Show r 6A Standard-Examin- Friday Oct 16 1981 er © By JANE E BRODY NY Times NEW YORK — At a time when women are pressing for more natural childbirth without anesthetics and instruments sometimes without hospitals there is also a strong trend in the opposite direction: Caesarean births are rising precipitously The proportion of deliveries by Caesa- rean section which had been growing slowly from about 4 percent of births in the 1950s tripled n the 1970s and stood at 18 percent last year In large hospitals today about one in four births is by Caesarean In some institutions Caesareans constitute as much as 40 percent of deliveries This increase has sparked national debate A number of health professionals and consumer interest groups charge that many perhaps for the doctor’s convenience and to head off malpractice suits that can arise if a newborn is damaged Obstetricians say their goal in perform fi®ravemewce ing Caesareans is to deliver healthier babies with minimal risk to mothers Indeed a Cleveland medical team reported last year that the increase has been accompanied by an even more precipitous force recently concluded that fetal distress as shown by monitors accounts for only 10 to 15 percent of the increase in Caesareans “Not all changes in Caesarean birth rates can be directly ascribed to changes n decline in deaths among new mothers and obstetrical management” Dr Sidney F babies Bottoms and his colleagues at Cleveland “A high rate (of Caesareans) in and of Metropolitan General Hospital observed itself doesn’t tell the whole story” says Other factors that may be contributing Dr Fredric Frigoletto obstetrician at to the growing popularity of Caesareans Brigham and Women’s Hospital in Boston include the older age of new mothers (older “For several reasons one hospital — or women are more likely to experience comone physician — might have a justifiably plications in pregnancy and labor and more often need surgery) medical insurhigher rate than the next” Recent studies suggest that both propo- ance policies that reimburse for surgical nents and opponents of Caesareans are but not vaginal deliveries the dramatic partly right and that the matter is often improvement in the safety of Caesareans oversimplified For example some critics (the maternal death rate for Caesareans have attributed the high rate of Caesa- has dropped from about 114 per 100000 in reans to an explosion in the use of electric 1970 to 41 per 100000 in 1978) the growing fetal monitoring which signals moment-to-mome- proportion of births that take place in g fetal during labor hospitals with obstetricians who But a National Institute of Health task are trained to operate (rather than general nt well-equipp- ed well-bein- practitioners or midwives who are not) in attendance The advent of Medicaid has brought sophisticated medical treatment and techniques such as Caesareans to poor women The increase in malpractice suits when babies are damaged during delivery coupled with parental demands for healthy babies in an era of a few carefully planned births may further influence physicians to deliver surgically In a recent issue of The Hastings Center Report Jeanne Guillemin a sociologist at Boston College and an NIH task force member deplored the role of financial considerations in deciding for or against Caesareans She noted that the specialty of obstetrics is growing more rapidly than most that obstetricians charge higher fees for surgical than nonsurgical deliveries that Caesarean patients keep hospital beds filled for long periods that malpractice suits have been brought not ©n bid tfeox ing themselves charging “wrongful life” She cited two studies showing that the Caesarean rate was lower among members of prepaid medical plans than among patients In addition to the lack of monetary incentives for surgery she commented prepaid plans place more emphasis on preventive care which could deliveries that result in fewer high-ris- k fee-for-servi- ce require As to the medically documented reasons for the high number of Caesareans the national task force cited the failure of labor to progress normally (dystocia) as the most important accounting for 30 percent of the increase and the belief trhat “once a Caesarean always a Caesarean” (such mothers the argument goes cannot safely experience vaginal delivery) as the reason for 25 to 30 percrent of the increase 0 mid kited ©wisDom NEW YORK (AP) — A federal indictment charging the Rev Sun Myung Moon with income tax evasion is an “attempted assassination” of the Unification Church’s & SR United Press International Two "soldiers" pause at Yorktown where some 20000 participated in re-creat- ion of the famous battle that took place 200 years ago Redcoats heaters again at Yorktown YORKTOWN Va (UPI) — Thousands of soldiers playing the parts of Colonial regiments British “Redcoats” and the Battle of French troops are Yorktown which 200 years ago won the War of Independence for America make-believ- e re-creati- ng The celebration beginning today includes parades and fireworks as well as the mock battle dramatizing the day of Oct 19 1781 when British troops under Lord Cornwallis surrendered to the Colonists and four-da- y French of the vicPlanners for the tory at Yorktown expect more than 60000 people to attend including President Reagan and French President Francois ify WASHINGTON (AP) — The Reagan administration worried that countries in the Middle East are overreacting says tensions caused over Libyan by charges and counter-charge- s if not soon war could actions explode into defused But the State Department emphasized Thursday that US actions in the area are designed to “defuse the tensions through deterring possible hostilities” In a carefully worded statement the department tried to bring “perspective” to the situation in the Middle East including stepped-u- p US involvement since the assassination of Egyptian President Anwar Sadat Thursday in preparation for the celebration sponsored by the American Bicentennial Commission American and French naval vessels slowly worked their way up the York River to assume