Midwives of the Revolution

Explorations, analysis, and reflections on women's health, midwifery, and politics from a feminist, marxist lens


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[Some] Breastfeeding Moms Can Now Do More!

There has been much jubilation this week in the women’s health and lactation (and tech) worlds this week as a brand new “smart” breast pump that will be hitting the market this Spring got the tech world excited at CES 2017. While the Scary Mommy blog and Association of Women’s Health, Obstetric, and Neonatal Nurses were beside themselves with joy over the new Willow breastpump, I believe a healthy dose of skepticism about this type of product is in order.

What’s the big idea? It’s quiet and discrete–you can wear it under your bra, it’s wireless, and it has some cool tech features. It’s being pitched as a way to multitask while pumping. Imagine easily commuting, going to the movies, making dinner, or cleaning the bathroom while pumping! Great for busy nursing parents, right?!

willow-breast-pump

Willow has a beautiful design,and if such technology was developed and made available in order to actually improve working parents’ lives, including, say, being a covered benefit under state Medicaid programs that would actually help working class and poor women meet their breastfeeding goals, that would be great! And, you know, if it came with gains for our side like the Fight for 15 movement is fighting for, it would be even more meaningful.

Don’t get me wrong–as a supporter of human milk for human babies and a former (and possibly future) pumping and working mama, I am for easing the burden of expressing milk when needed. For instance, as a nursing mama, I did bring my electric pump to the opening night of Star Wars: Force Awakens last year–went straight from clinic to the movies and plugged in during the previews and opening credits! This pump would have indeed made my expression of milk easier. The critique that follows is more about lower wage women than about professional workers such as myself that could likely afford the Willow. In regard to the Willow, we must consider the following not just about our own potential personal use of the pump but about what it represents.

  1. Moms are under pressure more than ever to Do More. You’ve heard that cute phrase “mother’s work is never done”? Or perhaps are familiar with the concept of the “second shift” of women* having two jobs–one (usually under-) paid at work, then going home to be mainly responsible for housework and childcare? With the devaluing of care and women’s work generally, nursing mamas are producing even more value for the economy by making food for their infants that doesn’t have to be paid for (unlike artificial milk for babies, which can be exorbitant but is paid for by programs like WIC). This product allows the pumping parent to Do More while pumping. Sure, that may be convenient and beneficial for many mamas struggling to feed their children, whether working outside of the home or not. However, it strikes me that this product is a symptom (not a creator) of the general societal expectation for mamas to be Super Mothers. In this time of neoliberalism and very few social resources that would actually help parents raise healthy children like, say, socialized high quality daycare/other childcare, postpartum in-home nurse care, excellent local public schools, accessible healthy food for families, walkable safe neighborhoods, paid maternity leave (for at least 12 months like a civilized county) etc.–mothers are still expected to Do Everything to raise healthy children by: breastfeeding in spite of all odds, prepare homemade meals for our kids every night, and sacrifice everything to be the right kind of mother who balances career and parenting. No such standards are ever applied to men/fathers because Sexism.
  2. willow-working-mom

    Ah, the working pumping mother! She’s so efficient and beautiful and productive! You hardly notice she’s a working mother! Makes you wonder if the manufacturer looked at the federal laws on pumping before launching this marketing campaign, or if they are directing it to capital. 

    Let’s be real. While mothers who can afford it (see point #3, below) would likely benefit from a pump like this to get more done at home–though most pumping moms I know do most of their pumping while at work, except exclusively pumping mamas–the real and direct beneficiary of products like Willow are the corporations that don’t really want to support their employees’ right to undisturbed pumping time on the job that is (for now) guaranteed under the Affordable Care Act. Makes you wonder if the creators of Willow have just been waiting for the ACA to be closer to repeal in order to promote this product. In every circle of breastfeeding parents I have been part of, there are constant questions about workers’ rights to pumping time. Many people resort to working through pumping time (though not as discretely as they would with the Willow) because it’s just not practical to take proper breaks to pump (I myself usually did charting while pumping because there’s always charting to be done, and the extra charting time lessened my time staying late). This will only get worse if nursing protections are lost with the almost inevitable upcoming ACA repeal. Bad news for maternal and child health–and workers’ rights. But here’s Willow, and ready to accommodate your upcoming loss of rights! Wouldn’t you like to see your midwife while they express milk for their child?! Or have your latte prepped by a properly productive multitasking discretely pumping barista? Or groceries rung up by a pumping cashier?

