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.
Today, induction of labour is known to increase the risk of PPH. Find out more about postpartum haemorrhage.
…
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.
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So, it seems that doctors were and are the cause of maternal death! I wonder then why maternal and neonatal mortality is far less nowadays than before . Oh ! I forgot ! It is because the midwives ( who are clean while doctors are spending their time doing autopsy ) conducting more deliveries, not because the infection rate dropped after doctors invented the disinfectant and antibiotics to decrease postpartum infection. . It is because midwives conduct more deliveries and they are kind enough not to cause trauma to the birth canal not because doctors spend their lives to search for causes of contracted pelvis and end up discovering that vitamin D deficiency ( or may be midwives discovered it ! ) and lack of mobility are the main causes of the problem, then again doctors searched to the proper doses and formula to prevent it .. and now your article discovered that the main cause of postpartum hemorrhage is trauma ? So it is not atonic uterus ( which is mainly caused by prolonged labour due to lack of monitoring and lack of proper antinatal care )which in now prevented by using oxytocin . Well let me remind you by another cause of maternal mortatilty in the past .. that was ruptured uterus again after prolonged labour with narrow pelvis.. it was not a doctor who first did CS to save both the mother and her baby ?! .. Please remind me who first tried blood transfusion ? They must be midwives also ! And the last sham on doctors who invented induction of labour . That terminate mothers with preeclampsea or diabetic mothers for example. . OK .. let mothers avoid induction of labor and face death with fits, respiratory failure, intracranial hemorrhage or diabetic coma with such complications , rather than having their babies safe and get the chance to raise them with induction of labor !
Well as a doctor I felt unappreciated. . As a lady I felt sorry for you ! I used to work with wonderful midwives, who never felt that inferiority. . We worked as a team with respect and appreciation. . It is not necessary to get some one down so you reach higher position. . Doctors give all their time and effort to support their patients. . I am not saying they are God ., still we are humans and proud, we may do some mistakes, but we are trying our best not to .. thank you for your time and patience to read my comments and I am sorry if I had offered any reseonable person
It’s a shame that you’re offended by this article, which is based on what happened in the 1700s. Facts are just facts, not taunts. And these facts are from very long ago, and are not reflective of current practices or attitudes these days.
Although doctors were inducing women with misoprostol a few decades ago, until they realised it was the cause of ruptured uteruses and lost babies. So now it’s only used for termination. Xrays on pelvises of pregnant women… there has been so much devastating learning along the way.
Have you seen the documentary, The Business of Being Born? Loads of fantastic experts including Ob/Gyns feature in it.
We’re very grateful for doctors who are able to save lives today.
This article isn’t about current medical practices, but about causes of maternal morbidity 300 years ago.
Dr. Iman Bastawisy,
I will take issue with a couple of your complaint points. Prolonged labors causing atonic uterus. First, prolonged labors are not caused by lack of monitoring or antenatal care. The more monitoring, the higher the likelihood of prolonged labors. During labor, moms need to be up and moving. That means no epidurals. They need to eat and drink during labor. This keeps their strength up. And they don’t need to be in lithotomy position for delivery. That’s only for the doctors convenience, bad for moms.
As for your wisecrack about doctors performing the first c section to save a woman’s life, the first c section b performed that the mother actually survived was done by a farmer in 1500, not a doctor.
Childbed fever was caused by doctors, who had no clue that they needed to wash their hands between patients. Simple fact, recorded by history. Many times excessive bleeding was blamedon imbalances of humors and was treated by being sliced open with a filthy blade, sometimes leading todeath more rapidly.
The reason midwives were the safer route for birth is because while they didn’t wash hands either, they were caring only for one patient.
Sorry, doc, but while doctors have saved lives, they have also made normal childbirth far more dangerous than it ever was before.
