Is it true that maternal death in childbirth spiked in the 17th century when male doctors began to take over from traditional midwives?

by mynameisminho_

I read a recent viral Twitter thread with this eye-catching claim and was wondering if anyone here could verify it and/or could provide some more context to the state of maternal death and medieval/Renaissance midwifery in Europe.

thewrestlingnord

This is a timely question that has been the subject of renewed interest in the past few years. The history of childbirth is a bit out of my wheelhouse, but I can offer some information regarding that thread you linked. The poster argues two points: maternal mortality rates increased as women moved away from homebirths and midwifery to hospitals and doctors. They also claim that Medieval midwives prioritized the mother's life above all else. I think she is correct in both claims, but I can only offer information regarding the former.

Childbirth in the 17th-early 20th century was always a scary endeavor for mothers. Expecting mothers had up to a 1/8 chance of death during childbirth; their babies had an even higher chance. Some women would go as far as to write letters to their newborns in case of their death. It was terrifying. Especially considering the birth rates were much higher in 18th and 19th century America-- mothers would go through this process 4-8 times, sometimes more.

The poster of that thread is correct-- childbirth was the domain of women. Presumably, every person in the room during birth would have been a woman. Midwives helped facilitate the delivery, but neighbors, friends, and family members would also be present for emotional and medical support, especially if they had experienced giving birth in a similar setting. This type of birth was standard in America until the mid-late 18th century when women began opting for more medicalized births.

It's important to point out that women often requested a male doctor instead of midwifery. This was thanks to two crucial medical advancements. The first was the invention of forceps. As a warning, the following description is a bit graphic. Before the invention of forceps, if a baby got stuck in the birth canal, there was little a midwife could do except call a doctor to perform something called a "craniotomy" that would remove the baby in pieces. This process, of course, resulted in the death of the child but would save the mother's life. Unsurprisingly, this experience was incredibly traumatizing for all parties involved. Forceps were considered a medical tool used by trained physicians and thus were not typically used by midwives. Expecting mothers then chose to visit a physician with forceps to prevent terrifying complications like a stuck baby.

The other significant medical advancement that led women to call on male physicians was pain relief medicine, which made the excruciating childbirth experience more tolerable. The most popular drug was Scopolamine, popularly referred to as "twilight sleep." This drug was administered early in labor and often put women in an "amnesic state," resulting in almost a complete loss of memory of the childbirth experience. Now, the effect of this was a bit more complicated, as the drug may have made the mental aspects of childbirth more tolerable, but it did nothing to help with the physical toll that came with having a child. This drug was also heavily marketed in department stores and magazines. There was even a proto-infomercial film produced to advertise the drug. As a result, many women chose the "painless" birth option using this drug. However, despite the pain relief, this practice certainly medicalized and alienated the birthing process. As a result, many doctors began taking mothers' needs less into account, opting instead for the "wonders" of modern science to fulfill any need they might have.

Okay, so how did forceps and twilight sleep increase the maternal mortality rate? There are various explanations, but the simplest is a lack of sterilization in the home. Many women still gave birth at home, which caused physicians to complain about uncleanliness and the lack of proper equipment. Here, we see a lethal fusion of the public and the private. Doctors, equipped with cutting-edge medical tools, operated in an unsterile environment that remained the mother's domain. As a result, many doctors felt they did not have the necessary control to facilitate labor properly. Women, conversely, wanted to stay in a comfortable environment, just with the help of a trained medical professional. They felt that doctors had too much control and refused to give up that agency in their own homes. This combination was lethal and partly responsible for the higher maternal mortality rates that the Twitter thread discussed.

Maternal mortality rates eventually plummeted thanks to the discovery of germ theory. In the 1920s and 1930s, more and more women chose to give birth in the hospital, which they saw as the pinnacle of modern scientific achievement. These hospitals were sterile and practiced scrupulous cleanliness of tools, hands, and beds. But, again, this further alienated the birth experience. Instead of being surrounded by family and trusted friends in the comfort of their own home, women now gave birth surrounded by strangers, barely conscious, in a sterile environment (in more ways than one). Thus, expecting mothers had to choose between the freedom of choice offered in home births or better pain relief and sterilized medical tools; did they opt for familiar surroundings and supportive women? Or did they choose the safer yet alienating and medicalized birth? Most women opted for the hospital, as they still do today.

I can provide sources if you need them, but the immediate book that comes to mind is Judith Walzer Leavitt's Brought to Bed: Childbearing in America, 1750-1950. There’s also a great podcast that discusses a lot of this https://podcasts.apple.com/us/podcast/dig-a-history-podcast/id1271238763?i=1000532096941

EDIT: There are a ton of great questions and comments here that I will try my best to get to later. In the meantime, check out this comment from /u/jellystonemd for some additional context and a correction. Also, I see a lot of comments questioning the statistic that claims 1 out of every 8 mothers died in childbirth. I was unclear: this statistic was for lifetime chances of death during childbirth. From this source

During the seventeenth and eighteenth centuries, between 1 percent and 1.5 percent of all births ended in the mother's death as a result of exhaustion, dehydration, infection, hemorrhage, or convulsions. Since the typical mother gave birth to between five and eight children, her lifetime chances of dying in childbirth ran as high as 1 in 8. This meant that if a woman had eight female friends, it was likely that one might die in childbirth.