Labor and delivery units are losing money and struggling to find staff, in rural areas and large cities alike.Over 500 hospitals have closed their labor and delivery departments since 2010, according to a large new study, leaving most rural hospitals and more than a third of urban hospitals without obstetric care.Those closures, the study found, were slightly offset by the opening of new units in about 130 hospitals. Even so, the share of hospitals without maternity wards increased every year, according to the study, published on Wednesday in JAMA, a prominent medical journal. Maternal deaths remained persistently high over that period, spiking during the pandemic.Because its data runs only through 2022, the study does not account for the additional challenges that hospitals have faced since the Supreme Court case that overturned Roe v. Wade that year and led many states to restrict abortion. States with abortion bans have experienced a sharp decline in their obstetrician work force.“We’re more than a decade into a severe maternal mortality crisis in the United States, and access to hospital-based maternity care has continued to decline over that entire time period,” said Katy Kozhimannil, the study’s lead author and a professor of health policy at the University of Minnesota.Other research from Dr. Kozhimannil and her colleagues has found that the closures of rural maternity wards can lead to an increase in births in emergency rooms or outside of hospitals.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Healthy Black women with low risk factors were far more likely to get C-sections than white women with similar medical histories, a large new study found.Obstetricians are more likely to give Black women unnecessary cesarean sections, putting those women at higher risk for serious complications like ruptured surgical wounds.That’s the conclusion of a new report of nearly one million births in 68 hospitals in New Jersey, one of the largest studies to tackle the subject.Even if a Black mother and a white mother with similar medical histories saw the same doctor at the same hospital, the Black mother was about 20 percent more likely to have her baby via C-section, the study found.The additional operations on Black patients were more likely to happen when hospitals had no scheduled C-sections, meaning their operating rooms were sitting empty. That suggests that racial bias paired with financial incentives played a role in doctors’ decision-making, the researchers said.How that bias creeps in is not entirely clear. Doctors may rush to perform a C-section faster for Black women, worried about the well-known racial disparities in childbirth outcomes. Black women may feel less empowered to push back against the suggestion of C-section when their labor is not progressing — or, when they do push back, they may be less likely to have their concerns taken seriously.“Physicians may have certain beliefs about Black women,” said Janet Currie, a health economist at Princeton University and a co-author of the study. “They might not be listening to Black women as much, or be more afraid that something will go wrong.”We want to hear from Black parents and their medical providers about childbirthThe New York Times is investigating disparities in hospital treatment for new parents. We want to hear from Black parents who have given birth within the last five years, and the medical providers (such as doulas, midwives, nurses and doctors) who treat them. We will not publish any part of your submission without contacting you first.

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Patients received “substantial” payments, their lawyers said, and the clinic agreed to staffing changes.Yale agreed on Monday to pay dozens of patients who had filed lawsuits claiming that they had endured excruciatingly painful egg retrieval procedures after a nurse at its fertility clinic secretly swapped their anesthesia for saline.The amount of money Yale paid was not disclosed, but the plaintiffs’ lawyers said it was “substantial.” In court filings late last year, they proposed a settlement of roughly $2 million for each patient.“This mutual agreement allows both parties to move forward and begin healing,” Karen Peart, a spokeswoman for Yale, said.The 93 patients involved in the settlement were seen at Yale Fertility Center in 2020. Some of their shocking stories were told in “The Retrievals,” a popular 2023 podcast from Serial Productions and The New York Times.In the lawsuits, the patients described their egg retrievals — short surgical procedures that typically use fentanyl as an anesthetic — as intensely painful. Many said they had complained to Yale but were ignored.Unbeknown to the patients, a nurse with a drug addiction had tampered with most of the clinic’s fentanyl supply, replacing the powerful narcotic with a salt and water solution. A subsequent Yale investigation found that, from June to October 2020, approximately 75 percent of the fentanyl given to patients was either diluted or completely replaced with saline.That nurse, Donna Monticone, was sentenced in May 2021 to four weekends of incarceration and three months