There is an interesting and thought-provoking article by David Leonhardt and Amanda Cox in The New York Times Sunday Review (October 12, 2014).  The article describes research done on a huge set of data, “merged birth and school records for all children born in Florida from 1992 to 2002, to study the effects of birth weight on cognitive development from kindergarten through schooling” (Figlio et al, cited below).    The results of the data analysis conclude that children who were heavier at birth scored significantly higher on math and reading tests in grades 3 through 8 – 43rd percentile for 6-pounders vs 57th percentile for 10-pounders.  The researchers controlled for other factors, including the health and sex of the baby, the length of the pregnancy and the health, age, race and education of the mother, but concluded that their results still held.  According to the NYT authors, “the results are sufficiently striking — across a very large population, and present in every subgroup — that they’re likely to influence the debate about the medicalization of birth.” 

In addition to describing these intriguing results and asking what they imply for the inexorable increase, until recently, in elective inductions*  (that is to say, the medicalization of birth), Leonhardt and Cox state that “the results also play into a larger issue: the growing sense among many doctors and other experts that Americans would actually be healthier if our health care system were sometimes less aggressive.”  As a midwife, of course, I had to cheer when I read this.  Midwives believe that, in most cases, less is more when it comes to intervention in pregnancy and childbirth, that most births are normal physiological events and shouldn’t be managed or tampered with.  This is not the case with medical and obstetric problems, of course – they sometimes do need management and interventions, although not always, and certainly not always as much as they get.  (Remember the old adage about the common cold; it will go away in a week if you see the doctor, and seven days if you don’t.)  Medical technology has resulted in lifesaving treatment for those who need it, but is also being widely used with less effectiveness or even harm in patients who could be successfully treated with older, simpler, less expensive therapies that have fewer risks and side effects.

ACOG has already issued a practice guideline limiting elective inductions to 39 weeks or later, and, commendably, some hospitals and providers are acting on this.  The rate of elective inductions is declining, albeit not enough.  Whether obstetric researchers and policy-makers will use these latest study results for further research and to advise further restrictions on “elective” interventions in a natural process that is progressing normally on its own remains to be seen.  We can hope so.



Big Baby, Smart Kid.  David Leonhardt and Amanda Cox; The New York Times Sunday Review, October 12, 2014; and Heavier Babies Do Better in School; David Leonhardt and Amanda Cox, online at

The Effects of Poor Neonatal Health on Children’s Cognitive Developoment.  David Figlio, Jonathan Guryan, Krzysztof Karbownik, and Jeffrey Roth; Northwestern University Institute for Policy Research,  The working paper can be downloaded in PDF format from the linked page.

*Elective induction is induction of labor when there is no clear medical benefit to mother or child for delivery at that point in time compared with continuation of pregnancy; American College of Obstetricians and Gynecologists Guideline Suggestions for Elective Labor Induction,