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Even With Medicine Where It Is Today, Childbirth is Risky Business

I talked last week about maternal mortality in childbirth, a trend that is disturbingly on the rise in the United States, especially among rural women and women of color. To learn more, check out my last post (linked in the sentence above), and the links at the bottom of this post.

Today, let’s talk about how much historical precedent there is for this exact problem. Although women have been told for centuries that their main job is to bear children, our bodies have never been particularly safe during childbirth. For Victorian women, childbirth was often a life-or-death situation.

150 Years Ago, I Almost Certainly Would Have Died

In Victorian England, the average woman had a .5% chance of dying in childbirth. That number may not sound huge, but it is.

That means that 1 out of every 200 women died in or as a result of childbirth.

An astronomical number, if you ask me. But I’m in the less than 1% of women who has experienced recurrent miscarriage, after all, so statistics be damned.

If I were a Victorian, I wouldn’t have made it to childbirth.

I’d likely have died of an infection when my body didn’t recognize the need to miscarry an already deceased baby. Or I’d have developed cancer from retaining tissue for too long.

Had I managed to survive that one, a ruptured fallopian tube from an ectopic pregnancy would’ve taken me.

And what if I had miraculously carried a baby? (The uterine surgery that finally allowed it certainly would never have occurred at the time.) During my successful pregnancy, I was pre-eclamptic with no signs of early labor. I may very well have died from ecamplsia after childbirth.

two pregnant women
A major sign of preeclampsia is swelling. My entire body was swollen for months. This photo was taken less than 48 hours before I was induced, but Danielle and I were only about 2 weeks apart in gestation. Pre-eclampsia isn’t always visible, but it can be. (Side note: Check Danielle out if you haven’t already @mamademics)

Eclampsia in Downton Abbey. That’s Sort of History, Right?

Thanks in part to pop culture depictions like (spoiler alert) the sudden death of Lady Sybil in Downton Abbey, we’re becoming more aware of the risks of childbirth. In this popular BBC show, Lady Sybil dies of eclampsia, or the onset of seizures in a woman with pre-eclampsia. The complications that can lead to actual death are various, but trust me, they’re not how any of us wants to die.

Pre-eclampsia is diagnosed when a pregnant mother has high (or erratic) blood pressure and high levels of protein in her urine. This couldn’t all be checked in the Victorian period, or the post-Edwardian one, which is the setting of Downton Abbey. They relied on symptoms, and some of Lady Sybil’s were overlooked. Symptoms include severe headache, abnormal bloating, blurry vision, and pain in the upper right quadrant of the abdomen.

man and woman with infant child
Jessica Brown Findlay as Lady Sybil and Allen Leech as Tom Branson in ‘Downtown Abbey’ Photo by Joss Barratt – © Carnival Films

Along with hemorrhage, eclampsia is one of the most common causes of maternal death today.

The Many Perils of Victorian Childbirth

Pregnant Victorians had a lot to worry about, as the statistics make clear.

Obviously, there was the whole pre-eclampsia issue. Even if the symptoms are caught early, the only treatment is delivery. Without good induction techniques, most women would’ve needed a c-section. Not exactly the safest procedure either, at the time.

Further, obstetricians and midwives didn’t understand that drugs administered to the mother could potentially transfer through the placental barrier. (Weirdly, though, they worried about diseases and personality traits being transferred through breast milk. Actually, it’s not so weird. It’s a fear of poor people. I’ll talk a lot more about that another day.)

That is to say, pregnant women were given all sorts of medications they shouldn’t have been. Thanks to Dr. James Simpson, ether and chloroform became common anesthetics for childbirth in the 1840s and 50s. Seriously?

Even worse, many doctors treated uterine inflammation with the direct application of leeches to the cervix. I’ll talk more about that another day too. In more severe cases, or if leeching didn’t produce the desired results, many doctors applied mercury. Just what we’ve all hoped to have in our cervixes while pregnant. (Cervixes? Cervices? What’s even the plural here?)

And in lying-in hospitals, where poor women often went to give birth, women died in astronomical numbers.

City of London Lying-In Hospital (engraving). Credit: Wellcome Collection

Hospital Birth vs. Home Birth

Death doesn’t discriminate by race, class, gender. And yet, somehow, it often seems to. Lying-in hospitals served mostly poor, urban women (though there were instances of increased higher-class maternal death among women who chose to receive hospital care).

Florence Nightingale. Photograph by the London Stereoscopic & Photographic Company Ltd. Credit: Wellcome Collection

And according to Florence Nightingale, these hospitals fostered death’s discrimination.

“For every two women who would die if delivered at home, fifteen must die if delivered in lying-in.” – Florence Nightingale

Florence Nightingale is best known a the “Lady with the Lamp,” famous for making rounds at night to nurse soldiers during the Crimean War.

What she should be most famous for, in my opinion, is the reforms she made to nursing, particularly as a result of her work as both a statistician and medical care provider. She marked data points, found connections, and wrote about them until people would listen. This sounds obvious, but these were not common practices.

As a note: Nightingale was born into a very wealthy, well-connected family. She went against their wishes—and societal norms in general—to take up nursing. Although subversive in this way, her social status allowed her a voice she could force people to hear. This is a luxury most women in medicine didn’t have.

So It’s 1872. Nightingale Reports that 15 Women are Dying in Hospitals for Every 2 Who Die Birthing at Home.

And here’s where things get really perplexing, and infuriating, and just like huh?

An early nineteenth-century doctor, Robert Collins, had basically eradicated maternal death in hospitals in 1829. 

Yep. You read it right. 18 TWENTY-NINE!

Why, almost 50 years later, had his practices not become commonplace? Why were women still dying in droves in hospitals? Trust me; it’s not because he didn’t tell anyone. 

Stay tuned next week, when I’ll tell you all about it.

Want to Know More About Maternal Mortality Today? Check Out These Resources

If you’re interested in the subject of contemporary maternal mortality, check out last week’s post, “Maternal Mortality: How Far Have We Really Come?”

Interested in understanding why rural women and women of color die far more often in childbirth than their white, urban counterparts?

There’s a pretty detailed report about maternal healthcare in rural areas from Scientific American, and a shorter, very easily digestible discussion from Refinery 29. And Linda Robinson’s Ted Talk, based on her own experiences in midwifery, is also pretty great.

To learn more about the high levels of maternal death in women of color, brace yourself with some tissues and dig into this New York Times piece, “Why America’s Black Mothers and Babies are in a Life-or-Death Crisis.” This article from NPR is pretty great too. For a more condensed explanation, check out this short piece from Our Bodies, Our Selves.