No one living on earth got here any other way than gestation, so there ought to be some power attached to being part of that 51%. Historically, it might be said that the power has been merely for survival…the good breeders survived long enough to produce heirs and those who lived on knew where the roots and fruit grew.

Only women can make more people with their bodies.

Here are some things to consider:

• Women make people
• Women’s health and fitness before pregnancy affects whether the pregnancy is healthy
• Women’s health and fitness during pregnancy affects her lifetime health and that of her offspring
• Maternal survival is important to offspring well-being
• Maternal health and fitness affects maternal adaptation and thereby offspring well-being

Thus, is it not a sanguine notion that the health and survival of women is critical to the health of everyone? After all, the health of nations is associated with this slight majority of females, and the wealth of nations is associated with its health.

The good news is that people working from this understanding are making some headway around the globe. Recently, the World Health Organization noted that maternal death among pregnant and birthing women world-wide has been dramatically reduced from the 1980’s to recently. This is very good news!

Here is the interesting footnote:  Maternal death in the U.S. has risen 42% in the same period. While the absolute numbers remain small, this is a disturbing picture. What could be causing this?

Time will tell if we can figure it out and fix it. I venture to suggest some directions for consideration:

• The elevated cesarean birth rate with its sequellae of cardiovascular and immune system disorders
• Obesity
• Metabolic syndromes
• Diabetes
• Heart disease

Why am I hopeful, then? I see among our current educated generation of new moms and moms-to-be a willingness to exert their influence – as breeders – over the health care scene. They want less technological birth. They want support. They want more information. They want to be healthy. These are wonderful things. I salute these young women…they also make my job easier in the process.

In addition, I see among young health care practitioners an understanding of the value of these things. Among practitioners working in public health clinics there is a sense of desperation on the one hand that the poor and indigent have no capacity or will to take care of themselves. On the other hand, the first step is always education and there are a lot of people working on this issue.

Which brings me to the closing point:  How do we bring more resources and intelligence to helping women be healthy, prepare for pregnancy, have healthy babies, reduce pregnancy complications, and improve infant and maternal death rates? I, for one, will keep blogging on this issue. You, I hope, will vote for people who understand this issue. The political power and will is in our hands.

51% of us are women…some day 51% of us can set priorities

• the value of exercise in pregnancy

• health care reform

Check out the ACNM site!!

What revisions would most benefit pregnant women, their offspring, families and communities?

1. Reward healthy behaviors. A system that provides reduced premiums for health care for women who exercise, eat well, do not smoke and are in a normal weight range is evidence-based.

Yes! We could provide financial incentives for being healthy during pregnancy. Why? Healthy moms have healthy babies; healthy babies cost the payer less money.

2. Review best practices. Is a 40 or 50% cesarean rate the best practice?  Accompanying the rise in cesarean births is growing information that babies born by cesarean are at increased risk for a number of immune disorders. But the business model of medicine rewards cesarean because it both pays the provider more and is defensive medical practice.

Fetal monitoring to determine if a cesarean may be necessary, is wrong 3/4 of the time. In an effort to change this, guidelines are changing for the use of monitors during labor. What is the evidence that this change of practice is beneficial? Will it lead to more or less monitoring, which may itself be an intervention that can disrupt normal labor?

Why does insurance pay for cesareans? Well, they will do it once. After all, the care providers have to practice defensive medicine. But, once you have a cesarean, you become a risk for the insurance company (they know what the research says about cesareans and offspring health problems) and may be denied insurance. They can no longer afford you.

Because care providers are paid fee for service and must practice defensive medicine, pregnancy and birth have become increasingly burdened with intervening procedures that do not necessarily promote a healthy pregnancy or birth process. How is this playing out? Increasingly, we see women giving birth in what they perceive as a more supportive and health-inducing setting:  their own homes. Think of it this way:  many women now believe that it is safer to stay home than go to a hospital to give birth.

Unless health care becomes about best practices and healthy outcomes — not price, size, and getting paid for passing money back and forth — the U.S. will continue to have some of the worst maternal/infant outcomes in the developed world.