Embryo Project Encyclopedia

In 1949, Priscilla White published Pregnancy Complicating Diabetes, which described the results and implications of a fifteen-year study about pregnant diabetic women. Published in the American Journal of Medicine, the article details possible causes of and ways to prevent the high fetal mortality rate associated with pregnant diabetic women. Diabetes is a disease in which the body's ability to produce or respond to the hormone insulin is impaired, and it can be particularly dangerous during pregnancies. In her article, White reported that prematurely delivering infants for diabetic pregnant women reduces infant and maternal mortality rates. Pregnancy Complicating Diabetes helped make premature delivery of infants the standard of care for diabetic pregnant women, and it has contributed to the increased survival rate of infants born from diabetic mothers from less than fifty percent in the 1940s to over ninety percent in 2017.

In 1986, Vern L. Katz, Deborah J. Dotters, and William Droegemueller published “Perimortem Cesarean Delivery,” an article in which they developed the Four Minute Rule for perimortem cesarean sections. The Four Minute Rule states that if a pregnant woman’s heart stops beating, physicians should begin an operation to deliver the fetus within four minutes and aim to have the fetus delivered within five minutes of cardiac arrest. Although cardiac arrest during pregnancy is uncommon, it can happen when pregnant women experience trauma, blood clots, infection, or have preexisting heart conditions. In the article, the authors emphasize how the Four Minute Rule increased maternal and fetal survival rates and decreased cases of severe fetal brain damage. The article “Perimortem Cesarean Delivery” was the first article to present the Four Minute Rule, which has influenced international guidelines and become the standard for maternal resuscitation and fetal survival in emergency medicine, operating rooms, and many other aspects of medical practice.

In 1894, William Stewart Halsted published The Results of Operations for the Cure of Cancer of the Breast Performed at the Johns Hopkins Hospital from June, 1889, to January, 1894, in the medical journal Annals of Surgery. In the article, Halsted describes the results from fifty of his operations on women with breast cancer, performed at Johns Hopkins Hospital in Baltimore, Maryland. Those operations involved a surgical procedure Halsted called radical mastectomy, which consists in removing all of the patient’s breast tissue, chest muscle, and underarm lymph nodes. Halsted’s surgery effectively cured breast cancer in a time period when no other effective treatment options were available. The radical mastectomy remained the standard of care from the 1890s to the 1970s as a means of treating a type of reproductive cancer common to women.

William Withey Gull studied paraplegia, anorexia, and hormones as a physician in England during the nineteenth century. In addition to caring for patients, he described the role of the posterior column of the spinal cord in paraplegia, and he was among the first to describe the conditions of anorexia and of hypochondria. He also researched the effects of thyroid hormone deficiencies in women who had malfunctioning thyroid glands. Gull's research on thyroid hormone confirmed that chemicals in the body directly affect health, and he contributed to the foundation of endocrinology, the scientific field for the study of hormones.

In July 2015, Ana J. Torvie, Lisa S. Callegari, Melissa A. Schiff, and Katherine E. Debiec published “Labor and Delivery Outcomes Among Young Adolescents,” hereafter “Labor and Delivery Outcomes,” in the American Journal for Obstetrics and Gynecology. The authors conducted a study using birth certificate data and hospital records in the state of Washington to compare the frequency and outcomes of cesarean and surgically assisted vaginal births among different age groups of pregnant people. They found that adolescents aged eleven to fourteen years are less likely to require cesarean or surgically assisted births but that their neonates were more likely to have birth-related complications than those of adults aged twenty to twenty-four years. While previous studies had yielded conflicting results, “Labor and Delivery Outcomes” reports generalized trends about young adolescents in labor and delivery. The researchers’ findings support future physicians in making more informed considerations for the care of pregnant patients under the age of fifteen.

In 2010, the Catholic Church excommunicated Margaret McBride, a nun and ethics board member at St. Joseph’s Hospital and Medical Center in Phoenix, Arizona. McBride was excommunicated latae sententiae, or automatically, for approving a therapeutic abortion, which is an abortion that is required to save a pregnant woman’s life. McBride approved an abortion for a woman who was twenty-seven years old, eleven weeks pregnant with her fifth child, and suffered from pulmonary hypertension, a life-threatening condition during pregnancy. Following McBride’s decision, St. Joseph’s lost its affiliation with the Catholic Church, which it had maintained since the late 1800s. Affiliation with the Catholic Church required that the hospital abide by Canon Law, which is the law of the Catholic Church. Under Canon Law, abortion is serious wrongdoing that could result in excommunication, as it did in the case of McBride. McBride’s excommunication illustrated the impact that affiliation of Catholicism with hospitals had on patients’ ability to receive comprehensive reproductive health care.

In December 2011, the Stillbirth Collaborative Research Network, or SCRN, published the article “Causes of Death Among Stillbirths” in The Journal of the American Medical Association. The authors of the article investigate the causes of stillbirth and possible reasons for the racial, ethnic, and geographic disparities in stillbirth rates. According to the Centers for Disease Control and Prevention, or CDC, stillbirth is the death of a fetus at twenty or more weeks during pregnancy. “Causes of Death Among Stillbirths” explores the common causes of stillbirth in different racial and ethnic groups, and provides a framework for future research into medical interventions to help reduce racial and ethnic stillbirth disparity.

In April 1994, Elizabeth Raymond, Sven Cnattingius, and John Kiely published “Effects of Maternal Age, Parity, and Smoking on the Risk of Stillbirth” in the British Journal of Obstetrics and Gynecology, now known as BJOG: An International Journal of Obstetrics and Gynecology. The article examines how advanced maternal age, defined as delivery at thirty-five years old or older, cigarette smoking, and nulliparity, or the state of never having given birth, can negatively impact pregnancy. At the time of publication, according to Raymond and colleagues, stillbirths comprised over half of all perinatal, or close to birth, deaths and more than one-third of total fetal and infant deaths in Europe and North America. In the article, Raymond and her coauthors demonstrate how certain risk factors may increase the risk of stillbirth at different stages of pregnancy, which helped set a foundation for future research in interventions to prevent stillbirth.

In 2019, Americans United for Life, hereafter AUL, published a model legislation, called the Women’s Right to Know Act, in their annual publication Defending Life. The goal of the model legislation, which AUL annually updates, is to help state governments enact enhanced informed consent laws for abortion. The Women’s Right to Know Act requires physicians to provide specific information to women before they may consent to having an abortion. It also suggests that individual US state governments to develop informational materials about abortion and pregnancy that healthcare providers must give to women before they receive an abortion. As of 2020, twenty-eight states have enacted informed consent laws for abortion that resemble the Women’s Right to Know Act. In a larger effort to dismantle legal access to abortion, the AUL’s Women’s Right to Know Act encourages individual states to restrict access to abortion to protect, what the organization calls, the unborn child.

Elinor Catherine Hamlin founded and helped fund centers in Ethiopia to treat women affected by fistulas from obstetric complications. Obstetric fistulas develop in women who experience prolonged labor, as the pressure placed on the pelvis by the fetus during labor causes a hole, or fistula, to form between the vagina and the bladder (vesicovaginal fistula) or between the vagina and the rectum (rectovaginal fistula). Both of those conditions result in urinary or fecal incontinence, which often impacts womenÍs social status within their communities. Hamlin co-founded a hospital to treat fistulas and help fund health clinics, a rehabilitation center, and a midwife school. Her work in Ethiopia helped to help train the next cohort of midwives to treat women with obstetric complications and has contributed to the health and social well-being of Ethiopian women.