of house arrest.In 2022, Yale University paid $308,000 to settle a Department of Justice investigation into whether Yale had failed to keep its fentanyl supply secure. And a Drug Enforcement Administration audit of the facility identified more than 600 discrepancies in its record-keeping for controlled substances like fentanyl and ketamine.Other health care providers have faced similar lawsuits over stolen fentanyl. Last week, the families of 16 patients who died at an Oregon hospital sued the facility for lacking safeguards to prevent a nurse from swapping fentanyl with tap water. The patients died after contracting bacterial infections from the unfiltered water.The patients’ experiences at Yale gained new attention with “The Retrievals.” The five-part podcast included accounts from patients who said they had screamed out in pain during the procedures and had complained to their doctors, only to be dismissed.Joshua Koskoff, a lawyer for the plaintiffs, said that a key part of the finalizing the settlement was assurances from Yale that the clinic had made changes to prevent similar situations.“The women in this case were absolutely insistent that there would be no monetary settlement until the university had addressed all the problems that resulted in this occurring,” he said.Yale University changed its fertility clinic to have “rigorous processes, procedures, and safeguards in place,” Ms. Peart, the university spokeswoman, said. Those include additional staff training and a new doctor in charge of the facility.

Getting the expensive fertility treatments covered would be possible, but an uphill battle, health policy experts said.Former President Donald J. Trump said on the campaign trail Thursday that he wants to make in vitro fertilization treatment free for all Americans.“Under the Trump administration your government will pay or your insurance company will be mandated to pay for all costs associated with I.V.F. treatment,” Mr. Trump said on Thursday at a rally in Potterville, Mich.I.V.F. often costs tens of thousands of dollars. Policies to cover those costs would be difficult to implement, experts said.Requiring insurers to pay would most likely mean passing laws in Congress or persuading a panel of experts to add I.V.F. to a list of free preventive women’s health services established by the Affordable Care Act, the health coverage law Mr. Trump tried to repeal.Having the government pay directly for I.V.F. would mean creating essentially a single-payer health care system for a single condition. The approach would require Congress to fund a new division of a federal government to oversee the program.“The president cannot do this on his own,” said Alina Salganicoff, director of the women’s health policy program at KFF, a health research nonprofit. “You need to have federal funds to do this. Congress needs to appropriate money.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

In a new report, the American Academy of Pediatrics said that breastfeeding problems were rarely caused by infant tongue-ties.In recent years, more and more women struggling to breastfeed have taken their babies to a dentist to sever the tissue under the tongue.But little evidence supports the use of these “tongue-tie releases” for most babies, according to a report published on Monday by the American Academy of Pediatrics, which represents 67,000 doctors. The tongue procedures, which often cost several hundred dollars, should be done only to the small fraction of infants with severely tethered tongues, the report said.“Our patients are paying out-of-pocket, outrageous amounts for something they don’t need,” said Dr. Jennifer Thomas, a pediatrician in Wisconsin who oversees the academy’s breastfeeding group and was the lead author of the report.Dr. Thomas said she and her colleagues began working on the report nearly nine years ago when they noticed a significant uptick in parents asking them to check their infants for tongue-ties. One study estimated an 800 percent rise in the number of tongue-tie procedures between 1997 and 2012.A New York Times investigation last year found that some dentists and lactation consultants aggressively promoted the surgery, despite a risk of side effects. Serious complications are rare. But doctors told The Times that they had seen the cuts cause such pain that babies had refused to eat, becoming dehydrated and malnourished. A few said that newly floppy tongues blocked infants’ airways.