Severe Complications for Pregnant Veterans Nearly Doubled in the Last Decade, a GAO Report Finds
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After the Supreme Court overturned Roe v. Wade, ending nearly 50 years of federal protection for abortion, some states began enforcing strict abortion bans while others became new havens for the procedure. ProPublica is investigating how sweeping changes to reproductive health care access in America are affecting people, institutions and governments.
Over the past decade, the rate of veterans suffering severe pregnancy complications has risen dramatically, a new federal report found.
Veterans have raced to the hospital with dangerous infections, kidney failure, aneurysms or blood loss. They’ve required hysterectomies, breathing machines and blood transfusions to save their lives. Between 2011 and 2020, 13 veterans died after such complications.
The report found that among people getting health care benefits through the Department of Veterans Affairs, the rate of severe complications nearly doubled during that time, from about 93 per 10,000 hospitalizations in 2011 to just over 184 per 10,000 hospitalizations in 2020. Black veterans had the highest rates.
The report, which was put together by the Government Accountability Office, also made recommendations for reducing the problem, which focus on conducting more routine screenings throughout pregnancy and in the postpartum period.
“It is imperative that the VA help ensure veterans have the healthiest pregnancy outcomes possible,” the report said, highlighting the increasing number of veterans using the agency’s maternity benefits as well as the troublesome complication rates faced by Black women.
The report’s findings are an unfortunate trend, said Alyssa Hundrup, director of health care at the GAO. The office analyzed data on 40,000 hospitalizations related to deliveries paid for by the VA. It captures a time period before 21 states banned or greatly restricted abortion and the military was thrust into a political battle over whether it would pay for active service members to travel for abortion care if a pregnancy was a risk to their health.
Hundrup, who led the review, said the analysis included hospital records from days after delivery to a year postpartum. The report was mandated after Congress passed a law in 2021 that aimed to address the maternal health crisis among veterans. The law led to a $15 million investment in maternity care coordination programs for veterans.
The report recommended that the VA analyze and collect more data on severe complications as well as data on the mental health, race and ethnicity of veterans who experience complications to understand the causes behind the increase and the reasons for the disparity. The report also states that oversight is needed to ensure screenings are being completed.
Studies show there’s a connection between mental health conditions and pregnancy-related complications, VA officials said.
The report recommended expanding the screening questions that providers ask patients at appointments to glean more information about their mental health, including anxiety and PTSD symptoms. It urged the VA to review the data more regularly.
“You don’t know what you don’t measure,” Hundrup said in an interview with ProPublica.
The VA health system, which historically served a male population, does not provide maternity care at its facilities. Instead, the agency has outsourced maternity care. But when patients were treated by those providers, the VA failed to track whether they were getting screened for other health issues and mental health problems.
Officials hope the improved data collection will help the VA study underlying issues that may lead to complications. For example, do higher rates of anxiety have a connection to rates of high blood pressure in pregnant people?
VA officials are working with a maternal health review committee to monitor the data as it is gathered. The agency recently conducted its first review of data going back five years about pregnancy-related complications, said Dr. Amanda Johnson, acting head of the VA’s Office of Women’s Health, who is overseeing the implementation of the report’s recommendations.
The VA has created a dashboard to monitor pregnant veterans’ health outcomes. The VA’s data analysis team will also examine the impact of veterans’ ages on complications and whether they differ for people who live in urban and rural areas.
VA officials will begin to review mental health screenings conducted by maternal care coordinators in March. The coordinators advocate for veterans, helping them between health care visits, whether their providers are inside or outside the VA.
Johnson said that reducing racial and ethnic disparities is a priority for the agency. In 2018, ProPublica published “Lost Mothers,” a series that shed light on the country’s maternal health crisis. Studies have shown that in the general population, Black women are three times more likely than white women to die from pregnancy-related complications. While deaths made up only a small portion of the bad outcomes for Black veterans cited in the report, VA care could not spare them from elevated rates of severe complications. Johnson said the maternal health crisis also persists within the VA.
“There is a disparity,” Johnson said. “We are not immune to that.”
Research shows pregnant people who have used the VA’s coverage have higher rates of trauma and mental conditions that can increase their risks of complications and bad outcomes.
