients’ wishes.\u003c/p>\n\u003cp>Turbin, a 29-year-old dental assistant who now lives in Stockton, is suing her former doctor, Alex Abassi, for assault and battery. In June, a judge ruled that the case could go to trial this fall. Citing cognitive impairment, Abassi surrendered his medical license last year. The executive director of the attorney’s office representing Abassi declined to comment.\u003c/p>\n\u003cp>Since the episiotomy, Turbin said, “I had major, major, major, major pain.”\u003c/p>\n\u003cp>She’s afraid to go to the doctor now, she said, and she’s terrified of getting pregnant again.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If I go back to that day, there’s nothing I could have done,” she said. “That doctor was going to cut me no matter what.”\u003c/p>\n\n","blocks":[],"excerpt":"See which California hospitals have the highest and lowest rates of episiotomies. ","status":"publish","parent":0,"modified":1467991607,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":40,"wordCount":1398},"headData":{"title":"'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common | KQED","description":"See which California hospitals have the highest and lowest rates of episiotomies. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common","datePublished":"2016-07-08T15:26:47.000Z","dateModified":"2016-07-08T15:26:47.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"210214 http://ww2.kqed.org/stateofhealth/?p=210214","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/08/dont-cut-me-episiotomies-now-discouraged-still-too-common/","disqusTitle":"'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common","nprByline":"Jocelyn Wiener\u003cbr />\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>","path":"/stateofhealth/210214/dont-cut-me-episiotomies-now-discouraged-still-too-common","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Since it was uploaded to YouTube, \u003ca href=\"https://youtu.be/lCfXxtoAN-I\" target=\"_blank\">the video of Kimberly Turbin’s 2013 episiotomy \u003c/a>has been viewed more than 430,000 times. In the video, Turbin lies on her back in a hospital bed. Her knees are bent, her legs and feet are elevated above her in stirrups. She is trying to push the baby out.\u003c/p>\n\u003cp>“Push, push, push. Go, go, go,” the nurse says.\u003c/p>\n\u003cp>A doctor walks into her room in Providence Tarzana Medical Center in California’s San Fernando Valley. He pulls out a pair of sharp scissors.\u003c/p>\n\u003cp>“What are you doing?” Turbin asks, breathless, between contractions.\u003c/p>\n\u003cp>He tells her he is going to cut her perineum, a procedure known as an episiotomy.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“What? Why? We haven’t even tried,” Turbin cries. “No, don’t cut me!”\u003c/p>\n\u003cp>“What do you mean, ‘Why?’” the doctor responds, sounding increasingly irritated as Turbin continues to protest. “That’s my reason. Listen: I am the expert here.”\u003c/p>\n\u003cp>“You cannot fight with the doctor,” Turbin’s mother tells her daughter. “Just do it, doctor. Don’t worry.”\u003c/p>\n\u003cp>Then comes the audible sound of him snipping Turbin’s flesh.\u003c/p>\n\u003cp>Episiotomy, a once-common childbirth procedure that involves cutting tissue between the vagina and anus to enlarge the vaginal opening, has been officially discouraged in most cases for a decade. Yet it is still being performed at much higher than recommended rates in certain hospitals and by certain doctors.\u003c/p>\n\u003cp>In 2006, the American College of Obstetricians and Gynecologists released a \u003ca href=\"http://www.acog.org/About-ACOG/News-Room/News-Releases/2006/ACOG-Recommends-Restricted-Use-of-Episiotomies\" target=\"_blank\">recommendation against routine use of episiotomy, \u003c/a>finding that it benefited neither mothers nor babies. In 2008, the \u003ca href=\"http://www.qualityforum.org/Home.aspx\">National Quality Forum\u003c/a> also endorsed \u003ca href=\"http://www.npic.org/services/Sample_V093_Incidence_of_Episiotomy_Analysis.pdf\">limiting the routine use\u003c/a> of episiotomies. The procedure is still supported for use in certain emergency situations.\u003c/p>\n\u003cp>Nationally, and throughout California, the use of episiotomies has dropped significantly since the official recommendations came out — from 21 percent of all vaginal births in the state in 2005 to less than 12 percent in 2014.\u003c/p>\n\u003cp>That overall drop masks some giant disparities. A majority of the state’s hospitals now have rates under 10 percent, according to state data. But a few, including Whittier Hospital Medical Center and Beverly Hospital, in Los Angeles, are performing the procedure in more than 60 percent of vaginal births. Neither hospital returned calls for comment.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-210233\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png\" alt=\"Screen Shot 2016-07-08 at 8.12.48 AM\" width=\"1386\" height=\"904\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png 1386w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-400x261.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-800x522.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-768x501.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-1180x770.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-960x626.png 960w\" sizes=\"(max-width: 1386px) 100vw, 1386px\">“If you perform an episiotomy, you’re more likely than not going to cause more postpartum pain and discomfort,” said Dr. Alexander Friedman, an assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center.\u003c/p>\n\u003cp>Friedman was the lead author of a 2015 \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2089343\" target=\"_blank\">JAMA report about the variation in episiotomy rates\u003c/a>among hospitals nationally. While it’s difficult to determine precisely what that rate should be, he said, it should likely be less than 10 percent.\u003c/p>\n\u003cp>As recently as the late 1970s, episiotomy was used in more than 60 percent of vaginal deliveries because doctors believed a clean incision made it easier to stitch up a woman and prevented overstretching of the muscles surrounding the vagina. In the past few decades, though, research began showing that the cuts were sometimes causing serious pain and injuries, including third and fourth degree lacerations, incontinence and sexual dysfunction. The cuts often proved slower to heal than a natural tear.\u003c/p>\n\u003cp>Armed with this information, many pregnant women started refusing the procedure, and most obstetricians stopped doing it routinely.\u003c/p>\n\u003cp>But some doctors are going against that trend.\u003c/p>\n\u003cp>Dr. Emiliano Chavira, a maternal and fetal medicine specialist at Dignity Health’s California Hospital Medical Center in Los Angeles, lists three main reasons why he suspects some providers continue to perform routine episiotomies: They’ve always done them, they lack awareness of best practices or they want to speed up deliveries.\u003c/p>\n\u003cp>“Certain segments of the obstetric community are very slow to modernize the practice,” he said. “They’re very slow to abandon procedures that are not a benefit and, in fact, may be harmful. And it’s really disappointing.”\u003c/p>\n\u003cp>Such variation exists not only among providers, but among hospitals. Case in point: The Los Angeles hospital chain, AHMC Healthcare Inc. Each of its six hospitals have continued to do episiotomies in more than 29 percent of vaginal births, according to state data. Two of them — Garfield Medical Center and Whittier Hospital Medical Center — have episiotomy rates close to 60 percent. Representatives of the chain and its hospitals did not return repeated calls and emails requesting comment.\u003c/p>\n\u003cp>By contrast, Kaiser hospitals have seen huge reductions in use of the procedure since the Oakland-based managed care organization undertook an intentional effort to address overuse.\u003c/p>\n\u003cp>Dr. Tracy Flanagan, director of women’s health and maternity at Kaiser Permanente in Northern California, said her office began examining episiotomy rates at different hospitals four or five years ago. They first looked at rates at the hospital level, then at the physician level, she said.\u003c/p>\n\u003cp>“When we generated the data, we saw a lot of the variation and got to work on it,” she said.\u003c/p>\n\u003cp>They sent the data to the individual hospitals. Then, doctors at each hospital who rarely performed episiotomies educated their colleagues about the appropriate use and risks.\u003c/p>\n\u003cp>Physicians tend to respond best if other physicians present them with a compelling argument to change their practices, Flanagan said. Reliable data, transparency and peer-to-peer education is a good recipe for narrowing variation, she said.\u003c/p>\n\u003cp>The average episiotomy rate for the Northern California Kaiser hospitals is now about 3 percent, she said. Zero percent would be too low, she added, since there are some cases where the procedure’s use is indicated — if a baby’s shoulder is stuck, if a baby’s heart rate drops, or if the mother is exhausted and wants an episiotomy, for instance.\u003c/p>\n\u003cp>Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative at Stanford University, says the episiotomy data offers a lesson on how quickly practices can change. It also highlights the hospitals where doctors refuse to alter their ways, he said.\u003c/p>\n\u003cp>In the case of C-sections, doctors may be motivated to perform the procedures because they allow for faster deliveries or better pay, he said. But the main reason most doctors still perform episiotomies is because they always have done so, he said.\u003c/p>\n\u003cp>“It is always hard for people to relearn,” Main said.\u003c/p>\n\u003cp>His organization is leading an effort to provide doctors and hospitals with data on certain childbirth practices to show them how they compare with their peers around the state. Beginning in 2010, they \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/toolkits/early-elective-deliveries-toolkit\" target=\"_blank\">partnered with the March of Dimes to educate providers\u003c/a> about the dangers of elective delivery prior to 39 weeks. Within three years, that practice had dropped off rapidly, he said. They are currently undertaking similar efforts related to C-sections.\u003c/p>\n\u003cp>Chavira, the maternal and fetal medicine specialist at California Hospital in Los Angeles, said he would like to see similar transparency with episiotomies.\u003c/p>\n\u003cp>“If you have a hospital where people are doing 5 percent episiotomies and one guy is doing 60 percent episiotomies, all of a sudden he sticks out like a sore thumb,” he said.\u003c/p>\n\u003cp>A lot of women don’t want the procedure, he noted, and doctors are supposed to honor their patients’ wishes.\u003c/p>\n\u003cp>Turbin, a 29-year-old dental assistant who now lives in Stockton, is suing her former doctor, Alex Abassi, for assault and battery. In June, a judge ruled that the case could go to trial this fall. Citing cognitive impairment, Abassi surrendered his medical license last year. The executive director of the attorney’s office representing Abassi declined to comment.\u003c/p>\n\u003cp>Since the episiotomy, Turbin said, “I had major, major, major, major pain.”\u003c/p>\n\u003cp>She’s afraid to go to the doctor now, she said, and she’s terrified of getting pregnant again.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If I go back to that day, there’s nothing I could have done,” she said. “That doctor was going to cut me no matter what.