By Nada Hassanein, Stateline.org

“Don’t give me narcotics.”

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Emmalee Hortin, a doula, recalled one of her clients delivering that message to hospital staff. Doctors were operating on the woman to clear tissue after a miscarriage.

But despite her patient’s pleas, clinicians still administered fentanyl via IV to manage pain, Hortin said. Her client had substance use disorder and had been working toward recovery.

“She was really, really upset,” Hortin said. “She actually was really worried about returning to use, and so was her husband.”

Hortin is a doula trained in supporting pregnant and postpartum moms with substance use disorder — a role in increasing demand amid the nation’s concurrent crises of maternal mortality and addiction.

In recent years, more states, including Colorado and Utah, have passed laws to include Medicaid coverage for doula care. Some clinics are incorporating peer recovery doulas and other providers are offering training to bolster the workforce.

Many doulas who specialize in helping moms with substance use disorder are recovering from addiction themselves, or have helped loved ones with addiction. Hortin, a mother of three and stepmom to three others, is nine years into her recovery. Drawing on her own experience of isolation and addiction, she’s able to relate to struggling moms. She works at One Health, a Montana community health center that trains doulas from across the state in peer recovery.

In the case of the woman who asked not to be given fentanyl, Hortin recalled, hospital staff asked for her help to “defuse” her client’s emotions. “I was like, ‘Well, my job is not to defuse emotions, if you weren’t listening to my patient,’” she said. “When a patient in recovery, or that is working towards recovery, asks specifically for no fentanyl — that’s one of her triggers — you need to respect that.

“We had to do a lot of breakdown work and debriefing through the emotions,” Hortin said. “She felt like she couldn’t trust the hospital.”

Mental health conditions and substance use are leading underlying causes of maternal death, according to the federal Centers for Disease Control and Prevention.

Those conditions can arise, or worsen, during pregnancy. Without treatment, it can be an especially vulnerable time for people with addiction and those who are trying to get sober, said recovery doula Britt Westmoreland, program coordinator for the University of Colorado’s recovery coach doula program.

Founder of Eggbaby Doula Services Aleece Weaver, right, demonstrates the work she does with pregnant clients. Weaver does pro bono doula care with clients in recovery at Utah perinatal recovery clinic SUPeRAD. Peer recovery doulas help moms with addiction, and state Medicaid plans have been expanding to cover doula care. (Anna Shmynets/Anna Shmynets/TNS)

Peer recovery doulas can advocate for patients in labor settings as well as support them when they face stressors or crave illicit substances during pregnancy or postpartum. Being in recovery themselves also helps foster trust and more open communication.

“It’s a lot easier for us to build rapport with people because there’s not a power differential or that systemic mistrust,” said Westmoreland, who is in long-term recovery and, like Hortin, knows the stigma and difficulties firsthand.

Stigma and bias

Stigma and bias around substance use disorder, mental health conditions and pregnancy can cause shame that prevents moms from reaching out for help or opening up about their struggle, doulas and doctors say. Those issues are exacerbated for Black and Indigenous women, who are disproportionately drug tested in hospitals during labor and disproportionately likely to be investigated by child welfare agencies, research has shown.

Native women can feel they’re treated differently in hospitals, said Julianne Denny, who is Cree, Ojibway and Mikmaq. Denny refers to her role as an Indigenous “birth worker,” as she supports women through cultural practices as well as through doula care. She trained at One Health and earned an addiction studies degree at Stone Child College.

It’s her job “to remind [moms] of their humanity and that they can gain control over their addictions and they can keep their babies,” she said. “That’s the endgame — is that their baby is safe and they’re safe, and we want our moms to grow with our babies, and our babies to grow with our moms.

“A big part of our work is working through the tough parts with moms to get them through to a successful pregnancy where they’re proud of themselves and they feel empowered.”

Hortin helps recovering moms up to three years postpartum. Working with clinicians, she helps create a personalized care plan for each family.

Emmalee Hortin works with a client this month. (Emmalee Hortin/Emmalee Hortin/TNS)

“No matter what these parents are struggling or facing, that’s not all they are,” said Hortin. “When we keep people held to our stigma and our bias, why would they want to change when no one’s willing to trust that they can?”

Policies to expand coverage

One day last week, 34 pregnant and postpartum patients with substance use disorder were on the schedule at the University of Utah’s Substance Use & Pregnancy—Recovery, Addiction, and Dependence (SUPeRAD) Clinic, where Dr. Marcela Smid is the medical director.

