Embryo Project Encyclopedia Articles

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 2011, fetal researcher Vivette Glover published “Annual Research Review: Prenatal Stress and the Origins of Psychopathology: An Evolutionary Perspective,” hereafter, “Prenatal Stress and the Origins of Psychopathology,” in the Journal of Child Psychology and Psychiatry. In that article, Glover explained how an evolutionary perspective may be useful in understanding the effects of fetal programming. Fetal programming is a hypothesis that attempts to explain how factors during pregnancy can affect fetuses after birth. Researchers associate exposure to prenatal stress, or stress experienced before birth, with an increased likelihood of some mental disorders. Glover states that such outcomes may be traced back to a fetus’s response to stress during pregnancy, and that those outcomes may have been beneficial in the past. By taking an evolutionary approach toward understanding mental disorders, Glover provided insights for studying the lasting effects of maternal stress during pregnancy on children’s mental health.

In 1999, Joseph Bruner, Susan B. Drummond, Anna L. Meenan, and Ina May Gaskin published, “All-fours Maneuver for Reducing Shoulder Dystocia During Labor,” in the medical journal, Obstetrical and Gynecological Survey. In the article, the authors described a birthing technique named the all-fours maneuver, or the Gaskin maneuver, and explained its effectiveness in treating fetal shoulder dystocia as compared to other maneuvers. Shoulder dystocia occurs when the neonate’s head has exited the vaginal canal, but the shoulders get stuck behind the woman’s pelvic bone, which prevents the birth of the neonate’s body. Healthcare practitioners’ use of previous methods to dislodge the fetal shoulders sometimes resulted in fetal and maternal injury. The all-fours maneuver differed from previous methods by positioning the laboring woman on her hands and knees rather than on her back. Through the article, the authors established the all-fours maneuver as a safe, fast, and effective technique for reducing shoulder dystocia.

In 1987, the World Health Organization, or WHO, took action to improve the quality of maternal health around the world through the declaration of the Safe Motherhood Initiative, or the SMI, at an international conference concerning maternal mortality in Nairobi, Kenya. Initially, the SMI aimed to reduce the prevalence of maternal mortality around the world, as over 500,000 women died during pregnancy and childbirth annually at the time of its inception, while about 98 percent of those deaths occurred in low-income countries. While WHO led the initiative, many organizations in various countries participated in additional programs in order to implement the goals of the SMI. WHO developed the SMI in order to reduce the prevalence of maternal death, developing one of the first proposals that brought attention to maternal health on a global basis at a time when global maternal mortality was high.