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/210214/dont-cut-me-episiotomies-now-discouraged-still-too-common","authors":["byline_stateofhealth_210214"],"categories":["stateofhealth_2746","stateofhealth_13"],"tags":["stateofhealth_169","stateofhealth_2519","stateofhealth_397"],"featImg":"stateofhealth_210238","label":"stateofhealth"},"stateofhealth_203417":{"type":"posts","id":"stateofhealth_203417","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"203417","score":null,"sort":[1467760578000]},"guestAuthors":[],"slug":"oakland-seeks-to-ban-false-advertising-by-anti-abortion-clinics","title":"Oakland Seeks to Ban False Advertising by Anti-Abortion Clinics","publishDate":1467760578,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>Update -- July 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>The ordinance to fine pregnancy centers that claim to offer abortion services, but don't, was passed unanimously by the Oakland City Council's Life Enrichment Committee on June 28. The full City Council will hear the measure tonight. If it passes, it must be heard again in two weeks.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>Oakland officials are considering an ordinance that would allow the city to fine pregnancy centers that claim to offer abortion services, but do not.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We believe women who need care should not be lied to.' \u003ccite>Annie Campbell Washington, Oakland Vice Mayor\u003c/cite>\u003c/aside>\n\u003cp>Officials say some anti-abortion groups' internet advertising and mass transit billboards are misleading, and intended to lure pregnant women in for counseling against abortion.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We believe women who need care should not be lied to,” said Annie Campbell Washington, vice mayor of Oakland and a proponent of the ordinance.\u003c/p>\n\u003cp>Oakland officials are particularly concerned about search advertising. For example, typing \"abortion services\" into a Google or Yahoo search engine can bring up links to nearby crisis pregnancy centers that do not offer abortion.\u003c/p>\n\u003cp>These pregnancy centers buy the search ads for terms like \"abortion\" or \"pregnancy test\" so links for their clinics will appear on users' screens when they enter searches for those terms. Their websites often say they offer \"abortion information\" or \"counseling for women seeking abortion.\"\u003c/p>\n\u003cp>Oakland officials want to prohibit them from doing this. Fines would range from $50 to $500 per violation.\u003c/p>\n\u003cp>\"When a woman is misled into believing that a clinic offers services that it does not in fact offer, she loses time crucial to her decision-making process,\" Washington says.\u003c/p>\n\u003cp>Washington says delays in care can mean women may have to get a more invasive, more expensive procedure, or may lose her right to terminate the pregnancy at all, because too much time has passed and her pregnancy is too far along to lawfully terminate.\u003c/p>\n\u003cp>“We want to send a clear message that false advertising is not acceptable in the city of Oakland,” she said.\u003c/p>\n\u003cp>Up until a few months ago, if iPhone users asked Siri to locate a nearby abortion clinic, the voice assistant would return a list of adoption agencies.\u003c/p>\n\u003cp>Apple, which is responsible for Siri search results, said it was aware of the glitch right after Siri debuted in 2011, but it was not fixed until January, 2016. The company \u003ca href=\"https://techcrunch.com/2016/01/29/apple%E2%80%A6\" target=\"_blank\">told Tech Crunch\u003c/a> that it has been \"updating its search results over time.\"\u003c/p>\n\u003cp>Crisis pregnancy centers say the marketing and counseling they do is not false advertising. It's free speech. They say this kind of ordinance is an attack on their first amendment rights.\u003c/p>\n\u003cp>“Using search terms to make women aware of your ministry and the services you provide, with regards to pregnancy alternatives, is very legitimate and would be foolhardy not to be utilized,” said Brad Dacus, an attorney with the Pacific Justice Institute, a nonprofit law firm that defends religious freedom.\u003c/p>\n\u003cp>Staff at crisis pregnancy centers do not lie, he said, adding, it’s \"insulting to women\" to assume they don't have the ability to ask questions before making an appointment to make sure the services they want are available.\u003c/p>\n\u003cp>“It’s also very presumptive to believe that those who use search terms such as ‘abortion’ are presumably seeking just an abortion,\" he said. \"They may also be open, and possibly yearning, for other options.\"\u003c/p>\n\u003cp>Some crisis pregnancy centers challenged a similar false advertising law in San Francisco, which took effect in late 2011. Last year, a district judge \u003ca href=\"http://www.sfgate.com/bayarea/article/Limits-upheld-on-ads-by-antiabortion-pregnancy-6097159.php\" target=\"_blank\">upheld the law\u003c/a>, saying false and misleading commercial speech is not protected by the First Amendment.\u003c/p>\n\u003cp>The Oakland ordinance builds on a new statewide law that was signed by Gov. Jerry Brown last fall, the \u003ca href=\"http://ww2.kqed.org/news/2015/11/04/california-law-adds-new-twist-to-abortion-religious-freedom-debate\" target=\"_blank\">Reproductive FACT Act\u003c/a>. It requires crisis pregnancy centers to notify their clients if they are not medically licensed.\u003c/p>\n\u003cp>In addition, clinics that are medically licensed are required to post a notice in their waiting room -- or let patients know when they check in for an appointment -- that there is financial assistance available for family planning services and abortion. They must also provide the phone number for the local county health department.\u003c/p>\n\u003cp>The Pacific Justice Institute has filed one of several lawsuits challenging the state law. It is currently under review by the 9th Circuit Court of Appeals. Dacus says if the law is upheld, his group will appeal to the U.S. Supreme Court.\u003c/p>\n\u003cp>The state law did not cover issues of false advertising.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Oakland’s ordinance goes before the city's Life Enrichment Committee for a vote on Tuesday, then will be reviewed and voted on by the full City Council twice in July.\u003c/p>\n\n","blocks":[],"excerpt":"Typing \"abortion services\" into Google's search engine can bring up links to nearby crisis pregnancy centers that do not offer abortion.","status":"publish","parent":0,"modified":1467915631,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":809},"headData":{"title":"Oakland Seeks to Ban False Advertising by Anti-Abortion Clinics | KQED","description":"Typing "abortion services" into Google's search engine can bring up links to nearby crisis pregnancy centers that do not offer abortion.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Oakland Seeks to Ban False Advertising by Anti-Abortion Clinics","datePublished":"2016-07-05T23:16:18.000Z","dateModified":"2016-07-07T18:20:31.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"203417 http://ww2.kqed.org/stateofhealth/?p=203417","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/05/oakland-seeks-to-ban-false-advertising-by-anti-abortion-clinics/","disqusTitle":"Oakland Seeks to Ban False Advertising by Anti-Abortion Clinics","customPermalink":"2016/06/28/oakland-seeks-to-ban-false-advertising-by-anti-abortion-clinics/","path":"/stateofhealth/203417/oakland-seeks-to-ban-false-advertising-by-anti-abortion-clinics","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update -- July 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>The ordinance to fine pregnancy centers that claim to offer abortion services, but don't, was passed unanimously by the Oakland City Council's Life Enrichment Committee on June 28. The full City Council will hear the measure tonight. If it passes, it must be heard again in two weeks.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>Oakland officials are considering an ordinance that would allow the city to fine pregnancy centers that claim to offer abortion services, but do not.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We believe women who need care should not be lied to.' \u003ccite>Annie Campbell Washington, Oakland Vice Mayor\u003c/cite>\u003c/aside>\n\u003cp>Officials say some anti-abortion groups' internet advertising and mass transit billboards are misleading, and intended to lure pregnant women in for counseling against abortion.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We believe women who need care should not be lied to,” said Annie Campbell Washington, vice mayor of Oakland and a proponent of the ordinance.\u003c/p>\n\u003cp>Oakland officials are particularly concerned about search advertising. For example, typing \"abortion services\" into a Google or Yahoo search engine can bring up links to nearby crisis pregnancy centers that do not offer abortion.\u003c/p>\n\u003cp>These pregnancy centers buy the search ads for terms like \"abortion\" or \"pregnancy test\" so links for their clinics will appear on users' screens when they enter searches for those terms. Their websites often say they offer \"abortion information\" or \"counseling for women seeking abortion.\"\u003c/p>\n\u003cp>Oakland officials want to prohibit them from doing this. Fines would range from $50 to $500 per violation.\u003c/p>\n\u003cp>\"When a woman is misled into believing that a clinic offers services that it does not in fact offer, she loses time crucial to her decision-making process,\" Washington says.\u003c/p>\n\u003cp>Washington says delays in care can mean women may have to get a more invasive, more expensive procedure, or may lose her right to terminate the pregnancy at all, because too much time has passed and her pregnancy is too far along to lawfully terminate.\u003c/p>\n\u003cp>“We want to send a clear message that false advertising is not acceptable in the city of Oakland,” she said.\u003c/p>\n\u003cp>Up until a few months ago, if iPhone users asked Siri to locate a nearby abortion clinic, the voice assistant would return a list of adoption agencies.\u003c/p>\n\u003cp>Apple, which is responsible for Siri search results, said it was aware of the glitch right after Siri debuted in 2011, but it was not fixed until January, 2016. The company \u003ca href=\"https://techcrunch.com/2016/01/29/apple%E2%80%A6\" target=\"_blank\">told Tech Crunch\u003c/a> that it has been \"updating its search results over time.\"\u003c/p>\n\u003cp>Crisis pregnancy centers say the marketing and counseling they do is not false advertising. It's free speech. They say this kind of ordinance is an attack on their first amendment rights.\u003c/p>\n\u003cp>“Using search terms to make women aware of your ministry and the services you provide, with regards to pregnancy alternatives, is very legitimate and would be foolhardy not to be utilized,” said Brad Dacus, an attorney with the Pacific Justice Institute, a nonprofit law firm that defends religious freedom.\u003c/p>\n\u003cp>Staff at crisis pregnancy centers do not lie, he said, adding, it’s \"insulting to women\" to assume they don't have the ability to ask questions before making an appointment to make sure the services they want are available.\u003c/p>\n\u003cp>“It’s also very presumptive to believe that those who use search terms such as ‘abortion’ are presumably seeking just an abortion,\" he said. \"They may also be open, and possibly yearning, for other options.