Embryo Project Encyclopedia

During the mid-twentieth century, Virginia Apgar worked as an obstetrical anesthesiologist and gave drugs to women that reduced their pain during childbirth in the US. In 1953, Apgar created a scoring system, called the Apgar score, that uses five measurements, including heart rate and breathing rate. The Apgar score evaluates newborn infants and determines who needs immediate medical attention. Apgar's work helped decrease infant mortality rates. As of 2020, hospitals around the world use the Apgar score.

In 2001, the Supreme Court of New Jersey decided a dispute between a divorced couple over cryopreserved preembryos created through in vitro fertilization (IVF) during the coupleÕs marriage. The former wife (J.B.) wanted the preembryos destroyed, while her former husband (M.B.) wanted them to be used for future implantation attempts, such as by an infertile couple. In J.B. v. M.B. (2001), the court declined to force J.B. to become a parent against her will, concluding that doing so would violate state public policy. Instead, the Supreme Court of New Jersey decided that agreements directing the allocation of cryopreserved preembryos will be enforced, unless one party changes his or her mind prior to the preembryosÕ use or destruction. Should a party revoke an earlier decision about the preembryos, New Jersey courts should weigh the partiesÕ interests with special weight given to an individualÕs right to not procreate.

Isotretinoin is a molecule and a byproduct (metabolite) of vitamin A, and in greater than normal amounts in pregnant women, it can cause fetal abnormalities including cleft lips, ear and eye defects, and mental retardation. Isotretinoin is commonly called by its trade name Accutane, and it's a chemical compound derived from vitamin A, or retinoic acid. Doctors prescribe isotretinoin to treat severe acne. For pregnant women, too much vitamin A or isotretinoin can also cause greater than normal rates of stillbirths and fetal disintegrations after the ninth week of gestation. Women who use isotretinoin during the first trimester of their pregnancies, even in small amounts, risk defects to their fetuses such as external ear malformations, cleft palates, undersized jaws (micrognathia), a variety of heart defects, buildups of fluids inside the skulls that leads to brain swelling (hydrocephalus), small heads and brains (microcephaly), and mental retardation.

The case of Smith v. Cote (1986) answered two important questions concerning law and childbirth: does the State of New Hampshire recognize a cause of action for what is defined as wrongful birth, and does the State recognize a cause of action for what is classified as wrongful life? In the case of Smith v. Cote, damages were permitted for wrongful birth, but not for the action of wrongful life.

This influential opinion by famed jurist Oliver Wendell Holmes, Jr. was copied by courts throughout the United States. For over sixty years, courts refused to recognize a cause of action on behalf of a child who died before or after birth as a result of injuries suffered in the womb because the fetus was considered legally a part of its mother and thus did not possess personhood. This policy changed after the decision in Bonbrest v. Kotz in 1946.

The US 2nd Circuit Court of Appeals' 1984 decision United States v. University Hospital, State University Hospital of New York at Stony Brook set a significant precedent for affirming parental privilege to make medical decisions for handicapped newborns, while limiting the ability of the federal government to intervene. The ruling stemmed from the 1983 case involving an infant born with severe physical and mental congenital defects; the infant was only identified as Baby Jane Doe. After her parents opted against corrective surgery for some of her deformities, Baby Jane Doe became the epicenter of a national right-to-life debate that had been previously sparked one year prior with the case of Baby Doe, an Indiana infant born with similarly severe handicaps.

In the 1936 case United States v. One Package of Japanese Pessaries, the US Court of Appeals for the Second Circuit in New York City, New York, confirmed that physicians had the right to distribute contraceptives to patients for medical purposes. In January 1933, US Customs confiscated a package of contraceptives imported from Japan by US physician Hannah Stone. They claimed that the package violated section 305 of the Tariff Act of 1930, which, like the 1873 anti-obscenity Comstock Act, granted the US government authority to seize contraceptive materials imported into the country or sent through the mail. The court ruled that US Customs was not justified in confiscating the package and ordered its return to Stone. United States v. One Package exempted physicians from the restrictions surrounding the distribution of contraceptives and contributed to the subsequent dismantling of the Comstock Act in later court cases.

In November 1921, US Congress passed the National Maternity and Infancy Protection Act, also called the Sheppard-Towner Act. The Act provided federal funds to states to establish programs to educate people about prenatal health and infant welfare. Advocates argued that it would curb the high infant mortality rate in the US. Many states accepted funding through the Sheppard-Towner Act, leading to the establishment of nearly 3,000 prenatal care clinics, 180,000 infant care seminars, over three million home visits by traveling nurses, and a national distribution of educational literature between 1921 and 1928. The Act provided funding for five years, but was repealed in 1929 after Congress did not renew it. Historians note that infant mortality did decrease during the years the Act was in effect. The Act also influenced provisions aimed at infant and maternity welfare in later legislation, such as the Social Security Act of 1935.

On 26 May 1994, US President Bill Clinton signed the Freedom of Access to Clinic Entrances Act in to law, which federally criminalized acts of obstruction and violence towards reproductive health clinics. The law was a reaction to the increasing violence toward abortion clinics, providers, and patients during the 1990s. That violence included clinic blockades and protests, assaults on physicians and patients, and murders. The Freedom of Access to Clinic Entrances Act established
criminal and civil penalties against people who obstructed or committed violence towards reproductive health clinics, and has supported women's access to safe reproductive healthcare.

Josef Warkany studied the environmental causes of birth defects in the United States in the twentieth century. Warkany was one of the first researchers to show that factors in the environment could cause birth defects, and he helped to develop guidelines for the field of teratology, the study of birth defects. Prior to Warkany’s work, scientists struggled to explain if or how environmental agents could cause birth defects. Warkany demonstrated that a deficiency or excess of vitamin A in maternal nutrition could cause birth defects. He also established that mercury in teething powders increased infant mortality rates. Warkany showed how substances outside the human body could adversely affect conception, growth, and development of the human fetus in utero.