Hello avid readers of this little blog, and welcome to another article and hopefully the start of a new segment. I have a very keen interest in Obstetrics and Gynaecology, and as such have decided to compliment my study with learning about the history of this incredibly rewarding and interesting field of medicine. So without further ado, let’s get started!
Every day 830 women die from preventable causes related to pregnancy and childbirth (1). Whilst historically women have a longer lifespan than that of their male counterparts, maternal death has always been one of the highest causes of death in females and remains one of the eight WHO Millennium Development Goals (2). With these kinds of statistics it is difficult to see how far maternal health has come, but from the earliest reliable data (from the early 19th century onwards) it is clear that, at least in developed countries, leaps and bounds have been made in protecting women and their newborns from perishing.
WHO defines maternal death as “… the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.” (3) This definition has changed slightly throughout history, with the time frame between pregnancy and death being one month up the start
of the 20th century (4). What hasn’t changed, however, is the devastation and emotional turmoil that follows what some OBGYN doctors have called “the most terrifying scenario that [is faced by] medical professionals working in obstetrics” .
Prior to the 19th century, records of maternal mortality and death were largely kept by the Church of England, but these records have been met with heavy criticism. The Clergy who reported these deaths could be careless in their recording, and the clerks of the Church were largely illiterate. Furthermore the definition of maternal death that is used currently, when used in pre-19th century contexts, is largely inaccurate, with baptism records detailing the death of the infant being the mainstay of identification for maternal mortality rates .
Once the Registration of Deaths Act of 1837 was passed in England the data surrounding maternal mortality rates became much more consistent and reliable. The rate per 1000 live births stayed above 35 until the start of the 20th century with the introduction of legal contraception that revolutionised women’s medicine, and the significant drop after 1930 can be attributed to the introduction of antibiotics (especially prontosil in 1936) in the treatment of postpartum infections. (4)
The so-called Four Horsemen of Death in regards to Maternal health were rampant throughout the colonies and major civilisations during 19th and early 20th centuries and are still considered the main causes of maternal mortality today. These included puerperal pyrexia, haemorrhage, toxaemia, and abortion, with the introduction of antiseptic techniques (including that from Ignaz Semmelweis ), increased awareness of these conditions, acceptance of supposedly taboo practices, and the general advancement of medical technology reducing the incidence and complications of these conditions . Bloodbonesandbodies will delve into these causes of maternal death in later articles, so keep an eye out for that!
Today, the rates of maternal mortality have dropped to 6 per 100 000 live births in Australia , thanks largely to the major advancements in both science and civil rights for women. The ability for women to decide what to do with their own bodies and the availability of contraceptives remain the biggest contributions to the significant and continual drop in maternal mortality, with the focus now turning from developed to developing countries. Organisations like Medecins Sans Frontieres, WHO, Australian Society for Medical Research, and many others are bringing the issue of maternal health to the forefront of medical innovation and research, but with such shocking statistics surrounding the death of the world’s most vulnerable people there is still a long way to go.
Picture credit: Childbirth was rarely as picturesque as pictured in this Jacopo Robusti Tintoretto painting, Birth of John the Baptist. Available from: http://www.arthermitage.org/Jacopo-Robusti-Tintoretto/Birth-of-John-the-Baptist.html
- WHO | Maternal mortality ratio (per 100 000 live births) [Internet]. Who.int. 2016 [cited 1 October 2016]. Available from: http://www.who.int/healthinfo/statistics/indmaternalmortality/en/
- WHO | Millennium Development Goals (MDGs) [Internet]. Who.int. 2016 [cited 1 October 2016]. Available from: http://www.who.int/topics/millennium_development_goals/about/en/
- Maternal mortality [Internet]. World Health Organization. 2016 [cited 1 October 2016]. Available from: http://www.who.int/mediacentre/factsheets/fs348/en/
- Chamberlain G. British maternal mortality in the 19th and early 20th centuries. Journal of the Royal Society of Medicine. 2006;99(11):559-563.
- Bendall A. Editorial. O&G Magazine. 2013;(15:1):14.
- Dobbie B. An attempt to estimate the true rate of maternal mortality, sixteenth to eighteenth centuries. Medical History. 1982;26(01):79-90.
- Hardy C, Ewers D. Famous Faces: Ignaz Semmelweis [Internet]. bloodbonesandbodies. 2016 [cited 1 October 2016]. Available from: https://bloodbonesandbodies.wordpress.com/2016/08/15/famous-faces-ignaz-semmelweis/