In 2003, the Texas state legislature passed the Woman’s Right to Know Act, hereafter the Act, as Chapter 171 of the state’s Health and Safety Code. The Act sets requirements that physicians must follow during the informed consent process for abortion, or a medical procedure to terminate pregnancy, in Texas. Lawmakers amended the Act and added several additional regulations that restrict access to abortion in 2011, 2013, 2015, and 2017. For instance, the Act requires that physicians perform abortions after sixteen weeks of pregnancy in ambulatory surgical centers or hospitals and states that physicians must perform an ultrasound to view images, called sonograms, of a developing fetus inside a woman’s uterus before a woman may receive an abortion. The Act further requires practitioners and clinics to offer state-developed informational materials to women who seek an abortion. The Act placed several restrictions on abortion care in Texas, making it more difficult for women to access safe and legal abortion care, which opponents have challenged in courts.
In 1980 the US National Institutes of Health (NIH) and the US National Institute of Child Health and Human Development (NICHD) released a report titled, “National Institutes of Health Consensus Development Conference Statement September 22–24, 1980.” The report lists recommendations for birth delivery through cesarean sections, a surgical procedure used to deliver the fetus via the pregnant woman’s abdomen. The recommendations arose from the 1980 Consensus Development Conference on Cesarean Childbirth in Bethesda, Maryland. Medical professionals, consumers, and biomedical research scientists attended the conference, and the NIH’s taskforce on the subject helped facilitate discussions regarding the safety of cesarean sections. The NIH taskforce concluded that cesarean section rates can be decreased and possibly reversed in addition to improving maternal and fetal outcomes and provided recommendations for future research on cesarean sections.
Roberto Caldeyro-Barcia studied fetal health in Uruguay during the second half of the twentieth century. Caldeyro-Barcia developed Montevideo units, which are used to quantify intrauterine pressure, or the force of contractions during labor. Intrauterine pressure is a useful measure of the progression of labor and the health of a fetus. Caldeyro-Barcia’s research on fetal health often contradicted common obstetric practices, prompting him to publically challenge practices such as induction of labor using oxytocin, forced pushing during labor, and birth position in which the woman lays on her back during labor. Caldeyro-Barcia’s methods of monitoring intrauterine pressure and development of Montevideo units furthered research in maternal and fetal health and improved the use of medical interventions during labor and delivery.
An intrauterine pressure catheter (IUPC) is a device placed inside a pregnant woman’s uterus to monitor uterine contractions during labor. During labor, a woman’s uterus contracts to dilate, or open, the cervix and push the fetus into the birth canal. The catheter measures the pressure within the amniotic space during contractions and allows physicians to evaluate the strength, frequency, and duration of contractions. Those measurements enable physicians to evaluate the progression of labor and intervene when contractions are too weak to properly dilate a laboring woman’s cervix to successfully deliver a fetus. Though IUPCs are not used routinely, they are important in cases where external fetal monitoring is not sufficient to monitor a difficult labor. Intrauterine pressure catheters give physicians an extremely accurate measurement of intrauterine pressure, making it possible to determine whether intervention is needed to progress the labor.
In 2004, Amanda J. Drake and Brian R. Walker published “The Intergenerational Effects of Fetal Programming: Non-genomic Mechanisms for the Inheritance of Low Birth Weight and Cardiovascular Risk,” hereafter, “The Intergenerational Effects,” in the Journal of Endocrinology. In their article, the authors assert that cardiovascular disease may develop via fetal programming, which is when a certain event occurring during a critical point of pregnancy affects the fetus long after birth. Drake and Walker were among the first to show that the programming effects of cardiovascular disease could be sustained across generations through non-genetic means. In “The Intergenerational Effects,” the authors identify how non-genetic mechanisms may perpetuate fetal programming influences over generations, highlighting the importance for further research on fetal programming.
Fetal programming, or prenatal programming, is a concept that suggests certain events occurring during critical points of pregnancy may cause permanent effects on the fetus and the infant long after birth. The concept of fetal programming stemmed from the fetal origins hypothesis, also known as Barker’s hypothesis, that David Barker proposed in 1995 at the University of Southampton in Southampton, England. The fetal origins hypothesis states that undernutrition in the womb during middle to late pregnancy causes improper fetal growth, which in turn, causes a predisposition to certain diseases in adulthood. In addition to nutritional impacts, researchers have studied the fetal programming effects of many factors, such as maternal anxiety or violence during pregnancy. Researchers proposing the concept of fetal programming established a new area of research into the developmental causes of disease, pointing towards the in utero environment and its critical role in healthy human development.