How American doctors systematically killed new moms

I found this Laura Helmuth piece in Slate, subtitled “do not read this if you are pregnant” on the history of death in childbirth to be absolutely fascinating.  Check out the rise in maternal deaths in the early 20th century:


And who’s at fault?  Doctors.  Literally.

One piece of evidence Loudon uses to attribute blame for unnecessary early 20th century deaths to doctors is that rich women were more likely to die in childbirth than poor women. (Mary Wollstonecraft was one victim of an incompetent doctor; she died of puerperal fever after delivering a daughter who would grow up to write Frankenstein.) For almost any other cause of death, the poor were more likely to die than the rich. But for childbirth, poor women could afford only midwives. Rich women could afford doctors. Doctors in turn had to justify their fees and distinguish themselves from lowly midwives by providing new tools and techniques.

Things got worse as obstetricians started professionalizing and coming up with new ways to treat—and often inadvertently kill—their patients. Forceps, episiotomies, anesthesia, and deep sedation were overused. Cesarean sections became more common and did occasionally save women who would have died of obstructed labor, but often the mother died of blood loss or infection…

Too many doctors and midwives were chasing after a limited number of pregnant women, and they gained market share by touting dazzling new techniques and bad-mouthing their competitors. Exacerbating the problem, there was little government oversight of medical care or education in the early part of the 20th century. As Loudon explains, “Medical care in the United States was dominated by the belief in the virtues of competitive free enterprise combined with an intense distrust of government interference.”

“If I was forced to identify one factor above all others as the determinant of high maternal mortality in the USA,” Loudon wrote in Death in Childbirth, “I would unhesitatingly choose the standard of obstetric training in the medical schools.” They instilled an attitude of carelessness, impatience, and unnecessary interference. These deaths were “a blot for which the leaders of the medical profession are wholly to blame.”

Good news.  We’re a lot better now.  Still, until you are 35, it is safer to take the birth control pill than to be pregnant.  Lots more interesting stuff, too.

About Steve Greene
Professor of Political Science at NC State

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