Beware, Madam, of Hastening the Delivery Date!

"Events prove, as the days pass, the greatness and precision of what nature does, and the danger of opposing it or hastening its work." What brings me to this saying, which man has repeated since ancient times, is the following incident:

One of my relatives went to her obstetrician, and after the examination he gave her to understand that he would be taking his vacation the following week, and that he therefore had no objection to her entering the maternity hospital the next morning so that he might perform the delivery — even though nearly three weeks still remained before the natural date. And although the possibility of tampering with the date of delivery had never crossed the lady's mind, she accepted the offer out of trust in her doctor. How great was the husband's joy at the news, and his admiration for the progress of medicine, which had put an end to the anxiety that reigns over the household in the days before the delivery date! For it had become possible for the doctor to direct the delivery, fixing the day and the hour himself, and the expectant mother was no longer at the mercy of nature. But the shock was violent after the complications that arose from tampering with the natural date of birth: the result was that my relative suffered a hemorrhage that nearly cost her her life and the life of the newborn.

What is the nature of advancing the date of birth — or, as it is called, the "directed delivery" — which takes place according to the doctor's will and the date he appoints, not as nature intended it to be? It is known that during pregnancy the fetus rests in the womb, and at delivery the womb's muscles contract, causing pain; its shape flattens and it presses upon the fetus. Under this pressure the opening of the womb dilates, the passage widens, and the fetus is pushed outward. This process takes place as the result of an organic transformation, occurring as soon as the hormonal balance, which has altered during pregnancy, returns to its natural state. In the "directed delivery" — as we have called it — the obstetrician who wishes to advance the date of delivery injects the expectant mother with substances that restore this hormonal balance to its natural state — and the womb does not distinguish between the natural hormonal secretion and that which reaches it by injection — so the process of delivery is set in motion at once.

But what is the wisdom of hastening nature's work, when nature has its own reasons for fixing the length of pregnancy at nine months? There is no doubt that the last month is the most miserable and wearisome of the nine: during it the fetus reaches its full size, its burden grows heavy, and the mother's size increases visibly, so that she lives all through this month in a whirl of anxiety, pulled between two thoughts — the fear of pain and the thought of deliverance. In such a state it is hard for the mother to refuse the idea of the "rescuing" doctor who offers to put an end to all these apprehensions and troubles. This is apart from other considerations, which sometimes reach the point of absurdity — like that actress who does not want to lose her contract on account of her figure, or — and here is the farce of farces — the expectant mother who hastens the delivery to secure the right zodiac sign for her baby!

But must the doctor bow to all these considerations to justify resorting to tampering with the natural date of delivery? No — answers Dr. Daniel Morton, one of the leading authorities on obstetrics in the United States. In most cases the obstetrician neglects to warn the expectant mother of the dangers and troubles to which she is exposed in advancing the date of birth.

An operation of this kind requires an obstetrician of thorough experience, able to gauge how far the delivery date may be advanced before setting it in motion. And the expectant mother and her doctor are often mistaken in fixing the date of delivery. The slightest contraction of the womb during her last month produces pain; fear seizes the mother and she hurries to her doctor, who in turn proceeds to set the delivery in motion before its time, relying on the expectant mother's own sensations. And what is the result? A spasm in the muscles of the womb, which has been forced to work before its time without being able to take up the natural course we described above; inflammations follow, which may end only in a Caesarean operation that may cost the fetus its life. Even when a competent doctor is at hand, the directed delivery is not free of troubles, for it is more violent and more painful: a slight error in the quantity of the hormonal compound is enough to prolong the delivery and complicate it.

Often the fetus suffers, or is left with a permanent infirmity. For the injection of the hormonal compound that sets the delivery in motion cannot have the same effect as the slow changes carried out by nature in preparing the muscles and the organs surrounding the womb, each according to what is required of it — contraction or relaxation — to ease the passage of the fetus. In the "directed delivery" these muscles and organs remain rigid; they do not respond to the contractions of the womb, and they obstruct the fetus's descent, so that the outcome is either its deformation or the tearing of the mother's vessels, which in many cases suffer a severe hemorrhage.

As for the inflammations that accompany the directed delivery, they remain obscure. Perhaps the reason is that the hormonal compound injected to set it in motion at the same time stimulates the secretion of "cortisone," and it is medically known that the latter, if used by itself, lessens the body's power of defense against microbes and consequently causes inflammations.

When, then, may one resort to advancing the date of birth, which as we have seen is not free of violence and troubles? The obvious answer: in those cases where, by means of this operation, a greater danger can be avoided — as in eclampsia (the convulsions of pregnancy), or high blood pressure, or inflammation of the kidneys, or diabetes, or the bursting of the waters that protect the fetus, or after a severe hemorrhage. In such cases the doctor is bound to advance the date of delivery. One may also consider resorting to this operation when the mother has previously delivered a stillborn child, or when the child exceeds the normal size, or when the mother has passed the normal term of pregnancy (290 days), or when she lives in a remote region — for it is more fitting that her delivery be advanced in the presence of a doctor than that the birth take place at its natural time while she is in a remote region.

The importance of advancing the date of birth appears in the Rhésus factor — the factor of incompatibility between the mother's blood and the blood of her fetus, whose effect appears only in the last weeks of pregnancy. By advancing the date of delivery at the hands of a skilled doctor, its consequences can be avoided and the child saved from certain death.

How is one to explain the spread of the "directed delivery," to which many doctors resort on many occasions, with or without excuse, despite the unanimity of the medical bodies in condemning it? In answer, Dr. Frank Brentano cites a memorable saying of his father, who was the greatest obstetrician of his day: "The doctor must keep two things before his eyes: the health of the mother and the health of the newborn. But today he cares for nothing but his own health!" No doubt there is some exaggeration in this saying; but on closer examination it becomes clear what conveniences this operation offers the doctors who perform it — whether from the economic standpoint, by keeping the rooms of their clinics continuously filled, or from the standpoint of their personal comfort, by fixing a delivery date that suits them and not the expectant mother herself, so that they are spared sleepless nights waiting for the mother's deliverance. In the face of these temptations they forget the difficulties that result from this operation, especially since it poses no direct danger to life. But is it permissible that the mother should be an instrument of experiment for a doctor who does not weigh the responsibilities that such an act entails? And is it in any way lawful that the fetus should be treated — without any justification — like the plant that is forced to grow quickly by means of chemical preparations? No, a thousand times no; the question is far too important to be decided lightly, with the lives of two creatures in the balance.