My understanding is that birth became dangerous when doctors started getting involved in the business of birth- going straight from autopsies to delivering babies and giving moms infections.

Prior to that, yeah, there were certain specific complications that are currently handled via c/s today. Those aren't particularly common, but in a time and/or place where c/s isn't an option, those situations are likely terrifying for the whole family and community.

Between the reduction in doctor-caused infections, and the appropriate use of interventions, doctors like to claim that they've "saved" women from "the horrors of childbirth."

I think that with medical minded people, the best thing you can do is point out modern studies on homebirth safety vs hospital birth safety. Plus you need to emphasize that hospital transfer IS available in the case of a true emergency.

 

• Iatrogenic puerperal fever
  
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  Hospitals throughout Europe and America consistently reported death rates [just from puerperal fever] between 20% to 25% of all women giving birth, punctuated by intermittent epidemics with up to 100% fatalities of women giving birth, in childbirth wards.

  Also see the Rejection of Semmelweis by the Medical Establishment
  
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  In the autumn of 1860 at Vienna General Hospital, long after the dismissal of Semmelweis, in the same ward where he demonstrated how to virtually eradicate childbed fever, 35 of 101 patients died.

• Pelvic deformity caused by corset use in girlhood and by lack of vitamin D (due to restriction of sun exposure and lack of food sources/fortification)
• Lack of access to emergency care for abnormalities such as hemorrhage following miscarriage; bacterial infections; and prolonged obstructed labor
• Lack of sanitation

The last two remain leading causes of maternal morbidity and mortality in developing countries, along with general malnutrition and the after-effects of female circumcision.

 

There are 3 main things that come to mind for me concerning this issue:

One has been mentioned--the doctor (and especially the hospital) take over of birth that occurred during the time frame mentioned. And did you know that Europe accepted Semmelweis' premise, and adopted handwashing for doctors, some 30 or more years before docs in the US did? Europe thus seeing an immediate reduction in deaths by childbed fever, 30yrs before the US docs managed to quit killing women by dirty hands --after having persuaded women that their midwives were dangerous quacks and they/the hospitals were the safest, most advanced and scientific way to go for birth.

Another was also mentioned, and I have read that this is the true reason for the drop in maternal and infant deaths--and really, stands still as the main 'friends' of mothers and babies even now: the combined effects of better sanitation and better nutrition.

Finally, in the US during that time frame, so many people were leaving the cities of the East Coast and coming West. They were leaving behind the midwives and even the dubious help of the doctors that women had been using, and going it much alone (or in very small communities) as pioneers. These families had neither the benefits of their former birth helpers, nor the benefits of what the Indians had in their mws and birthways...the pioneers had not yet learned about the local herbs for health/healing. Also with this, for a long time while these pioneers were trying to get established in new territory, they had to deal with issues of hunger and lack of good shelter as they were building homes and getting farms/food supply on track.

Birth has never been any more (or less) dangerous, at any time in history, really. It has always worked the very same way: when a woman has reasonably decent food, shelter, warmth available, as well as clean water and the form/s of birth support she feels safest with, the most frequent result is a healthy mom and baby. Moms who are hungry or at least malnourished, who are struggling to stay warm and fed, do not have adequately clean, abundant water available nor sufficient community nor form/s of birth support that help her feel safest, you see more dead/damaged moms and babies.

But it is certainly true that those who believe in medical care, and don't really trust birth, often like to cite this far greater rate of infant and maternal mortality of 100-200 yrs ago as 'evidence' that it is advances in medicine that are responsible for better stats now. I have heard this so often!

 

THese days we have some of the worst infant and maternal mortality rates in the industrialized world. Some third world countries lose fewer babies and mothers than we do. Once the cesarean rate goes over 15%, mothers die for no reason and we're at twice that.

 

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Originally Posted by Contented73 Well, I've always wondered just how often women did die in childbirth 100 or 200 years ago. I've wondered exactly what the causes were. Honestly, sometimes I wonder if it isn't just our culture which has taught us to be afraid and think that women died so easily in childbirth. I mean, obviously far more women died previously than do now - but I wonder if maybe the majority of that was due to infection or lack of good nutrition. Does anyone have any information? Studies? Evidence about this? Or maybe a birth professional can share how they respond to a comment like this.

100 years ago is different from 200 years ago, which is different from 300 years ago -- which is different from 500 years ago...

