Authors

Alexa Richardson is a law student at Harvard Law School and a Certified Professional Midwife. Prior to coming to law school, Alexa cared for families as the Director of a private midwifery practice in Baltimore, and led successful efforts to license and regulate Certified Professional Midwives in Maryland in her roles as President of the Association of Independent Midwives of Maryland (AIMM) and Chair of the Direct-Entry Midwife Committee under the Board of Nursing. Her research interests center on pregnant and birthing people, with particular focus in expanding the legal rights and protections available to this population. At HLS, Alexa serves as an editor of the Harvard Law Review, and as a student attorney in the Prison Legal Assistance Project.
Baby feet in hands

Colorado Passes Landmark Birth Equity Bill Package

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By Alexa Richardson

This month, activists in Colorado succeeded in passing a sweeping package of bills designed to address lack of access, inequities, and mistreatment throughout the obstetric system.

The ambitious provisions offer a new model for legislative approaches to transforming maternity care.

The bills, SB21-193, SB21-194, and SB21-101, were crafted in large part through the efforts of Elephant Circle, an organization that advocates birth justice by promoting self-determination and support for pregnant people, and tackling power and oppression. In an interview, Elephant Circle Founder and Director, Indra Lusero, described the Birth Equity Bill Package as “an opportunity to change the conversation by pulling together the broad range of issues facing pregnant people and presenting them as one coherent policy platform.”

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Busy Nurse's Station In Modern Hospital

Medical Licensure Law Suspensions During COVID-19 Present Opportunity for Change

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By Alexa Richardson

As the coronavirus pandemic threatens to overwhelm the health care system, states have responded by broadly suspending licensure laws for health care providers.

The collective rollback of licensure laws is an opportunity for states to reexamine their priorities around provider licensing, and to pursue values like access to care and evidence-based scope of practice over protection of provider interest groups.

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An exam glove, a scalpel, and a handcuff rest on a table.

Shackling of Pregnant Prisoners Is Ongoing

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By Alexa Richardson

Pregnant incarcerated women continue to be shackled–in prison, while being transported, during labor, and in the postpartum days at the hospital they may share with the baby.  Michele Aldana, who was serving time for a drug offense when she gave birth, was shackled throughout her thirty-hour labor while her ankles and wrists bled. “I felt like a farm animal,” she explained.  Eight times as many women are incarcerated today as in 1980, and 1,400 women are estimated to give birth each year while incarcerated. 

Recently, there have been significant reform efforts around the issue. In 2018, the First Step Act included a prohibition on shackling prisoners in federal prisons, except where the correctional officer felt shackling was necessary to prevent serious harm or escape. At the state level, laws are variable. Thirty-two states have some form of restriction on pregnant shackling, but only thirteen ban it broadly throughout pregnancy, labor, postpartum, and during transport; only nine states cover juveniles; only twenty states allow the physician to immediately remove the restraints if necessary; and only nine require that correctional staff stand outside the room for privacy considerations during childbirth. South Carolina is the latest to consider legislation prohibiting shackling of pregnant prisoners, in a bill currently before the state senate.

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Can Bedside Consent Apps Improve Informed Consent During Childbirth?

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By Alexa Richardson

Informed consent in childbirth is under fire by advocates, who stress that there is a widespread absence of meaningful informed consent during birth. While informed consent in medical settings always poses challenges, informed consent in childbirth raises particular concerns. Labor unfolds in real-time, and people are heavily reliant on their provider for information during birth. Providers may not adequately seek informed consent out of a belief that they should make decisions in the fetal interest, rather than the parent. Furthermore, laboring people make choices that are more than medical: birth is a value-laden process entwined with beliefs about parenting, life-meaning, and fetal interests.  A new solution is on the table that could help improve the process of informed consent in childbirth: guided decision-making apps. This year, multiple mobile apps are in the works that would assist laboring people and clinicians in real-time decision-making during labor and birth.

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Illustration of a black woman nursing a swaddled baby

Policy Roundup: Improving Maternal Health Outcomes for Black Women

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By Alexa Richardson

Data has long shown alarming rates of maternal mortality for black women in the United States, with deaths three to four times the rate for white women. Such deaths are not accounted for by differences in education or income, and systemic racism, including racial bias within the healthcare system, is believed to be a significant contributing factor to the problem. In the past year, this issue has finally made it into the policy arena, with a number of serious policy proposals put forth to try to reduce black maternal mortality.

In April, Congresswomen Lauren Underwood and Alma Adams formed the Black Maternal Health Caucus. Democratic primary candidates Senator Elizabeth Warren, Senator Kamala Harris, and Senator Cory Booker have all put forward proposals to address racial disparities in maternal mortality. And in October, California enacted legislation aimed at reducing racism and improving maternal health outcomes in obstetrics.

