I’ve been reading some novels and inevitably one of the women in them dies in childbirth.
Now all these were set in about 1900…
In one it was said the woman was old and a theraputic abortion was in order to save the life. But the religion wouldn’t allow it and so of course, according to the dictates of the religion they save the baby and sacrifice the mother.
Why did women die so much in childbirth in the old days…Did they hemmoridge to death??
There were a bunch of reasons why this happened (and some of them ares still possibilities)
Yes, women used to hemmorhage to death from time to time (they still can). The blood vessels supplying the placenta are pretty big, hence the bloodiness of childbirth. The vessels are supposed to contract and pinch off on their own, but they don’t always. Also, if something gets torn she can bleed to death that way.
Another reason is a pulmonary embolism - that’s when air (or possibily other gunk, like bits of afterbirth) get into the mother’s circulatory system, hit the lungs, cause breathing difficulties, and can even kill (still does, sometimes). If the circulating gunk hits the brain she can wind up with a massive stroke, if it hits the heart, she can have a heart attack. More fun with the circulatory system is “eclampsia”, a sudden rise in blood pressure that can kill if not brought under control.
Also, it’s possible to have a heart attack or stroke just from the effort of childbirth.
In the old days, if the mother and child needed a cesearean and either no one was around to perform it or know how to perform one both mother and child died. In the days of corsets and poor nutrition, a certain number of women had deformed hips that made it impossible to give birth the natural way and so they became statistics. Sometimes, after the mother died, they succesfully cut the baby out of her. Sometimes, if the baby was dead, they could cut it into pieces small enough for the mother to expell, but this was less likely to work and could also result in the doctor being brought up on murder charges if there was any question about just how dead the child was beforehand. It was also a pretty advanced technique and could result in the death of the mother through internal injuries.
And, of course, there was always the possibility of infection, which killed a lot of women.
There is also a bizarre form of cancer that can arise from pregnancy and childbirth. Untreated, it is almost always fatal, but if caught in time is usually curable. Needless to say, 100 or more years ago we didn’t have good treatments, if it was diagnosed at all it was late stage and terminal, and a certain number of women died of it. But it’s rare.
And there are all sorts of complicating conditions - such as gestational diabetes - that can be medically managed these days but way back when could prove fatal, if severe enough. In 1900, if a mother-to-be slipped into a diabetic coma there was nothing that could be done for her at all.
In the days before modern sanitation methods, post-partum infections were very common and often fatal. This was referred to as “childbed fever.” It became most common around the time that doctors started taking over the baby-catching business from midwives. Since this happened before germ theory was understood, it was common practice for a doctor to go directly from treating a sick patient (or, better yet, from the autopsy table) to delivering a baby without washing his hands.
Hemmorhaging and other rare complications certainly took their toll, but most women died because the people taking care of them didn’t wash their hands.
The baby’s blood goes through the placenta not the mothers. The 2 blood streams do not cross and nutrients and O2 (and waste and CO2 on the return) are exchanged by capliaries near each other but not mixing.
What could happen in the placenta could tear off the uterus wall and cause the mother to bleed.
Death during childbirth used t be a common occurence but with modern medical technology it is very rare today.
I wouldn’t say most–childbirth was still a very dangerous process when the midwives were supervising it, and before corsets became popular.
A few more conditions that are routinely treated today but which were invariably fatal in the past:
1)Placenta prevaria, where the placenta blocks the birth canal.
Breech births. Not invariably fatal, but often enough (and the inevitable tearing made a secondary infection even more likely) Breech births are really quite common–approaching 10% I think, though I am not sure.
Overall poor health of the mother going into it. Your pre-modern woman likely had half a dozen chronic conditions that three was no treatment for–yeast infections, allergies, lingering infections, malnourishment, absecesses. All these things made recovery from childbirth more difficult.