  3. Retailing at over $400, plus and astonishing $0.50 per single-use milk storage bag, Willow will be cost prohibitive to the vast majority of working mothers. For a product that will make it easier to make pumping parents work through their pumping session, the least capital could do is subsidize this product. In a rational world, corporations would be made to bear the burden of the cost of such a product, rather than consumers. Sure, eventually, Willow would benefit under the current ACA requirement for health insurance to provide lactation benefits. But until then–or after, if/when ACA is repealed under the next Administration–Willow will be a privilege of a small minority of wealthier professionals who can afford it. I wouldn’t consider Willow a “game-changer,” as it’s being touted, unless and until it is free to all pumping parents who need it in order to meet their breastfeeding goals.
  4. Finally, one question about this product that I’ve seen raised by lots of mamas on breastfeeding forums has to do with the actual science of milk production. Willow claims that it senses letdown and then switches to expression mode (not far off from Medela’s technology), but many pumping parents have expressed (um, sorry) concern that it can be hard to actually produce more milk while focusing on things other than nourishing the baby you love. That’s why many people don’t like pumping–you are always having to measure your output against your baby’s nutrition needs for the next day, and for many, the pressure of making enough makes this a stressful rather than satisfying process. The pressure many of us feel to pump enough in our stressful parenting and working lives does more harm for milk production than good. Some may feel better getting things done while pumping rather than staring at the pump as it fills up, but I question the physiologic good of hooking a mama up to a pump so she can be disconnected from the thing her body is doing (expressing milk) while her mind can be focused on doing something else. This seems to suggest that our nursing bodies are just machines for milk output. Most of the writing I’ve seen on increasing milk production (and I have ear a lot of it while struggling with it personally) suggests focusing your mind on your body and your baby–prety much the opposite of what Willow encourages. I am reminded of the pumping women in Mad Max: Fury Road, who I swear must have all been taking domperidone–making milk for the society and able to do little else. They needed Willow to up their capacity as contributors to the patriarchy!

    fury-road-pumping

    Imagine a post-apocalyptic world with human milk a major source of sustenance and Willow at the ready to integrate pumping people into other productive endeavors!

  5. I hope the next phase of the women’s and reproductive justice movement will fight for paid maternity leave, and more collective solutions to infant nutrition and maternal health than are currently on offer under capitalism, and more specifically, neoliberalism. I hope we will be fighting for more leisure time for workers, so that we could start to imagine technology not to benefit the bosses and the war on women, but solutions for the common good and public health. Willow seems to me a symptom of a particularly American problem, whereas a society that actually values maternal-child health and in which mothers and workers actually have rights, would produce, say, workplace-based nurseries where nursing parents can feed their babies on demand and not be shackled to a pump during the workday at all. Or, say, hospital-grade pumps you could just hook up to (BYO parts), and more lactation lounges at your workplace or public locations like cafes, libraries, bars, etc. De-stigmatizing and promoting breastfeeding is not about individual decisions to nurse or breastfeeding in public, but must be part of changing the infrastructure of our society, and fighting sexism at every step, so that women’s reproductive work (pregnancy/parenting/nursing) can be separated from her life in a healthy, holistic way (yes, nursing parents and other mothers do need to get out of the house/be away from their nurslings sometimes).

    Some of these solutions exist in social democracies, and many of them have not yet been won anywhere, to my knowledge. Let’s not lower our horizons to hoping a product like Willow will lift busy nursing mamas from our drudgery, but use this as a way to vision a better way to integrate the needs of nursing dyads into society.

    *I am using “mother” and “mama” and “women here for linguistic ease. I do recognize that not all breastfeeding parents identify in these ways, and I seek to honor that in my writing. Most of the theoretical work about social reproduction and the second shift focuses on the care work of “women,”  and sexism has generally underpinned the war on mothers specifically. In the framework and sense of solidarity that I would like to put forward here, I do generally refer to women/mothers, because an attack on women and mothers generally underpins the war on parents of all genders, including gender non-conforming and trans* parents. I hope that as the movements for reproductive and gender justice grow in the coming years, they will help us develop more useful and inclusive language that helps capture the shared and also distinct experiences of sexism, misogyny, etc. of gendered oppression. And I hope you will read my piece with understanding and generosity toward my linguistic limits.