This may be because many people who join the military enter it having already faced trauma, said Dr. Laura Miller, a psychiatrist and the medical director of reproductive mental health at the VA.
She said veterans with PTSD have higher rates of complications such as preeclampsia, a potentially fatal condition related to high blood pressure, gestational diabetes and postpartum depression. If untreated during pregnancy, depression also increases the likelihood of preterm birth and lingering problems for babies.
Hundrup said she hopes this proactive work will improve maternal health.
“We want these numbers trending in the other direction,” Hundrup said.
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Quiet Your Mind And Get To Sleep – by Dr. Colleen Carney & Dr. Rachel Manber
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One of the biggest problems with disrupted sleep is how it relates to other conditions, especially chronic pain or mental health difficulties—each part of it makes the other part(s) worse.
How, then, to interrupt that cycle, and enjoy better sleep that allows one to improve the other things too? Of course, you can tackle all parts of it in any order, but this book deals with it from a “sleep first” angle, with the philosophy that you’ll then be well-rested and better able to take on the other things.
The authors use an approach based in Cognitive Behavioral Therapy for Insomnia (CBT-I), which you’ve probably encountered elsewhere, but the difference here is that the authors don’t assume that all your problems can be just flowcharted away (which is otherwise a common weakness of CBT; attempts to note that the thing isn’t as bad as you automatically assumed will fail, if the thing really is that bad).
Instead, we see tools for improving sleep from the inside out, examining in detail how sleep works and what can go wrong with it, before then troubleshooting sleep-incompatible behaviors, optimizing our sleep system, and, as the title promises, quieting our mind. The authors give us tools for change to implement in all parts of this, including tools for changing our way of thinking about sleep, when often the stress of sleeplessness can, by painful irony, contribute to our sleeplessness.
It’s not all about head-stuff though; the authors do also cover peripheral matters including discussing quite an assortment of substances and medications that can help, harm, or both).
Lastly, the authors talk us through creating a plan, including working out in advance the possible challenges we may face (due to factors unforeseen by the authors, but known to us) and how we’ll overcome them or, if necessary, work around them.
The style is to-the-point self-help pop-science, without undue jargon, and/but with copious citations throughout, and an extensive bibliography, itself preceded by a generous set of resource-containing appendices.
Bottom line: if you struggle with sleep and that problem is comorbid with something else (e.g. chronic pain, stress, anxiety, depression, PTSD, etc—actually the authors cover far more conditions than we’ve had room to mention here) then this is an excellent book to tackle your sleep holistically with those things in mind.
Click here to check out Quiet Your Mind And Get To Sleep, and rest well!
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Banana vs Dates – Which is Healthier?
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Our Verdict
When comparing bananas to dates, we picked the dates
Why?
Both are great, but there was a clear winner! We pitted these two against each other as they’re both sweet fruits often used as a sweetening and consistency-altering ingredient in desserts and sweet snacks, so if you’re making a choice between them, here are the things to consider:
In terms of macros, dates have more than 3x the fiber, more than 2x the protein, and a little over 3x the carbs. You may be wondering how this adds up in terms of glycemic index: dates have the lower GI. So, we pick dates, here, for that reason and overall nutritional density too.
In the category of vitmains, bananas have more of vitamins A, B6, C, and E, while dates have more of vitamins B1, B3, B5, B7, and K making for a marginal victory for dates in this round.
Looking at minerals next, however, it’s quite one-sided: bananas are not higher in any minerals (no, not even potassium, for which they are famous—dates have nearly 2x more potassium than bananas), while dates have more dates have more calcium, copper, iron, magnesium, phosphorus, potassium (as mentioned), selenium, and zinc. So, an overwhelming win for dates here.
Adding up the sections makes for a very clear overall win for dates, but by all means do enjoy either or both, as diversity is best!
Want to learn more?
You might like:
From Apples to Bees, and High-Fructose Cs: Which Sugars Are Healthier, And Which Are Just The Same?
Enjoy!
