Another example, from Britain, was the widespread use of chloroform and forceps by general practitioners in uncomplicated deliveries between ≈1870 and the 1940s. Doctors, motivated in part by the income potential of attending births, began offering the hospital as a cleaner, newer, more "scientific" place for wealthy, urban mothers to have their babies. What happened before 1850? The conflict between doctors and midwives puts pregnant women in the middle and can be uncomfortable and dangerous in itself. In 1800, women gave birth an average of seven times during their lives, and a survey of births in Illinois in the 1820s shows that 30 percent of women gave birth to 10 or more children. They included the use of ergometrine, blood transfusions, and penicillin; better training; better anesthesia; improved organization of obstetric services; less interference in normal labors; and the decline in virulence of the streptococcus. Slate is published by The Slate Group, a Graham Holdings Company. In addition, in a welfare state, people may have been disadvantaged or unemployed, but the fact that they had reasonable income from the government meant that at least their level of nutrition would be within acceptable limits. Once more for emphasis, though: This is only for women who have an extremely low chance of complications and who have access to emergency medical treatment if anything goes wrong. At the beginning of the 1900s, maternal death rates were around 1 in 100 for live births. “Cesarean sections were death rituals, not lifesaving procedures. By joining Slate Plus you support our work and get exclusive content. Some were incompetent, some were skilled. The sudden and dramatic decline in maternal mortality rates, which occurred after 1937, took place in all developed countries and eliminated the previously wide country-level differences in national mortality rates. The death rate in the overall population started dropping at the end of the 1800s, and it dropped most dramatically during the first few decades of the 20th century. Maternal mortality in this group was 872/100000 births compared with 9/100000 for Indiana as a whole, a rate that was 92 times higher (95% CI: 19, 280) than that for the remainder of Indiana (20). Second, the criteria used to define a maternal death in the United States differed from those used in Britain. 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. Doctors had an entire armamentarium of gruesome gadgets to hook, stab, and rip apart a hard-to-deliver baby. 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. One thing that struck me was that most of the natural decline in maternal mortality was after 1940, which coincided with the introduction of the National Health Service, when every individual in the United Kingdom had access to good care. By 1946, maternal mortality in these countries was separated by a whisker. The main battlefield today is over home births. This is particularly true when the underlying causes vary in extent, importance, or both, among developing countries. Other factors that were more important for the sharp decline in maternal mortality were the use of antibiotics, availability of blood transfusion, and reduction in the high-risk pregnancies in the United Kingdom—notably teenage pregnancy and grand multiparity. 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 one recent and absolutely fascinating fact that does not affect maternal mortality at all, but it affects the topic we are talking about today. That’s way too many, but a century ago it was more than 600 women per 100,000 births. The best source of historic information on this subject is a book called Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800-1950, by Irvine Loudon. The industrial town of Rochdale in northwestern England had, in the early 1930s, the unenviable distinction of having the highest rate of maternal mortality in the country. After this time, both mortality rates suddenly came down, crossed over, and adopted the position described above for the next 150 y. Sometimes doctors broke the pubic bone, which often killed the mother but spared the baby. The second example comes from the United States, where a religious group in the state of Indiana, called the Faith Assembly, was investigated in the early 1980s. Doctors in turn had to justify their fees and distinguish themselves from lowly midwives by providing new tools and techniques. Although it can be argued that social status and standards of maternal care were not wholly independent variables, because the rich could buy what they thought was the best maternal care and the poor could not, the reduction in maternal mortality in the past was generally independent of the economic status of the mothers. 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.