By Jazmin Orozco Rodriguez, Oona Zenda, KFF Health News

Just hours after Rhonda Swaney left a prenatal appointment for her first pregnancy, she felt severe pain in her stomach and started vomiting.

Then 25 years old and six months pregnant, she drove herself to the emergency room in Ronan, Montana, on the Flathead Indian Reservation, where an ambulance transferred her to a larger hospital 60 miles away in Missoula. Once she arrived, the staff couldn’t detect her baby’s heartbeat. Swaney began to bleed heavily. She delivered a stillborn baby and was hospitalized for several days. At one point, doctors told her to call her family. They didn’t expect her to survive.

“It certainly changed my life — the experience — but my life has not been a bad life,” she told KFF Health News.

Though her experiences were nearly 50 years ago, Swaney, a member of the Confederated Salish and Kootenai Tribes, said Native Americans continue to receive inadequate maternal care. The data appears to support that belief.

(Oona Zenda/KFF Health News/TNS) (Oona Zenda/KFF Health News/TNS)

In 2024, the most recent year for which data for the population is available, Native American and Alaska Native people had the highest pregnancy-related mortality ratio among major demographic groups, according to the Centers for Disease Control and Prevention.

In response to this disparity, Native organizations, the CDC, and some states are working to boost tribal participation in state maternal mortality review committees to better track and address pregnancy-related deaths in their communities. Native organizations are also considering ways tribes could create their own committees.

State maternal mortality review committees investigate deaths that occur during pregnancy or within a year after pregnancy, analyze data, and issue policy recommendations to lower death rates.

According to 2021 CDC data, compiled from 46 maternal mortality review committees, 87% of maternal deaths in the U.S. were deemed preventable. Committees reported that most, if not all, deaths among Native American and Alaska Native people were considered preventable.

Our matriarchs, our moms, are what carries a nation forward.

State committees have received federal money through the Preventing Maternal Deaths Act, which President Donald Trump signed in 2018.

But the money is scheduled to dry up on Jan. 31, when the short-term spending bill that ended the government shutdown expires.

Funding for the committees is included in the Labor, Health and Human Services, Education, and Related Agencies appropriations bill for fiscal year 2026. That bill must be approved by the House, Senate, and president to take effect.

Native American leaders said including members of their communities in maternal mortality review committee activities is an important step in addressing mortality disparities.

In 2023, tribal leaders and federal officials met to discuss four models: a mortality review committee for each tribe, a committee for each of the 12 Indian Health Service administrative regions, a national committee to review all Native American maternal deaths, and the addition of Native American subcommittees to state committees.

Whatever the model, tribal sovereignty, experience, and traditional knowledge are important factors, said Kim Moore-Salas, a co-chair of the Arizona Maternal Mortality Review Committee. She’s also the chairperson of the panel’s American Indian/Alaska Native mortality review subcommittee and a member of the Navajo Nation.

“Our matriarchs, our moms, are what carries a nation forward,” she said.

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Mental health conditions and infection were the leading underlying causes of pregnancy-related death among Native American and Alaska Native women as of 2021, according to the CDC report analyzing data from 46 states.

The CDC found an estimated 68% of pregnancy-related deaths among Native American and Alaska Native people happened within a week of delivery to a year postpartum. The majority of those happened between 43 days and a year after birth.

The federal government has a responsibility under signed treaties to provide health care to the 575 federally recognized tribes in the U.S. through the Indian Health Service. Tribal members can receive limited services at no cost, but the agency is underfunded and understaffed.

A study published in 2024 that analyzed data from 2016 to 2020 found that approximately 75% of Native American and Alaska Native pregnant people didn’t have access to care through the Indian Health Service around the time of giving birth, meaning many likely sought care elsewhere. More than 90% of Native American and Alaska Native births occur outside of IHS facilities, according to the agency. For those who did deliver at IHS facilities, a 2020 report from the Department of Health and Human Services’ Office of Inspector General found that 56% of labor and delivery patients received care that did not follow national clinical guidelines.

The 2024 study’s authors also found that members of the population were less likely to have stable insurance coverage and more likely to have a lapse in coverage during the period close to birth than non-Hispanic white people.

