Author Archives: Sarah Knarzer

The Legal Obstacles a Woman Faces in Choosing Her Birth Experience

The labor and delivery process has evolved immensely over the years in the types of procedures and use of medication. More patient focused than ever, the trends towards natural water births, pre-planned C-sections, and hiring doulas are likely to continue. However, while the physical toll a woman experiences in giving birth is obvious, the emotional and psychological burden is often carried alone and in secret. Women are talking about their struggles with postpartum depression and the traumas associated with giving birth. In lawsuits, women’s claims include being forced to undergo painful invasive vaginal procedures against their consent, feeling imprisoned to a bed for hours at a time, and even having their birthing plan completely ignored by staff. All of these indicate abuse at the hands of doctors and nurses whose primary focus is the birth of a child and not the woman in labor. Women should have the right to make choices about their bodies. This type of “obstetric violence” has led to an uptick in diagnoses of postpartum PTSD, which is often misdiagnosed as postpartum depression. 

This trauma has led a growing number of women to turn to alternative birth plans that avoid hospitals and put the mother in control of her birthing process. Many of these birthing plans occur in a tub or pool, filled with warm water, and incorporate types hypnotherapy and calming techniques to ensure a smooth and serene process. Proponents of this movement include midwives, who are trained in child birthing, and doulas, who assist and advocate for birthing women during the process, who emphasize that healthy women with uncomplicated pregnancies are usually more satisfied with the process than their previous births in hospitals. Natural water birth is praised for having lower cost, more freedom to choose medications or methods, less pain/anxiety, a comfortable and peaceful setting, and a personal connection to the process. However, critics argue that for difficult births, women who insist on natural water birth put both themselves and their baby at a higher risk for complications, or even death. If there is distress, bleeding, or other unknown conditions, the ability to get help and necessary care is more difficult and will take longer. In the UK, doctors are discussing a consent requirement for vaginal pirths beacause the risks of vaginal birth are so high and debating whether it should be the default option. Others discourage the notion that “natural birth is fulfilling while unnatural birth is traumatic” because it disenfranchises women who want to make the choice to have a C-section or epidural as part of their labor and delivery process. Regardless, experts agree natural water birth is a safe and successful birthing plan when well planned and executed. 

Unfortunately, across the United States laws are being passed that constrict a pregnant woman’s opportunity to choose a natural birth. Many doctors refuse to indulge in a natural water birth, which forces women to seek out midwives to facilitate their birthing plan. Twenty-three states refuse to license midwives, driving up the cost of natural water birth and making it less safe for those who insist on it. Like abortion, placing obstacles on water births do not stop them from happening. Some states, like Arkansas and Arizona, even require “vaginal assessments” prior to clearing a woman for a water birth, which is comprised of a series of STD testing and invasive vaginal examinations that a woman giving traditional vaginal birth in a hospital does not have to undergo. New York has attempted to reduce the number of water births by minimizing the number of facilities that would be prepared to facilitate them to three, for the entire state’s population. The effect of this is to limit the freedom of a women to control their birthing plans by requiring them to jump through hoops, increase costs, wait on impossibly long wait lists, and in some cases, even jeopardize her own safety just to exert any authority on the extremely painful and intimate process of bringing a child into the world. It is time for state laws to catch up with modern birthing practices and to give women the power to make their own decisions about their bodies as they give birth. 

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“Alexa, Reinvent the Healthcare System.” 

Amazon’s move to the health care space has the potential to revolutionize the industry.

Beginning in January, 2018, Amazon has been moving towards its latest business venture: healthcare. While a shift to health care may be unusual for Amazon, the change recognizes the fact that health care is an intricate and complex business that a disrupter like Amazon could greatly influence. Healthcare is one of the biggest industries in the U.S., but also one of the most inefficient. Approximately one third of health care spending is unnecessary and is usually wasted. A number of companies have attempted to reduce some of this waste, most notably with the partnership between Amazon, Berkshire Hathaway and JPMorgan Chase. These three businesses have a combined 1.2 million employees and the hope is their partnership will allow them to bring costs down in their own health care plans. This announcement has already had an impact on the healthcare community and drawn notice from other stakeholders in health care. 

According to the alliance, this business venture will not be aimed towards making a profit, but instead will focus on reducing the costs of the healthcare system and making the system easier to navigate. Dr. Atul Gawande, a physician and advocate for health care reform, has been chosen to lead this new venture. While details about the venture are not yet known, Dr. Gawande’s past comments have hinted that he will concentrate on three main issues: improving health benefits, boosting primary care and lowering pharmacy costs. 