It also varied widely by urban vs. rural, by poor vs. rich, by ethnic group... because much of what affects maternal mortality is maternal health related. Mothers in northern climates, with poor diets, often had rickets, which could cause real problems in birth. Cultures that married girls off too young had higher rates of maternal mortality. For a long time, women in cities had higher rates of mortality than women in the country.

There aren't any widespread statistics, but people have used records available from one town that had a priest or midwife who kept good records and reconstructed rates. In general, prior to the widespread use of childbirth wards and doctors, they're much lower than most people expect - 14.4 per 1000 in Florence in the 1400s, for example.

Aha... a little time in the U archives produces this:

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Reconstructing data from 13 parishes, Schofield (1986) tried to distinguish deaths associated with childbirth from other deaths and to estimate maternal mortality in the period 1550-1849. He concluded that mothers died at ratios that dropped steadily: 157 per 10,000 in the period 1650-99, 113 during 1700-49, 77 in 1750-99, and 55 in 1800-49. Those estimates were far enough below what his- torians had assumed to lead Schofield to conclude that, far from dreading childbirth as a great hazard, women in the past considered death in childbirth 'such a rare event that there was little risk that the tragedy would befall them' (Schofield 1986, p. 260). Loudon (1992) found that maternal mortality in England declined from the range of 125-210 deaths per 10,000 deliveries around 1650 to about 55 deaths in the period 1800-70. Wrigley et al. (1997) found a level of 170 deaths per 10,000 birth events during 1650-74, which declined to 47 deaths in the period 1825-37. The maternal mortality ratio that Schofield reported for the first half of the nineteenth century remained little changed in the second half. Loudon shows that mothers in England and Wales died at ratios between 47 and 50.9 deaths per 10,000 births in the period 1851-1900. After the nineteenth-century plateau, the ratio dropped slightly to about 40 deaths per 10,000 live births in the period 1901-30, and then more sharply to 16.8 deaths in 1941-50 and to only 1.2 deaths in 1971-80.

Riley, JC (2003). Did Mothers Begin with an Advantage? A Study of Childbirth and Maternal Health in England and Wales, 1778-1929.
Population Studies 57,(1), 5-20.

 

hmm...I've seen OBs cite a 10% death rate for childbearing women before "modern medicine" came along. These numbers are higher than we expect today, but they don't look anything like 10% to me.

...although I do find the 20-25% with occasional epidemics of 100% to be truly terrifying. How on earth did they manage to sell the idea that the hospital was the place to give birth with deaths happening at that rate on the wards???

 

maternal mortality rates were higher in the "olden" days. of course, it's a complete exaggeration to say women used to die in childbirth *all* the time, because they didn't (obviously or the world would not be populated as it is today)

when doctors started taking over birth, maternal mortality rates did not decline, and midwife attended births at the same time had lower maternal mortality rates than doctors. i think it's really important that women recognize that it was *not* doctors who made birth safer.

when doctors first started coming into the field of birth, you have to remember that women were afraid of death and many also lived a life of pain after birth. women suffered from incontinence, fistulas, postpartum infections and unrepaired perineal tears, even worse if your pelvis was broken during childbirth (on purpose to deliver a baby) you would be paralyzed and in pain for life. these were real fears that women dealt with every time they became pregnant.

when doctors came along, they did have techniques that could help. when wisely used, forceps could help women deliver babies safely and ensure a live infant. of course, what happened was most doctors abused the use of forceps and so many women and babies suffered because of forceps. but still, when women realized that doctors could potentially make childbirth safer and shorter, they embraced it. it became fashionable for higher class women to call in doctors.

hospitals were first established for poor women. over time hospitals became more popular because doctors basically insisted on it. they did not like homebirths because they felt female birth attendants were too meddlesome in their own efforts to control birth, and doctors also argued that it was too hard to keep homebirths sterile the same way they could in hospitals.

for the most part, women and midwives were not allowed into medical schools or to take any kind of formal training and that decreased the numbers of midwives. it was also ridiculously expensive to go to these schools and very few women could afford to go.

women believed that the education men were receiving was superior to that of the midwives and that is also part of the reason women turned to doctors. and doctors did set out to get rid of midwives. doctors were smart enough to recognize that most birthing women still preferred female attendants and knew that could affect their money making potential. doctors worked hard to ruin the reputation of midwives.

