Birth Defects

About 3 percent of babies born alive have serious birth defects. Some defects are genetic; others may result from damage to a growing fetus caused by infection, chemicals (including fertilizers, alcohol, or drugs), diet, X rays, or a mixture of these. They can also be caused by direct damage, as in a failed abortion. Interest in damaged children, who were once known as "monsters," goes back at least to ancient Egypt. The study of birth defects is now known as teratology and the damaging agents as teratogens.

For many centuries birth defects were seen as warnings or divine omens and children with birth defects were often confused with mythological beings. It was an ancient Jewish custom to put a beautiful child at the door of public baths to help women to "have children as fine as he." In ancient Carthage it is said that alcohol was forbidden to a bridal couple in case a fetus was damaged by it. Later monsters became objects of interest, to be collected and described. Most museums of pathology still possess a collection of them, although recently this has come to be regarded as inappropriate.

Definition of defects depends also, of course, on time and place. In Western Europe around 1700, babies born "with the cowl" (a piece of placenta attached to the head) were viewed as defective, marked by the devil. In some societies twins were seen as defective, again marked by evil. Generally, with the rise of modern science and global contacts, these particular definitions of defects have declined.

In the eighteenth century there was much interest in maternal impressions; a fright, for example, was believed to cause birth defects. In the mid-nineteenth century it was believed in the English-speaking world that heredity could be altered by external circumstances at any point between conception and weaning. Physicians warned against sexual inter-course under the influence of drugs or alcohol as they believed that these could affect the constitution of a child. In 1870 the medical profession was criticized for its prevalent belief in the ability of maternal impressions to cause any degree of malformation.

In the late nineteenth century this kind of belief was falling into disrepute because it was linked with magic and "unscientific" thinking. This connection may be a reason the subject was rejected and ignored for so long. As medicine became more scientific, magic was increasingly despised. The placenta was steeped in myth and mystery, so no one working with humans thought to analyze it scientifically. It remained in a kind of quasi-magical limbo, vulnerable to the social fantasies of the time. Moreover, in the late nineteenth century there was little medical interest in the well-being of pregnant women, newborn babies, or older children. So many babies and children died from infection that the smaller number who were afflicted with birth defects was not seen as important. It was widely acceptable to drop them into a bucket of water as soon as they were born.

Belief in the placenta as a perfect barrier against damaging influences in the environment was reinforced by the Victorian tendency to put woman on a pedestal. This led to the idealization of the womb as well as of the woman. Women's reproductive organs were regarded as different and special and also as the source of all symptoms and ills that were not visibly due to something else.

By the 1930s there was more serious interest in teratology but, typically, as late as 1937 a popular textbook discussed the diagnosis of fetal abnormalities but not their causes. In 1941, when it was shown that rubella in pregnancy caused birth defects, the peculiarity of the infection was emphasized but it was not taken as a general warning about the vulnerability of fetuses. Today one can still find examples of residual idealization of the womb, perhaps describing it as a perfect environment or an ideal convalescent home.

Another possible reason little notice was taken of environmental dangers in pregnancy was that fetuses, stillbirths, and newborn babies had long been regarded as expendable, or at least as not very important. Few doctors were interested in them for their own sake. Unborn children created danger for their mothers at a time when maternal mortality was

Boy with a Clubfoot (c. 1642-1652), Jusepe de Ribera. In early modern Europe, children born with birth defects often had to rely on charity for their care. Ribera's subject holds a paper in his hands that reads "Give me alms, for the love of God."

high. By the 1930s the maternal mortality rate was falling, BIRTH CONTROL was spreading, families were smaller, and there was greater interest in infants and their survival. Also, decline in mortality from infection and improved prenatal care meant that congenital defects became more prominent as a cause of death and debility, which at least provided a reason for studying them.

Still, the subject interested few doctors and scientists. Medical students were taught that the placenta was a perfect barrier protecting the fetus from the outside. All this was changed by the discovery, in 1962, that the drug thalidomide was causing horrifying defects in fetuses. Suddenly many people had to change their views.

Thalidomide changed the way in which the medical profession regarded drugs taken in pregnancy. It also played a part in breaking down the alternate idealization and denigration of women and the idealization of the placenta that has been so prominent in Western medical history. However, thalidomide was a useful and effective drug and recently it has been used again in some parts of the world in the treatment of leprosy, with the inevitable result that "thalidomide babies" are once again being born. Meanwhile pregnant women today are discouraged from taking drugs or exposing themselves to other teratogens and there are much more enlightened attitudes toward birth defects.

See also: Conception and Birth.


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