he American College of Obstetricians and Gynecologists (2016a,c) has taken a lead in adopting a fair system for malpractice litigation-or maloccurrence itigation. And nationally, there is the possibility of federl tort reform under the Trump administration (Lockwood, 2017; Mello, 2017).
Following a slight decline from 1990 through 2004, the percentage of out-of-hospital births in the United States increased from 0.86 to 1.5 percent-almost 75 percent-through 2014 (MacDorman, 2016a). Of these home births, only a third are attended by nurse midwives certiied by the American Midwife Certiication Board (Grtinebaum, 2015; Snowden, 2015).
Proponents of home births cite successes derived from laudatory observational data from England and he Netherlands (de Jonge, 2015; Van der Kooy, 2011). Data from the United States, however, are less convincing and indicate a higher incidence of perinatal morbidity and mortality (Grtinebaum, 2014, 2015; Snowden, 2015; Wasden, 2014; Wax, 2010). hese latter findings have led Chervenak and coworkers (2013, 2015) to question the ethics of participation in planned home births. Greene and Ecker (2015) take a broader view. Given data from these more recently cited studies, they are of the view that these data empower women to make a rational decision regarding home delivery. he American College of Obstetricians and Gynecologists (20 17b) believes that hospitals and accredited birth centers ofer the safest settings, but that each woman has the right to make a medically informed decision regarding delivery.
Politics and religion over the years have led to various govern mental interferences with the reproductive rights of women.
adolescents. This is despite all reports of the overwhelming suc cess of such programs. One example is the exclusion of Planned
Parenthood ailiates from the Texas Medicaid fee-for-service family planning program. In some groups of women served, there was discontinuation of contraception and an increased rate of Medicaid binhs (Stevenson, 2016),
According to the Gurrmacher Institute (2016a), publicly funded family planning services are needed by 20 million American women. In 2014, such services prevenred nearly 2 million unintended pregnancies and 700,000 abonions in the United States. The fate of family planning services is not fully determined, while waiting for decisions regarding provisions within the 2017 American Healrh Care Ace (AHCA). or "Trumpcare." In his response ro news that the AHCA may dismantle cOlHraceptive coverage, American College of Obstetricians and Gynecologises President Dt. Haywood Brown (2017) called this a deep disregard for women's health.
According to the CDC (2014). there were 259 million prescriptions written in 2012 for opioid medications. In 2013, more than a rhird of American adults reported prescrip tion opioid use (Han, 2017). These fteely available-albeit requiring a prescription-addictive drugs are associated with opioid use disorders. It remains uncercain if opioid use is terarogenic (Lind, 2017). Still, their abuse by pregnam women has caused an unprecedented rise in the 1eonata/ abstinence syndrome. described furrher in Chapters 12 (p. 248) and 33 (p. 625). Treatment of opioid abuse in pregnancy and its sequelae result in $1.5 billion annually in hospital charges.