 

It also seems important to draw a line between "death in childbirth" and people dying of pueperal fever -- generally contracted because of people sticking hands and instruments into the birth canal that weren't clean, and women contracting infections because of them, and which seems like it was really wide spread.

That's a whole different ballgame from women dying IN childbirth -- ie. during labor, before or suddenly after the baby is born. My understanding is that most of these deaths were either from pelvic deformity due to rickets, which is a disease of malnutrition, or that they were issues of postpartum hemmorage.

But none of those things have anything to do with modern midwifery or homebirth. I mean, we ALL know that we've got to wash our hands now, right? Okay, some people in my office appear to have missed this memo... but generally, the germ theory of disease is pretty well respected among all medical professionals. So it's not like doctors are or ever were safer because of handwashing. And rickets just aren't an issue anymore with modern diet. As far as hemmorage, midwives use exactly the same methods to control an emergency hemmorage as doctors would -- pitocin.

So in the end it's kind of a straw man argument to bring up, you know?

 

Women historically, and currently in the Third World, die in childbirth pretty frequently. And so do infants. Lack of skilled birth attendants is a big contributor to those deaths.

However, less interventive, less medicalized birth as we know here it is different than those conditions, because women tend to have better nutrition at this time in the developed world, and medical help is available if needed. You know? It's not like most women who die in childbirth die of a sudden emergency that could be saved at the hospital, but not at home. Babies get stuck, labour fails to progress, medical emergencies develop over time and become fatal. If medical intervention was accessible within a reasonable time frame, many more women would survive.

Even unassisted childbirth here is nothing like unassisted childbirth in places where assistance is not just a 911 call away.

 

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Originally Posted by thismama Women historically, and currently in the Third World, die in childbirth pretty frequently. And so do infants. Lack of skilled birth attendants is a big contributor to those deaths. However, less interventive, less medicalized birth as we know here it is different than those conditions, because women tend to have better nutrition at this time in the developed world, and medical help is available if needed. You know? It's not like most women who die in childbirth die of a sudden emergency that could be saved at the hospital, but not at home. Babies get stuck, labour fails to progress, medical emergencies develop over time and become fatal. If medical intervention was accessible within a reasonable time frame, many more women would survive. Even unassisted childbirth here is nothing like unassisted childbirth in places where assistance is not just a 911 call away.

Yup. (Although I think the best thing we could do for "third world" mortality rates is better nutrition and better health overall; not that skilled, supportive midwives with back up medical care wouldn't be awfully nice also.) I truly believe birth is basically safe - but there are times (maybe 1-5% - when the cesarean rate drops below 1% we tend to see an increase in preventable maternal or fetal deaths) when medical intervention is helpful. Modern midwifery is NOT "just like olden days" - we know way too much for that. We know to avoid a lot of interventions that midwives used to practice. We can have patience about a lot of things midwives used to get antsy about, because worse comes to worse, we can transfer for a cesarean, and worse comes to worse back then was a call for the barber surgeon and his fetal dismemberment hook, or a call to a priest for both the babe and mama. We don't need to be afraid of labor, because we know it works 99% of the time, and we have the tools available to use to actually help the other 1%. We know more about the hormonal processes of labor and birth - we know the hormones for labor are the same as for love, and require similar conditions to optimize. We know SO MUCH MORE, and we have the luxury of doing so much less. I can't say I wouldn't prefer to have an "olden times" midwife to a modern obstetrician, but those aren't the choices, and hands down a modern midwife is safer than either, and for many women, modern UC is safer than either, too.

 

Arwyn, I really love your post. Maybe one way I could address this with my clients is to type up something similar to this, and include it in my info packet. Maybe something entitled "the safety of childbirth" or "overcoming fear about birth." One of the most frustrating things about being a doula is figuring out how to have a conversation about some of these things without seeming confrontational or debating. No one wants to get into a heated debate with their doula about how often women used to die in childbirth! No one wants their doula to make them look silly for believing what they believe, you know? Yet, the fact remains: childbirth is safe. Especially, as you say, when we know we have options for those few times when it becomes un-safe. And, most importantly, that modern OB care piles on layers and layers of things that really have nothing to do with making birth "safer."

 

There's a section towards the end of "Ina May's Guide" that profiles several midwives from several centuries ago who kept meticulous records of their maternal mortality rates. They all had as good as, or better, outcomes compared to US maternal mortality rates in the 1930s. That is probably the most convincing argument that women did *not* die in droves (when they weren't in hospitals before hand-washing, that is) even several centuries ago.

