Giving birth in America, 1988

Advances in medical science have improved the prospects for pregnant women to deliver safely and for childless women to become pregnant. However, the picture is not as positive as it may seem. The liability crisis that is driving many obstetricians out of practice is likely to persist, limiting women's access to obstetric care. Reliance on cesarean delivery has risen to unacceptable levels, in part as a result of excessive use of electronic fetal monitoring. Pregnancy complications, prematurity and perinatal morbidity and mortality continue to be serious problems. U.S. perinatal mortality data do not compare favorably with those of many other developed nations, and the rate of prematurity will probably exceed that 1990 target of five percent set by the U.S. government. Prematurity and pregnancy complications are rooted in the associated social factors of poverty, welfare dependence and limited education, and they will not be eliminated until those problems are eased. There also is little hope that obstetric outcomes can be improved without reducing the extent of smoking, drug use and alcohol consumption during pregnancy. Infertility also can be caused or worsened by social factors that defy easy resolution. For the next 20 years, dealing with these societal problems should be a top priority.