The following is reprinted by permission from 21st Century Obstetrics Now! (David Stewart, PhD, and Lee Stewart, CCE, Editors), National Association of Parents & Professionals for Safe Alternatives in Childbirth, 1977. (p. 387)

The 1977 NAPSAC Conference, as well as the one in 1976, depicts the growing concern among concerned individuals and organizations that technological approaches to childbirth obscure the basic principles of preventive obstetrical and pediatric care. The underlying consensus among those who contributed to NAPSAC's publication Safe Alternatives in Childbirth (NAPSAC, 1976), which resulted from the 1976 conference, was that until hospitals and other medical institutions begin to fulfill the needs of those they are established to serve, those dedicated to making childbirth a safe, healthy, and joyous family-oriented experience must unite and remain organized. NAPSAC has provided the forum crucial to the dissemination of information and advocacy of uncomplicated childbirth. As NAPSAC's president profoundly stated, "The outcome of birth is only in the hands of the obstetrician and the hospital staff for a short while; but the outcome of birth remains with the parents and the child for life." [1]

As hospitals and physicians become more inclined to take advantage of the recently developed (but not proven safe) medical technologies, such as elaborate laboratory testing, oxytocin challenge tests, fetal monitoring, amniocentesis, sonargrams, and other devices, principles of patient care become more oriented to the convenience of the hospital staff and that of the doctors than to the health care needs of the pregnant woman. Automated childbirth is threatening the lives and health of thousands of pregnant women and their newborns in our nation. Will obstetrics of the future be characterized by "the drama of instrumented babies under plastic bubbles kept alive and restored to health by space-age medicine?"[2] Will "many births in the near tomorrow...take place in a setting of blinking lights, green glowing cathode-ray screens, dials and wires and tubes,"[2] or will those who recognize the inherent risks of such space-age obstetrics be able to channel medical advancements into family-centered preventive care?

Because many physicians have not learned to correctly interpret readings from the modern electronic machines, the rate of cesarean section has increased dramatically in many areas. Trained in techniques to monitor abnormal childbirth, many physicians apply them to innumerable instances of normal pregnancy, thereby converting the normal to abnormal. Premature delivery caused by over-zealous use of these modern devices can affect the newborn's health deleteriously.

The pyramiding effect of automated perinatal care, besides presenting dangers to the health of the mother and baby, camouflages some basic, physiologic processes of pregnancy and childbirth. The concept of primary prevention of complications of pregnancy and delivery and prevention of neonatal abnormalities through sound prenatal nutrition has been supplanted by secondary prevention, which consists of elaborate intensive care nurseries which electronically monitor premature babies, many of whom would have been normal size at birth. The relatively new specialty of neonatology (or perinatology), with its emphasis on treatment of abnormalities (many of which would have been unnecessary had primary prevention been applied), seems to be an appropriate addition to the medical hierarchy. The use of drugs, which are prescribed (frequently futilely) to facilitate control of weight and/or water retention during pregnancy, and restrictive dietary regimens (e.g., low-salt and/or low-calorie diets) are prime causes of prematurity, creating the need for electronic gadgetry in an attempt to prevent much of the disease, damage, and death associated with prematuriy.

Why is there increased utilization of fetal monitoring when studies have shown that most cases of births of children with mental retardation, cerebral palsy, or other central nervous system impairment are not associated with complications during labor or delivery? One physician presented data to show that 70% of all such births are not complicated during labor or delivery.[3] Most of those that do have such labor and delivery abnormalities are likely to be caused by the same factor that led to the disability--inadequate prenatal nutrition. As far back as 1897, Freud contested the prevailing medical theories that prematurity, dystocia, ashyxia, and related complications were directly related to the fetal developmental disability.[4] Instead, Freud believed the complications and disability were caused by the same developmental factor. More current studies have shown that malnutrition frequently lies at the etiology of both the pregnancy, labor, and/or delivery complication(s) and the child's disability.