Cindy Gamble, who is Tlingit and a tribal community health consultant for the American Indian Health Commission in Washington, has been a member of the state’s maternal mortality review panel for about eight years. In the time she’s been on the state panel, she said, its composition has broadened to include more people of color and community members.

The panel also began to include suicide, overdose, and homicide deaths in its data analysis and added racism and discrimination to the risk factors considered during its case review process.

Solutions need to be tailored to the tribe’s identity and needs, Gamble said.

“It’s not a one-size-fits-all,” Gamble said, “because of all the beliefs and different cultures and languages that different tribes have.”

Gamble’s tenure on the state committee is distinctive. Few states have tribal representation on maternal mortality review committees, according to the National Indian Health Board, a nonprofit organization that advocates for tribal health.

The National Council of Urban Indian Health is also working to increase the participation of Urban Indian health organizations, which provide care for Native American people who live outside of reservations, in state maternal mortality review processes. As of 2025, the council had connected Urban Indian health organizations to state review committees in California, Kansas, Oklahoma, and South Dakota.

Native leaders such as Moore-Salas find the current efforts encouraging.

“It shows that state and tribes can work together,” she said.

In March 2024, Moore-Salas became the first Native American co-chair of Arizona’s Maternal Mortality Review Committee. In 2025 she and other Native American members of the committee developed guidelines for the American Indian/Alaska Native subcommittee and reviewed the group’s first cases.

The subcommittee is exploring ways to make the data collection and analysis process more culturally relevant to their population, Moore-Salas said.

But it takes time for policy changes to create widespread change in the health of a population, Gamble said. Despite efforts around the country, other factors may hinder the pace of progress. For example, maternity care deserts are growing nationally, caused by rapid hospital and labor and delivery unit closures. Health experts have raised concerns that upcoming cuts to Medicaid will hasten these closures.

Despite her experience and the ongoing crisis among Native American and Alaska Native people, Swaney hopes for change.

She had a second complicated pregnancy soon after her stillbirth. She went into labor about three months early, and the doctors said her son wouldn’t live to the next morning. But he did, and he was transferred about 525 miles away from Missoula to the nearest advanced neonatal unit, in Salt Lake City.

Her son, Kelly Camel, is now 48. He has severe cerebral palsy and profound deafness. He lives alone but has caregivers to help with cooking and other tasks, said Swaney, 73.

He “has a good sense of humor. He’s kind to other people. We couldn’t ask for a more complete child.”

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

One welcome effect of President Donald Trump’s intervention in Venezuela that led to the capture of strongman Nicolás Maduro is the release of political detainees in the South American nation. It appears that another authoritarian regime, this one in Central America, has taken notice: Nicaragua.

This month, the Nicaraguan government announced the release of dozens of political prisoners after the U.S. ramped up pressure on President Daniel Ortega’s regime. Of course, anything coming from Nicaragua has to be taken with a grain of salt.

Ortega, 80, has been in power for almost two decades.

Without a hint of irony, the government stated the official reason for the prisoner release was to commemorate Ortega’s 19 years of rule. There was no mention of who was released and under what conditions, but a day earlier, the U.S. Embassy lamented that “more than 60 people remain unjustly detained or disappeared, including pastors, religious workers, the sick, and the elderly.”

Nicaragua doesn’t have oil reserves like Venezuela or a strong lobby of exiles like Cuba, but it is as ruthless as the other two dictatorships in the region. Ortega and his wife, Rosario Murillo, who is now “co-president,” have managed so far to remain under the radar of the Trump administration, but there are signs this might be changing.

A recent post from the State Department’s Bureau of Western Hemisphere Affairs stated: “Nicaraguans voted for a president in 2006, not a lifetime of an illegitimate dynasty.” U.S. Sen. Rick Scott, R-Fla., a Trump ally, also said Nicaragua “will get fixed.”

The Ortega-Murillo regime is known for arbitrary detentions of political adversaries, religious leaders and journalists. The couple has stripped hundreds of Nicaraguans of their citizenship and possessions and more than 5,000 religious and civic organizations have been shuttered. Thousands have fled the country.