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Reflections on Birth and Immediate Postpartum Life

Well, this is now six months late…but I’m a new mom! And a full-time working nurse-midwife! I’m finally ready to dust off the keyboard and start blogging again! So, to kick it off, here’s a post I started right after the transformative experience of welcoming my baby into the world and finally polished off this week. It was fresh when the birth smells were deliciously enveloping my newborn, and fun to revisit now. Enjoy.

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My daughter is now just over a week old. The heat of late summer has broken,  and the kids are back in school at the elementary school across the street. Her umbilical cord stump has just detached, and my bottom and other muscles are gradually returning to normal. I’m generally following the advice I so emphatically dish to my patients: sleep when baby sleeps. Now, I’m taking a breather and making note of what this whole birth thing was like.

Empowerment: I made labor and birth affirmations so I could hear my own midwife voice assuring me during challenging times. My partner drew on this principle several times during labor a few times by asking what I would say to a patient at that phase, when needing reassurance or guidance.

One of the inspirations I had in the week before birth was to make myself affirmations to look at when things got hard during labor. I had been thinking of turning to my friends who had had natural or home births and asking for advice I could use to prepare. While I did receive some good advice (both solicited and not) from such sources, it started to feel strange to me — after all, I’ve attended dozens of births as a student and as a certified nurse-midwife: I know what to expect! Granted, many of the births I’ve attended since beginning professional practice have been in a highly medicalized environment, and few of my patients choose unmedicated birth — fewer have the resources for prepared childbirth.

Yet, I knew the chief thing for me to be successful was not just hearing positive birth stories — and I have read and viewed many — and connecting with the friends and family who were there at my Blessingway, provided beads for my labor necklace, or who were lighting candles for me both near and across the country during my labor. Even having the best labor team possible — which I was fortunate to have — was not a guarantee that I would be okay. No, what I needed more than anything was to be able to hear it from the most authoritative voice I know, my own from my heart as a midwife and my own strength as a woman. For what good is a labor team if the mama isn’t the most willing and capable member?

Though I didn’t look too consciously at the pictures I created, they helped promote a good birth environment — my support team would recite the mantras I had written: Ya mero! Fierce mamas believe in you! You are going to get huge! Yes, yes you can. Trust your body, and so on…And more than anything, I was grateful for the opportunity to make them in the days I was “overdue” and making my nest and heart ready for my baby.

The days after birth, I kept reliving the experience. I was so exhausted and overwhelmed with love and sore in ways I never thought possible. Tears would flow every time I remembered how I felt when my little girl was wet and warm and just screaming her little head off, fresh out of the birth canal on my chest. I had heard and taught women about the “baby blues” on countless postpartum rounds. This was more like a spiritual high, of connection that nourished the parts of me that had been longing for this moment of readiness for years.

I also woke up this week in a panic, realizing that I am probably at high risk for postpartum depression. So I called up my doula, who had mentioned that she does placenta encapsulation, and I ordered up an edible form of the afterbirth to ward off the very real possibility of falling prey to the dark side of new mama life.

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Tree of life: placenta print

I had been hearing about placenta encapsulation for a few years, and knew it hadn’t been studied much. Searches in scientific literatures brings up little of substance, mostly concluding that more research needs to be done. But I also knew that loads of mamas and midwives swore by its powers. I had been planning to plant the placenta in the garden, but when I had a major panic thinking of returning to a very challenging work environment just 10 weeks after the birth, I thought why not give this a chance? Most mammals eat their placentas (seemingly more for survival reasons relating to evading predators), and the power of the oxytocin and progesterone gave me hope it would do more good than harm to try it out. So my lovely doula came over and picked up the placenta a couple days after the birth, and generously returned two days later with a beautiful jar of the capsules and extra home-made herbalist goodies.

In spite of my fears of impending depression, I mostly can’t help but think about how lucky I am to have experienced the birth I did, and how well this network of birth and postpartum support is setting up my little family for a bounty of love, patience, and joy. I had one of the most highly skilled midwives in my area at my birth, who worked with me through a fairly long labor and helped me achieve a normal birth. In almost any hospital, I am certain I would not have had such a nice outcome. Being denied freedom to move and oral nourishment, while being strapped into continuous monitors, I imagine my baby and I would have become very stressed, and a surgical birth would have likely ensued.

