Although birth is the same process today as it was many hundreds of years ago, over time, the care women received during childbirth has seen some dramatic changes.
These changes have come with a considerable impact on the outcome for women and their babies.
We might assume that globalisation and advances in technology and obstetrics would have reduced maternal mortality and morbidity in the last few centuries.
But unfortunately, there have been some changes that impacted normal physiological childbirth.
While the birth process itself didn't change, the way we lived and cared for women did.
It's a sad fact that today, the United States has the highest maternal and newborn death rate in the developed world. And the rates are currently increasing, not decreasing.
But back to long ago: how is it that so many women died during childbirth, when women had increased access to medical care and hospitals? Were homebirths and midwives to blame for the deaths?
Why Did So Many Women Die During Childbirth?
It's not uncommon to hear people say things like, “Ha, you want a homebirth? In the olden days, that's why so many women died!” But they don't actually know all the details. Here are 4 major reasons why so many women died during childbirth and soon after:
#1: Changes in Maternity Care
Historically, birth was a home-centred, rite of passage. It included the birthing woman, her female relatives and usually a midwife. Midwives would advise on prenatal care and nutrition, preparing the pregnant woman for her labour, and the role of motherhood. Male surgeons were rarely involved in birth, unless serious complications occurred.
During the 1700s, male midwives began attending both abnormal and normal labours. Many were barber surgeons. Barber surgeons were medical practitioners who received a crash course in obstetrics before delivering babies — but without even having seen a real birth, and with very little understanding of the normal birth process. This led to many deaths, while the male midwives gained experience, and a better understanding that interventions caused more problems than they solved.
There was little prenatal care, other than fasting diets and blood letting. This was intended to ensure a small baby and easy birth. But disastrously, this left pregnant women weak when going into labour. A long labour would cause further exhaustion, and leave women with little ability to recover if they experienced complications, infection or blood loss.
Male midwives would often use instruments to ‘ease childbirth’ or shorten labours, with the result that babies and mothers were left with permanent injuries or even dead, due to blood loss or infection. Sanitation and poor hygiene were never considered to cause problems in those days, leading to further deaths that could have been avoided.
#2: Puerperal Fever (Childbed Fever)
Women who survived childbirth were often struck down a few days later with extreme stomach pain, fever and weakness. This illness, known as childbed fever, progressed very quickly. Death was the eventual outcome. No one understood why women became ill with childbed fever, but it was one of the biggest killers of childbearing women in Europe and America for many generations.
There were many theories surrounding the cause of childbed or puerperal fever, including bad air, vapours, cold, poor ventilation or ‘putrid tendencies’. Many treatments were tried, but few succeeded — or if they did, it appeared to be luck that saved lives.
It wasn’t until the mid 1800s that a Hungarian doctor named Ignaz Semmelweis made the connection between puerperal fever and doctors.
Semmelweis made the discovery that when doctors performed autopsies and then delivered babies — without washing their hands or changing their clothes — women would develop puerperal fever and die. He came to the conclusion that doctors were transferring parts of the autopsied corpses to mothers, which went on to cause infection.
Despite implementing sanitation rules for washing hands and instruments, as well as decreasing the death rate dramatically, Semmelweis was not applauded for his discovery. Doctors were offended by the accusation that they were responsible for causing disease, and continued to practice as always.
Death due to puerperal fever averaged rates of 25%. At times of epidemic proportions, it claimed the lives of 80-100% of women birthing in maternity hospitals.
Eventually, the germ theory of contagion was finally accepted, and strict guidelines for sanitation were adhered to. This resulted in an immediate reduction in deaths by puerperal fever.
#3: Obstructed Labour
During the 17th century, European migration from country to city was high. People were indoors more frequently, and their diet was less varied than those who lived in the country. This saw an increase in vitamin D deficiency, resulting in rickets. It became a very common problem in industrialised towns and cities. Rickets caused pelvic deformities, which had a significant impact on childbearing women.
Women with pelvic problems would often be in labour for many hours, even days. Lying down during labour had also become the accepted norm during this time, to provide greater ease and access for doctors, who had moved into the birth business. Often women were forbidden to drink or eat during labour, only being given sips of wine or spirits, and would become completely exhausted.
The methods of treating obstructed labour before the invention of the forceps would be considered barbaric today. Midwives would sometimes crack the baby’s skull, which would spare the mother from death. Doctors would use a number of gadgets such as hooks to pull babies out in parts, and this could caused serious complications for the mother that caused death later. Sometimes doctors would break the pelvic bone of the mother, which killed her but saved the baby’s life.
Even the use of forceps were not always successful, as the shape of early forceps were flat and not curved, and could only reach the heads of babies that were low in the birth canal, with mothers who had normal pelvises. C-sections were rarely performed, and if the mother survived the surgery, she was likely die of blood loss or infection afterward.
#4: Postpartum Haemorrhage (PPH)
Historically, excessive bleeding after childbirth (postpartum haemorrhage) was one of the leading causes of maternal death. It was feared by midwives and doctors alike.
Women who successfully gave birth often went on to die of massive bleeding and shock in the hours following. Little could be done to stop the haemorrhage, and the accepted treatment of the time was to pack the uterus with linen rags, dipped in wine or other astringents. Other treatments included applying heated compresses or taking herbal tonics.
In 1817, Princess Charlotte of Wales died of a massive haemorrhage after a 50 hour labour. The male midwife who attended Charlotte did not intervene during her labour, and his inaction was believed to have contributed to her death. The public outcry over this tragedy was significant and lead to the call for more ‘rational intervention’ for women during childbirth and after.
The year after Charlotte’s death, a British obstetrician successfully transfused human blood to a patient who had haemorrhaged during childbirth. This, and the use of ergot (which is an extract from fungi), paved the way for more successful treatment when postpartum haemorrhage occurred.
We have clearly come a long way from the days where women needed to rightly fear for their lives during childbirth. Looking back however, it does make us wonder what future generations might think of our birth interventions today.
While we saw a steep decline in maternal morbidity and mortality, we then saw a rise in some countries with an increase in the regular use of interventions. Fortunately, we are now seeing improvement, awareness and a call to action to improve the care, health and safety of our mothers and babies.
For an intriguing look into the history of childbirth, check out Tina Cassidy's fascinating, brilliant and yet sobering book, Birth: The Surprising History of How We Are Born.
Also, check out this eye opening clip from the documentary, The Business of Being Born.