This week, more than 50 patients are on the schedule in a three-day period. Smid said her clinic gets patients from rural areas in Wyoming, Idaho and eastern Nevada.

States are slowly expanding coverage for doulas. Utah passed a law last year to start the process toward Medicaid coverage of doula care. Federal officials approved Utah’s plan, effective April 1, to allow certified doulas to be reimbursed via Medicaid.

“Now that we will be able to be paid through Medicaid, a lot of doulas will be able to feel this work is sustainable for them,” said Aleece Weaver, founder of the Utah Doula Access Project. She currently does doula work pro bono with Smid’s clinic.

Smid said the majority of the clinic’s patients are on Medicaid, which is the largest payer for behavioral health care nationwide. Most of her patients can’t afford to pay for doula care out of pocket, and because the state policy hasn’t gone into effect yet, doulas care for her patients pro bono.

Lanita Hoskinson, a peer recovery doula at One Health in Montana, holds a newborn. (Lanita Hoskinson/Lanita Hoskinson/TNS)

Colorado also recently expanded its Medicaid coverage to include doulas, and Montana passed a law last year establishing doula licensures, a first step toward coverage.

Beyond coverage, access is also an issue — especially in rural communities where health care providers, including mental and maternal health clinicians, are scarce. Smid travels monthly to Wyoming, where most residents don’t have easy access to maternal-fetal medicine specialists, she said.

States included goals of expanding behavioral and maternal health care access in their bids for federal dollars under the new five-year Rural Health Transformation Program.

For example, in its application, Montana said it would use the money to train a variety of health care providers and community-based professionals, including peer support specialists, in maternal health and crisis intervention.

Mental health conditions contributed to about 70% of Montana’s maternal deaths between 2020 and 2022 — with substance use contributing to more than 40% of those women’s deaths.

“It’s really just providing support to people that are already feeling hopeless. It’s about giving them the tiniest bit of hope and walking through it,” said One Health recovery doula Lanita Hoskinson. “All these families, they need somebody, especially in these frontier rural areas — they have nobody.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

©2026 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By ERIC TUCKER, Associated Press

WASHINGTON (AP) — A key participant in the deadly 2012 attack on the U.S. compound in Benghazi, Libya, that killed four Americans has been taken into custody and will be prosecuted in their deaths, Attorney General Pam Bondi said Friday.

Bondi said in a news conference that Zubayr Al-Bakoush had landed at Joint Base Andrews at 3 a.m. on Friday.

“We have never stopped seeking justice for that crime against our nation,” Bondi said.

U.S. Attorney Jeanine Pirro said that an eight-count indictment charged Al-Bakoush with crimes including the murders of Ambassador Chris Stevens and State Department employee Sean Smith. It was unclear if Al-Bakoush had an attorney representing him.

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The 2012 attack on the U.S. compound immediately emerged as a divisive political issue as Republicans challenged President Barack Obama and then-Secretary of State Hillary Clinton on security at the facility, the military response to the violence and the administration’s changing narrative about who was responsible and why.

A final report by a Republican-led congressional panel faulted the Obama administration for security deficiencies at the Libyan outpost and a slow response to the attacs. The report, however, found no wrongdoing by Clinton.

Clinton dismissed the report as an echo of previous probes with no new discoveries, saying it was “time to move on.” Other Democrats denounced the Republicans’ report as “a conspiracy theory on steroids.

On the night of Sept. 11, 2012, U.S. officials have said, at least 20 militants armed with AK-47s and grenade launchers breached the gate of the consulate compound and set buildings on fire.

The fire led to the deaths of Stevens and Smith. Other State Department personnel escaped to a nearby U.S. facility known as the annex.

A large group assembled for an attack on the annex. That attack, including a precision mortar barrage, resulted in the deaths of security officers Tyrone Woods and Glen Doherty.

A Libyan militant suspected of being a mastermind of the attacks, Ahmed Abu Khattala, was captured by U.S. special forces in 2014 and was brought to Washington for prosecution. He was convicted and is serving a prison sentence. His attorneys argued that the evidence was inconclusive and that he was singled out because of his ultra-conservative Muslim beliefs.

By DAVE SKRETTA, Associated Press Sports Writer

MILAN (AP) — Madison Chock and Evan Bates set the tone for the powerful U.S. Figure Skating team at the Milan Cortina Olympics on Friday with a rocking, high-energy rhythm dance set to music by Lenny Kravitz to open the team figure skating competition.