Even the undue emphasis on labor and delivery on the part of childbirth education groups must be questioned and their ultimate intentions reconsidered. Not only does the gestation period encompass a greater and more comprehensive period of development than labor and delivery, but environmental (particularly nutritional) factors play a significant role in affecting the final stages of the birth process. An analysis of Social Security recipients who had a long-term disability which afflicted them before the age of 18 revealed that in 75% of the cases the disability originated during the prenatal period.[5] In 94% of the cases the disability was neurological.

Not only is fetal monitoring ineffective in reversing intrauterine growth retardation caused by malnutrition and other environmental factors, its use has been associated with increased complications of labor and delivery in addition to higher risks of surgery. A Department of HEW study of 483 "high risk" pregnant women who delivered at one hospital revealed the possible hazards of the utilization of fetal monitors.[6] All of the 483 women were fitted with fetal scalp electrodes and intrauterine catheters so that the fetal heart rate and uterine contractions could be monitored. With the use of a random selection procedure, in approximately half of the pregnancies, controls of the monitors were disconnected without the women's knowledge. In all of these cases, nurses monitored the fetal heartbeats without the use of electronic equipment.

The results were startling. There were two and a half more cesarean sections (40) in the electronically monitored group than in the group monitored by the nurses (16). An even more dramatic difference was observed in postpartum infections. In the monitored group 13% of the women experienced postpartum infections in contrast to 3.4% among the controls. In addition, pediatric evaluations showed that the health of those children born without the use of fetal monitors was, in general, superior to that of the monitored births. Five of the study group infants, in contrast to none of those whose births were monitored by nurses, needed assistance to maintain breathing two minutes after birth.

Another recent but more comprehensive study also demonstrated that greater utilization of elaborate machinery is not necessarily associated with reduced risks of complications, particularly prematurity.[7] The study analyzed nearly 300,000 births in North Carolina, where the perinatal mortality rate is much higher among nonwhites (41.0) than whites (25.7), to determine means of reducing the interracial difference in perinatal mortality. Neither the number of prenatal visits nor the level of sophistication of the obstetrical and neonatal care facilities at the hospital where the child was delivered was shown to significantly affect the perinatal mortality rate. The mortality difference was due primarily to the much higher rates of low birth weight and prematurity among nonwhites (14.0% or the nonwhite births were of less than 35 weeks' gestation and/or weighed less than 2001 grams (4 pounds 6 1/2 ounces) than whites, where 5.7% of the births were similarly premature or underweight).

The authors of the study concluded:

A similar report concurred that "regionalization of perinatal services" and "sophisticated hospitals" staffed by highly trained neonatologists do not necessarily lead to an improvement in perinatal health.[8] The study showed that a marked increase in perinatal care services did not appreciably improve the outcome of pregnancy. The author wrote: "The location of the larger obstetrical services and the inclusion of the majority of medical teaching centers, as well as the existence of a large ratio of specialists per unit population in this area have not been sufficient to overcome this fault of medical care (i.e., poor maternal and infant health)." [8]

The prevailing nonchalance among health care professionals about the role of sound maternal nutrition in protecting the health of the pregnant woman and her newborn coupled with our preoccupation with technologically advanced medical machinery, which suppresses the concept of primary prevention, are primarily responsible for the high rates of infant and maternal mortality in the U.S. As revealed in Tables 1 and 2, the U.S. ranks 19th among all nations in infant mortality and 14th in maternal mortality.[9]

Note from Joy: Please note that these infant mortality rates were accurate in 1977, but they are much worse 30 years later as of 2007 (as compared to those of other countries), when the U.S. had worse infant mortality rates than 41 other countries--even as our level of high-tech, mechanized birth is ever increasing!

