Data from reference 6. See disclaimer. Most notably, US maternal mortality rates declined steadily from the beginning of—and throughout—the great depression of the 1930s (Figure 2). Life expectancy in the United States and the developed world basically doubled in the past 150 years, and a decrease in maternal mortality is ultimately a big reason for our longer, healthier lives. Annual maternal mortality rates attributable to puerperal fever and to all other causes (logarithmic scale), in England and Wales, 1920–1945. Forceps, episiotomies, anesthesia, and deep sedation were overused. Although there was no change in social conditions, maternal mortality rates decreased within a few years from 900/100000 births (compared with 400–500 maternal deaths in England as a whole) to 170 maternal deaths and this low rate was sustained (15). Despite the poverty, maternal mortality rates were ≈10 times lower than those in the nearby city of Lexington and the United States as a whole (Table 1) (6). Although there may be differences in detail, it is probably safe to say that in developing countries with high rates of maternal mortality today, the rank order of causes is reasonably similar to that in Britain in the 1870s. The classic explanation for why human infants are born at such an early stage of development has to do with anatomical limits on women’s hips. The Cochrane Collaboration, a highly respected organization that carefully judges medical treatments, analyzed the available evidence—which is admittedly a bit of a mess.

Oxford: Clarendon Press, 1992] that shows maternal mortality stretching back in history and, as you go back, it goes up very slightly and then we lose track because there really are no data as yet. Things got worse as obstetricians started professionalizing and coming up with new ways to treat—and often inadvertently kill—their patients. Hospital deliveries, however, were so few that national maternal mortality rates were only reduced if antisepsis was used both extensively and properly in home deliveries.

The midwives and doctors, though—they’re still tangling. Recorded separately as hemorrhage and placenta previa. It is impossible to know what would have happened without this system of continuous audit, but the reports certainly give the impression that they identified the avoidable maternal deaths and led to ways of preventing such deaths. There is little historical record of popular birth control use during this time due to the taboo nature of the subject, but the widespread practice of extended breastfeeding helped with child spacing, and coitus interruptus, or withdrawal, was a traditional and often-used birth control method. If you trace back infant mortality divided into neonatal and postneonatal mortality right through the 19th century, postneonatal mortality rates were much higher than neonatal rates, and that continued into the 20th century. Pregnant women are sapped of energy.

By the late stages of pregnancy and during childbirth, almost anything can go wrong. Here the evidence comes almost entirely from Britain.

Maternal mortality rates during deliveries undertaken by the Kentucky Frontier Nursing Service, 1925–1937, compared with maternal mortality rates in other local and general populations of the United States in the same period1. The vast majority of births in the 19th century happened at home and were attended by traditional midwives who obtained their training through practical experience. These drugs relieved pain and erased the memory of the birth, but they also caused complications in childbirth for mother and baby, and they did not improve maternal or infant mortality rates. (Psst, guys, you know what makes an excellent 35th birthday present for your partner? In contrast with the above findings, maternal mortality rates were very high in countries, states, regions, or areas where most deliveries were performed by physicians, especially in the hospital. Rich women could afford doctors. Life expectancy for women was below that of men, and the 1850 U.S. census shows the infant mortality rate at 28 percent. This is purely a point of academic fascination, discovered by Professor Wrigley. There is overwhelming evidence that social and economic conditions were very weak determinants of the levels of maternal mortality, whereas the standard of obstetric care was a very strong determinant. Doctors focus on risks and complications; midwives focus on a pregnant woman’s comfort. The potential relevance of these findings to developing countries is discussed. Pediatric undernutrition defined by body composition—are we there yet? And it turns both sides into caricatures of themselves. This is called the “obstetric dilemma” hypothesis and it’s been dominant for years, but it’s almost certainly wrong, or at least not the full story. That’s way too many, but a century ago it was more than … Their religion, however, led them to reject all forms of orthodox medicine, including the services of obstetricians and midwives.