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Why You Feel Like You Have To Pee Again Right After You Just Went
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Dr. Amy Konvalin talks us through breaking the pattern:
When nature calls… Repeatedly
Fun fact: feeling like you need to pee again right after standing up is often more a matter of bladder sensation, pelvic floor tension, positioning, and learned bathroom habits, rather than necessarily incomplete emptying.
Notably, repeatedly sitting back down “just in case” can accidentally train your brain and bladder into expecting a second round, reinforcing the pattern over time.
So, what to do instead?
- Before: sit down, take three slow deep belly breaths in through your nose, then exhale fully, to help relax your nervous system and pelvic floor before starting.
- During: consciously relax your pelvic floor instead of rushing or straining.
- After: once you feel done, take one more deep breath, exhale, and check once, dry and stand up, resisting any urge to return.
- After after: distract yourself and move on with your day to help break the automatic “go twice” pattern.
Safety note, though: persistent urinary urgency, frequent urination, pain, burning, blood in your urine, prolapse symptoms, recurrent infections, or trouble emptying should all be checked out by an medical professional, as many causes—including UTIs, overactive bladder, pelvic floor dysfunction, or prostate/bladder issues and even cancer—can overlap.
For more on all of this and for some mysterious reason absolutely no visual demonstrations for this one, enjoy:
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How To Get Your First Pull-Up
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Pull-ups are a great compound exercise that works most of the upper body. However, it can be frustrating for many, if unable to do more than dangle and struggle while not going anywhere. That’s not actually bad, by the way! Of course it’s not great athletic performance, but in terms of exercise, “dangling and struggling while not going anywhere” is an isometric exercise that has plenty of benefits of its own. However, for those who would rather go up in the world, personal trainer Meg Gallagher shows the way:
The Only Way Is Up?
Gallagher offers a few methods; the first is simply an improvement on the “dangling and struggling while not going anywhere” method, but doing it with good form. It’s called the…
Hollow body hold:
- Hang from the bar with legs and feet together.
- Maintain a posterior pelvic tilt (i.e. don’t let your hips roll forwards, and don’t let your butt stick out more than is necessary by mere virtue of having a butt)
- Engage your core by shortening the space between your ribs and pelvis.
- Turn on your abs and lats, with your head slightly behind the bar.
- Practice the hollow body hang instead of dead hangs to build grip and core strength.
Another method is now moving on from the hollow body hold, and shows that in fact, up is not the only way. It’s called…
Negative pull-ups:
- Jump up to get your chin over the bar, then slowly lower yourself in a controlled manner.
- Prioritize negative pull-ups over other exercises to build strength.
- You can use modifications like resistance bands or feet assistance if necessary to extend the duration of your negative pull-up, but these are “crutches”, so try to move on from them as soon as you reasonably can—same if your gym has an “assisted pull-up” machine, consisting of a moving platform with a variable counterweight, mimicking how a pull-up would feel if your body were lighter.
- Practice resisting throughout the entire range of motion.
To give a sense of direction, Gallagher offers the following program:
- On day 1, test how long you can resist the negative pull-up (e.g., 10 seconds).
- For each session, multiply your time by 2 (e.g., 10 seconds × 2 = 20 seconds total).
- Break the total volume into as many sets as needed (e.g., 2 sets of 10 seconds or 4 sets of 5 seconds).
- After each session, add 2 seconds to the total volume for the next session.
- Aim for 3 sessions per week for 3–4 weeks, increasing by 2 seconds each session.
- When you reach about 25 seconds, you should be close to performing your first pull-up.
For more on all of this, plus a few other things to try, plus visual demonstrations, enjoy:
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You might also like to read:
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The Most Anti-Aging Exercise
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We’ve referenced this (excellent) video before, but never actually put it under the spotlight in one of these features, so here we go!
Deep squats
It’s about deep squats, also called Slav squats, Asian squats, sitting squats, resting squats, or various other names. However, fear not; you don’t need to be Slavic or Asian to do it; you just need to practice.
As for why this is called “anti-aging”, by the way, it’s because being able to get up off the ground is one of the main tests of age-related mobility decline, and if you can deep-squat comfortably, then you can do that easily. And so long as you continue being able to deep-squat comfortably, you’ll continue to be able to get up off the ground easily too, because you have the strength in the right muscles, as well as the suppleness, comfort with range of motion, and balance (those stabilizing muscles are used constantly in a deep squat, whereas Western lifestyle sitting leaves those muscles very neglected and thus atrophied).