After Maduro’s fall, the Nicaraguan regime seems to be in survival mode, doing the bare minimum to avoid international scrutiny, but at the same time, repression is still business as usual. A human rights group reported that roughly 60 people were detained for expressing support for Maduro’s capture.

Ortega and Murillo are doubling down on their police state, increasing surveillance in neighborhoods and social media monitoring, El País reported. An analyst interviewed by the Spanish newspaper added that the Nicaraguan “power couple” is increasingly paranoid. This is a sign of weakness that the U.S. could exploit.

There are plenty of reasons why the Trump administration should increase pressure on Nicaragua through political and diplomatic channels. For one, the country has enhanced its ties with Russia and China while remaining defiant in its relationship with the U.S.

Nicaragua is also a transit point for drug cartels. Last year, the Drug Enforcement Administration was set to leave the country due to Nicaragua’s rampant corruption and lack of cooperation, but at least one White House official told Politico that the Central American nation has been changing its tune lately.

The Trump administration should not be fooled. The Ortega-Murillo regime is not interested in drug cooperation, but only in its own survival.

— The Dallas Morning News

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In the 140 yeas since the first St. Paul Winter Carnival, plenty has changed.

In 1886, there was no Vulcan Krewe in red running suits to battle the king then known as Borealis; there was no medallion hunt nor Klondike Kate. In 2026, several-hundred-member toboggan clubs no longer line up to race down purpose-built slides.

But one tradition has not changed: the blanket bounce.

In fact, the legacy now carried on by the St. Paul Bouncing Team represents one of the only annual activities that has existed continuously since the carnival’s first days.

The St. Paul Bouncing Team performs during the 2022 King Boreas Grande Day Parade, Presented by Hamernick’s, along West 7th Street in St. Paul on Saturday, January 29, 2022. (John Autey / Pioneer Press)

Today, the Bouncing Team consists of three ‘bouncing girls’ and an alternate, plus a roster of ‘pullers,’ 14 of whom are needed around the blanket for any given bounce. They count “One! Two! Up she goes!” and swiftly pull the blanket taut, launching the acrobat some 30 feet in the air.

The blanket bounce stems from an Alaskan Inupiat tradition called nalukataq, still part of community celebrations and sport competitions today. And in early Winter Carnival parades, bouncing “units” were as common for social organizations to have as drum and bugle corps and flag brigades and floats. During the 1887 parade, the Daily Pioneer Press noted that “there was not a bouncing blanket that was not in active operation.”

Eventually, in St. Paul, many bouncing units eventually either folded or consolidated under the St. Paul Athletic Club, which had introduced the modern aerialist “bouncing girl” format in the 1930s and was the only game in town by 1950. After the Athletic Club abruptly declared bankruptcy in late 1989, the blanket bunch bounced off on their own and formed the St. Paul Bouncing Team.

To celebrate the 140th anniversary of the Carnival — and with it, 140 years of bouncing at the Carnival —  the Bouncing Team is holding a public exhibition showcase by present and past bouncing girls from across the decades. The event runs open-house-style from 6 to 9 p.m. on Jan. 30 inside Landmark Center.

“Once anybody joins our team, they’re literally part of a family for life,” bouncing girl Lindsay Ferris Martin said. “And the crowd support is so, so energizing. One of my favorite things to do is watch the little kids standing with their parents, and all their jaws just drop. It brings so much joy.”

The blanket toss is among the St. Paul Winter Carnival’s oldest continuous traditions. Here, a team of “pullers” launches a “bouncing girl” high into the air amid a crowd of downtown spectators in January 1917. (Pioneer Press file photo)

‘It just looks like a ball of fun’

A good bounce starts with a good blanket.

In the early days of the blanket bounce and even into the post-Athletic Club era, teams used rectangular blankets, usually wool. Today, the Bouncing Team uses custom-designed round blankets, made of two layers of nylon canvas with a layer of criss-crossing straps sandwiched between them, Appleton said. The Bouncing Team owns two, and stores them with a level of security befitting the country’s nuclear codes.

“There aren’t any other ones in the world; these are the only two that exist,” longtime puller Mike Appleton said. “So a quirky thing we do is, for safety’s sake, we keep them in different places in case something happens.”