The venture has also examined additional ways to lower health care costs, such as purchasing the pharmacy startup, Pillpack and investing in better software to compile medical records.Some see this as a move to make an online pharmacy platform that would allow patients to simplify obtaining prescriptions, moving the entire process to a personal, computerized system. Amazon may be able to capitalize on this new market through their existing success in online retail services. Amazon already provides medical supplies to hospital systems and they may be able to further expand within this market through sales of prescription drugs. Additionally, Amazon may also be able to integrate their Alexa home assistant technology into an integrated health program. Recent projects have used Alexa to monitor personal health, provide first aid response and report medical data. Increased utilization of Alexa-related services would allow for greater integration of Amazon products within the health care industry and may create additional ways to bring down costs. 

Amazon’s move to the health care space has the potential to revolutionize the industry, as they may create a more efficient system that other large businesses may choose to adopt. The increased uncertainty for medical practitioners will likely lead to a number of legal questions, such as issues of data privacy and monopolistic behavior. There will likely be some government regulation of these new businesses and it will be essential to keep up-to-date with legal changes to allow businesses to stay in compliance as well as participate in these new ventures.

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From Counsel to Counselor: A Brief Overview of the Legal Profession’s Relationship with Mental Health

People joke that being an attorney sucks the life out of you. And frankly, it does. There is a high mental and emotional toll on legal professionals. A 2016 survey from the American Bar Associationfound that “21-36% of lawyers qualify as problem drinkers, approximately 28 percent of lawyers are struggling with some level of depression, and approximately 19 percent are struggling with anxiety.” These rates are especially high among young lawyers in firms. A North Carolina studyreported that one in every four attorneys displayed symptoms that would indicate clinical depression, such as a loss of appetite, lethargy, insomnia, or suicidal thoughts. The percentage of legal professionals battling substance abuse is almost twice as highas the general population. The general attitude towards lawyers from both the public and the community itself is one of resignation: lawyers are workaholics, egotistical, soulless, etc. But what changes within the community can positively impact the wellbeing of legal professionals? Can improvements in the ways lawyers handle mental health shift public perception of the occupation? 

The environment inherent in the legal profession can have a lasting impact on anxiety and depression.Work in the legal profession includes time constraints, high stakes (loss of property, freedom, life), and high expectations from peers and clients. Deadlines never really end for lawyers; even when one case closes, many others open and there is always an impending due date. The perpetual threat of malpractice leaves no room for lawyers to make mistakes. The constant scrutiny, judgment, competition, and conflict-driven nature of the occupation obstruct the formation of professional relationships and camaraderie. Oftentimes these strains extend past the courthouse and into the personal lives of lawyers, such as a depletion of energy, an inability to stop worrying about the work, and the tendency to argue their point at any given moment. 

These factors are such an integral part of the profession that many of them begin to manifest even in law school. The effects of these pressures are felt by a majority of students at some point in their education. The Survey of Law Student Well-Being in the spring of 2014showed that 17% of law students experience depression, 14% experience severe anxiety, and 43% of students report binge drinking at least once in the last two weeks. These numbers are especially high among men and continue to climb with each year of law school. These statistics are staggering. They demonstrate that young professionals entering the workforce are already in the mindset that their mental health and well-being should take a backseat to their career, success, and work. 

The remedy is no quick fix; it involves community-wide changesto the culture and mentality of how to be a successful lawyer. To start, the profession must learn to acknowledge and recognize the mental health struggles facing many lawyers. Leaders should value well-being and act as role models—not only from a business perspective, but a personal one. By destigmatizing and encouraging open communication about the mental health issues faced by the community, people may start to feel comfortable asking for help when they are burned out or depressed. When firms stress billable hours as success, they encourage overtime and discourage a work-life balance, which is necessary in mental health. There are several well-being programs that can be introduced both in the firm and outside that build teamwork, camaraderie, and collegiality. For example, there is a Lawyer Assistance Program at the D.C. Bar that is free and assists those in the legal community with issues like addiction, stress, and mental health symptoms. 

The legal profession’s relationship with booze should also be reevaluated.Social events, meetings, job recruitment, and mentorship generally occur over the consumption of alcohol, even beginning as early as law school. Addiction prone lawyers may jeopardize their sobriety in order to attend networking and social events, under the pressure that these events are necessary for promotions and positive office relations. 

Lawyers are skilled in managing risk, but lawyers have repeatedly failed to recognize that their community is the one at risk. So, then, why is it so difficult for lawyers to recognize that their community is the one at risk? The current structure and culture leave no room for well-being or mental health. To ignore this problem any longer is to continue to put lawyers, clients, firms, and the profession as a whole in jeopardy.  

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