Dr Bastawisy,
History shows us that pride and defensiveness lead to deaths and needless negative outcomes when it comes to health. No one is criticising doctors, surely if there’s one profession everyone appreciates, that must be it. However, whether it’s wasting time accepting germ theory because no doctor would intentionally do anything wrong, or refusing to accept different models of birth for the same reason, the outcome is the same. Your response boils down to: “Accept what doctors do without criticism, or take your chances on your own.” I know for a fact that people become doctors because they care about others and want to help them. I always wonder to myself how so many fellow health professionals manage to lose the humbleness they started out with. We don’t need appreciation, the benefit of the patient is sufficient. And no, I’m not a midwife.
I know you love what you do the same way I do, which is why I say to you, put aside that instinct to defend your profession. It’s already top dog, no one can tear it down. Their criticism, when listened to, can only make it better and make practitioners better too. That will in turn make lives better.
Well said! Great response.
There is no such word as humbleness. The correct word is humility. Actually not all people who become doctors do it to help people. Many did it to help themselves, to become wealthy. However, because of insurance companies most doctors today are not getting wealthy. I think many more are now doing it because they do wish to help people.
This does not apply to cosmetic surgery which is still very lucrative.
Thankyou Sam. I love your article and have to concur that introducing men and medical models to women’s business of birthing has had devastating impacts on women and babies. Midwives and women have known for thousands of years that things like ‘lack of mobility’ during labour contributes to ‘failure to progress’. It was male medical professionals who placed women on their backs during labour, so that they had a better view! Similarly, midwives and women have known for thousands of years that the uterus engages in practice contractions for weeks or months before labour….this wisdom was not discovered by ‘Dr BraxtonHicks’, who claimed to be the first person to know about such contractions and hence named them after himself. Many of the so-called ‘discoveries’ of modern medicine relating to safe birthing practices are actually a return to what midwives and women intuitively knew for thousands of years before modern medicine started instilling fear and self-doubt in pregnant and birthing women. There is no doubting that there are times when modern medicine has an important place and saves the lives of mothers and babies, but you will never convince me that current Caesarian rates, sometimes as high as 45% in private hospitals where Obstetric care is often the norm, are due to women’s bodies not being able to do what nature built them to do. The high Caesarian rates have a strong correlation to current medical interventions and fear-mongering. Dr Iman, it makes me even sadder when it’s female doctors colluding in such ignorant, arrogant madness. Go and do some midwifery training, spend time with female midwives, and challenge yourself to standby and unobtrusively watch natural birth unfold in safe environments where women are afforded women-centred care….I promise you you’ll walk away a better, much more humble Dr than your previous comments reflect.
Kim, wondering where you are that they have stopped using misoprostol to induce women? In the U.S. it is still being used pretty routinely. I was offered Cytotec 3 years ago despite my birth plan very explicitly stating that I did not consent to its use and a year ago my doctor was going to give it to me postpartum before my husband told her to find something else. I have seen numerous women in various birthing groups during that time being induced with it, never told the dangers it seems.
Sorry, that was meant for Kelly.
They stopped using Cytotec in the US for VBAC (vaginal birth after c-section). We don’t use Misoprostol here in Australia for induction at all, as far as I know.
If you haven’t seen this clip about it, you can find out more: https://www.youtube.com/watch?v=DKZAoEPjHbY.
Here is the RANZCOG link to information on misoprostol use in Australia.
This is a poorly written article that ignores the real causes of maternal death. Poverty, malnutrition and too many closely spaced pregnancies were the main causes leading to maternal death.
Yes, poverty which of course goes hand in hand with malnutrition is a contributing factor, Having too many babies and close spacing is also a problem even today, but they are not the main causes of maternal death, which was and still is infection. Excessive bleeding is related to anemia I think, but now we have pitocin (the synthetic form of oxtocin) to stop bleeding, and if you wish to do it naturally, when the baby sucks at the breast, bleeding slows & usually stops. This is because the sucking action releases oxtocin in the mother’s body. Some newborns will suck immediately, some have to learn to do it. (spelling errors in pitocin & oxtocin, I think)
My mother passed away giving birth to me back in 1966,she died from Toxemia,I’m wondering can it be the cause of my problems in life,health wise,my body pains daily,all my life and swells all the time,can you help me out here,can a child really be affected by mother,I suffer from uncomfortable high blood pressure as well,never knows when I’m going to feel bad,no warning!!#
The article itself confirms that poverty never was the main cause. Countryside people actually were safer from stillbirth.
