AP NEWS| RICARDO ALONSO-ZALDIVAR

WASHINGTON (AP) — Labor and delivery are thought of as the riskiest times for new mothers, but many women die in the weeks and months after giving birth. Now a provision in the COVID-19 relief bill could help change that.

The legislation gives states the option of extending Medicaid coverage to women with low to modest incomes for a full year after childbirth. States are currently required to provide 60 days of coverage, but medical experts point to research showing that women can die from pregnancy-related conditions up to a year after giving birth, and that 3 in 5 of all such deaths are preventable.

The maternal health provisions would make it easier for states to cover new mothers for a full year by cutting the time and paperwork needed to obtain approval from Washington under Medicaid, as well as the Children’s Health Insurance Program. Maternal health advisory groups in 19 states, from Texas to Massachusetts, and Washington to Tennessee, have recommended such an extension. Last year a bipartisan bill to do so cleared the House but failed to advance in the Senate.

The legislation has been shepherded by Rep. Robin Kelly, D-Ill., who serves on the House committee that oversees Medicaid, the federal-state program covering about 1 in 5 Americans, from many newborns, to low-income adults and frail nursing home residents. Kelly explained that a constituent brought the problem to her attention several years ago.

“I never realized that maternal mortality was such a big issue in this country,” said Kelly, who represents Chicago.

It’s particularly serious for Black women, whose pregnancy-related death rate is three times that of white women. “For Black women, it cuts across socio-economic levels,” said Kelly, who is Black. “It’s a health equity issue.”

JAAPA | Jackson, Toni MMS, PA-C; Watkins, Elyse DHSc, PA-C, DFAAPA

Previously called spontaneous abortion, early pregnancy loss (EPL) is the preferred term encompassing threatened abortion, incomplete abortion, complete abortion, and anembryonic pregnancy. EPL has many causes, including chromosomal abnormalities, immunologic and infectious causes, and underlying maternal risk factors. Because many patients present with first-trimester bleeding, clinicians must know the appropriate evaluation and management techniques.

Read more.

Survey: OBGYNs Report That the Affordable Care Act Has Increased Use of Contraceptives Among Patients, but the Cost of Reproductive Health Care Still a Burden for Their Low-Income Patients

As the nation awaits the Supreme Court ruling on the future of the Affordable Care Act (ACA), a 2020 KFF survey of obstetrician-gynecologists (OBGYNs) finds that since implementation of the ACA’s contraceptive coverage requirement, nearly two-thirds of OBGYNs (63%) reported an increase in contraceptive uptake from their patients and 69% reported an increase in their patients use of their desired contraceptive method. However, nearly all OBGYNs (92%) reported the cost of reproductive health care services still presents a challenge for low-income patients.

Click here to read more

Some key findings include:

• Nearly all OBGYNs offered their patients some forms of contraceptive care, but just 18% of OBGYNs offered their patients all methods of non-permanent contraception that must be either prescribed or provided by a clinician. These methods include the pill, patch, ring, diaphragm or cervical cap, intrauterine devices (IUDs), contraceptive implants (Nexplanon), contraceptive injections (Depo-Provera) and emergency contraception (Copper IUD and Ulipristal Acetate/Ella). Those that offered all methods tended to be younger and work in large practices, with more than 10 clinicians.
• Most OBGYNs (75%) reported their practices did not provide abortions for pregnancy termination, but over one in five (23%) worked in practices that do. Abortion provision was more common among OBGYNs in urban and suburban locations compared to rural, and in the Northeast and West compared to the Midwest and South.
• A sizeable minority said they had encountered at least one Medicaid restriction regarding contraceptive care, including needing to obtain prior authorization (45%), being limited to an initial contraceptive supply of 30 days (33%), requiring “step-therapy” (15%) or being denied immediate replacement of expelled or removed LARCs (15%).
• Over six in ten OBGYNs reported an increase in the share of their patients who were using any contraceptive method (63%) as well as their desired contraceptive method (69%) since implementation of the ACA’s contraceptive coverage requirement in 2012.