See 2007-2008 Infant Mortality Rates here

TABLE 1
NATIONS WITH A LOWER INFANT MORTALITY RATE
THAN THAT OF THE U.S. IN 1973*

	Country	Mortality Rate
1.	Sweden	9.6
2.	Finland	10.1
3.	Papua New Guinea (1971)	10.2
4.	Norway (1972)	11.3
5.	Iceland (1972)	11.6
6.	Netherlands	11.6
7.	Japan (1972)	11.7
8.	Switzerland	12.8
9.	Panama Canal Zone	14.3
10.	Luxembourg	15.5
11.	France (1972)	16.0
12.	East Germany	16.0
13.	New Zealand	16.2
14.	Liechtenstein (1969)	16.7
15.	Australia (1972)	16.7
16.	Canada	16.8
17.	Belgium	17.0
18.	Hong Kong (1972)	17.4
19.	United States	17.6

TABLE 2
NATIONS WITH A MATERNAL MORTALITY RATE
EQUAL TO OR LOWER THAN U.S. IN 1971*

	Country	Mortality Rate
1.	Sweden	0.2
2.	Finland	0.2
3.	United Kingdom (1972)	0.3
4.	Belgium (1970)	0.4
5.	Netherlands	0.4
6.	Czechoslovakia	0.5
7.	Denmark	0.5
8.	East Germany (1972)	0.5
9.	Canada	0.5
10.	Luxembourg (1972)	0.6
11.	Austria (1972)	0.6
12.	Bulgaria (1972)	0.6
13.	Poland (1972)	0.6
14.	United States	0.6

Because of our emphasis on providing elaborate intensive care nurseries equipped with modern electronic machinery and our neglect of establishing networks to prevent prematurity and low birth weight, an international comparison of low birth weight puts the U.S. in an even less favorable position than in the case of infant mortality. It is particularly startling that the incidence of low birth weight (under 5 1/2 pounds) babies in the U.S. is no lower today than it was in the early 1920's.[10,11] As Table 3 reveals, the rate of underweight births has remained fairly stabilized in the U.S.; the rate for non-whites has increased significantly.

The U.S. incidence of low birth weight babies is 75% higher than Finland's,[12] 60% higher than Iceland's, and 25% higher than that of Japan.[13] Our rate of underweight babies is even 16% higher than that of Britain[13] even though the U.S. infant mortality rate is lower.[9] In the People's Republic of China, an emphasis on preventive medicine and applied research has led to a decline in the prematurity rate to less than 3%.[14]

TABLE 3
U.S. LOW BIRTH WEIGHT INCIDENCE
(DATA NOT AVAILABLE FOR YEARS PRIOR TO 1950)

	...All...   Nonwhite(1950-1967)/ Year................. ......Births+...... .....White..... Black (1968-1972)*

	1950^ 7.5% 7.1% 10.2% 1951^ 7.6 7.1 10.8 1952 7.7 7.1 11.2 1953 7.7 7.1 11.4 1954 7.5 6.9 11.4 1955 7.6 6.8 11.7 1956 7.6 6.8 12.1 1957 7.6 6.8 12.5 1958 7.7 6.8 12.9 1959 7.7 6.8 12.9 1960 7.7 6.8 12.8 1961 7.8 6.9 13.0 1962 8.0 7.0 13.1 1963 8.2 7.1 13.6 1964 8.2 7.1 13.9 1965 8.3 7.2 13.8 1966 8.3 7.2 13.9 1967 8.2 7.1 13.6 1968 8.2 7.1 13.7 1969 8.1 7.1 13.9

	1970 7.9 6.8 13.9 1971 7.7 6.6 13.4 1972 7.7 6.5 13.6

+ Live births with known weight.
^ Excludes Connecticut and Massachusetts.
* Births other than white or black are included in col.1 (all births) but excluded from the composite of the last 2 cols for 1968-1972.

Prenatal Nutrition and Birth Weight

Nutrition has been shown to have a more profound effect on birth weight than any other environmental factor. The relationship between nutrition and birth weight has been known for 50 years [as of 1977]. In a study conducted in the 1920's, Acosta-Sison observed that women on poor prenatal diets were more than ten times as likely as well-fed women to give birth to a low birth weight baby.[15] (See Table 4) As the nutritional status of the women worsened, both the maximum and average birth weights declined.

TABLE 4
RELATIONSHIP BETWEEN PRENATAL NUTRITION
AND BIRTH WEIGHT

Nutritional Status of Gravid Women

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