Thank you very much for this insight. As a Dianetics Counsellor I have come across people having severe birth trauma. I luckily researched and found myself an amazing midwife and doula and was able to have two very happy drug and intervention free births. This article explains how and why birth is such a point of anxiety for many women ( and men).
PPH, infection, eclampsia, been the same killers for a long time.
True, but not on such a grand scale, thank goodness. So glad doctors wash their hands now, especially after attending to dead patients 😉
Don’t forget the rhesus factor. Thank goodness we now have the anti-D injection!!
Hi, Interesting article…..One fact about princess Charlotte that I read …. There was intervention during her labour. It consisted of multiple Bleedings….This was done with the patient sitting up until she began to feel faint… Very likely by the time she gave birth…her clotting factors would have been all used up. We can only wonder whether not being bled would have made a difference. Not anyones fault…just standard practice of the day.
I gave birth to my 3 children at home, the first in 1972 when I was 21 years old.Almost 8 yrs. later I had my second home birth, and 5 yrs. later, the third. All went very well with experienced and competent midwives. All healthy babies and myself of course. Only healthy mothers are candidates for home birth.
Midwives are experts at screening for problems which could lead to complications. Of course, high blood pressure, smoking/drinking/drugs or diabetes, all disqualify a woman from having a home birth. I had complete confidence in all my birthing practioners. One was a lay midwife, one a certified nurse-midwife. My oldest daughter witnessed the births of her younger siblings. My own mother witnessed the birth of my second child & afterwards said she wished she had her own babies at home.
I understand the various complications that women are subject to during childbirth, but I still wonder WHY. Why are human women so feeble compared to other mammals when it comes to pregnancy and childbirth? While it’s true that all animals can and do suffer pre- and post natal problems, the scale is almost incomparable when it comes to humans. For instance, the average, adequately fed animal in a reasonably safe habitat will gestate normally and deliver a baby without assistance of any kind… no special nutritional supplements, medicines or hygienic protections required, and no doctors or midwives. I understand a human infant’s head is disproportionately large to the size of the pelvis and birth canal, but the same is true for elephants. Are our bodies just inferior to everything else that reproduces?
I think a big problem is in our minds. From the day we are born we are told that childbirth is dangerous and have been told for centuries by now. So instead of trusting or body and leave ourselves to follow it we try to control everything which will result in stress rather than relaxation.
I have no proof of this but my opinion is that animals don’t think like that, they find a good spot and they let themselves in to their birthingmode and following their body without thinking “what if”. we should learn from them
I agree with you terese….. I’ve had both of my girls in a hospital, not really how I wanted to but , but it’s good to have people there just in case of an emergency…but .. honestly I hate to say it but at the rate things are going the only way women will be able to have natural birth years from now is if your child is practically half way out of you by the time you get to the hospital… doctors are soooooooo quick to hook you up to pitocin and give you a time frame of when the baby needs to be out or they will have to do a c section… what mother in labor wants to feel pressured in that way or rushed when it’s suppose to be a relaxing time,and a great mother child bonding experience… I dunnno it’s really hard to find good obgyns who are going to be there when you go into labor now they make you see all 30 of the doctors bc who knows which one will be on call, -and then the doctor whos on call is just trying to hurry up and get home… doesn’t anyone actually just take pride in having a few patients and let them have a good delivery in hospitals… everybodies always in a rush… and FYI I’ve been on both sides I did my clinicals in labor and delivery so I’ve witnessed the doctors side from several different hospitals and then I’ve been through a terrible delivery which resulted in emergency c section and there’s the possibility that the c section could have been avoided if *health care providers * would actually stop and listen sometimes..
Many mothers were teenagers, as young as 13. Most teenagers have underdeveloped pelvis with results in obstructed labour..