Since even before deciding I wanted to be a midwife, I knew home birth would be for me, and now having done it, I feel so strong and powerful as a mama, but also even more convinced of the importance of preserving normal, natural birth. At no point would drugs have helped my labor. At every point, my preparation and support team — my mother, partner, doula, and the midwife assistant — helped me more than any drugs normally administered during labor could. Every laboring woman deserves this type of set-up. How much better for me and my baby (therefore also for public health) that neither of us was too stressed physically during labor, so that we could have such a good, non-interventive birth?!

I know that not every laboring person desires unmedicated birth, but if given the tools and support, it seems many more might at least feel they could make that choice. It seems likely that this could be so helpful in lowering our national rates of surgical births, now more than a staggering one third of all births.

Yet birth is only the beginning. After bringing new life into the world, you have to keep sustaining it! And protecting it for many years!

People have asked me how pregnancy, and now how birth, has changed me as a midwife, but I think that piece, the postpartum and parenting piece has been the most humbling as a women’s healthcare provider. Now, I have pushed this baby out into the world, and now I am responsible for her. I am lucky that I have experience with babies and that I feel so confident in caring for her after this magical birth experience. But if it weren’t for my mother staying with us the first week, the meal train organized by other parent friends, and living in a supportive community, I don’t know I would feel capable of doing hardly anything this week! And I have mamas I care for who have hardly any such support — single mamas, teenage mamas, and mamas with unhelpful or unavailable families. It hardly makes sense to leave new moms alone as a society to figure out recovery from birth and caring for a vulnerable newborn baby.

And then there’s breastfeeding! What a major

BFing linocut

Image borrowed from Rachel Epp Buller’s book cover Have Milk Will Travel

commitment! And I knew it was something I wanted to do, and in fact had literally had dreams about for years. But then doing it is another thing all together. So far, so good. I love how it feels to snuggle this little person and I love how cool it is that my body is making the only food she needs now. I also love how my midwife and doula prepared me to deal with the pain in my nipples the first few days, with ointment, exposing them to air, and the homeopathic medicine. But again, how humbling to have worked with dozens of women to initiate the process immediately postpartum, and then realize how hard it is in real life to keep it up, all hours of the day and night. And a crying newborn. How much patience and calm it takes to keep on loving and caring for a needy newborn. No wonder, with such little support from friends, family, and healthcare providers, so few women in this country actually do commit to breastfeeding for any length of time.

I guess that’s it. Just sharing my thoughts on being a new and breastfeeding mama of a beautiful baby girl that I’m head over heels in love with! And of being a transformed midwife with a new appreciation for birth, the yoni, midwives, doulas, and mothers of all kind everywhere and of every time.

 


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Surprise! Anti-Abortion Lies Across America!

Where do I begin with what is wrong with this ad?

The fact that a dad was surprised that he got someone pregnant, for one.

The fact that this suggests a cute baby is all women need to convince them that they should accept and embrace any surprise pregnancy, for two.

That the fact a potential baby has a heartbeat is supposed to sway an actual human that she shouldn’t have an abortion, for another.

But really, the fact that this has been up and prominent on my commute route home for at least two months and it hasn’t been defaced, is what really bums me out. I’m not saying that y’all should go out and mess it up. But if there was a movement to turn the tide against this kind of anti-woman garbage, that might have happened.

We have a lot of work to do to de-stigmatize abortion. These kinds of billboards show us our work is cut out for us. We desperately need a movement in the streets that proclaims that whatever the reason a person wants to terminate a pregnancy is ok.

Only a pregnant person can know if it’s right to continue a pregnancy, whether it was a surprise (for her or the sperm donor) or not. I look forward to the day such messages of reproductive freedom are found publicly and beautifully in public spaces, paid and not.


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Some Things I Have Been Thinking About in the Realm of Reproductive Justice

I wouldn’t be a very good Marxist or feminist midwife if I didn’t have some things to say about what’s going on in the world. But once my first three months of the new job were over, I finally had energy to do more political work, and therefore have had less time for blogging.