\"\u003c/p>\n\u003cp>Some crisis pregnancy centers challenged a similar false advertising law in San Francisco, which took effect in late 2011. Last year, a district judge \u003ca href=\"http://www.sfgate.com/bayarea/article/Limits-upheld-on-ads-by-antiabortion-pregnancy-6097159.php\" target=\"_blank\">upheld the law\u003c/a>, saying false and misleading commercial speech is not protected by the First Amendment.\u003c/p>\n\u003cp>The Oakland ordinance builds on a new statewide law that was signed by Gov. Jerry Brown last fall, the \u003ca href=\"http://ww2.kqed.org/news/2015/11/04/california-law-adds-new-twist-to-abortion-religious-freedom-debate\" target=\"_blank\">Reproductive FACT Act\u003c/a>. It requires crisis pregnancy centers to notify their clients if they are not medically licensed.\u003c/p>\n\u003cp>In addition, clinics that are medically licensed are required to post a notice in their waiting room -- or let patients know when they check in for an appointment -- that there is financial assistance available for family planning services and abortion. They must also provide the phone number for the local county health department.\u003c/p>\n\u003cp>The Pacific Justice Institute has filed one of several lawsuits challenging the state law. It is currently under review by the 9th Circuit Court of Appeals. Dacus says if the law is upheld, his group will appeal to the U.S. Supreme Court.\u003c/p>\n\u003cp>The state law did not cover issues of false advertising.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Oakland’s ordinance goes before the city's Life Enrichment Committee for a vote on Tuesday, then will be reviewed and voted on by the full City Council twice in July.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/203417/oakland-seeks-to-ban-false-advertising-by-anti-abortion-clinics","authors":["3205"],"categories":["stateofhealth_2407","stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_160","stateofhealth_2808","stateofhealth_2519","stateofhealth_397"],"featImg":"stateofhealth_205124","label":"stateofhealth"},"stateofhealth_206784":{"type":"posts","id":"stateofhealth_206784","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"206784","score":null,"sort":[1467396889000]},"guestAuthors":[],"slug":"5-things-to-consider-about-the-supreme-courts-decision-on-texas-abortion-law","title":"5 Things To Consider About The Supreme Court's Decision On Texas Abortion Law","publishDate":1467396889,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>The Supreme Court this week delivered its strongest affirmation of a women's right to abortion in years. By a margin of 5-3, it struck down two key provisions of a Texas law restricting the procedure.\u003c/p>\n\u003cp>But where does the decision in \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/15-274_p8k0.pdf\" target=\"_blank\">Whole Woman's Health v. Hellerstedt\u003c/a> fit in the court's long history of actions abortion rights and restrictions? And what effect might the case have on similar laws in other states and this fall's elections? Here are five insights about the case that provide some context:\u003c/p>\n\u003cp>\u003cstrong>1. It's the first big win for supporters of abortion rights in a long time.\u003c/strong>\u003c/p>\n\u003cp>The last time abortion-rights supporters were on the winning side of a big case at the Supreme Court was 16 years ago, when a 5-4 ruling in \u003ca href=\"https://www.oyez.org/cases/1999/99-830\" target=\"_blank\">Stenberg v. Carhart\u003c/a> struck down a Nebraska law banning a specific procedure abortion opponents called \"partial birth abortion.\" That win was effectively reversed in 2007, however, when the court upheld a similar federal law banning the same procedure, also on a 5-4 ruling, in \u003ca href=\"https://www.oyez.org/cases/2006/05-380\" target=\"_blank\">Gonzales v. Carhart\u003c/a>. The substance hadn't changed much, but the replacement of Justice Sandra Day O'Connor with Justice Samuel Alito in 2006 gave abortion opponents an extra vote, which was enough to change the outcome.\u003c/p>\n\u003cp>After Monday's decision, many foes of abortion rights complained that there were few restrictions on abortion that would pass muster with the high court. But, in fact, in the years since the court first legalized abortion nationwide in \u003ca href=\"https://www.oyez.org/cases/1971/70-18\" target=\"_blank\">Roe v. Wade\u003c/a> in 1973, about half the major cases have been clear wins for abortion opponents, including upholding state laws requiring \u003ca href=\"https://www.law.cornell.edu/supremecourt/text/497/502\" target=\"_blank\">parental involvement for minors\u003c/a>, \u003ca href=\"https://www.oyez.org/cases/1991/91-744\" target=\"_blank\">waiting periods\u003c/a>, and \u003ca href=\"https://www.oyez.org/cases/1979/79-1268\" target=\"_blank\">bans on the use of public funds\u003c/a> to pay for abortions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>2. It could put pro-abortion rights forces on the offensive.\u003c/strong>\u003c/p>\n\u003cp>Since Republicans took over Congress and most state legislatures after the 2010 elections, states have enacted \u003ca href=\"https://www.guttmacher.org/article/2016/01/last-five-years-account-more-one-quarter-all-abortion-restrictions-enacted-roe\" target=\"_blank\">nearly 300 separate abortion restrictions\u003c/a>; the most in any five-year period since \u003cem>Roe v. Wade\u003c/em> was decided. Many of those were the same types of \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_TRAP.pdf\" target=\"_blank\">laws claiming protections for women's health\u003c/a> that were struck down by the Supreme Court this week. Those laws include requiring doctors who perform abortions to have admitting privileges at a nearby hospital and requiring abortion clinics to meet the standards of facilities performing more involved surgical procedures.\u003c/p>\n\u003cp>The justices have already responded to petitions from some states with similar laws. Just a day after handing down the Texas ruling, they rejected appeals from \u003ca href=\"http://www.reuters.com/article/us-usa-court-abortion-idUSKCN0ZE1MJ\" target=\"_blank\">Mississippi and Wisconsin\u003c/a>, where physician admitting privilege laws had been blocked by lower court judges. Those laws are now permanently blocked. Officials in \u003ca href=\"http://www.ago.state.al.us/News-863\" target=\"_blank\">Alabama\u003c/a> also dropped their defense of a similar law.\u003c/p>\n\u003cp>But the decision doesn't automatically invalidate similar laws in other states because the effect of such statutes is different in every community. For example, what may amount to an \"undue burden\" in Texas because of the sheer size of the state might not be as burdensome in states with clinics closer together.\u003c/p>\n\u003cp>In states where lower court judges have already blocked laws, those blocks are almost certain to remain in place. But in other states opponents of the restrictions would have to work to overturn each law individually.\u003c/p>\n\u003cp>They say that is what they plan to do. \"We will now will take this fight state by state to challenge and repeal laws all across the country,\" Planned Parenthood President Cecile Richards told reporters in a conference call immediately after the ruling.\u003c/p>\n\u003cp>Planned Parenthood announced on Thursday that it would pursue efforts to block or repeal similar laws in eight states: Arizona, Florida, Michigan, Missouri, Pennsylvania, Tennessee, Texas, and Virginia.\u003c/p>\n\u003cp>Abortion-rights supporters are also taking aim at some long-standing abortion restrictions in federal law. The \u003ca href=\"https://demconvention.com/news/democratic-platform-drafting-meeting-concludes/\" target=\"_blank\">draft Democratic platform\u003c/a> that will be finalized at the party's nominating convention in late July includes a plan calling for the repeal of the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=121402281\" target=\"_blank\">Hyde Amendment\u003c/a>, which has banned most federal abortion funding since 1977. That provision was \u003ca href=\"https://www.hillaryclinton.com/briefing/statements/2016/06/25/statement-from-senior-policy-advisor-maya-harris-on-democratic-platform/\" target=\"_blank\">highlighted and praised\u003c/a> by presumptive nominee Hillary Clinton's campaign, noting that it represents the first time such an explicit vow has been included.\u003c/p>\n\u003cp>\u003cstrong>3. Opponents of abortion rights aren't likely to retreat.\u003c/strong>\u003c/p>\n\u003cp>While the latest Supreme Court ruling was definitely a setback for abortion foes, they are not giving up. For one thing, \u003ca href=\"http://www.prochoiceamerica.org/assets/download-files/2016-wd-report.pdf\" target=\"_blank\">opponents remain in control of a majority\u003c/a> of state legislatures and governorships, and that's unlikely to change following this year's national elections.\u003c/p>\n\u003cp>\"Americans United for Life will continue to fight — in legislatures and in the courts — to protect women from a dangerous and greedy abortion industry,\" said AUL Acting President and Senior Counsel Clarke Forsythe. Americans United for Life has been at the forefront of \u003ca href=\"http://www.npr.org/sections/health-shots/2016/03/04/469094346/legal-foes-in-texas-abortion-case-are-using-new-playbooks\" target=\"_blank\">developing model laws\u003c/a> restricting access to abortion.\u003c/p>\n\u003cp>The movement against abortion rights has a much larger menu to choose from than the two issues the high court addressed. For example, many states (including Texas) have passed or are considering \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_PLTA.pdf\" target=\"_blank\">bans on abortion after roughly 20 weeks of pregnancy\u003c/a>. Many of those bans are being \u003ca href=\"http://www.latimes.com/nation/nationnow/la-na-nn-abortion-idaho-20150530-story.html\" target=\"_blank\">challenged in the courts\u003c/a> but none has yet reached the Supreme Court. Other restrictions include requiring pregnant women to have ultrasounds before an abortion, to make multiple visits to an abortion provider and banning the use of \u003ca href=\"http://www.theatlantic.com/business/archive/2014/10/the-safer-more-affordable-abortion-only-available-in-two-states/381321/\" target=\"_blank\">telemedicine\u003c/a> for medical (as opposed to surgical) abortions using the abortion pill \u003ca href=\"https://www.nlm.nih.gov/medlineplus/druginfo/meds/a600042.html\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>Abortion opponents say they aren't giving up on pursuing health and safety standards like the ones struck down in Texas, either. \"This issue of safety standards is not over,\" said Marilyn Musgrave, vice president of government affairs at Susan B. Anthony List.\u003c/p>\n\u003cp>Even some similar laws could pass muster if they are crafted carefully enough, said Kristi Hamrick, a spokeswoman for Americans United for Life. \"We don't have a one-size-fits-all bill to send to the 50 states,\" she said. \"The law is specific and so the tools must be too.\"\u003c/p>\n\u003cp>\u003cstrong>4. The decision could shake up national politics.\u003c/strong>\u003c/p>\n\u003cp>Both sides in the long-polarized abortion debate are already pointing to the case in an effort to mobilize their supporters.\u003c/p>\n\u003cp>\"This certainly makes the November presidential election even more critical,\" said Musgrave of the Susan B. Anthony List. \"It is so obvious that we need to elect a pro-life president.\"\u003c/p>\n\u003cp>On the opposite side, Ilyse Hogue, president of NARAL Pro-Choice America, says the decision \"underscores what the election means for Supreme Court jurisprudence.