National Nurses United

"We had a lot of patients that didn't speak English, and a lot of them that didn't have a significant other," recalled Zeman. "They would come in with a mother or sister and we would just support them the best way we could. We treated them like we would treat anybody within our home. We felt like we were really helping the community, helping these moms at a different level. We helped them not just medically, but emotionally as well." Zeman said her unit would often help provide prenatal care. "A lot of patients would just come in with no prenatal history at all and just like come in for a check. So, we would check things out for them and do all the tests, and make sure everything was okay and then encourage them to find a physician and help them find a physician." Of course, these burdens fall on communities already suffering health inequities. "We discovered that some communities, particu- larly those in rural areas with a higher percentage of Black residents and lower incomes, were more vulnerable to losing or not having OB services," reported Katy Kozhimannil, the director of research for the University of Minnesota Rural Health Research Center. "The groups that already suffer the worst health burdens were most likely to lose hospital-based obstetric care." Kozhimannil's research also found, perhaps not surprisingly, that the loss of hospital-based obstetric care increased the likelihood of preterm birth, which is the leading cause of infant mortality. Kozhimannil is one of many public health policy researchers and experts who fear health outcomes could get much worse for women and other pregnant people after the Supreme Court over- turned Roe v. Wade. "I think we're going to see a lot more emergency obstetric needs in rural communities that are not at all equipped to handle them," she told ProPublica in a May 4 article. In an amicus brief filed on behalf of nearly 550 health policy pro- fessionals and three major health care policy organizations in connection with the Supreme Court case, the experts lay out the drastic consequences they foresee for people giving birth and chil- dren when access to abortion is drastically restricted. "Women living in states with the most restrictive abortion pol- icies … were found to be more likely to die while pregant or shortly thereafter than women living in states with less restrictive abor- tion polices." The authors of the amicus brief note that abortion bans "will dis- proportionately affect young women, women of color, and low-income women who live in families and communities already vulnerable to elevated health care and social risks and reduced access to necessary health care." As far as children born out of unintended pregnancies, the brief cites studies that indicate these children not only carry a high risk of preterm birth, low birthweight, and impaired development, but a higher risk for domestic violence, abuse, neglect, or other traumas as children. "Where you live shouldn't dictate the outcome of your preg- nancy," said Kozhimannil. But in fact, many health care advocates and providers say that is indeed the case and they fear that as more labor and delivery units close, the situation will become even more critical, putting mothers and birthing people at risk. And nurses know these closures don't just affect the person giv- ing birth; it adds stress and burden on entire families. If these patients or infants suffer complications in pregnancy and or during birth, those consequences can drastically alter the health of the entire family. "Mothers and children are recognized worldwide as this very vul- nerable community, who are at a really pivotal point in their lives, especially in regards to their health," said Hovie. "So it just seems to make no sense that they would limit those services." Hovie said providing adequate care up front will reduce the need for more expensive care on the back end. Professor McLemore said the people of the United States need to ask themselves if they really care about families. She said it is not only a question of who is making decisions about access to health care, but how we fail to support parents as a society. "Birthing folks should be the revered holders of our species," said McLemore. "It changes how we think about the people who have the courage to parent? It's a really different narrative than saying, Oh, good luck, you had your baby at the hospital, we're going to push you out, and oh, by the way, good luck with that. And we're not going to give these things like paid family leave and all the other things that you need in order to be successful, or we're going to extend your health coverage a year postpartum. Because we actually don't really care if you live or die." Rachel Berger is a communications specialist with National Nurses United. A P R I L | M AY | J U N E 2 0 2 2 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 27 "Some of them are absolutely struggling to find a ride into the hospital, finding gas money, and now we've put this greater burden on them. How do you decide: Do I pay my rent and feed the kids I already have or deal with something that I can't see and I can't touch and they're telling me maybe it's a problem, or maybe it's not?"

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