 

"Women used to die in childbirth all the time"
"So what. If it was that dangerous humans would be extinct."

I've told exactly that to several people. Yeah it might sound cold and unfeeling, not that I don't feel bad for those women and their babies who grow up without a mother, but their bad luck isn't going to stop me from giving birth the way I want to, which is out of a hospital and away from dangerous interventions and unethical treatment.

 

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Originally Posted by Arwyn Yup. (Although I think the best thing we could do for "third world" mortality rates is better nutrition and better health overall; not that skilled, supportive midwives with back up medical care wouldn't be awfully nice also.) I truly believe birth is basically safe - but there are times (maybe 1-5% - when the cesarean rate drops below 1% we tend to see an increase in preventable maternal or fetal deaths) when medical intervention is helpful.

I believe the figure is 10% - this is what WHO says. In practice you'll always have slightly more than that because of erring on the side of caution (no major industrialised country has a CS rate of less than 15%; also, increased use of ART is going to raise that figure slightly).

Childbirth did kill women once upon a time, and we'd be stupid to deny that. Modern medicine has solved this in more ways than one--not just through obstetrical advances but improvements in general health such as research into diet. But this doesn't justify all intervention. If we simply gave all women an elective CS (no I am NOT suggesting this!) we'd avoid some problems but we'd give ourselves a whole host of new ones. I like to think of modern medicine as a set of tools. It's nice to have access to those tools, but you don't need to use all of them all of the time.

 

Sorry, can't type--nak.
Just read Birth by Tina Cassidy. Lots of info a/b this topic, and a quick/easy read.

 

Another factor that might be significant is the advent of birth control, and various factors that have reduced fertility rates (such as increased rates of female education). 100-200 years ago, married couples, as I understand it, did not decide "we're going to have X number of children." You did what you did, and if you got pregnant, so be it. While pre-agricultural women could expect to bear 2-4 children during their lifetime, the adoption of subsistence agriculture meant that women were more fertile (due to greater caloric intake and lower activity level) and might give birth 10 or more times.

The more times you do something that carries risks, the more likely you are to run afoul of those risks.

It would be interesting to see a plot of maternal mortality data against fertility data... I'd be shocked if there wasn't at least some correlation.

 

There are two developments in modern medicine that have specifically saved women in childbirth.

ONE: blood transfusions; this advancement can be supplanted by pitocin and ergots derivatives.

TWO: antibiotics and better antiseptics.

Neither of these require hospitalization for childbirth. Most women do not need nor do they have problems with bleeding or infections with proper attention to cleaning.

The hospitalization rate for pregnancy and childbirth would drop to 15%-20% if most women had to deliver at home and only go to the hospital in case of an emergency. Even then there would be a triage of what would constitute an emergency, as the difference between FTP and PPH.

Quote:

... While pre-agricultural women could expect to bear 2-4 children during their lifetime, the adoption of subsistence agriculture meant that women were more fertile (due to greater caloric intake and lower activity level) and might give birth 10 or more times....

OTOH, in my Women's History class at UCLA, the case was made that women's fertility has been declining steadily since 1700 in the western world, from a total average of six children per woman during her childbearing years. This does not mean that all six of the children lived to adulthood. This means that the woman who has ten is balanced by the woman who has two. it is an an average per woman. Today, the median family per woman in the western world is below 2.1, which is replacement level.

 

Quote:

Originally Posted by Ironica While pre-agricultural women could expect to bear 2-4 children during their lifetime, the adoption of subsistence agriculture meant that women were more fertile (due to greater caloric intake and lower activity level) and might give birth 10 or more times.

I heard a documentary on the radio once about how this also correlated with the invention of porridge for babies, which meant less breastfeeding. Preagricultural women are believed to have breastfed for five years, whereas porridge made out of grains made it possible to breastfeed shorter to increase the number of children.

 

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Originally Posted by AlexisT Childbirth did kill women once upon a time, and we'd be stupid to deny that.

Childbirth currently carries a risk of death at 1 in 16 in sub-Saharan Africa, & in developed nations 1 in 2,800.