\" With one vacancy already on the court and others likely in the next four years, she said, \"reproductive freedom is very much on the ballot this November.\"\u003c/p>\n\u003cp>Hillary Clinton's campaign hailed the decision. \"We need a president who will defend women's health and rights and appoint Supreme Court justices who recognize Roe v. Wade as settled law,\" said a statement from the candidate.\u003c/p>\n\u003cp>And while presumptive GOP nominee Donald Trump's campaign was silent on the issue in the immediate aftermath of the decision, Musgrave said abortion opponents are confident he is on their side. \"Say what you will about Donald Trump, his commitment to nominate pro-life justices — I've never seen another candidate do that,\" she said.\u003c/p>\n\u003cp>\u003cstrong>5. Younger generation will have a lot to say about the future of abortion rights.\u003c/strong>\u003c/p>\n\u003cp>Among the many things the two sides in the abortion debate disagree about is how the younger generation feels about abortion. Polls tend to differ dramatically depending on how the question is asked.\u003c/p>\n\u003cp>Musgrave says, \"Our polling shows more and more millennials are pro-life, particularly when you look at things like 20-week (abortion) bans.\"\u003c/p>\n\u003cp>But Dawn Laguens, executive vice president of Planned Parenthood, says they are seeing the exact opposite — that younger women are more supportive of abortion rights. \"They're so social justice oriented,\" she said.\u003c/p>\n\u003cp>And Laguens says that coming \u003ca href=\"http://www.wsj.com/articles/changing-u-s-demographics-favor-democrats-in-election-report-says-1456376460\" target=\"_blank\">demographic changes\u003c/a>, including a more diverse electorate that could tilt Democratic, are a main reason for the recent spike in anti-abortion legislating.\u003c/p>\n\u003cp>\"They feel it slipping away,\" she said. \"They can see the demographics, too, and they want to lock this stuff in.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. You can follow Julie Rovner\u003c/em>\u003cem> on Twitter:\u003c/em>\u003ca href=\"https://twitter.com/jrovner\">@jrovner\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=5+Things+To+Consider+About+The+Supreme+Court%27s+Decision+On+Texas+Abortion+Law+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Where does the decision fit in the court's long history of actions on abortion rights and restrictions? ","status":"publish","parent":0,"modified":1467396889,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":34,"wordCount":1399},"headData":{"title":"5 Things To Consider About The Supreme Court's Decision On Texas Abortion Law | KQED","description":"Where does the decision fit in the court's long history of actions on abortion rights and restrictions? ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"5 Things To Consider About The Supreme Court's Decision On Texas Abortion Law","datePublished":"2016-07-01T18:14:49.000Z","dateModified":"2016-07-01T18:14:49.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"206784 http://ww2.kqed.org/stateofhealth/?p=206784","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/01/5-things-to-consider-about-the-supreme-courts-decision-on-texas-abortion-law/","disqusTitle":"5 Things To Consider About The Supreme Court's Decision On Texas Abortion Law","nprImageCredit":"Mandel Ngan","nprByline":"Julie Rovner\u003cbr />\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>","nprImageAgency":"AFP/Getty Images","nprStoryId":"484332807","nprApiLink":"http://api.npr.org/query?id=484332807&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/07/01/484332807/5-things-to-consider-about-the-supreme-court-s-decision-on-texas-abortion-law?ft=nprml&f=484332807","nprRetrievedStory":"1","nprPubDate":"Fri, 01 Jul 2016 13:52:00 -0400","nprStoryDate":"Fri, 01 Jul 2016 13:51:00 -0400","nprLastModifiedDate":"Fri, 01 Jul 2016 13:52:48 -0400","path":"/stateofhealth/206784/5-things-to-consider-about-the-supreme-courts-decision-on-texas-abortion-law","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Supreme Court this week delivered its strongest affirmation of a women's right to abortion in years. By a margin of 5-3, it struck down two key provisions of a Texas law restricting the procedure.\u003c/p>\n\u003cp>But where does the decision in \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/15-274_p8k0.pdf\" target=\"_blank\">Whole Woman's Health v. Hellerstedt\u003c/a> fit in the court's long history of actions abortion rights and restrictions? And what effect might the case have on similar laws in other states and this fall's elections? Here are five insights about the case that provide some context:\u003c/p>\n\u003cp>\u003cstrong>1. It's the first big win for supporters of abortion rights in a long time.\u003c/strong>\u003c/p>\n\u003cp>The last time abortion-rights supporters were on the winning side of a big case at the Supreme Court was 16 years ago, when a 5-4 ruling in \u003ca href=\"https://www.oyez.org/cases/1999/99-830\" target=\"_blank\">Stenberg v. Carhart\u003c/a> struck down a Nebraska law banning a specific procedure abortion opponents called \"partial birth abortion.\" That win was effectively reversed in 2007, however, when the court upheld a similar federal law banning the same procedure, also on a 5-4 ruling, in \u003ca href=\"https://www.oyez.org/cases/2006/05-380\" target=\"_blank\">Gonzales v. Carhart\u003c/a>. The substance hadn't changed much, but the replacement of Justice Sandra Day O'Connor with Justice Samuel Alito in 2006 gave abortion opponents an extra vote, which was enough to change the outcome.\u003c/p>\n\u003cp>After Monday's decision, many foes of abortion rights complained that there were few restrictions on abortion that would pass muster with the high court. But, in fact, in the years since the court first legalized abortion nationwide in \u003ca href=\"https://www.oyez.org/cases/1971/70-18\" target=\"_blank\">Roe v. Wade\u003c/a> in 1973, about half the major cases have been clear wins for abortion opponents, including upholding state laws requiring \u003ca href=\"https://www.law.cornell.edu/supremecourt/text/497/502\" target=\"_blank\">parental involvement for minors\u003c/a>, \u003ca href=\"https://www.oyez.org/cases/1991/91-744\" target=\"_blank\">waiting periods\u003c/a>, and \u003ca href=\"https://www.oyez.org/cases/1979/79-1268\" target=\"_blank\">bans on the use of public funds\u003c/a> to pay for abortions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>2. It could put pro-abortion rights forces on the offensive.\u003c/strong>\u003c/p>\n\u003cp>Since Republicans took over Congress and most state legislatures after the 2010 elections, states have enacted \u003ca href=\"https://www.guttmacher.org/article/2016/01/last-five-years-account-more-one-quarter-all-abortion-restrictions-enacted-roe\" target=\"_blank\">nearly 300 separate abortion restrictions\u003c/a>; the most in any five-year period since \u003cem>Roe v. Wade\u003c/em> was decided. Many of those were the same types of \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_TRAP.pdf\" target=\"_blank\">laws claiming protections for women's health\u003c/a> that were struck down by the Supreme Court this week. Those laws include requiring doctors who perform abortions to have admitting privileges at a nearby hospital and requiring abortion clinics to meet the standards of facilities performing more involved surgical procedures.\u003c/p>\n\u003cp>The justices have already responded to petitions from some states with similar laws. Just a day after handing down the Texas ruling, they rejected appeals from \u003ca href=\"http://www.reuters.com/article/us-usa-court-abortion-idUSKCN0ZE1MJ\" target=\"_blank\">Mississippi and Wisconsin\u003c/a>, where physician admitting privilege laws had been blocked by lower court judges. Those laws are now permanently blocked. Officials in \u003ca href=\"http://www.ago.state.al.us/News-863\" target=\"_blank\">Alabama\u003c/a> also dropped their defense of a similar law.\u003c/p>\n\u003cp>But the decision doesn't automatically invalidate similar laws in other states because the effect of such statutes is different in every community. For example, what may amount to an \"undue burden\" in Texas because of the sheer size of the state might not be as burdensome in states with clinics closer together.\u003c/p>\n\u003cp>In states where lower court judges have already blocked laws, those blocks are almost certain to remain in place. But in other states opponents of the restrictions would have to work to overturn each law individually.\u003c/p>\n\u003cp>They say that is what they plan to do. \"We will now will take this fight state by state to challenge and repeal laws all across the country,\" Planned Parenthood President Cecile Richards told reporters in a conference call immediately after the ruling.\u003c/p>\n\u003cp>Planned Parenthood announced on Thursday that it would pursue efforts to block or repeal similar laws in eight states: Arizona, Florida, Michigan, Missouri, Pennsylvania, Tennessee, Texas, and Virginia.\u003c/p>\n\u003cp>Abortion-rights supporters are also taking aim at some long-standing abortion restrictions in federal law. The \u003ca href=\"https://demconvention.com/news/democratic-platform-drafting-meeting-concludes/\" target=\"_blank\">draft Democratic platform\u003c/a> that will be finalized at the party's nominating convention in late July includes a plan calling for the repeal of the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=121402281\" target=\"_blank\">Hyde Amendment\u003c/a>, which has banned most federal abortion funding since 1977. That provision was \u003ca href=\"https://www.hillaryclinton.com/briefing/statements/2016/06/25/statement-from-senior-policy-advisor-maya-harris-on-democratic-platform/\" target=\"_blank\">highlighted and praised\u003c/a> by presumptive nominee Hillary Clinton's campaign, noting that it represents the first time such an explicit vow has been included.\u003c/p>\n\u003cp>\u003cstrong>3. Opponents of abortion rights aren't likely to retreat.\u003c/strong>\u003c/p>\n\u003cp>While the latest Supreme Court ruling was definitely a setback for abortion foes, they are not giving up. For one thing, \u003ca href=\"http://www.prochoiceamerica.org/assets/download-files/2016-wd-report.pdf\" target=\"_blank\">opponents remain in control of a majority\u003c/a> of state legislatures and governorships, and that's unlikely to change following this year's national elections.\u003c/p>\n\u003cp>\"Americans United for Life will continue to fight — in legislatures and in the courts — to protect women from a dangerous and greedy abortion industry,\" said AUL Acting President and Senior Counsel Clarke Forsythe. Americans United for Life has been at the forefront of \u003ca href=\"http://www.npr.org/sections/health-shots/2016/03/04/469094346/legal-foes-in-texas-abortion-case-are-using-new-playbooks\" target=\"_blank\">developing model laws\u003c/a> restricting access to abortion.