I am trying to carve out more time to write on this forum about the ongoing war on women, and what people of all genders and political persuasions can and are doing to fight it. I wanted to share just a few things here about what I’ve been thinking about, and that I hope to explore more in later, more in depth posts.

Hobby Lobby Protest

The Hobby Lobby decision prompted immediate protest at the grassroots

First, the Hobby Lobby Supreme Court decision of last month irked me more than I can say. It was an insult to science and to “freedom” and to women’s bodily autonomy. And so everything I wanted to say about it was published over at SocialistWorker.org, in this piece: “The ‘Freedom’ to Deny Women Healthcare.” I have more to say on the resistance to that decision, especially how defensive everyone is about contraception, but that will hopefully be developed in another upcoming article in that publication.

Also, I follow with great interest the ongoing legal battles over forced surgical birth, and their connection to abortion and other reproductive rights in this country. I really liked this piece, and laud Jennifer Goodall for her courageous stance for normal birth after c-section: “Pregnant Women Warned: Consent to Surgical Birth or Else.” Women losing the right to how they give birth is intimately connected to the right to contraception and abortion — another topic I look forward to exploring more in this space and others. 

Obvious Child

You must see this film. #ObviousChild

On a lighter note, I LOVED seeing Obvious Child in the theaters on its brief stint in my city. What a *fabulous* and hilarious comedy about abortion, of all wonderful things. There is nothing so wonderful as a bunch of sex-positive, abortion-positive, pro-woman people dealing with an unplanned pregnancy in a very real way on the big screen. I have heard people say that if Knocked Up or Juno were about abortion, there wouldn’t have been a story. But guess what — you can have a story when an unplanned pregnancy results in abortion (like half of all unplanned pregnancies do in this country) — that story just happens to then focus on the woman herself. Revolutionary. 

Finally, I am sick to death of the divisive commentary that passes for analysis about why the LGBT movement has made strides, while the war on women continues. This disturbing piece from the Daily Beast, “Ten Reasons Women Are Losing While Gays Keep Winning” has its response from yours truly coming up quickly. Suffice it to say that biological determinism has no role in progressive analysis, and apology about abortion is what got us further entrenched in the war on women, and will not provide our way out.

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Too many teasers? Sorry. Let’s say this is my way of holding myself accountable to myself and my readers. It shall be written!


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Resisting a Dangerous Consequence of Privatizing Medicaid

As of July 1 this year, my state has adopted an HMO model for its Medicaid plans. All Medicaid members have been assigned a primary care provider in the network. Many members were bumped from the regular Medicaid onto one of the handful of private insurance companies this state’s Medicaid has contracted with. This will be a disaster for patients in loads of ways: private insurance is part of the problem with peoples’ access to healthcare in the United States. Those insurance companies and the underfunded state programs are really the only ones for whom this can be seen in any way as part of a solution. What a boon for Blue Cross Blue Shield, Humana, and a host of other for profit corporations that they now have millions more customers handed to them from state governments. 

As with all of the reforms packaged with the Affordable Care Act, I am waiting to see how it will all shake out. So far, however, I have noticed that a huge problem for patients is how difficult it is to navigate these plans. And from a provider standpoint, it is much more confusing. Where do we send our OB patients for ultrasound or to see a Maternal-Fetal Medicine specialist when their pregnancy is complicated? Well, it depends on their insurance. Whereas many area hospitals still accept regular Medicaid, many have decided not to contract with some of these new private Medicaid plans. So depending on the managed care plan you were assigned, you may have to travel farther to get care than previously. 

One plan in particular has been on my shit list for years. My clinic actually does have a contract with this company, so this is the first time I’ve seen up close how it operates — everywhere else I’ve worked or had a student rotation at didn’t take it. They used to do this direct marketing thing — set up a booth at the shopping mall or in the neighborhood and offer women diapers, coupons, and other incentives to get them to switch to their plan. The woman would sign up only to find that she now cannot go to the clinic where she already had established care. Luckily, this practice is no longer allowed, so in theory patients are signing up for more above-board reasons.