I once read a paper on maternal mortality in Zambia. I don't have my notes on it now, & I can't quite remember the figures, but the two biggest killers were pre-eclampsia (which goes un-noticed & un-treated if there is no antenatal care) & untrained medical attendants pulling on the placenta to bring it out.

 

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Originally Posted by TinyMama Sorry, can't type--nak. Just read Birth by Tina Cassidy. Lots of info a/b this topic, and a quick/easy read.

I read this book and photocopied the juicy pages, to have on hand for discussions like this....here's a quote from her 2006 book.

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Today, according to WHO: -25% of maternal deaths are from hemorrhage -15% from infection -13% from unsafe abortions -12% from eclampsia - 8%from obstructed labor (a category that includes placenta previa

she cited this from World Heath Organization's Making Pregnancy Safer fact sheet no. 276 Feb 2004

She also sez

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Americans may feel smugly safe, but twenty-five countries--including Qatar and Slovakia--have better records when it comes to mothers surviving birth.

and points out

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for all the perils a woman might face, birth is more than one hundred times deadlier for the baby. It has always been this way.

Which, in my opinion, would be quite a zinger to throw back at someone in a debate when they're talking about how women die.

I highly suggest Tina Cassidy's book as a reference for this tiresome debate--it's an interesting, well-written book.

 

I was recently looking into international maternal mortality rates, out of curiosity to find where the worst maternal mortality rates were and what they were. I believe the worst were Sierra Leone, Afghanistan, and Sudan. The numbers ranged from 1 in 6 to 1 in 10, roughly. In one of those countries, a woman had a 1 in 3 chance of dying from childbirth-related causes during her lifetime. The data was published by Unicef or the WHO depending on what data it was, exactly.

I think there's a tremendous difference between understanding hygiene, basic prenatal care, the warning signs of pregnancy or birth problems and having access to clean water and plenty of nutrition and . . . what women are suffering through in extremely deprived nations with poor access to healthcare, midwives who *do not* have the benefit of any real medical knowledge, and little or no access to uncontaminated water and food supplies.

None of this is an argument against homebirth or UC. I actually think it supports the safety of homebirth and UC. However, there is a perception that anything outside the OB medical model is inherently and terribly dangerous, and I think this is one major source of that perception. The other, of course, is the main focus of this thread, which is women dying a much higher numbers prior to more MD intervention in birth. I haven't done extensive research on this, but again, I think it's more perception than reality, and that medicine didn't really improve birth stats until hygiene and antibiotics, among other things, became readily available/used.

I don't think pregnancy and birth are themselves especially dangerous enterprises, but I do think the conditions under which they take place, and the level of skill available to treat problems that may arise, makes an immense difference in who lives and who dies. I'm with arwyn that the most important thing is probably nutrition and clean water, followed closely by skilled midwifery assistance.

 

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Originally Posted by Romana9+2 I was recently looking into international maternal mortality rates, out of curiosity to find where the worst maternal mortality rates were and what they were. I believe the worst were Sierra Leone, Afghanistan, and Sudan.

These are all countries that practice female circumcision, at least in part, no? FGM is a known contributor to birthing problems.

 

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Originally Posted by Contented73 I am a doula and work with a range of different types of people, with different perspectives on pregnancy and birth. Often when I am talking to someone who is more "medically minded" this eventually gets said.

I would probably point out that women still do...in fact, the maternal mortality rate went up for the first time in decades here in the US. I'd also point out that we're ranked second worst in infant mortality rates as well.

Quote:

Originally Posted by Ironica The more times you do something that carries risks, the more likely you are to run afoul of those risks.

This is actually an interesting way to look at it - especially because the OBs are insisting that the rates for c/s are going up precisely because women are having less children than they once did.

:

 

Quote:

Originally Posted by gcgirl These are all countries that practice female circumcision, at least in part, no? FGM is a known contributor to birthing problems.

I'm fairly sure that Afghanistan isn't an FGM culture. Also, it's important to distinguish between the different types of FGM; Types I and II, the most prevalent (roughly 80%), are not likely to interfere with pregnancy/childbirth. Where the extreme forms of FGM are practiced, these obviously do have major impacts on safe childbirth, but there are other factors at play in terms of maternal/infant mortality in cultures that don't have Types III/IV FGM going on.

 

Quote:

Originally Posted by gcgirl These are all countries that practice female circumcision, at least in part, no? FGM is a known contributor to birthing problems.

They are countries that are ravaged by war.