Alysa Liu made sure the defending champion Americans would maintain their lead going into Day 2 of the event.

Madison Chock and Evan Bates of the United States react to their scores after competing during the figure skating ice dance team event at the 2026 Winter Olympics, in Milan, Italy, Friday, Feb. 6, 2026. (AP Photo/Stephanie Scarbrough)

Chock and Bates scored a world-leading 91.06 points to open the three-day competition, where the U.S. is the defending champ, before a packed crowd at the Milano Ice Skating Arena that included U.S. Vice President JD Vance, his family and other dignitaries.

Vice President JD Vance, center, and his wife Usha Vance applaud while Madison Chock and Evan Bates of the United States compete during the figure skating ice dance team event at the 2026 Winter Olympics, in Milan, Italy, Friday, Feb. 6, 2026. (AP Photo/Francisco Seco)

Pairs skaters Ellie Kam and Danny O’Shea finished solidly in the middle of the pack in their short program for the U.S., while Liu was second to Japan’s Kaori Sakamoto in the women’s short program, leaving the Americans with 25 points.

Japan was second with 23 and host-nation Italy third with 22 going into the men’s short program Saturday. After that, the competition is whittled from 10 teams to the top five, with those five also performing their free dance later in the day.

The men’s, women’s and pairs free skates will ultimately decide the medals Sunday.

“We definitely skated great and we’re very happy, as you saw when we finished. I think we both felt the excitement of just getting these Olympics underway,” said Bates, who along with Chock were part of the gold medal-winning team at the 2022 Winter Games.

Yet Chock and Bates, the three-time world ice dance champions, never received their medals in Beijing, thanks to an investigation into Russian doping. In fact, Chock and Bates wouldn’t get them until two years later at the Summer Olympics in Paris.

So there is a little added motivation for the Americans to win a second consecutive team title.

“I think we have the best generation of figure skaters within the U.S. right now,” O’Shea said. “Amazing people helping each other, supporting each other, and Maddy and Evan leading the charge, being the experienced group who are so helpful to everybody.”

Chock and Bates, fresh off their record seventh U.S. title, also are favored to win the individual ice dance event later in the Winter Games. But they got a taste of how challenging that could be from the new French duo of Laurence Fournier Beaudry and Guillaume Cizeron — the latter the defending Olympic champion with his former partner, Gabriella Papadakis.

Just before Chock and Bates took the ice, Beaudry and Cizeron had posted their own world-best score of 89.98 points.

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“I think our goal was to really keep building,” Cizeron said. “I think we’ve been improving at each competition and adding to our score, obviously, but getting more precise with our technical elements and having more fun, enjoying the performance, and giving 100%. So I think we’re kind of still climbing that ramp a little bit.”

Chock and Bates gave the U.S. a big lead over the Japanese after struggles by their ice dancers, but the pairs duo of world champions Riku Miura and Ryuichi Kihara got the reigning silver medalists back in the mix by winning their portion of the competition.

Anastasiia Metelkina and Luka Berulava were second in pairs for Georgia with Italy’s Sara Conti and Niccolo Macii third.

Kam and O’Shea were fifth in the pairs short program, but that was good enough to keep the Americans in the lead.

“You could hear it when we landed our side-by-side jump set. It was so loud, I literally couldn’t hear anything,” Kam said. “I couldn’t hear our music for a second. I was like, ‘Oh, OK. Lock in. We need to do the rest of this program.’”

Perhaps fittingly, the last two women on the ice Friday represented the favored American and Japanese teams.

They also happened to be the last two world champions.

The 20-year-old Liu, back at the Olympics after a brief retirement, was clean on all three of her jumping passes, including her finishing triple lutz-triple loop. She wound up with 74.90 points for her program, set to “Promise” by Icelandic-Chinese artist Laufey.

She wouldn’t wipe the smile off he face afterward.

“I never thought I would be back, honestly,” Liu said. “It’s surreal.”

With the Americans poised to take a big lead into Saturday, the 25-year-old Sakamoto delivered with the poise and precision of a veteran. The reigning Olympic bronze medalist also was clean on her jumping passes, including a triple flip-triple toe, and her score of 78.88 points gave the Japanese squad a much-needed 10 points to keep pace with the U.S.

By Karen Bennett, Bankrate.com

The thought of saving money may feel overwhelming, especially if you have nothing saved and struggle to afford necessities like rent and groceries.

