Abraham Lincoln

Today is Abraham Lincoln's 202nd birthday. Born in Hardin County, Ky., on Feb. 12, 1809, Lincoln was the 16th President of the United States.

He was also a man who endured an uncommon amount of loss, at least by today's standards.Abraham Lincoln

The son of a Kentucky frontiersman who himself had seen his parents murdered by Indians, Lincoln lost his mother, both siblings and three of his four sons to untimely death before he was assassinated in 1865.

Lincoln's mother died in Indiana when he was nine, poisoned by milk tainted with white snakeroot. Cows ate the plant when grazing was bad in a fairly narrow area west of the Appalachian mountains. No one understood the danger of white snakeroot at the time.

Lincoln's brother Thomas died in infancy.

His sister Sarah, married to Aaron Grigsby, died in childbirth at the age of 20. Her baby died, too. Lincoln was furious with the Grigsbys for not calling a doctor when Sarah's labor went on and on. "They let her lay too long," a neighbor said.

Three of Lincoln's four sons with his wife, Mary, also died young — Edward, William and Thomas. Only Robert lived into adulthood.

Image from Wikimedia Commons

Easy to be hard

Birth is the most common reason for a person to be hospitalized in the United States, a major point of intersection for a healthy population with the health-care system.

But while birth may be common, it isn't cheap. The average cost of maternity care in the United States in 2004 was $8,800, according to a report by the March of Dimes, and that figure can take off for the stratosphere — into the tens and even hundreds of thousands of dollars — in the event of complications.Pregnant Graffiti

With the national mid-term elections just a few weeks away, many politicians are drumming up votes by weighing in on the health-care reform legislation Congress passed earlier this year, and on government programs that subsidize health-care services like maternity care for low-income people.

Rand Paul, an ophthamologist who is the Republican candidate for the Senate in Kentucky, remarked last week that half the state's 57,000 yearly births are paid for by Medicaid. “Half of the people in Kentucky are not poor. We’ve made it too easy,” Paul said.

You could say Paul is right. A woman doesn't have to be officially poor in Kentucky to have her baby's birth paid for by Medicaid.  Kentucky allows Medicaid coverage for a woman whose income is 185 percent of the official federal poverty level of $18,310 for a family of three. That is, her family of three can make just under $34,000 and still qualify.

But remember, the average birth experience will cost her almost $9,000.

The March of Dimes analysis found that consumer costs for a birth averaged just under $500, but that pre-supposes that the mother has health insurance that covers childbirth and maternity care.

Analysts for The Guttmacher Institute, which concerns itself with sexual and reproductive health both in the United States and globally, working with recent figures from the U.S. Census Bureau, figure that 2.3 million women of reproductive age lost health insurance in the year between 2008 and 2009 alone.

The National Women's Law Center has found that individual insurance plans, which are exempt from the Pregnancy Discrimination Act of 1978, tend not to offer maternity care. The NWLC found that just 12 percent of the plans it examined offered maternity care, and that the provisions they offered were often limited.

"That’s why having insurance coverage is so critical. Employer-based group plans usually have good maternity care coverage, but most low-income women don’t get insurance through the workplace," the Guttmacher Institute states on its website today.

So looked at from that aspect, Paul is wrong. We're not making things too easy at all. The way thing are set up now, we're making it too hard for women to obtain coverage for maternity care.

Pregnant Graffiti by Petteri Sulonen, courtesy of Wikimedia Commons

The Flexner Report

The so-called "Flexner Report," issued in 1910, was a game-changer in American medical education.

Previously, a man — or woman — could become a physician by sitting through a winter's worth of lectures at a "medical school," which might be some doctor's parlor. Only the more rigorous schools survived after 1910 — all the women's medical schools and most of those that accepted minority candidates closed.

Abraham Flexner

Candidates had to qualify for the schools that remained, and they spent years, not months, learning the craft, which began to include hands-on training with patients. All these innovations impacted the birth story.

Abraham Flexner, who wrote the report for the Carnegie Foundation, was primarily an educator. He got his start with a private laboratory school he founded in his native Louisville, Ky., after graduation from Johns Hopkins University, and wrote a book in 1908, The American College, that brought him national attention.

Flexner was deeply involved in re-structuring the nation's medical schools in the years leading up to World War I. Later, he was the first director of the Institute for Advanced Study, a colossally influential "think tank," founded in 1930 in Princeton, N.J., by Newark retailer Louis Bamberger and his sister Caroline Bamberger Fuld.

At the IAS, Flexner saw opportunity in the political clouds gathering over Europe, recruiting scientists like John von Newmann and Kurt Godel. And, Flexner personally wrote the letter that brought Albert Einstein to the United States in 1933.

The Frontier Nursing Service

Mary Breckinridge, a daughter of a prominent Kentucky family that included John C. Breckinridge, James Buchanan’s vice president, suffered the loss of both her children before they reached the age of 5. Instead of allowing these tragedies to ruin her life, she channeled her energy into a passionate campaign to improve the health of the children of Appalachia.

Mary Breckinridge

Mary Breckinridge at work

To Breckinridge, a healthy child required a safe birth, a living mother and a healthy family. Making childbirth safe was a primary goal when, in 1925, she founded the Frontier Nursing Service in Leslie County, Ky. The previous year, Breckinridge, 43 and already a nurse, had traveled to England to learn midwifery because she could find no adequate course in the United States. She continued to send FNS nurses to England until the outbreak of World War II.

The FNS deployed the first nurse-midwives to practice in the United States. Breckinridge had encountered nurse-midwives in Europe, and thought that the model was well suited not only for delivering babies but also for providing prenatal care and for assessing and helping to plan for the health needs of the whole family and, indeed, the whole community.

FNS nurses traveled by horseback to attend home births; high-risk patients went to the FNS hospital in Hyden, Ky. Clinics in the community served an average of 250 families. The FNS maternal mortality rate for its first 30 years was about one quarter of the rate for the United States as a whole.

Breckinridge died in 1965. The Frontier Nursing Service, based in Wendover, Ky., is still active, as its midwifery school, which was added in 1939.