But what is the content of the policies being proposed? Are some better than others? This post surveys some of the biggest initiatives underway. It turns out that the measures being discussed vary widely–in approach, in scope, and in ambition. Read More

U.S. Supreme Court building

Health Law Cases in the Upcoming Supreme Court Term

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By Alexa Richardson

The next Supreme Court term is shaping up to include a number of critical cases that will impact health law. From insurance, the Affordable Care Act, abortion access, and mental health, the decisions made this term could have significant impacts on public health moving forward. Here are some of the key health law cases upcoming this term to keep an eye on:

June Medical Services, LLC v. Gee

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Opioid Claims for Fetal Opioid Exposure Alarm Pregnancy Advocates

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By Alexa Richardson

Lawyers calling themselves the “Opioid Justice Team” are pushing forward in their mission to certify babies exposed to opioids in utero, as well as “all women in the United States capable of becoming pregnant,” as distinct classes in the multi-district opioid litigation now unfolding in federal court in Ohio. Last week, lawyers filed an amended complaint on behalf of the legal guardians of individuals diagnosed with neonatal abstinence syndrome (NAS), and a list of “experts” with the court. Their claims misrepresent the science regarding fetal exposure to opioids and position fetal rights in opposition to those of pregnant people. National Advocates for Pregnant Women (NAPW) has issued a statement and fact sheet denouncing the claims.

In a series of court filings, sweeping claims about the impact of prescription opioid exposure on fetuses are being made. The lawyers falsely claim “[a]nything a pregnant woman ingests or breathes is transmitted to her baby by the placenta” and that “[i]n-utero opioid exposure leaves most children with physical, social, educational disabilities that require constant and regular interventions. Most of these disabilities are considered permanent.” In actuality, the American College of Obstetricians and Gynecologists states that the available data show “no significant differences” in long-term outcomes for individuals exposed to opioids in utero versus those who are not. The Centers for Disease Control (CDC) finds there may be early childhood impacts on cognitive or developmental abilities from prenatal opioid exposure. However, available studies struggle to separate the physical effects from environmental and social variables. There is not enough data to conclude whether any long-term consequences of fetal opioid exposure exist, the CDC finds.

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Photograph of a woman lying in a hospital bed holding her newborn wrapped in a blanket

Where Are the Legal Protections for People Mistreated in Childbirth?

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By Alexa Richardson

A new study indicates that 28.1% of women birthing in U.S. hospitals experienced mistreatment by providers during labor, with rates even higher for women of color. The multi-stakeholder study, convened in response to World Health Organization efforts to track maternal mistreatment, included more than 2,000 participants, and defined mistreatment as including one or more occurrences of: loss of autonomy; being shouted at, scolded, or threatened; or being ignored, refused, or receiving no response to requests for help. The study newly highlights the lack of legal protections available to for pregnant and birthing people who experience these kinds of mistreatment by providers.

Campaigns like Exposing the Silence have chronicled the outpouring of people’s harrowing birth stories, riddled with abuse and violations of consent. In one typical account, a user named Chastity explained:

I had a room full of student doctors, an OB I never met come in and forcibly give me extremely painful cervical exams while I screamed for them to stop and tried to get away. They had a nurse come and hold me down. There was at least 10 students practicing on me. I was a teen mom and my partner hadn’t gotten off work yet so I was all alone.

Another user named Abriana recounted:

As I was pushing, I got on my side and it was then that I started to feel pain much different from labor pains. I asked, ‘What is going on?’ The nurse replied, ‘I am doing a perineal rub.’ I immediately said, ‘Please stop doing that. You are hurting me.’ The nurse argued, ‘It will help you’ and didn’t move. I asked her again to please stop. I then yelled, while pushing, ‘Get your hands out of me!’ The nurse continued.

The traditional modes of seeking legal recourse have little to offer those who experience these kinds of mistreatment.

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Court Upholds Manslaughter Charge of Pregnant Mother For Death of Her Baby

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By Alexa Richardson

A woman whose hours-old baby was dying admitted to her care providers that she had abused prescription and over-the-counter medications shortly before the birth. This summer, in United States v. Flute, 929 F.3d 584 (2019), the Eighth Circuit held that she could be charged with federal manslaughter for the death of her baby. While some states have charged pregnant people with manslaughter for drug use during pregnancy, Flute marks the first time that federal prosecutors have brought such charges. The decision, which reversed the district court decision dismissing the charge, opens the door for pregnant people to be criminally charged for a wide range of prenatal conduct — should it result in the baby’s death after birth — such as driving recklessly, receiving chemotherapy treatment during pregnancy, failing to obtain adequate prenatal care, or declining a medical recommendation.

Samantha Flute, an American Indian woman, gave birth at a Sisseton, South Dakota hospital on August 19, 2016. She told the medical staff that she had ingested Lorazepam, hydrocodone (possibly laced with cocaine), and cough syrup before coming to the hospital. Four hours after birth, Baby Boy Flute died. The autopsy revealed a full-term baby with no anatomical cause of death, and the pathologist determined the death to be the result of drug toxicity from the substances ingested prenatally by Flute.

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