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If you don’t have a healthy emergency fund, you’re not alone. In fact, only 30% of Americans would pay a $1,000 emergency expense from savings, a recent Bankrate survey found. Other survey respondents said they’d go into debt to afford such an expense through credit cards or personal loans.

Saving certainly isn’t easy and we won’t pretend it is — but here are some practical steps you can take to get started.

1. Set clear savings goals

The key to successful saving is knowing what you’re saving for. Whether it’s an emergency fund, a down payment on a house or a dream vacation, having specific goals can keep you motivated and on track.

Start by deciding upon your savings goals, giving them names (like “new car” or “wedding”), and setting deadlines for when you want to achieve them. Then, calculate how much you need to save each month to reach your target amount by your deadline.

Your first goal should probably be to save for emergencies

Whether you’re hit with a curveball in the form of a car repair, medical bill or a job loss, having an emergency fund — with three to six months of living expenses — can help you weather financial storms without going into costly debt.

2. Create a budget that works for you

At its core, a budget is simply a plan for making sure you’re spending less than you earn. In addition to helping you pay your bills on time and cover essential expenses, a budget can help you accomplish things like saving money and paying down debt. The key is finding a budgeting method that works for your lifestyle and personality.

Popular budget methods include:

50/30/20 budget: To make this budget, you set aside 50% of your income to needs, 30% to wants and 20% to savings.
Zero-based budget: This budget method assigns a purpose to every dollar of your take-home pay — which can include a category for savings.

Whatever budgeting strategy you choose to follow, it’ll involve tracking where your money goes each month. This gives you the chance to find areas to cut spending. A digital budgeting app — such as YNAB or Rocket Money — can come in handy by tracking your spending and saving automatically.

3. Tackle high-interest debt

While it might not feel like paying off debt is helping you save, eliminating costly interest charges from carrying a balance can free up money to put toward your goals.

According to a recent Bankrate survey, nearly half of American credit cardholders carry a balance from month to month, with the average APR just under 20%.

Let’s say you have a $5,000 credit card balance with a 20% APR. Even if you pay $300 per month, you’ll end up paying an extra $906 in interest before reaching a zero balance. That’s money that could be going into your savings instead.

4. Automate your savings

One of the easiest ways to save more consistently? Make it automatic. Set up recurring transfers from your checking account to your savings account each payday, so you’re saving without even thinking about it.

Many banks also offer tools like round-up programs, which automatically round your debit card purchases to the nearest dollar and transfer the spare change to your savings. Over time, those small amounts can really add up.

You can also take advantage of money-saving apps like Oportun or Qapital, which can analyze your spending habits and automatically move small amounts of money into your savings when you can afford it.

Pro tip: Use multiple savings accounts

“Opening separate savings accounts for each of your goals can help you track your progress and stay organized. Plus, you can easily shift your money to the account with the higher interest rate to maximize your earnings,” says Hanna Horvath, CFP and Bankrate Managing Editor. You can also find a savings account that lets you divvy up your savings into goals or buckets, so you can keep one savings account but track your savings goal separately. Ally Bank and SoFi Bank are two online banks that offer this feature.

5. Separate your spending and saving

If you’re just getting started with saving money, consider opening up a savings account at a different bank from where you keep your checking account. This may help to create a psychological barrier between the money you have set aside for spending versus savings, making it less likely you’ll raid your savings on a whim.

“When you open your bank account app and your checking and savings numbers are in there, you kind of add those numbers together, and you’re like, ‘Oh, that’s how much money I have to spend,’” says Pamela Capalad, a certified financial planner and owner of Get Shameless Inc. “But if your bank accounts are at separate institutions — and better yet if your savings account is a high yield savings account — it’s out of sight, out of mind and your savings will grow.”

The bottom line

Starting to save can feel daunting, but the most important thing is to just start. No amount is too small, and no goal is too insignificant. Ways to begin include setting clear goals, creating a budget, tackling debt and automating your savings. Keeping your checking and savings accounts at different banks can also help eliminate the temptation to dip into savings for nonessentials.

Everyone’s financial journey is different. Stay open to trying new savings strategies and tools until you find the ones that work best for your situation and personality.

Key takeaways

The first step to saving is setting specific, achievable goals and tracking your progress using a digital budgeting tool, spreadsheet or pen and paper.
Following a budget can help you identify ways you can add to savings as well as pay down debt.
Ways to help you save more consistently include keeping your spending money separate from your savings, as well as automatically transferring money to savings each paycheck.

©2026 Bankrate.com. Distributed by Tribune Content Agency, LLC.