What I’m Seeing This Week

Good morning, {{first_name}}.

The thing that keeps coming back to me this week is how much of medicine depends on pattern recognition — and how dangerous that becomes when the patterns we’re trained on don’t cover everything we’re going to see.

We train for what’s common. We get good at what we see often. And then something rare shows up, and we have to catch ourselves before our brains file it under something familiar. That’s when things go wrong. Not with dramatic failures. With quiet misses.

Syphilis is one of those things. Most of us don’t see it often enough to have the pattern locked in. And right now, we’re seeing a 30-year high in babies born with it — a disease we have had a treatment for since 1943. That tells you this is not a knowledge problem. It is a system problem. The surveillance infrastructure that should have caught this surge earlier has been systematically defunded. The medication that treats it is on shortage. And the clinicians who are seeing it are operating without the support they need.

I want you paying attention to this. Not because you are responsible for fixing federal public health infrastructure. But because your patient is in front of you, and she needs you to know what you’re looking at.

— Dr. Yamicia D. Connor, MD PhD MPH

The Stories

Story 01

We Are Seeing a 30-Year High in Babies Born With Syphilis. Here’s Why.

Congenital syphilis cases in the U.S. hit 3,882 in 2022 — a 937% increase since 2012. These are babies born with a disease their mothers transmitted during pregnancy. A disease we have been able to treat since 1943. A disease that is entirely preventable if we catch it in time.

The treatment is Bicillin L-A — penicillin G benzathine — the only antibiotic proven to cross the placenta and protect the fetus. It is currently on FDA shortage. The alternatives have documented treatment failures in pregnancy. So we have a surge, a medication shortage, and a clinical workforce that doesn’t see syphilis often enough to have the pattern locked in.

Part of what is driving this is the collapse of public health infrastructure over decades. STI screening programs were defunded. The CDC’s Division of Reproductive Health has had two of its three branches eliminated. When a physician sees something unusual today, there is no longer a well-resourced federal body to call.

Story 02

ICE in the Exam Room. Women Going Into Labor Alone at Home.

A woman with a high-risk pregnancy goes into labor at home. Not because she didn’t know she needed a hospital. Because she calculated what walking into one might cost her and decided the risk was too high.

Physicians at HCMC in Minneapolis documented this pattern directly: patients with risky pregnancies avoiding prenatal care, going into labor alone, because of fear of immigration enforcement. ICE agents were reported refusing to leave exam rooms during private clinical encounters. The Minnesota Medical Association president said it out loud. The American Medical Association issued statements. None of it has enforcement power.

The hospital used to be one of the places society agreed was different. What happens outside waits at the door. That agreement is being dissolved — deliberately, by people who understand exactly what it does to a pregnant woman’s willingness to seek care.

Story 03

The Only System That Tracks What Happens to Pregnant Women Is Being Defunded. April 2026.

The Pregnancy Risk Assessment Monitoring System has been collecting state-level data on maternal experiences before, during, and after pregnancy since 1987. It is the only surveillance system of its kind in the United States. Federal funding expires April 2026.

This is not bureaucratic overhead. This is the evidence base. The clinical practice guidelines you follow, the risk estimates you use when counseling patients, the disparity data that motivates policy change — these come from population surveillance systems like PRAMS. Without it, maternal mortality review committees lose the population-level context they need to investigate deaths meaningfully.

Two of three branches of the CDC’s Division of Reproductive Health were eliminated in 2025 layoffs. PRAMS expiration doesn’t happen in isolation. We are operating on the last clean data this system will produce for years, possibly longer.

From the Labora Collective

Featured this week: Immigration Enforcement in Healthcare Settings — Crisis Playbook. A structured framework for providers navigating ICE enforcement in clinical spaces. Covers patient rights, provider rights, documentation protocols, and what hospital administrators are obligated to do. Designed to be pulled out in the moment. → Read the Playbook

Also this week: Essay: “Why We Don’t Know What We’re Doing — And Who’s Responsible” — The full clinical and political argument on syphilis, pattern recognition, and what happens when the federal government stops listening. → Read the Essay

Also this week: Essay: “The Hospital Was Supposed to Be Safe. That Is Being Taken From Us.” → Read the Essay

Inside Labora This Week

Labora Rounds tracked 10 domains this month

Women’s Health Policy: VA abortion ban effective January 30 — zero exceptions for rape or incest. 700,000 women veterans affected.

Maternal Health: Maternal mortality 18.6 per 100,000 in 2023. Black women die at 3.5x the rate of white women. Louisiana at 58.1/100k. California at 4.0/100k. Same country.

Healthcare Access: Title X funding frozen affecting 879 clinics. 834,000 patients losing access.

Coming to Yemaya’s Circle of Care: Three more OB essays publishing this cycle — on maternity unit closures, the VA abortion ban, and the OB-GYN workforce collapse. Members see them first.

One Action This Week

Forward this to one person who is pregnant, thinking about pregnancy, or supporting someone who is.

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