Over the past fifteen years, U.S. women have become more likely to die during childbirth or in its aftermath. Our maternal mortality rate now stands at 26.4 deaths for every 100,000 births, compared with less than 8 in Canada and Western Europe. Meanwhile, infant mortality has declined somewhat in recent years but remains much higher than in other rich nations.
These statistics are particularly tragic when contrasted with the dramatic successes of the twentieth century. As the CDC reported in December 1999, one of the greatest achievement of the previous 100 years for people in the United States was making birth a relatively safe event. Over the course of the century, infant mortality dropped more than 90 percent, and maternal mortality fell almost 99 percent.
For babies, some of the greatest heroes of the early twentieth century were public health advocates. In urban areas, safe drinking water, sewage systems, and the pasteurization of milk played huge roles in saving infants’ lives. Also important were smaller family sizes, better nutrition for mothers and babies, and rising education levels which helped in the spread of information about health.
And yet for mothers, things didn’t change much. Women mostly gave birth at home, attended by midwives or general practitioners with limited training in childbirth. When obstetricians did perform deliveries, they often used excessive, dangerous techniques. Methods like induction of labor, use of forceps, episiotomy, and cesarean deliveries became more common during the 1920s. Making matters worse, doctors performing these interventions didn’t address the danger of sepsis, which, along with hemorrhage and toxemia, was a major cause of death for women in childbirth.
The medical profession woke up to these issues in the 1930s and ‘40s, reaching a consensus on the need for aseptic practice and creating institutional practice guidelines for hospitals. Births also shifted from homes to hospitals, creating cleaner conditions and allowing for better follow-up care.
Between 1930 and 1950, advances in medicine also contributed to continuing, dramatic improvement in infants’ survival chances. Penicillin, safe blood transfusions, and fluid and electrolyte replacement therapies all helped, particularly for babies over a month old.
By the second half of the century, much of the remaining danger for infants came from issues during pregnancy that put newborns at high risk. Starting in the 1960s, Medicaid and other federal programs helped address this through greater access to prenatal care. And, during the 1970s, advances in neonatal medicine saved many babies who wouldn’t have made it in previous eras.
The challenge today is to apply the lessons we started learning 100 years ago to the current moment, when poverty, racial inequality, and gaps in medical care are still contributing to avoidable deaths of mothers and babies.
Population and Development Review , Vol. 25, No. 4 (Dec., 1999), pp. 821-826