positions The largest of the outdoor exhibits will be the reconstructed military encampment More than 4000 soldiers will live in 1200 tents in a recreation of the camp life of colonial military units Reagan Mitterand and Vice President George Bush were slated for appearances Saturday Sunday and Monday Bush hosts a dinner in honor of Mitterand Saturday in nearby Colonial Williamsburg Reagan is to fly into the Coast Guard station at Yorktown around noon Sunday the White House said He will have lunch with Bush and Mitterrand aboard the de Grasse a French ship named for the admiral whose sea victory ensured the success of the land battle Reagan and Mitterrand who is making his first trip to the United States as president are to meet for IV2 hours Sunday Reagan will host a state dinner Sunday night for Mitterrand and 96 guests in the Governor’s Palace at Colonial burg Reagan and Mitterrand will fly from Williamsburg to Yorktown Monday morning by helicopter for the celebration’s climax — the of the surrender of Cornwallis al with a flood situation in the town of Sherman described as “hell” US-Egypti- an ment” statement by Sudan’s Foreign Minister Mohammed Mirghani that “Sudanese patience is stretched to the limit” by alleged Libyan bombing of border villages —A prediction by Egyptian Foreign Minister Kamal Hassan Aly that Egypt will have to act if Libyan President Moammar Khadafy “dares to do anything on the borders of Sudan” Fischer said some countries in the Middle East are “in a state of some tension there are some military alerts that have been reported” —A F-5- F B-5- effect” State Department official who didn’t want to be identified said “tensions are mounting” in Libya indicating concern that Khadafy might be provoked even further Meanwhile the administration is having difficulty assembling a representative peacekeeping force to patrol the borders of Israel and Egypt next year The force is supposed to be in place when Israel withdraws completely from the Egyptian Sinai in April as provided by the 1978 Camp David peace accords A multi-nation- Nimieri V Hasani IV million members of the Unification Church” He said the indictment was even “more significant than what happened to (slain Egyptian President Anwar) Sadat Rev Moon is the most significant religious figure in the world” If convicted Moon and his aide could get up to five years in prison on the charge of conspiring to cheat the government of income taxes and three years on each tax count Both defendants were to be arraigned on the indictment Oct 22 in US District Court here Leaders of the sect said Moon was “out of the country” and would not say whether he would return to the United States to face charges In a separate case federal investigators are trying to determine whether Moon and hundreds of his followers had improperly obtained residency status in the United States The Justice Department said last June that deportation proceedings might begin soon Moon’s goal is the formation of a world “family” in which all religions and races unite before God But in this country it has been accused of brainwashing young converts and of using status to buy up property and carry g on businesses tax-exem- pt profit-makin- homes were nursing evacuated as water in Sand and Two parts of Texas today and National Post Oak Creeks spilled over the Guard troops were activated to de- banks M-60- King Hussein Representatives of the church denied the charges claiming their organization was being hounded Mose Durst president of the Unification Church in the United States called the indictments “the attempted assassination of Rev By United Press International A new wave of storms devastated There were these developments Thursday which apparently led to the administration’s concern that things might be getting out of hand: — An accusation by the Soviet newspaper Izvestia that the joint military exercises planned for next month are “part of a secret plan of overthrowing the Libyan govern- US-base- grand jury 3 Texas flood victims ©f woiir w®orirn©s U State Department spokesman Dean Fischer said the statement was “intended to serve as a warning to the Libyans and also meant to emphasize the deterrent nature of the actions we have taken in recent days” “There is a concern that the escalation of tensions and rhetoric associated with it could lead to the very situation we hope to avoid which is the continued escalation of tensions and the possible outbreak of hostilities” he said But at the same time Fischer accused Libya of frequent and “serious attacks” against the Sudan Egypt’s southern neighbor in recent weeks founder and its members a church official says The evangelist and South Korea from businessman was indicted Thursday along with one of his top aides The indictment accuses Moon of filing false personal tax returns for 1973 1974 and 1975 and failing to report about $112000 in interest earned on bank deposits in those years Moon also was charged with failing to report $70000 worth of stock he and his wife received in a trade for merchandise in 1973 Takeru Kamiyama 39 an aide to Moon who lives in Tarrytown was charged with conspiracy aiding in the filing of Moon’s allegedly false returns for 1974 and 1975 committing perjury and obstructing the investigation The perjury counts stemmed from alleged false material declarations under oath before a federal Moon and the Guard's assisting Williams- These tensions can “feed upon each other” he said increasing the danger of fighting But he said the United States has been trying to defuse the tensions through its actions including the expansion of next month’s military maneuvers with Egypt the dispatch of two AW ACS radar planes to Egypt and the speed-u- p in arms deliveries to Sudan and Egypt A Pentagon official said the United States plans to rush to Sudan before the end of this tanks about a dozen year about 20 155mm artillery pieces and two jet fighters to help strengthen that country against hostile Libya The official who asked not to be identified acknowledged that the amount of military power represented by the $100 million worth