Then, each of the 14 pullers is matched up with another puller directly across the blanket who has a similar height and grip strength, so the bouncing girl is launched directly upward and not at an angle.

Finally, the bouncing girl tumbles onto the blanket and prepares for takeoff.

Lindsay Martin of Forrest Lake took to the air with the St. Paul Bouncing Team during the Vulcan Victory Torchlight Parade, part of the 2025 St. Paul Winter Carnival, on Saturday, Feb. 1, 2025. (Craig Lassig / Special to the Pioneer Press)

Although many prospective bouncing girls have experience in gymnastics, cheerleading or aerial acrobatics, the powerful and sudden upward momentum on the blanket is a completely unique sensation, Ferris Martin said. It’s not uncommon for candidates to have to try out for the team multiple times before earning a spot. Ferris Martin herself auditioned for the first time in the mid-2010s and didn’t make the team till her third try, in 2024.

“You learn on the fly, pun intended,” Ferris Martin said, laughing. “There’s no other experience like it, so there’s really no place to practice beforehand. I know my first faces were probably just pure terror, but being able to lose that fear in your face for smiles really counts for a lot.”

There’s no specific rule that bouncing girls must be women, nor that they be a certain weight or height; they just have to be over 21 years old. However, the upward thrust force of the blanket launches smaller people higher, and those who typically get the most altitude — and therefore have the most time for flips and toe-touches and other crowd-pleasing maneuvers — tend to be younger and more petite women, organizers explained.

“We’ve had Jesse Ventura on the blanket. The pullers can handle it,” Appleton said. “But Jesse Ventura doesn’t go as high as Lindsay does.”

Even so, he said, everybody gets air: “I’ve been on the blanket, and it’s astonishing, feeling the amount of horsepower that’s underneath you.”

Although the Bouncing Team is most closely associated with the Winter Carnival, their busiest months are actually July and August, Casserly said. The team travels around the state on the summer parade circuit and makes appearances at special events including, in 2018, the Super Bowl.

And earning one of the regular spots on the blanket is competitive. Typically, the Bouncing Team holds tryouts once a year, during Winter Carnival, and only one new spot is made available.

This year, the team is not holding tryouts at all: Ahead of a busy 2025 summer schedule, early tryouts were held in May and the roster filled up, team president Joe Casserly said. He expects the regular January tryout schedule to resume next year.

The team is still actively looking for pullers this year, though. Prospective pullers can contact Casserly either online at stpaulbouncingteam.org/contact-us or via the team’s Facebook page and, if possible, should plan to attend the Jan. 30 exhibition, he said.

“I think it’s pretty much everybody’s goal on the team to make sure that we’re around 140 years from now,” Appleton said. “And what do we have to do now to make that happen? We need people to help us out with that and maintain the tradition.”

Although the bouncing girl flying up in the air is the most visible performer, the blanket bounce truly is a team sport, members said. And across 14 decades, Bouncing Team leaders say, every single person who has been bounced up has landed safely on the blanket.

“We are athletes, although you would never think about it that way because it just looks like a ball of fun,” Ferris Martin said. “And it really, really is. But beneath that, it’s the grit, it’s the family, it’s the brotherhood and sisterhood, and it is that continued Minnesota tradition.”

Bouncing Girl Sara LeBlanc holds 7 year-old Emme Arbuckle, from St. Paul, as she takes a turn on the blanket during the St. Paul Bouncing Team tryouts at the Landmark Center in St. Paul on Friday, February 5, 2016. (Pioneer Press: John Autey)

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It’s an eclectic reading day, with an 18th-century murder in an outhouse and nonfiction about art, community organizing and the environment.

(Courtesy of Wagonbridge Publishing)

“A Necessary Death”: by Terri Karsten (Wagonbridge Publishing, $15)

If you’re already tired of cold and snow, let Terri Karsten take you back to the spring of 1763. In her new mystery, Karsten introduces us to unhappy widow Penelope Corbitt. Her sailor husband is dead and all her possessions and her house were sold to pay his debts. Penelope is traveling from Philadelphia to Boston, where she and her teenage daughter and 10-year-old son will live with her sister. They are escorted by Penelope’s sister’s husband, an ill-tempered, haughty man who never lets the widow forget she will be living on his charity.