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Millions of parents have paid to bank blood from their infants’ umbilical cords. But storage companies have misled them about the cells’ promise.Pregnant women are bombarded with advertisements — on social media, in childbirth classes, even in their doctors’ offices — urging them to bank the blood in their baby’s umbilical cord and gain “peace of mind.”Private banks claim that the stem cells inside the blood are a powerful tool to have on hand in case a child one day becomes seriously ill. They charge several thousand dollars upfront for storage plus hundreds more every year thereafter.But an investigation by The New York Times found that leading banks have consistently misled parents about the technology’s promise. The few parents who try to withdraw samples often find that they are unusable — either because their volume is too low or they have been contaminated with microbes.Here’s what parents should know about cord blood banking.Cord blood is often marketed as an up-and-coming medical technology. In reality, its use is declining.In the 1990s, transplant doctors saw cord blood as a promising new source of stem cells for patients with sickle cell anemia and leukemia who could not find suitable matches from their families or bone marrow donor registries.The major cord blood banks — Cord Blood Registry, ViaCord and Cryo-Cell — told The Times that the cells they store had saved children’s lives and that no one knew what scientists may one day discover.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A nonprofit group called R.I.P. Medical Debt has relieved Americans of $11 billion in hospital bills. But that did not improve their mental health or their credit scores, a study found.Over the past decade, R.I.P. Medical Debt has grown from a tiny nonprofit group that received less than $3,000 in donations to a multimillion-dollar force in health care philanthropy.It has done so with a unique and simple strategy to tackling the enormous amounts that Americans owe hospitals: buying up old bills that would otherwise be sold to collection agencies and wiping out the debt.Since 2014, R.I.P. Medical Debt estimates that it has eliminated more than $11 billion of debt with the help of major donations from philanthropists and even city governments. In January, New York City’s mayor, Eric Adams, announced plans to give the organization $18 million.But a study published by a group of economists on Monday calls into question the premise of the high-profile charity. After following 213,000 people who were in debt and randomly selecting some to work with the nonprofit group, the researchers found that debt relief did not improve the mental health or the credit scores of debtors, on average. And those whose bills had been paid were just as likely to forgo medical care as those whose bills were left unpaid.“We were disappointed,” said Ray Kluender, an assistant professor at Harvard Business School and a co-author of the study. “We don’t want to sugarcoat it.”Allison Sesso, R.I.P. Medical Debt’s executive director, said the study was at odds with what the group had regularly heard from those it had helped. “We’re hearing back from people who are thrilled,” she said.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The decision means I.V.F. patients who want to transfer frozen embryos to another state may not be able to do so.Cryoport, a major embryo shipping company, said on Friday that it was “pausing” its business in Alabama as it evaluated the state’s Supreme Court decision that declared frozen embryos created through in vitro fertilization to be children.“Until the company has further clarity on the decision and what it means for Cryoport, clinics and intended parents, it is pausing all activity in Alabama until further notice,” read an email received by an Alabama fertility clinic and shared with The New York Times.The email said that Cryoport would “not be able to assist” with a scheduled shipment, and instead would offer a refund.The Alabama court’s ruling has already significantly limited fertility treatment for patients in that state. Three clinics have paused care as they evaluate what the ruling means for their patients and their own legal liability. The case involved several couples whose frozen embryos were accidentally destroyed at a clinic in Mobile. It found that clinics could be held liable for wrongful death claims, bringing new gravity to accidents that are not uncommon in fertility treatment.Cryoport’s decision will make it more difficult for current I.V.F. patients to move embryos out of state to continue treatments.Embryo shipping is common in modern fertility treatment, as patients sometimes move and need to switch clinics or move embryos they do not plan to use soon to a long-term storage facility.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

We want to hear from families about their experiences and medical bills in the past five years.Across the country, neonatal intensive care units provide critical care to seriously ill babies.That care can be lifesaving but also comes at a price, as some parents report receiving multimillion dollar bills for their babies’ hospital stays. Some researchers have questioned whether too many babies are being admitted to the NICU and whether there is a profit motive at play.The New York Times is looking to hear from readers who can share their recent experiences with NICU care. Hearing from families about their experiences helps us better understand where we should focus our reporting.We will not publish any part of your response to this questionnaire without talking with you first. We will not share your contact information outside the Times newsroom, and will use it only to reach out to you. If you’d feel more comfortable sharing your story with us anonymously, please visit our tips page.