\u003c/p>\n\u003cp>The movement against abortion rights has a much larger menu to choose from than the two issues the high court addressed. For example, many states (including Texas) have passed or are considering \u003ca href=\"https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_PLTA.pdf\" target=\"_blank\">bans on abortion after roughly 20 weeks of pregnancy\u003c/a>. Many of those bans are being \u003ca href=\"http://www.latimes.com/nation/nationnow/la-na-nn-abortion-idaho-20150530-story.html\" target=\"_blank\">challenged in the courts\u003c/a> but none has yet reached the Supreme Court. Other restrictions include requiring pregnant women to have ultrasounds before an abortion, to make multiple visits to an abortion provider and banning the use of \u003ca href=\"http://www.theatlantic.com/business/archive/2014/10/the-safer-more-affordable-abortion-only-available-in-two-states/381321/\" target=\"_blank\">telemedicine\u003c/a> for medical (as opposed to surgical) abortions using the abortion pill \u003ca href=\"https://www.nlm.nih.gov/medlineplus/druginfo/meds/a600042.html\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>Abortion opponents say they aren't giving up on pursuing health and safety standards like the ones struck down in Texas, either. \"This issue of safety standards is not over,\" said Marilyn Musgrave, vice president of government affairs at Susan B. Anthony List.\u003c/p>\n\u003cp>Even some similar laws could pass muster if they are crafted carefully enough, said Kristi Hamrick, a spokeswoman for Americans United for Life. \"We don't have a one-size-fits-all bill to send to the 50 states,\" she said. \"The law is specific and so the tools must be too.\"\u003c/p>\n\u003cp>\u003cstrong>4. The decision could shake up national politics.\u003c/strong>\u003c/p>\n\u003cp>Both sides in the long-polarized abortion debate are already pointing to the case in an effort to mobilize their supporters.\u003c/p>\n\u003cp>\"This certainly makes the November presidential election even more critical,\" said Musgrave of the Susan B. Anthony List. \"It is so obvious that we need to elect a pro-life president.\"\u003c/p>\n\u003cp>On the opposite side, Ilyse Hogue, president of NARAL Pro-Choice America, says the decision \"underscores what the election means for Supreme Court jurisprudence.\" With one vacancy already on the court and others likely in the next four years, she said, \"reproductive freedom is very much on the ballot this November.\"\u003c/p>\n\u003cp>Hillary Clinton's campaign hailed the decision. \"We need a president who will defend women's health and rights and appoint Supreme Court justices who recognize Roe v. Wade as settled law,\" said a statement from the candidate.\u003c/p>\n\u003cp>And while presumptive GOP nominee Donald Trump's campaign was silent on the issue in the immediate aftermath of the decision, Musgrave said abortion opponents are confident he is on their side. \"Say what you will about Donald Trump, his commitment to nominate pro-life justices — I've never seen another candidate do that,\" she said.\u003c/p>\n\u003cp>\u003cstrong>5. Younger generation will have a lot to say about the future of abortion rights.\u003c/strong>\u003c/p>\n\u003cp>Among the many things the two sides in the abortion debate disagree about is how the younger generation feels about abortion. Polls tend to differ dramatically depending on how the question is asked.\u003c/p>\n\u003cp>Musgrave says, \"Our polling shows more and more millennials are pro-life, particularly when you look at things like 20-week (abortion) bans.\"\u003c/p>\n\u003cp>But Dawn Laguens, executive vice president of Planned Parenthood, says they are seeing the exact opposite — that younger women are more supportive of abortion rights. \"They're so social justice oriented,\" she said.\u003c/p>\n\u003cp>And Laguens says that coming \u003ca href=\"http://www.wsj.com/articles/changing-u-s-demographics-favor-democrats-in-election-report-says-1456376460\" target=\"_blank\">demographic changes\u003c/a>, including a more diverse electorate that could tilt Democratic, are a main reason for the recent spike in anti-abortion legislating.\u003c/p>\n\u003cp>\"They feel it slipping away,\" she said. \"They can see the demographics, too, and they want to lock this stuff in.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. You can follow Julie Rovner\u003c/em>\u003cem> on Twitter:\u003c/em>\u003ca href=\"https://twitter.com/jrovner\">@jrovner\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=5+Things+To+Consider+About+The+Supreme+Court%27s+Decision+On+Texas+Abortion+Law+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/206784/5-things-to-consider-about-the-supreme-courts-decision-on-texas-abortion-law","authors":["byline_stateofhealth_206784"],"categories":["stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_160","stateofhealth_2519","stateofhealth_397"],"featImg":"stateofhealth_206785","label":"stateofhealth"},"stateofhealth_180926":{"type":"posts","id":"stateofhealth_180926","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"180926","score":null,"sort":[1467391852000]},"guestAuthors":[],"slug":"peeing-in-your-pants-is-more-common-than-you-think","title":"Peeing in Your Pants is More Common Than You Think","publishDate":1467391852,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>My two-year-old son doesn’t pee in his pants or wear diapers. But, ever since he was born, I do. I’m 35 years old and I buy diapers, for myself.\u003c/p>\n\u003cp>Some studies report that one out of 10 women my age are peeing themselves. Others say \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=486453&resultclick=1\" target=\"_blank\">the numbers could be higher\u003c/a>. But peeing in your pants is still embarrassing.\u003c/p>\n\u003cp>“Incontinence is still one of those frontiers that’s not really comfortable for many women to talk about,” said \u003ca href=\"https://www.uclahealth.org/provider/amy-rosenman-md\" target=\"_blank\">Dr. Amy Rosenman\u003c/a>, Health Sciences Clinical Professor at UCLA in the department of OB-GYN, Division of Urogynecology. “So if their doctor doesn’t specifically ask, ‘Do you leak urine?’ most of them won’t even tell.”\u003c/p>\n\u003cp>I have what’s called stress incontinence. Not from emotional stress, though leaking pee \u003ci>can\u003c/i> cause that. But, from the physical stress of coughing. Or jumping. Or wrestling and laughing with a two-year-old.\u003c/p>\n\u003cp>No, I’m not going to die from this. But, it has changed my life. I have all but stopped exercising, the activity that helps me stay calm and clear. For many women it’s a lot worse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Moderate incontinence is annoying, it requires wearing protection most of the time, but it doesn’t limit activities. Women will still go about their normal activities,\" Rosenman said. \"Severe incontinence, women stop traveling, they don’t want to be around other people at night, they’re embarrassed about their absorptive products and how they dispose of them, and it’s major life-altering. It makes some individuals have to be in assisted living or a nursing home environment.”\u003c/p>\n\u003cp>Urinary incontinence is what’s known as a pelvic floor disorder, which can also lead to fecal incontinence, which is leaking poop, or organ prolapse, when the uterus or bladder or intestines sag and fall into the vagina.\u003c/p>\n\u003cp>About \u003ca href=\"http://journals.lww.com/greenjournal/Abstract/2014/01000/Prevalence_and_Trends_of_Symptomatic_Pelvic_Floor.20.aspx\" target=\"_blank\">a quarter of American women have at least one pelvic floor disorder\u003c/a> – and urinary incontinence is the most common. The risk goes up as women get older.\u003c/p>\n\u003cp>“After age 60, greater than 30 percent of all women have some form of incontinence,” said Rosenman. And after age 80, about half of American women leak pee.\u003c/p>\n\u003cp>The good news is, there’s an entire subspecialty of medicine, called urogynecology, that treats pelvic floor disorders.\u003c/p>\n\u003cp>There is also pelvic floor physical therapy that includes exercises and tech tools to help women regain their muscle strength.\u003c/p>\n\u003cp>These include the \u003ca href=\"http://www.minnalife.com/products/kgoal\" target=\"_blank\">kGoal interactive kegel exerciser\u003c/a> that you insert into your vagina. When you tighten your muscles, data about how well your muscles are performing pop up on your smartphone via bluetooth.\u003c/p>\n\u003cp>The kGoal is a play on the word kegel, a well-known exercise in which you first tighten then relax the pelvic floor muscle in an effort to reconnect with and strengthen the muscles that control pee and poop.\u003c/p>\n\u003caside class=\"pullquote alignright\">Listen to the \u003ca href=\"https://beta.prx.org/stories/175331\" target=\"_blank\">radio version\u003c/a> of this story on PRX \u003c/aside>\n\u003cp>There are also apps. Lots of apps. Apps for tracking your pad usage and leaking. Or reminding you to pee more frequently. Urologists from the University of California, San Francisco recently developed the \u003ca href=\"http://urology.ucsf.edu/news/all/201601/ucsf-urologists-develop-kegel-app%23.Vyt0kRUrLVp\" target=\"_blank\">Kegel Nation\u003c/a> app, that can help monitor the frequency, progress and quality of a Kegel exercise regimen. The app features a built-in voice coach for the exercises.\u003c/p>\n\u003cp>In addition to physical therapy and strengthening exercises, you can treat pelvic floor disorders with diet, medication and surgery. Some women get Botox injected into the bladder to stop spasms. Some get bulking agents inserted into the urethra to beef it up. There are bigger surgeries, too, that can help.\u003c/p>\n\u003cp>“Our field is changing rapidly, and I think that’s what’s fun about it,” said my physical therapist Aimee Diaz. She’s a faculty member at the University of Southern California, in the division of biokinesiology and physical therapy. “From a prognosis perspective I think we’re only going to get better at treating these things, but unfortunately it’s still something that we’re going to have to deal with.”\u003c/p>\n\u003cp>Indeed, studies suggest that the number of American women with urinary incontinence will increase by \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/19935030\" target=\"_blank\">55 percent in the next 35 years\u003c/a>. Due to an aging and increasingly overweight population.\u003c/p>\n\u003cp>So innovators have their work cut out for them.\u003c/p>\n\u003cp>Thankfully for me, though, there is a new product on the market that could help me get back to running.\u003c/p>\n\u003cp>It looks like a tampon, but it’s made out of silicone. It’s called the \u003ca href=\"http://www.poise.com/products/impressa\" target=\"_blank\">Poise Impressa Bladder Support\u003c/a>. It’s inserted into the vagina, and holds the urethra in place so it doesn’t leak pee.\u003c/p>\n\u003cp>“I think it’s really a game changer, because prior to that the only thing we had was surgery unless (the incontinence) was mild,” Rosenman said. “Mild stress incontinence is treatable with pelvic floor exercise and physical therapy and biofeedback. But anything more than very mild isn’t. Now we have a non-surgical option.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ci>This audio piece was part of the STEM Story Project — distributed by PRX and made possible with funds from the Alfred P. Sloan Foundation.\u003c/i>\u003c/p>\n\n","blocks":[],"excerpt":"My two-year-old son doesn’t pee in his pants or wear diapers. But, ever since he was born, I do. I’m 35 years old and I buy diapers, for myself.\r\n","status":"publish","parent":0,"modified":1467392627,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":894},"headData":{"title":"Peeing in Your Pants is More Common Than You Think | KQED","description":"My two-year-old son doesn’t pee in his pants or wear diapers. But, ever since he was born, I do. I’m 35 years old and I buy diapers, for myself.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Peeing in Your Pants is More Common Than You Think","datePublished":"2016-07-01T16:50:52.000Z","dateModified":"2016-07-01T17:03:47.