of gear which will be drawn from US stocks is relatively small But he said it is important in a symbolic sense to Sudanese leaders Fischer meanwhile said the possibility of d 2 bombers to bomb an sending Egyptian target range during the Bright Star exercise is still under consideration “We wish to emphasize that all of the security-related actions that we are undertaking with our friends has the purpose of helping to defuse the tensions through deterring possible hostilities directed against them” he said “We are confident that the responses are having this sL- - only by parents but by the damaged offspr- al National Guard troops were or- The new flooding was caused by another bout of thunderstorms that dered to help evacuate residents of rumbled through Sherman Texas where flood wa- Texas early today Rains also ters reached the second story of struck the sprawling Dallas-For- t some buildings Worth area The National Weather “We’re having hell” said a Sher- Service reported from 3 to 5 inches man police dispatcher “We’ve of rain fell evacuated about 150 people so far west Texas over north and northto the They’re being taken Sherman West Floodwaters from earlier storms Municipal Building north-centr- al had begun to recede Thursday but water” “It’s a mess” said patrolman driving rains pounded the South is under David Wood “We’ve got every Plains late in the day and auboat we can get our hands on out thorities said three people were helping with this There’s two ma- killed in highway accidents It was jor creeks that go through town and not determined whether the deaths were weather related they’re both out of their banks” Leadership in the Middle East Israel Iran Despite recent strains m relations Israel under Prime Minister Menachem Begin remains the most dependable U S friend in the region The closeness of U S Israeli ties often seems excessive to both sides But widespread support for Israel here and Israeli isolation in the world ensures that the ties will continue to bind Begin s claims to a Biblical Is'aei including the occupied territories continue to strain the relationship Israel s dependence on U S military economic and political aid has become acute Once America s strategic linchpin in the Persian Gulf relations with Iran and its leader Ayatoitan Ruhollah Khomeini ae virtually nonexistent The rule of Khomeini apparently is falling apari with no succes sor in view The only points on which a maionty of Iranians might agree today is hatred of the U S Soviet Union Iraq and each other Saudi Arabia With its small population and larqe vulnerable oilfields the kingdom under King Khalid tries to keep a low political profile avoiding trouble by steering a course between Arab and American concerns The moderate leadership of King Khalid and Crown Prince Faisal has become even more important to the US in the wake of Sadat s murder But the Saudi rulers keen to internal criticism are wary ot becoming as closely linked to the U S as was Sadat The Saudis eight point peace plan tor the dispute now may achieve new prominence Libya The U S has no more bitter relations wi'h any country m the region although Lmya continues to sell most of its oil to the U S The mercurial Col Moammar Khaddafy ust concluded an alliance with Ethiopia and South Yemen directed against Saudi Arabia and Egypt He often threatened to overthrow Sadat and the Saudis The Reaqan administration has tried to find ways to punish radicals such as Khaddafy who support terrorism but so fa’ without any affect Khaddafy s gleeful rhetoric about Sadat s murder infuriated U S leaders but he specifically has been exonerated bom any ties to the assassins Arab-Israe- Jordan Jordan traditionally an American friend has been fence-sittinsince the Camp David accords three years ago King Hussein has lasted more than a quarter of a century on his throne playing factions and interests against each other and the present is g no exception He sided with Iraq m its war with Iran in part to gam a more prominent role in Arab councils His reluctance to Oin Camp David won him new respect in the Arab world Syria Syria has been a leader of the Arab reactionist front Strengthening relations with the Soviet Union following the Camp David accords President Hafez Assad s once cordial relations with the U S have gone into a deep freeze Domestically he has his own problems with Moslem fundamentalists His rulinq Alewite minority supported by the Soviet Union has managed to keep the lid on Syria in pah by military adventures in Lebanon Iraq Relations between Iraq and the Soviet Union cooled as the Soviets declined to supply large amounts of arms for the war with Iran The U S and Iraqis have discussed improving ties but iitiie has come o it Under President Saddam Hussein the Iraqis cite U S support tor Israel as a stumbling block and U S officials say they are in no hurry to get mixed up with Hussein s regime Cf’tdH 1 Du t1 UMpr Sudan Egyptian officials have called for more U S aid tor Sudan led by Prime Minister Gaafar Nimieri to prevent an invasion they say Libya plans as a first step to attacking Egvpt and Saudi Arabia U S officials say the Libyans already have begun creating mischief inside the Sudan but an invasion is not imminent The Libyan threat pushed Nimieri out of his long held neutrality and into an open alliance with Egypt South Yemen The Soviets and Cubans have established themselves here helping Pa'estimans run camps tor terrorists At Saudi insistence the U S has supplied aid to North Yemen which has fought Prime Minister All Nasir Muhammad Hasani s South Yemen Hasani s Soviet client state is a key imk in a new alliance of Libya Ethiopia and South Yemen aimed against Egypt and Saudi Arabia The PLO The PLO s Yasser Arafat continues to walk a line between extreme radicals and more flexible elements in the Palestinian community In the wake of Sadat s death he may renew active diplomacy amonq European leaders receptive to hm in the past The U S has ruled out direct talks with the PLO but used the Saudi Imk during the Summer to help arrange a cease tire between Israel and the PLO |