Journal of the American Academy of Physician Assistants | Webb, Lauren DMSc, PA-C

Multiple studies have shown that oral or vaginal probiotics can effectively treat and prevent recurrent bacterial vaginosis. The dose, route, and treatment protocols vary greatly between studies, but many have shown a statistically significant reduction in the rate of recurrence of bacterial vaginosis. Further research is needed to determine the adequate dose, specific probiotic, optimal duration, and route of administration, with or without antibiotics.

Read more.

If you want to increase your exposure to PAs who practice in women's health, this opportunity is for you. Our premium and supporting partner options provide a range of benefits at great 2021 prices.

Contact our office with any questions. Click here for more information!

Join us on National #WearRedDay to raise awareness about #HeartDisease, a leading cause of death in the US. Devoting a little time every day to care for yourself can go a long way toward protecting your heart health. 

#APAOG #PAs #OBGYN #WomensHealth #OurHearts #HeartMonth 

ACOG | Clinical 

All pregnant individuals who choose to receive the COVID-19 vaccine must be allowed to do so in alignment with their state and local vaccination allocation plan. This includes the estimated 330,000 health care workers who are pregnant and should be allowed to receive the vaccine as part of the first phase of vaccine distribution plans.  Reports of pregnant individuals being refused vaccination are concerning.

Pregnant individuals who otherwise meet the criteria for COVID-19 vaccines should not be denied the opportunity to be vaccinated, should they choose to do so. Although a conversation with a clinician may be helpful for patients to aid in their decision-making, it should not be required prior to vaccination. 

As the COVID-19 vaccine rollout continues, use must reflect the vaccines’ federal regulatory authorization as well as information and recommendations from the U.S. Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, and expert healthcare organizations.

Currently, available data demonstrate that pregnant individuals are at increased risk of more severe illness and death due to COVID-19 than their non-pregnant counterparts1. Providing pregnant individuals with the opportunity to be vaccinated can be critical to allowing them to protect themselves, particularly if their occupation puts them at increased risk of contracting the virus or if they have underlying and comorbid conditions. 

Read more.

he 2021 AAPA Salary Survey is now open – please participate! Results provide the data you need to negotiate the compensation and benefits you deserve. If the pandemic has impacted your earnings or job status, we also want to hear from you so we can understand COVID-19’s effect on the profession. Complete the survey by February 28 -- members will receive a copy of the national summary report, and you’ll be entered to win one of 20 $50 gift cards.

Click here to begin

February is International Prenatal Infection Prevention Month and we are sharing information with you to check out this month. Click here for more information on preventing infection before and during pregnancy. 

Practice Advisories

• Vaccinating Pregnant and Lactating Patients Against COVID-19 (December 2020)
• Novel Coronavirus 2019 (COVID-19) (Updated December 2020)
• Updated Guidance Regarding Fetal Growth Restriction (September 2020)
• See all Practice Advisories

New Committee Opinions

• NEW 821 Barriers to Breastfeeding: Supporting Initiation and Continuation of Breastfeeding (February 2021)
• NEW 820 Breastfeeding Challenges (February 2021) 
• NEW 819 Informed Consent and Shared Decision Making in Obstetrics and Gynecology (February 2021)
• NEW 818 Medically Indicated Late-Preterm and Early-Term Deliveries (February 2021)
• 817 Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment (January 2021)
• 816 Consumer Testing for Disease Risk (January 2021)
• 815 Increasing Access to Abortion (December 2020)
• 814 Delayed Umbilical Cord Clamping After Birth (December 2020)
• 813 Gynecologic Considerations for Adolescents and Young Women With Cardiac Conditions (November 2020)
• See all Committee Opinions

New Practice Bulletins

• NEW 227 Fetal Growth Restriction (February 2021) 
• 226 Screening for Fetal Chromosomal Abnormalities (October 2020) Published Ahead of Print
• 225 Medication Abortion Up to 70 Days’ Gestation (October 2020) Published Ahead of Print
• See all Practice Bulletins

More from ACOG

• Clinical Updates: Seizures (January 2021)
• Clinical Updates: Travel Medicine (November 2020)
• Clinical Updates: Anorectal Disorders (September 2020)