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"180926 http://ww2.kqed.org/stateofhealth/?p=180926","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/01/peeing-in-your-pants-is-more-common-than-you-think/","disqusTitle":"Peeing in Your Pants is More Common Than You Think","nprByline":"Lauren M. Whaley","path":"/stateofhealth/180926/peeing-in-your-pants-is-more-common-than-you-think","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>My two-year-old son doesn’t pee in his pants or wear diapers. But, ever since he was born, I do. I’m 35 years old and I buy diapers, for myself.\u003c/p>\n\u003cp>Some studies report that one out of 10 women my age are peeing themselves. Others say \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=486453&resultclick=1\" target=\"_blank\">the numbers could be higher\u003c/a>. But peeing in your pants is still embarrassing.\u003c/p>\n\u003cp>“Incontinence is still one of those frontiers that’s not really comfortable for many women to talk about,” said \u003ca href=\"https://www.uclahealth.org/provider/amy-rosenman-md\" target=\"_blank\">Dr. Amy Rosenman\u003c/a>, Health Sciences Clinical Professor at UCLA in the department of OB-GYN, Division of Urogynecology. “So if their doctor doesn’t specifically ask, ‘Do you leak urine?’ most of them won’t even tell.”\u003c/p>\n\u003cp>I have what’s called stress incontinence. Not from emotional stress, though leaking pee \u003ci>can\u003c/i> cause that. But, from the physical stress of coughing. Or jumping. Or wrestling and laughing with a two-year-old.\u003c/p>\n\u003cp>No, I’m not going to die from this. But, it has changed my life. I have all but stopped exercising, the activity that helps me stay calm and clear. For many women it’s a lot worse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Moderate incontinence is annoying, it requires wearing protection most of the time, but it doesn’t limit activities. Women will still go about their normal activities,\" Rosenman said. \"Severe incontinence, women stop traveling, they don’t want to be around other people at night, they’re embarrassed about their absorptive products and how they dispose of them, and it’s major life-altering. It makes some individuals have to be in assisted living or a nursing home environment.”\u003c/p>\n\u003cp>Urinary incontinence is what’s known as a pelvic floor disorder, which can also lead to fecal incontinence, which is leaking poop, or organ prolapse, when the uterus or bladder or intestines sag and fall into the vagina.\u003c/p>\n\u003cp>About \u003ca href=\"http://journals.lww.com/greenjournal/Abstract/2014/01000/Prevalence_and_Trends_of_Symptomatic_Pelvic_Floor.20.aspx\" target=\"_blank\">a quarter of American women have at least one pelvic floor disorder\u003c/a> – and urinary incontinence is the most common. The risk goes up as women get older.\u003c/p>\n\u003cp>“After age 60, greater than 30 percent of all women have some form of incontinence,” said Rosenman. And after age 80, about half of American women leak pee.\u003c/p>\n\u003cp>The good news is, there’s an entire subspecialty of medicine, called urogynecology, that treats pelvic floor disorders.\u003c/p>\n\u003cp>There is also pelvic floor physical therapy that includes exercises and tech tools to help women regain their muscle strength.\u003c/p>\n\u003cp>These include the \u003ca href=\"http://www.minnalife.com/products/kgoal\" target=\"_blank\">kGoal interactive kegel exerciser\u003c/a> that you insert into your vagina. When you tighten your muscles, data about how well your muscles are performing pop up on your smartphone via bluetooth.\u003c/p>\n\u003cp>The kGoal is a play on the word kegel, a well-known exercise in which you first tighten then relax the pelvic floor muscle in an effort to reconnect with and strengthen the muscles that control pee and poop.\u003c/p>\n\u003caside class=\"pullquote alignright\">Listen to the \u003ca href=\"https://beta.prx.org/stories/175331\" target=\"_blank\">radio version\u003c/a> of this story on PRX \u003c/aside>\n\u003cp>There are also apps. Lots of apps. Apps for tracking your pad usage and leaking. Or reminding you to pee more frequently. Urologists from the University of California, San Francisco recently developed the \u003ca href=\"http://urology.ucsf.edu/news/all/201601/ucsf-urologists-develop-kegel-app%23.Vyt0kRUrLVp\" target=\"_blank\">Kegel Nation\u003c/a> app, that can help monitor the frequency, progress and quality of a Kegel exercise regimen. The app features a built-in voice coach for the exercises.\u003c/p>\n\u003cp>In addition to physical therapy and strengthening exercises, you can treat pelvic floor disorders with diet, medication and surgery. Some women get Botox injected into the bladder to stop spasms. Some get bulking agents inserted into the urethra to beef it up. There are bigger surgeries, too, that can help.\u003c/p>\n\u003cp>“Our field is changing rapidly, and I think that’s what’s fun about it,” said my physical therapist Aimee Diaz. She’s a faculty member at the University of Southern California, in the division of biokinesiology and physical therapy. “From a prognosis perspective I think we’re only going to get better at treating these things, but unfortunately it’s still something that we’re going to have to deal with.”\u003c/p>\n\u003cp>Indeed, studies suggest that the number of American women with urinary incontinence will increase by \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/19935030\" target=\"_blank\">55 percent in the next 35 years\u003c/a>. Due to an aging and increasingly overweight population.\u003c/p>\n\u003cp>So innovators have their work cut out for them.\u003c/p>\n\u003cp>Thankfully for me, though, there is a new product on the market that could help me get back to running.\u003c/p>\n\u003cp>It looks like a tampon, but it’s made out of silicone. It’s called the \u003ca href=\"http://www.poise.com/products/impressa\" target=\"_blank\">Poise Impressa Bladder Support\u003c/a>. It’s inserted into the vagina, and holds the urethra in place so it doesn’t leak pee.\u003c/p>\n\u003cp>“I think it’s really a game changer, because prior to that the only thing we had was surgery unless (the incontinence) was mild,” Rosenman said. “Mild stress incontinence is treatable with pelvic floor exercise and physical therapy and biofeedback. But anything more than very mild isn’t. Now we have a non-surgical option.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ci>This audio piece was part of the STEM Story Project — distributed by PRX and made possible with funds from the Alfred P. Sloan Foundation.\u003c/i>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/180926/peeing-in-your-pants-is-more-common-than-you-think","authors":["byline_stateofhealth_180926"],"categories":["stateofhealth_12"],"tags":["stateofhealth_397"],"featImg":"stateofhealth_199627","label":"stateofhealth"},"stateofhealth_194704":{"type":"posts","id":"stateofhealth_194704","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"194704","score":null,"sort":[1465233753000]},"guestAuthors":[],"slug":"think-mothering-young-kids-is-hard-get-ready-for-even-tougher-times","title":"Think Mothering Young Kids Is Hard? Get Ready For Even Tougher Times","publishDate":1465233753,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>As a mother of young children, I've heard the following rosy message from more than one slightly more-seasoned mom: \"Don't worry, it gets easier!\"\u003c/p>\n\u003cp>It's a message of hope and encouragement, a recognition of how hard some aspects of early motherhood can be. But according to new research, it might also be wrong.\u003c/p>\n\u003caside class=\"pullquote alignright\">Yes, parenting toddlers is exhausting, but research suggests middle school age is toughest on mothers\u003cbr>\n\u003c/aside>\n\u003cp>A new \u003ca href=\"http://dx.doi.org/10.1037/dev0000062\" target=\"_blank\">paper\u003c/a>, published earlier this year in the journal \u003cem>Developmental Psychology,\u003c/em> suggests that the hardest time for mothers isn't when their children are in early childhood, but later — when their children reach middle school.\u003c/p>\n\u003cp>The paper, by Suniya Luthar and Lucia Ciciolla of Arizona State University, reports the findings from an Internet-based survey of 2,247 relatively well-educated American mothers.\u003c/p>\n\u003cp>The participants responded to a series of questions designed to assess multiple facets of their well-being, including aspects of their personal adjustment (such as stress and life satisfaction), perceptions of their child's behavior (including both positive and negative behaviors toward the mother) and aspects of their experiences as a parent (including feelings of guilt and being subsumed by parenthood). The mothers were also classified according to the ages of their children, with categories including infancy, preschool, elementary school, middle school, high school and adulthood.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The data revealed different patterns of well-being for mothers with children of different ages.\u003c/p>\n\u003cp>In the early years, when motherhood is often portrayed as especially demanding, mothers reported high levels of parenting \"overload.\" They felt that mothering crowded out time and energy for themselves and for other facets of their identities. But they also reported high levels of positive behaviors from their children and relatively high levels of parenting satisfaction overall. This suggests that the early challenges of motherhood were partially offset by high rewards.\u003c/p>\n\u003cp>By the time children reached adulthood, mothers reported significantly lower levels of parenting overload and guilt but maintained relatively high levels of parenting satisfaction. Contrary to the idea that mothers suffer from an empty nest, the data suggested that mothers of adult children enjoy relatively high levels of maternal well-being.\u003c/p>\n\u003cp>It was between these two periods that mothers reported the highest levels of dissatisfaction with parenting, with mothers of middle-school children representing the peak. Overall, life satisfaction also dipped in this period, with highs in stress, loneliness and feelings of emptiness — though ratings for these dimensions did not differ significantly between mothers of middle-school children and those in neighboring age groups. Mothers with middle school children also tended to perceive more negative behaviors from their children, and to perceive their children as less well-adjusted.\u003c/p>\n\u003cp>Importantly, these trends reflected group averages; there was considerable variation in the experiences of individual mothers. But the findings do suggest that some of the periods that are typically most difficult for children themselves — with the onset of puberty, a renegotiation of identities and sometimes forays into risky behavior — are also the most difficult for their mothers.\u003c/p>\n\u003cp>In a conversation by email, professor Luthar suggested that some of these threats to maternal well-being could be offset by \"mutually supportive groups for moms\" at schools, in the workplace or in individual communities. She also speculated that fathers similarly experience their children's middle school years as an especially stressful period.\u003c/p>\n\u003cp>So for mothers of young children, does it get easier? The data suggest that \u003cem>eventually\u003c/em> it does, but it might take longer than you expect — and there might be some rough spots along the way.