But unlike the Olympic gymnast, most people don’t raise enough money to cover their costs.When Mary Lou Retton, the decorated Olympic gymnast, accrued medical debt from a lengthy hospital stay, her family did what countless Americans have done before them: turned to crowdfunding to cover the bills.On Tuesday, Ms. Retton’s daughter started a fund-raising campaign on social media for her mother, who she said was hospitalized with a rare pneumonia.“We ask that if you could help in any way, that 1) you PRAY! and 2) if you could help us with finances for the hospital bill,” McKenna Kelley, Ms. Retton’s daughter, wrote in a post on Spotfund, a crowdfunding platform similar to GoFundMe.The public swiftly responded, with thousands donating $350,000 in less than two days, shattering the goal of $50,000.The United States has the highest health care prices in the world. Each year, a quarter of a million Americans start crowdfunding campaigns to pay medical bills. The Spotfund post for Ms. Retton, 55, did not share many details about her costs but noted that she did not have health insurance. (When another one of Ms. Retton’s daughters, Shayla Kelley Schrepfer, was reached by text, she did not respond to a question about why her mother was uninsured.)Unlike Ms. Retton, most patients do not meet their fund-raising goals. About 16 percent of the time, studies have found, crowdfunding campaigns generate no donations at all.About half of Americans report difficulty paying their medical bills, according to a 2022 Kaiser Family Foundation survey. The problem tends to be particularly acute among the 27.5 million Americans who do not have health insurance.Most uninsured Americans have low incomes and about two-thirds say they cannot afford to buy coverage. Some earn slightly too much for Obamacare’s subsidies or say that, even with the financial assistance, the premiums are still too expensive.Last year, Nora Kenworthy, an associate professor at the University of Washington Bothell, published the largest study to date of medical crowdfunding, which analyzed nearly a half-million GoFundMe campaigns. Her work showed that the typical fund-raiser generates about $1,970, falling far short of the $5,000 to $10,000 patients are typically seeking. The most successful campaign in her data set raised $2.4 million, but such high numbers were rare. Fewer than 12 percent of campaigns met their goals.“What is concealed in viral campaigns like this one is that the vast majority of crowdfunding efforts earn much smaller amounts of money,” Dr. Kenworthy said. “As competition in this marketplace expands, the rates of success are being driven lower.”GoFundMe offers tips on how to make campaigns successful, suggesting that campaigns include “high-quality images” of the person in need and that they share “the financial, physical, and emotional troubles” that patients are experiencing.A growing body of research, however, suggests that much of a crowdfunding campaign’s success boils down to factors outside a patient’s control, including race and income, and that crowdfunding often directs resources to those who need them the least.A 2022 study of cancer patients’ fund-raisers found that those run by patients in poor neighborhoods tended to raise the least money, leading the authors to conclude that “online crowdfunding may exacerbate socioeconomic disparities in cancer care.”Poorer patients may struggle to generate donations because of bias against them as lazy or undeserving of help, said Jeremy Snyder, a professor of health sciences at Simon Fraser University in Canada and the author of a book on the ethics of crowdfunding.And richer patients are often boosted by their social networks. “If you have a lot of wealthy friends, or live in a wealthy community, those are a lot more people who can potentially donate,” Dr. Snyder said.Racial and gender disparities also exist in crowdfunding. Dr. Kenworthy and her colleagues analyzed what makes a GoFundMe successful by looking at the 827 highest performing campaigns. She found that young white men coping with unexpected medical crises tend to attract the most support, while Black women were underrepresented among successful campaigns.Michael Levenson