It was precisely because of this problem that led the Hungarian obstetrician Phillippe Emmanuel Semmelweis to undertake stusy into puerperal fever in Budapest sometime around 1850 (or thereabouts). While having no concept or understanding of microbiology, he was able to establish a link between poor hygeine and postpartum mortality.
He observed many cases of fever developing quickly after delivery, followed by rapid decline and death within the next day or so. In those patients he followed up with autopsy, he observed the telltale signs of gross infection: inflammtion and purelence (pus).
After years of angst he was able to establish that simple hygeine measures such as washing hands between patients and regular changing of bed linen achieved a remarkable decline in deaths. His published findings were howled down by the medical establishment of the day, who refused to believe that their day-to-day habits were the cause of so much carnage.
It wasn’t until the discoveries of Pasteur and others that Semmelweis was vindicated, and posthumously accorded his rightful place in medical enlightenment.
“Childbed fever” is caused by a bacterium called group B streptococcus. Generally speaking, the mother carries the bug in the birth canal, where it’s part of her normal vaginal flora until she delivers the baby. It’s transmitted to the baby during labor and delivery. The baby contracts the infection and generally dies within 24 hours, although there is a delayed-onset form that kills within 30 days. The mother contracts a condition called chorioamnionitis, which can quickly spread and become systemic.
Today, it’s routine for all pregnant women to be screened for this bacterium. If the woman is a carrier (an estimated 15-40% of all women are carriers, depending on which set of numbers you believe), antibiotics are started during labor to prevent transmission (and which have a near 100% success rate at preventing transmission). There is also a vaccine in clinical trials that looks pretty promising.
[soapbox]As a note to all pregnant women, if your doctor does not screen you for GBS, ASK FOR IT!!! Since the bacterium does not make you sick, you may not know you have it. Sadly, my son died from the late-onset form of GBS disease, and the resulting chorioamnionitis has left me sterile, so I’m speaking from experience.[/soapbox]
Robin
“Childbed fever” referred to any overwhelming infection contracted as a result of childbirth - they had no way of knowing whether it was group B strep (GBS) or not, in fact they had never heard of GBS, or bacteria for that matter. The Semmelweiss story above is correct, deaths due to childbed fever were much higher at that time among mothers who had given birth in a hospital as opposed to those who had given birth at home with a midwife or local doctor in attendance. The reason wasn’t that the midwives knew any more about hygeine than the hospital docs - they simply had less contact with germs.
Also, while I agree about screening for GBS, you might be interested to hear that the antibiotic IV is not universally prescribed - when flod2k was born, for instance, I was given an antibacterial douche instead. (Probably just as well, since I wasn’t at the hospital for four hours before he was born!) Some hospitals are concerned that antibiotics are being overused and may lead to resistant GBS, a real nightmare.
One thing that has not been mentioned so far is the danger of ectopic pregnancies, that is to say pregnancies outside the uterus. These are particularly dangerous when the fertilized egg implants in a Fallopian tube, because it doesn’t take long for the egg to grow too big for the tube. If the egg isn’t removed, either by a miscarriage or a therapeutic abortion, the tube will split open, causing massive internal bleeding. Even for a woman with access to a modern hospital this is a risky situation; for a woman who doesn’t it’s a death sentence. If the egg implants elsewhere, it can grow for some time, but cause serious complications or death later on. When I read the description of the situation in the book Markxxx mentions, that’s what came to my mind.
Wow that is more than I thought. How about conditions that you would know BEFORE the birth began. Obviously this is just a book but here’s what they said.
Her first birth was HARD and DRY. Thus they told her not to have more kids. She was 30 years old.
The second birth was a “Change of Life” baby happened when she was 45.
Doctor said “Due to advanced age of mother, and harshness of first birth, mother will not live, recommend abortion.”
What of the above complications are indicated by that. Again this woman had access to a modern hospital in about 1910.
BTW in the novel it just said that she was in labor for 3 days and was exhausted and died. But they made it clear she would die if she didn’t get an abortion. (yes I realise this was most likely a slap agains Catholics[which the charachter was] and there stance on abortion-since it is literary).