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Tania Lombrozo is a psychology professor at the University of California, Berkeley. She writes about psychology, cognitive science and philosophy, with occasional forays into parenting and veganism. You can keep up with more of what she is thinking on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/tanialombrozo\" target=\"_blank\">@TaniaLombrozo\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Think+Mothering+Young+Kids+Is+Hard%3F+Get+Ready+For+Even+Tougher+Times&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"New research suggests the toughest time for mothers isn't when children are very young — but when the kids reach middle school.","status":"publish","parent":0,"modified":1465233753,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":650},"headData":{"title":"Think Mothering Young Kids Is Hard? Get Ready For Even Tougher Times | KQED","description":"New research suggests the toughest time for mothers isn't when children are very young — but when the kids reach middle school.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Think Mothering Young Kids Is Hard? Get Ready For Even Tougher Times","datePublished":"2016-06-06T17:22:33.000Z","dateModified":"2016-06-06T17:22:33.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"194704 http://ww2.kqed.org/stateofhealth/?p=194704","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/06/06/think-mothering-young-kids-is-hard-get-ready-for-even-tougher-times/","disqusTitle":"Think Mothering Young Kids Is Hard? Get Ready For Even Tougher Times","nprImageCredit":"Wander Woman Collective","nprByline":"Tania Lombrozo\u003cbr />\u003ca href=\"http://www.npr.org/\">NPR\u003c/a>","nprImageAgency":"Getty Images","nprStoryId":"480906083","nprApiLink":"http://api.npr.org/query?id=480906083&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/13.7/2016/06/06/480906083/think-mothering-young-kids-is-hard-get-ready-for-even-tougher-times?ft=nprml&f=480906083","nprRetrievedStory":"1","nprPubDate":"Mon, 06 Jun 2016 13:13:00 -0400","nprStoryDate":"Mon, 06 Jun 2016 05:00:00 -0400","nprLastModifiedDate":"Mon, 06 Jun 2016 13:13:14 -0400","path":"/stateofhealth/194704/think-mothering-young-kids-is-hard-get-ready-for-even-tougher-times","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>As a mother of young children, I've heard the following rosy message from more than one slightly more-seasoned mom: \"Don't worry, it gets easier!\"\u003c/p>\n\u003cp>It's a message of hope and encouragement, a recognition of how hard some aspects of early motherhood can be. But according to new research, it might also be wrong.\u003c/p>\n\u003caside class=\"pullquote alignright\">Yes, parenting toddlers is exhausting, but research suggests middle school age is toughest on mothers\u003cbr>\n\u003c/aside>\n\u003cp>A new \u003ca href=\"http://dx.doi.org/10.1037/dev0000062\" target=\"_blank\">paper\u003c/a>, published earlier this year in the journal \u003cem>Developmental Psychology,\u003c/em> suggests that the hardest time for mothers isn't when their children are in early childhood, but later — when their children reach middle school.\u003c/p>\n\u003cp>The paper, by Suniya Luthar and Lucia Ciciolla of Arizona State University, reports the findings from an Internet-based survey of 2,247 relatively well-educated American mothers.\u003c/p>\n\u003cp>The participants responded to a series of questions designed to assess multiple facets of their well-being, including aspects of their personal adjustment (such as stress and life satisfaction), perceptions of their child's behavior (including both positive and negative behaviors toward the mother) and aspects of their experiences as a parent (including feelings of guilt and being subsumed by parenthood). The mothers were also classified according to the ages of their children, with categories including infancy, preschool, elementary school, middle school, high school and adulthood.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The data revealed different patterns of well-being for mothers with children of different ages.\u003c/p>\n\u003cp>In the early years, when motherhood is often portrayed as especially demanding, mothers reported high levels of parenting \"overload.\" They felt that mothering crowded out time and energy for themselves and for other facets of their identities. But they also reported high levels of positive behaviors from their children and relatively high levels of parenting satisfaction overall. This suggests that the early challenges of motherhood were partially offset by high rewards.\u003c/p>\n\u003cp>By the time children reached adulthood, mothers reported significantly lower levels of parenting overload and guilt but maintained relatively high levels of parenting satisfaction. Contrary to the idea that mothers suffer from an empty nest, the data suggested that mothers of adult children enjoy relatively high levels of maternal well-being.\u003c/p>\n\u003cp>It was between these two periods that mothers reported the highest levels of dissatisfaction with parenting, with mothers of middle-school children representing the peak. Overall, life satisfaction also dipped in this period, with highs in stress, loneliness and feelings of emptiness — though ratings for these dimensions did not differ significantly between mothers of middle-school children and those in neighboring age groups. Mothers with middle school children also tended to perceive more negative behaviors from their children, and to perceive their children as less well-adjusted.\u003c/p>\n\u003cp>Importantly, these trends reflected group averages; there was considerable variation in the experiences of individual mothers. But the findings do suggest that some of the periods that are typically most difficult for children themselves — with the onset of puberty, a renegotiation of identities and sometimes forays into risky behavior — are also the most difficult for their mothers.\u003c/p>\n\u003cp>In a conversation by email, professor Luthar suggested that some of these threats to maternal well-being could be offset by \"mutually supportive groups for moms\" at schools, in the workplace or in individual communities. She also speculated that fathers similarly experience their children's middle school years as an especially stressful period.\u003c/p>\n\u003cp>So for mothers of young children, does it get easier? The data suggest that \u003cem>eventually\u003c/em> it does, but it might take longer than you expect — and there might be some rough spots along the way.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Tania Lombrozo is a psychology professor at the University of California, Berkeley. She writes about psychology, cognitive science and philosophy, with occasional forays into parenting and veganism. You can keep up with more of what she is thinking on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/tanialombrozo\" target=\"_blank\">@TaniaLombrozo\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Think+Mothering+Young+Kids+Is+Hard%3F+Get+Ready+For+Even+Tougher+Times&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/194704/think-mothering-young-kids-is-hard-get-ready-for-even-tougher-times","authors":["byline_stateofhealth_194704"],"categories":["stateofhealth_12"],"tags":["stateofhealth_96","stateofhealth_93","stateofhealth_397"],"featImg":"stateofhealth_194705","label":"stateofhealth"},"stateofhealth_194215":{"type":"posts","id":"stateofhealth_194215","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"194215","score":null,"sort":[1465148682000]},"guestAuthors":[],"slug":"guess-which-woman-is-having-a-heart-attack-hint-you-cant","title":"Guess Which Woman Is Having A Heart Attack (Hint: You Can't)","publishDate":1465148682,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Three months ago I had a heart attack. And since the symptoms of a heart attack are different for women, and since the kind I had can strike young people with no markers of heart disease, I've decided to tell my story. And because I love to name drop, I'll do some of that along the way because I was with authors I love that night.\u003c/p>\n\u003cp>I was at Queen Anne Book Company in Seattle, surrounded by friends. Authors \u003ca href=\"http://www.kirbylarson.com\">Kirby Larson\u003c/a>, \u003ca href=\"http://www.kristenkittscher.com/%22%3E\">Kristen Kittscher\u003c/a> and I had just finished a presentation on our middle-grade mysteries when in a flash everything changed for me. I had full-on flu-like symptoms, unlike anything I'd ever experienced before.\u003c/p>\n\u003cp>I whispered to Kirby that I didn't feel well and needed to leave. She took one look at me and tried to intervene, asking to take me home or to urgent care. Something was off. She told me she was worried, and that I looked \"ashen.\" (That word comes into play later.)\u003c/p>\n\u003cp>I assured her I'd be fine. My friend Sara Nickerson looked concerned and touched her chest, a movement that triggered something in my brain.\u003c/p>\n\u003cp>As I headed to my car, a pressure came into my chest. Weird, but not too bad. I thought about what Kirby had said, how Sara had touched her heart. I tried to stop the crazy thoughts in my head that maybe I was heading toward a heart attack. I thought about going back to the store, knowing that anyone in there would help me. My dear friend Jane, a friend since college, had just left the bookstore and lives nearby. I knew I didn't have to be alone. But I decided to drive home anyway.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A few minutes into the drive, stabbing pain in my back came and I knew precisely what it was — thank you PBS documentary on women and heart disease! Still, because I'm a dummy, I drove all the way home, threw up and then the pain went down my left arm to my little finger.\u003c/p>\n\u003cp>I walked inside and asked Kevin, my husband, to take me to the ER. He asked no questions, just jumped up and grabbed his keys. I remember saying something like I might be embarrassed if it was nothing, but that I'd rather be embarrassed than dead. He just said: \"We're going.\"\u003c/p>\n\u003cp>My heart attack was not the Hollywood kind where someone, almost always a man, grabs his chest and doubles over in pain. Every one of my symptoms was one that would stand on its own as a possible heart attack; all of my symptoms are ones that could be, and often are, dismissed by health care professionals, let alone by the people having them. When I walked into the ER, I listed them quickly and specifically. If you are a woman, or you know one, please take note:\u003c/p>\n\u003cul>\n\u003cli>Stabbing back pain between my shoulder blades\u003c/li>\n\u003cli>Pain radiating down my left arm to my little finger and ring finger\u003c/li>\n\u003cli>Vomiting\u003c/li>\n\u003cli>Chest pain (this was the least of my symptoms)\u003c/li>\n\u003cli>\"A friend said I looked ashen.\"\u003c/li>\n\u003c/ul>\n\u003cp>All were recorded on the intake form, the word \"ASHEN\" in all caps, and I was taken in immediately. It was confirmed that I was having a heart attack, or as I now call it, a myocardial infarction (MI). Just a couple months after a physical where I'd had a normal ECG and full blood work, with cholesterol scores so good I could have framed them. I exercise, eat reasonably well, don't smoke, I'm not \u003cem>that\u003c/em> old — OK, I'm 55. And I was having a heart attack.\u003c/p>\n\u003cp>The MI was caused by a tear in the inner lining of an artery, which is called a spontaneous coronary artery dissection, or \u003ca href=\"http://www.scadresearch.org/about/\" target=\"_blank\">SCAD\u003c/a>. SCADs occur predominantly in women who are \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060337/\" target=\"_blank\">fit and healthy\u003c/a>, with an average age of 42. We don't know why they happen, and I'm not sure there's anything I could have done to prevent it from happening. The first articles I read kept referring to SCAD as a rare disease. The \u003ca href=\"http://scadalliance.org/\" target=\"_blank\">SCAD Alliance\u003c/a> says this: \"SCAD isn't rare. It's rare to meet a survivor.