This is a wonderful time to have a baby, wonderful for both mother and baby, for in the long history of man birth has never been so safe. The progress made in this area during the past two decades defies imagination. Yet the goal has not been reached, though it is clear: no deaths for those who bring life, and no fetal wastage. What can be done to achieve this ideal?
Laymen must realize the importance of prenatal care; this means not merely registry with a doctor or a hospital for confinement, but also regular visits to the doctor from the early weeks of pregnancy until the time of delivery, and the carrying out of his advice to the letter. To have had one or several babies without complications does not eliminate the possibility of complications in a later pregnancy, and therefore prenatal care is as necessary for the fifth pregnancy as for the first.
The choice of a doctor is important, and the well-trained obstetrical specialist is the best guarantee of safety. The danger of ill-equipped and badly supervised private obstetrical sanatoria is great, and a separate obstetrical pavilion attached to a general hospital, or a special obstetric hospital, is greatly to be preferred. There is sore and pressing need for additional obstetric beds, especially in the more remote regions of this country. These beds should be made available equally to rich and poor, Negro and white. Furthermore, the proper nutrition of the malnourished in this, the breadbasket of the world, must be improved—certainly the nutrition of many of its pregnant women. During the siege of Leningrad in 1942, with its attendant starvation, prematurity rose from 6.5 per cent to 41.2 per cent, stillbirths more than doubled, and the death rate for newborn infants soared to more than 100 per 1000.
The public must develop a standard of obstetric values. A simple delivery is the best recommendation for an obstetrician, much better than a long list of impressive opera- tions. A completely painless labor may be bad obstetrics; the relief of pain is humane and necessary, but in some cases its obliteration may exact an excessive price.
The reader must realize that the vast majority of pregnancies have always ended successfully and they will continue to do so. If you are going to have a baby, the previous paragraphs should have dissolved your doubts and fears. Believe me when I say that birth has become almost 100 per cent safe. Many modern obstetricians have practiced two decades or longer without a single maternal death.
In more than thirty years of obstetric practice, during which I have delivered something like 6000 private patients, I have seen three of my own patients die, one from a fatal blood disease (leukemia) at the fourth month, one from a clotting of a blood vessel in the brain several days after delivery, and one two weeks following birth from the effects of a recurrent breast cancer. Pregnancy and labor had little to do with any of the three. I do not recite these personal statistics boastfully, for they can be duplicated or improved by hundreds of doctors—probably by your own obstetrician—but their recitation must perforce be reassuring.
How shall we interpret this? It does not mean that all obstetrical problems and complications have disappeared. It simply means that the modern doctor, together with his modern hospital, is fully capable of handling problems and complications when they arise. Potential parents of the second half of the twentieth century are truly fortunate people.
Even granting these facts, obstetrical knowledge is far from complete. Many unsolved problems remain. Some day the laboratory will reveal the precise cause of the onset of labor; then we shall be able to initiate and retard it at will. No longer will patients carry a pregnancy long beyond term or babies be born prematurely; no longer will labors be lengthened by inertia. Some day we shall know how to prevent erythroblastosis, and the malformed newborn of today will vanish tomorrow.. Research worker and clinician are striving shoulder to shoulder; progress—in some decades slow, in others rapid—is inevitable.
This brief narration of obstetrics, past, present, and future, is now at an end.