Their prescription drug coverage remains a reason for me to campaign against them. Regular Medicaid in my state is not perfect — but the drugs they cover actually make medical sense (though there are loads of gaps). Now, when prescribing, we have to look up the formulary for myriad private Medicaid plans. (And don’t get me started on the limitations of contraceptive coverage on regular or these private plans, even with the contraceptive mandate.) Insurance, not public health, is determining many of my medical treatments. This is not a rational healthcare delivery system.

injection medicationThe absolute tip of the iceberg for me, though, with privatized Medicaid, is the requirement for the provider or pharmacy to submit a prior authorization request when prescribing treatment for two conditions that I see pretty frequently: gonorrhea (which includes injection of a drug called ceftriaxone) and Pelvic Inflammatory Disease (PID) (which requires both ceftriaxone and 14 days of oral doxycycline). 

What is prior authorization? Basically, a road-block to getting my patient the necessary treatment immediately at the time of diagnosis. It means that either the pharmacy or I have to submit an form to the insurance company explaining my medical rationale for scripting this drug. We fax the request and then wait 24-48 hours for it to be approved. 

The request is invariably granted. They pay it. Then we have to get the patient back into the clinic pharmacy to pick up the medication, and in the case of ceftriaxone, to get an injection from clinical staff (it cannot be injected in the pharmacy). Some clinics get around this by stocking the medication themselves, but that is not an expense my clinic is able to take on.

These antibiotics are expensive, and should not be. But it is not as though we are throwing either around unnecessarily. Believe me, it is very important to not over-prescribe antibiotics. But is cost the only factor to consider in treatment? Don’t patients deserve to get appropriate treatment for infections that can have some pretty horrific consequences if not treated correctly

I believe that we who hold that healthcare is a right have a duty to work together to crack open the continuing gaps in the new healthcare systems and fight for one that includes everyone (and yes, that means including undocumented immigrants) and covers all basic healthcare as a human right. I plan on campaigning against privatized Medicaid, and this is just one example of how a for-profit corporation is putting their profits ahead of public health in that privatized system.

To that end, I wanted to share with you a letter that I sent to that private Medicaid contractor that requires prior authorization. I was fed up. And two weeks after sending it, I received a call from one of their representatives asking for more background on why I sent the letter. I’m not convinced this is the end of it, but I am happy to say that the representative reported to me that she would pass my concerns on to people [who I deduce are the company pharmacists] that make formulary decisions. 

If you are a healthcare provider dealing with this issue in your patient population, I heartily encourage you to pick up the phone and add your voice to the dissent. Or copy and paste elements of my letter and forward on to the insurance company that corresponds in your instance.

We are many. They need to hear from us.

 

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Hello,

I am writing today because I am very concerned about the prior authorization requirement for medication ceftriaxone (Rocephin) and doxycycline. According to the Centers for Disease Control, a one-time injection of 250mg of ceftriaxone is the most appropriate treatment for gonorrhea (to be prescribed with azithromycin or equivalent). It is also the best treatment for pelvic inflammatory disease, along with 100mg oral doxycycline for 14 days.

As a women’s health provider, many patients present to my office with one or both of these conditions, requiring immediate treatment. Due to your organization’s prior authorization requirement for these medications, my [private corporation contracted] Medicaid patients face an unnecessary and potentially unsafe barrier when seeking treatment for these conditions. The prior authorization requirement means that complete treatment is delayed for these patients. I work in a setting for which transportation to the health clinic can be a significant issue – patients often report they delay seeking care due to economic and transportation barriers. It may not be easy for the patient to present to the clinic on a different day to pick up the prescription from the pharmacy and then receive the injection from our staff.

In addition to facing the stigma and emotional stress of having a sexually transmitted infection or PID, which can threaten a patient’s future fertility, this added barrier of delaying ceftriaxone treatment not only increases the emotional toll of such an infection – it also increases the threat of antibiotic resistance. If patients are not able to complete the full dose of the last remaining medication we have to treat gonorrhea, we could see an increase in resistance. Injection treatment for gonorrhea is supposed to help decrease antibiotic resistance. The prior authorization requirement runs the risk of making this an infection that can become even more threatening in not only the community I serve, but on a larger scale as well.

I am extremely concerned about the barrier that prior authorization requirement for these two medications creates for my patients, who deserve nothing less than safe and compassionate quality healthcare. I hope you will add ceftriaxone and 100mg doxycycline to the preferred drug list immediately, so we can enhance our patients’ access to care and improve public health.

Thank you for your attention to this matter. I look forward to hearing from you

Sincerely,

A Concerned Certified Nurse Midwife

Clinic X