\"\u003c/p>\n\u003cp>My SCAD is being treated medically, which means healing on its own without stenting or bypass surgery. I've met survivors who have had multiple bypasses or stents, as well as a good percentage of us who, after an angiogram and hospital stays, are being treated with blood thinners and other prescription medications.\u003c/p>\n\u003cp>I've met some wonderful women through an online SCAD Survivors group and I'm thankful every day for them and the research now being done at the \u003ca href=\"http://www.scadresearch.org/about/research-notes/\">Mayo Clinic\u003c/a> in an effort to find causes and poss. SCAD survivors share information on how hard the first year is, the fear of recurrence (a real fear, as it happens frequently), anxiety, making progress in cardiac rehabilitation, and finding a \"new normal.\"\u003c/p>\n\u003cp>The Mayo SCAD study is a fine example of patient-initiated research and the power of social media. Women from around the world have connected online when searching for answers to a relatively unknown and underdiagnosed cause of heart attacks. We're still connecting online, still searching.\u003c/p>\n\u003cp>Each week there are new people sharing their stories, many who are in their 20s, 30s and 40s, and others like me, who are over 50 but still too young for a heart attack. Some tell stories where they slip in \"after my third SCAD and second MI\" or \"three MIs in the first year.\" Sometimes the numbers in their stories are even higher. We all hope to keep the numbers down and find answers.\u003c/p>\n\u003cp>I am incredibly grateful to my friend Kirby, because her concern and her words got me to the point where I knew this was real. This was big. Ashen is an unusual color for me unless, as it turns out, my heart is not getting enough oxygen.\u003c/p>\n\u003cp>Heaps of thanks to my family and to my friends, especially those who, when they asked what they could do, came when I said that the dog really could use a walk.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Linda Johns is a librarian and children's book author who is happy to still be alive in Seattle. Find her \u003ca href=\"https://lindajohns.net/\" target=\"_blank\">online\u003c/a>, on Twitter \u003ca href=\"https://twitter.com/LJBookie\" target=\"_blank\">@LJBookie\u003c/a>, and at cardiac rehabilitation three times a week. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Guess+Which+Woman+Is+Having+A+Heart+Attack+%28Hint%3A+You+Can%27t%29&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"This type of heart attack kills healthy young women. Here's what you need to know about it.","status":"publish","parent":0,"modified":1465148682,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":1085},"headData":{"title":"Guess Which Woman Is Having A Heart Attack (Hint: You Can't) | KQED","description":"This type of heart attack kills healthy young women. Here's what you need to know about it.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Guess Which Woman Is Having A Heart Attack (Hint: You Can't)","datePublished":"2016-06-05T17:44:42.000Z","dateModified":"2016-06-05T17:44:42.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"194215 http://ww2.kqed.org/stateofhealth/?p=194215","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/06/05/guess-which-woman-is-having-a-heart-attack-hint-you-cant/","disqusTitle":"Guess Which Woman Is Having A Heart Attack (Hint: You Can't)","nprByline":"Linda Johns\u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","nprImageAgency":"Courtesy of Linda Johns","nprStoryId":"480488038","nprApiLink":"http://api.npr.org/query?id=480488038&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/06/04/480488038/guess-which-woman-is-having-a-heart-attack-hint-you-cant?ft=nprml&f=480488038","nprRetrievedStory":"1","nprPubDate":"Sat, 04 Jun 2016 05:00:00 -0400","nprStoryDate":"Sat, 04 Jun 2016 05:00:20 -0400","nprLastModifiedDate":"Sat, 04 Jun 2016 05:00:20 -0400","path":"/stateofhealth/194215/guess-which-woman-is-having-a-heart-attack-hint-you-cant","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three months ago I had a heart attack. And since the symptoms of a heart attack are different for women, and since the kind I had can strike young people with no markers of heart disease, I've decided to tell my story. And because I love to name drop, I'll do some of that along the way because I was with authors I love that night.\u003c/p>\n\u003cp>I was at Queen Anne Book Company in Seattle, surrounded by friends. Authors \u003ca href=\"http://www.kirbylarson.com\">Kirby Larson\u003c/a>, \u003ca href=\"http://www.kristenkittscher.com/%22%3E\">Kristen Kittscher\u003c/a> and I had just finished a presentation on our middle-grade mysteries when in a flash everything changed for me. I had full-on flu-like symptoms, unlike anything I'd ever experienced before.\u003c/p>\n\u003cp>I whispered to Kirby that I didn't feel well and needed to leave. She took one look at me and tried to intervene, asking to take me home or to urgent care. Something was off. She told me she was worried, and that I looked \"ashen.\" (That word comes into play later.)\u003c/p>\n\u003cp>I assured her I'd be fine. My friend Sara Nickerson looked concerned and touched her chest, a movement that triggered something in my brain.\u003c/p>\n\u003cp>As I headed to my car, a pressure came into my chest. Weird, but not too bad. I thought about what Kirby had said, how Sara had touched her heart. I tried to stop the crazy thoughts in my head that maybe I was heading toward a heart attack. I thought about going back to the store, knowing that anyone in there would help me. My dear friend Jane, a friend since college, had just left the bookstore and lives nearby. I knew I didn't have to be alone. But I decided to drive home anyway.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A few minutes into the drive, stabbing pain in my back came and I knew precisely what it was — thank you PBS documentary on women and heart disease! Still, because I'm a dummy, I drove all the way home, threw up and then the pain went down my left arm to my little finger.\u003c/p>\n\u003cp>I walked inside and asked Kevin, my husband, to take me to the ER. He asked no questions, just jumped up and grabbed his keys. I remember saying something like I might be embarrassed if it was nothing, but that I'd rather be embarrassed than dead. He just said: \"We're going.\"\u003c/p>\n\u003cp>My heart attack was not the Hollywood kind where someone, almost always a man, grabs his chest and doubles over in pain. Every one of my symptoms was one that would stand on its own as a possible heart attack; all of my symptoms are ones that could be, and often are, dismissed by health care professionals, let alone by the people having them. When I walked into the ER, I listed them quickly and specifically. If you are a woman, or you know one, please take note:\u003c/p>\n\u003cul>\n\u003cli>Stabbing back pain between my shoulder blades\u003c/li>\n\u003cli>Pain radiating down my left arm to my little finger and ring finger\u003c/li>\n\u003cli>Vomiting\u003c/li>\n\u003cli>Chest pain (this was the least of my symptoms)\u003c/li>\n\u003cli>\"A friend said I looked ashen.\"\u003c/li>\n\u003c/ul>\n\u003cp>All were recorded on the intake form, the word \"ASHEN\" in all caps, and I was taken in immediately. It was confirmed that I was having a heart attack, or as I now call it, a myocardial infarction (MI). Just a couple months after a physical where I'd had a normal ECG and full blood work, with cholesterol scores so good I could have framed them. I exercise, eat reasonably well, don't smoke, I'm not \u003cem>that\u003c/em> old — OK, I'm 55. And I was having a heart attack.\u003c/p>\n\u003cp>The MI was caused by a tear in the inner lining of an artery, which is called a spontaneous coronary artery dissection, or \u003ca href=\"http://www.scadresearch.org/about/\" target=\"_blank\">SCAD\u003c/a>. SCADs occur predominantly in women who are \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060337/\" target=\"_blank\">fit and healthy\u003c/a>, with an average age of 42. We don't know why they happen, and I'm not sure there's anything I could have done to prevent it from happening. The first articles I read kept referring to SCAD as a rare disease. The \u003ca href=\"http://scadalliance.org/\" target=\"_blank\">SCAD Alliance\u003c/a> says this: \"SCAD isn't rare. It's rare to meet a survivor.\"\u003c/p>\n\u003cp>My SCAD is being treated medically, which means healing on its own without stenting or bypass surgery. I've met survivors who have had multiple bypasses or stents, as well as a good percentage of us who, after an angiogram and hospital stays, are being treated with blood thinners and other prescription medications.\u003c/p>\n\u003cp>I've met some wonderful women through an online SCAD Survivors group and I'm thankful every day for them and the research now being done at the \u003ca href=\"http://www.scadresearch.org/about/research-notes/\">Mayo Clinic\u003c/a> in an effort to find causes and poss. SCAD survivors share information on how hard the first year is, the fear of recurrence (a real fear, as it happens frequently), anxiety, making progress in cardiac rehabilitation, and finding a \"new normal.\"\u003c/p>\n\u003cp>The Mayo SCAD study is a fine example of patient-initiated research and the power of social media. Women from around the world have connected online when searching for answers to a relatively unknown and underdiagnosed cause of heart attacks. We're still connecting online, still searching.\u003c/p>\n\u003cp>Each week there are new people sharing their stories, many who are in their 20s, 30s and 40s, and others like me, who are over 50 but still too young for a heart attack. Some tell stories where they slip in \"after my third SCAD and second MI\" or \"three MIs in the first year.\" Sometimes the numbers in their stories are even higher. We all hope to keep the numbers down and find answers.\u003c/p>\n\u003cp>I am incredibly grateful to my friend Kirby, because her concern and her words got me to the point where I knew this was real. This was big. Ashen is an unusual color for me unless, as it turns out, my heart is not getting enough oxygen.\u003c/p>\n\u003cp>Heaps of thanks to my family and to my friends, especially those who, when they asked what they could do, came when I said that the dog really could use a walk.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Linda Johns is a librarian and children's book author who is happy to still be alive in Seattle. Find her \u003ca href=\"https://lindajohns.net/\" target=\"_blank\">online\u003c/a>, on Twitter \u003ca href=\"https://twitter.com/LJBookie\" target=\"_blank\">@LJBookie\u003c/a>, and at cardiac rehabilitation three times a week. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Guess+Which+Woman+Is+Having+A+Heart+Attack+%28Hint%3A+You+Can%27t%29&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/194215/guess-which-woman-is-having-a-heart-attack-hint-you-cant","authors":["byline_stateofhealth_194215"],"categories":["stateofhealth_12"],"tags":["stateofhealth_167","stateofhealth_397"],"featImg":"stateofhealth_194216","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. 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