That is what got me wondering is this an ACTUAL thing that used to worry people or mearly a literary device used to promote an agenda.
BTW the novel was written in the 50s
Don’t forget too, that while abortions may have been available, they were NOT safe, and most women would die after abortions. If she survived, it was most likely should would never have another child.
Also, during the Middle Ages, didn’t the midwives “pack” the birth canal after the woman had given birth? With herbs or something?
BTW, Catholic hospitals do NOT allow for therapeutic abortions at all-even in the case of eptopic pregnancies. This is a danger nowadays with Catholic hospital mergers. Hell, they don’t allow any therepuetic abortions-and not everyone knows this. Not preaching, just say make SURE you find out if your hospital has undergone a merger with a Catholic firm…it’s a serious serious problem today in women’s health issues.
If you want to read a truly gruesome account of a woman dying in childbirth, try the Charlotte, the Princess of Wales, daughter of the then Prince Regent, later George IV. Had she lived, Queen Victoria would never have come to the throne. Charlotte died in childbirth, and when you read about what she went through, it’s enough to make you vomit or cry.
WTF is a ‘therapeutic abortion’.
Whatever it is I can bet that it is anything but therapeutic for the baby.
I am assuming that a theraputic abortion is one when the mother’s life is at stake. And I am going ot have to ask for a cite, Guinastasia, for the claim that Catholic hospital’s won’t preform an abortion for a ectopic pregnancy. To the best of my knowledge, the Catholic church has always approved abotions when the baby has no chance of reaching viability (etopic pregnacies kill within 9 weeks of conception or something like that–there is absolutly NO chance of the baby surviving) and whenever the mother’s death is certain, not merely possible.
As far as “packing” goes, my understanding that along with herbs, dung and mud were used.
A “therapeutic abortion” is one done to save the life of the mother - of course, it’s not therapeutic for the baby, but if the mother dies from some condition or other before the baby can live on its own, the baby is doomed as well. The justification, of course, is that you can save one life instead of losing both mother and child.
It’s sort of the reverse of a cesearan performed on a deceased woman to save a baby that still has a chance of survival.
There’s also a condition - I think it’s called “hydatiform mole” or “molar pregnancy” but don’t quote me on that - that mimics a pregnancy but the “child” is nothing more than a disorganized mass of cells with no chance of viability - in such a case you might also have a “therapeutic abortion” because this condition also threatens the mother.
If a fetus has died but was not immediately expelled that is another situation calling for a “therapeutic abortion”. Basically, you have to be in an extreme situation to have one of these, as opposed to an “elective abortion”.
Death in utero isn’t a ‘therapeutic abortion’. It’s either an induced birth or more rarely a c/section. It’s also not all that dangerous for the mother. They need to screen for a rare blood clotting condition but if that is not present then you can carry a dead baby in utero for a looooong time. In the old days before safe c/sections or safe inductions, standard practice was to carry the baby to term.
That would have to be an absolute nightmare carrying a dead baby for weeks or months 
I felt the need to back up my assertion that post-partum infection was, at the time, the most common cause of maternal mortality.
From a description of the book The Tragedy of Childbed Fever, by Irvine Loudon:
Childbed Fever, or as it soon became known, “puerperal fever”, was by far the most common cause of maternal mortality throughout the Western World until the late 1930s. It was an infection of the uterus following childbirth, which rapidly spread into the peritoneal cavity causing agonising peritonitis, and into the bloodstream causing septicaemia or “blood poisoning” which was almost invariably fatal…Most cases of puerperal fever were sporadic, but the most frightening form were the epidemics, which swept through “lying-in” (i.e. maternity) hospitals and also through towns and villages where it could suddenly appear without warning. In epidemics, fatality rates were often as high as 80 per cent…Almost all fatalities due to puerperal fever were due to one microorganism, the Group A Streptococcus, which is also the cause of scarlet fever, erysipelas and several other conditions…Puerperal fever, before World War II, was universally acknowledged to be by far the greatest problem in obstetrics…
And from another review of the same book:
What we now recognize as a bacterial infection (usually streptococcal) of the uterus or genital tract of women after childbirth, puerperal fever or childbed fever in the 18th and 19th centuries affected, on average, 6 to 9 women in every 1000 deliveries, killing 2 to 3 of them with peritonitis or septicemia. During times of epidemics, many more suffered and died. It was the single most common cause of maternal mortality, accounting for about half of all deaths related to childbirth, and was second only to tuberculosis in killing women of childbearing age.