Epidemiological note: chairs, couches, and assorted modern conveniences reduce the need for squatting in daily life, leading to stiffness in joints, muscles, tendons, and ligaments. Many adults in developed countries struggle with deep squats due to lack of use, not aging. Which is a problem, because a lack of full range of motion in joints causes wear and tear, leading to chronic pain and degenerative joint diseases. People in countries where squatting is a common resting position have lower incidences of osteoarthritis, for example—contrary to what some might expect, squatting does not harm joints but rather protects them from arthritis and knee pain. Strengthening leg muscles through squatting can alleviate knee pain, whereas knee pain is often worsened by inactivity.
Notwithstanding the thumbnail, which is showing an interim position, one’s feet should be flat on the ground, by the way, and one’s butt should be nearby, just a few inches off the ground (in other words, the position that we see her in for most of this video).
Troubleshooting: if you’re accustomed to sitting in chairs a lot, then this may be uncomfortable at first. Zuzka advises us to go gently, and/but gradually increase our range of motion and (equally importantly) duration in the resting position.
You can use a wall or doorway to partially support you, at first, if you struggle with mobility or balance. Just try to gradually use it less, until you’re comfortable deep-squatting with no support.
Since this is not an intrinsically very exciting exercise, once you build up the duration for which you’re comfortable deep-squatting, it can be good to get in the habit of “sitting” this way (i.e. deep squatting, still butt-off-the-floor, but doing the job of sitting) while doing other things such as working (if you have an appropriate work set-up for that*), reading, or watching TV.
*this is probably easiest with a laptop placed on an object/surface of appropriate height, such as a coffee table or such. As a bonus, having your hands in front of you while working will also bring your center of gravity forwards a bit, making the position easier and more comfortable to maintain. This writer (hi, it’s me) prefers her standing desk for work in general, with a nice ergonomic keyboard and all that, but if using a laptop from time to time, then squatting is a very good option.
In terms of working up duration, if you can only manage seconds to start with, that’s fine. Just do a few more seconds each time, until it’s 30, 60, 120, and so on until it’s 5 minutes, 10, 15, and so on.
You can even start that habit-forming while you’re still in the “seconds at a time” stage! You can deep-squat just for some seconds while you:
- pick up something from the floor
- check on something in the oven
- get something out of the bottom of the fridge
…etc!
For more on all this, plus many visual demonstrations including interim exercises to get you there if it’s difficult for you at first, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Mobility For Now & For Later: Train For The Marathon That Is Your Life!
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Scheduling Tips for Overrunning Tasks
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Your Questions, Our Answers!
Q: Often I schedule time for things, but the task takes longer than I think, or multiplies while I’m doing it, and then my schedule gets thrown out. Any ideas?
A: A relatable struggle! Happily, there are remedies:
- Does the task really absolutely need to be finished today? If not, just continue it in scheduled timeslots until it’s completed.
- Some tasks do indeed need to be finished today (hi, writer of a daily newsletter here!), so it can be useful to have an idea of how long things really take, in advance. While new tasks can catch us unawares, recurring or similar-to-previous tasks can be estimated based on how long they took previously. For this reason, we recommend doing a time audit every now and again, to see how you really use your time.
- A great resource that you should include in your schedule is a “spare” timeslot, ideally at least one per day. Call it a “buffer” or a “backup” or whatever (in my schedule it’s labelled “discretionary”), but the basic idea is that it’s a scheduled timeslot with nothing scheduled in it, and it works as an “overflow” catch-all.
Additionally:
- You can usually cut down the time it takes you to do tasks by setting “Deep Work” rules for yourself. For example: cut out distractions, single-task, work in for example 25-minute bursts with 5-minute breaks, etc
- You can also usually cut down the time it takes you to do tasks by making sure you’re prepared for them. Not just task-specific preparation, either! A clear head on, plenty of energy, the resources you’ll need (including refreshments!) to hand, etc can make a huge difference to efficiency.
See Also: Time Optimism and the Planning Fallacy
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