When their coach breaks down near a barely-functioning inn, they are rescued by owner Miles, who has let his business fall in disrepair since his wife’s death. Miles and Penelope have a testy relationship but are also drawn to one another. Until another coach arrives, Penelope agrees to use her cooking skills at the inn so her brother-in-law doesn’t have to whine about paying for her and her children’s keep.

Heading to the “necessary” (outhouse), Priscilla finds the dead body of the town’s parson. Who would murder a man of God, even if he didn’t always live up to his calling? And how can Penelope help Mercy, his young, thin, frightened and pregnant widow? What part does a young slave girl have to do with the death? Who is Sam, the Native American who insists on seeing Mercy?  And what does the old man who sleeps by the fire know about the dead parson? Why doesn’t Miles listen to her suspicions?

And then, in the middle of the story, a new character appears who has a profound effect on everyone.

Karsten, who lives in Winona, is a writer, editor, educator and writing teacher. Her specialty is bringing history alive with a focus on women and girls of the past, seemingly powerless but with courage and strength to manage their futures.

All these qualities are in “A Necessary Death.” Penelope is a master baker who makes “dead cakes” for a funeral, mixes up porridge in no time, delights in baking pies and works tirelessly sweeping and washing dishes.  As in all 18th-century inns, men sleep by the hearth although Penelope and her children have a room upstairs. We learn the norms of the era, including Penelope’s sadness at knowing her children will become indentured servants and how widows must  be careful about how they conduct themselves because their reputations are easily questioned. It is taken for granted that husbands can beat their wives and children. The personal stories play out against a background of wider issues such as the French and Indian War being waged between France and England, and mutual distrust between white settlers and local Native Americans.

This is the first in a series and includes some of Penelope’s recipes, such as mincemeat pie. Can’t wait for her second adventure.

NONFICTION

“Place-Keepers: Latina/x Art, Performance, and Organizing in the Twin Cities”: by Jessica Lopez Lyman (University of Minnesota Press, $24.95)

This is an in-depth look at how Latina/x artists (a gender neutral term referring to people with Latin American cultural or ethnic identity) transform art into activism and reclaim space in the Twin Cities, written by an assistant professor at the University of Minnesota department of Chicano and Latino Studies. She examines how these artists navigate and challenge the region’s racial injustices, responding to systemic oppression through public performances and behind-the-scenes negotiations with the state, nonprofits and other institutions. Illustrated with drawings and other interesting artwork.

“A Heathy Agitation”: by Judy and Ralph Brown; illustrated by Richard Schletty (Lamprey Lake Press, no price listed).

Subtitled “West Side Community Organization and the building of democracy in Saint Paul, Minnesota,” this is a thorough look at community-building in the area of St. Paul that is cut off from the rest of the city by the river. As former St. Paul mayor Jim Scheibel writes in a foreword: “From the beginning WSCO was the voice of West Side residents. Early  on WSCO led the effort to save the Riverview Library, members supported the creation of Douglas School park and advocated for increasing the quality of education at Humboldt High School.”

The organization began in 1987 as West Side Citizens Organization and was renamed in 2011. Chapters include history of the organization and the influence of the West Side Voice community newspaper, fighting for Humboldt High School, transportation, services, housing, safety, environment, development and parkland.

“A National Legacy: Fifty Years of Nongame Wildlife Conservation in Minnesota”: by Carrol L. Henderson (University of Minnesota Press, $49.95)

Minnesota became a national leader for a new era of conservation in 1977 when the state’s Department of Natural Resources hired Carrol L. Henderson as supervisor of the Nongame Wildlife program, a position he held for more than 40 years. Now Henderson is an internationally renowned leader in wildlife conservation. He explains in this oversized paperback how the statewide goal to preserve biological diversity became a reality as the program began to prioritize the management and restoration of nonhunted wildlife, from butterflies, frogs, snakes to bats to bald eagles and other birds. It is filed with color photos of turtles, birds and other creatures who are our neighbors.

Henderson has written more than a dozen books and won multiple awards, including the Frances K. Hutchinson Medal from the Garden Club of America for his distinguished service to conservation.

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