From the World Health Organization:
*In the 19th century the notorious childbed fever took many victims. Today puerperal infections are still a major cause of maternal mortality in developing countries and, to a lesser degree, in developed countries…
One of the most dangerous causative agents of puerperal sepsis and the concomitant maternal mortality is the Group A Streptococcus (GAS) or Streptococcus pyogenes. It was the main cause of childbed fever in Europe in the 19th century. Since then the virulence of GAS seems to have diminished, but in recent years a new period of increased virulence has arrived (Gaworzewska & Colman 1988, Swingler et al 1988). Concurrently a new syndrome was introduced, the Streptococcal Toxic Shock Syndrome (Strep TSS), caused by endotoxin producing GAS (Hoge et al 1993).*
And, in case you were wondering, WHO states that the most common cause of maternal mortality today is post-partum hemorrhage.
Isn’t a breech birth when the baby comes out feet first as opposed to head first? Why is this so dangerous?
This is really interesting but do these things relate to the time period which would be around 1910?
Or are these modern things?
howardsims, a breech birth is any birth in which the baby isn’t oriented head-first. My niece, for example, was exactly sideways, and thus came out via a C-section. Even feet first can be dangerous because:
The baby’s legs may split, leaving one foot out and the other stuck inside.
When a baby’s body comes out before the head, it’s coming out narrow-end first. The advantage to a head-fist birth is primarily that the head is the largest and most difficult part to deliver. If the head makes it out, it’s almost guaranteed that the rest of the body will, too. If, however, the feet come out first, the mother may already be too exhausted to push out the head, or may not have dialated enough to deliver it (and may not dialate enough for a very long time). This is dangerous for the baby for any number of reasons, mainly because the baby can actually suffocate if left in that state for too long.
Yes, a breech is a birth in which the baby’s head comes out last. Sometimes the feet present first, sometimes one or both legs are tucked up and the buttocks come first. In any case, the danger lies in the fact that the head of the baby is the largest part. Generally, once the head is delivered, the rest of the body just kind of slides out. If you have a true cephalo-pelvic disproportion (the baby’s head is too large to fit between the bones of the pelvis) and a breech baby, you could deliver the body and then get stuck. Fortunately, CPD is much less common than most people think. Also, if this is not the first baby, CPD is much less a concern. Risk is also determined by the position of the baby’s head. If his chin is tucked into his chest he is more likely to come through easily. Rarely, the baby will be in the “stargazer” position, with the head tilted back. This position makes the birth much more difficult and much more risky. There is additional risk if the people attending the birth aren’t well versed in breech deliveries. Panicking and trying to pull the baby out can cause severe spinal cord damage.
Manda Jo:
Re: Catholic hospitals and abortions. I did a google search on ‘Catholic hospitals + merger + abortion’ and came up with 1,140 hits. Lots of stuff to look at.
The following is from the Ethical and Religious Directives for Catholic Health care services:
http://www.usc.edu/hsc/info/newman/resources/chc/part4.html
Quote: “45. Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation. In this context, Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers.”
The following is titled "Vatican Criticizes Management Agreement at Catholic Managed Hospitals:
http://www.reporternews.com/texas/hospital0731.html
It not only disallows abortions, but sterilization and some infertility treatments.