Maternal Mortality—Why Mothers Died

MATERNAL MORTALITY—WHY MOTHERS DIED

A Cause for Concern

A major health concern of the decade was the high rate of mothers who died giving birth. In 1936 the Federal Children's Bureau called attention to an "alarmingly high" maternal mortality rate of 59 mothers per 10,000 live births in 1934, the highest among the industrialized nations. More women in the reproductive period of life from ages fifteen to twenty-four died from diseases and complications of pregnancy and childbirth than from any other cause except tuberculosis. The specific reasons recorded on death certificates for these 12,859 deaths included septicemia or puerperal fever, a contagious infection responsible for about 40 percent of the deaths. Twenty-three percent of maternal mortalities were due to albuminuria with eclampsia, a condition of protein in the urine which can lead to coma and convulsions. "Other causes," a blanket group of emergencies, abnormalities, operative procedures, etc., accounted for about 37 percent of the mothers' deaths.

Poverty and Rural Isolation

Although unlisted on death certificates, poverty and rural isolation from prenatal and obstetrical care were major causes of maternal deaths. Prenatal care meant visits to the doctor, and visits to the doctor, when there was one available, cost money. The comparison of maternal mortality rates for white and African American women was an additional cause for concern. The mortality rate for African American women for 1934 was 93 per 10,000 live births as compared with 54 for white women. In the early part of the decade home births were still traditional. In Europe trained midwives were often more highly skilled in obstetrics than physicians, but the midwife profession was not as well developed in the United States. By 1930, 80 percent of the forty-seven thousand midwives in the United States were practicing in the rural South where maternal mortality rates ran as high as 114 deaths per 10,000 live births in some states.

Cultural and Medical Attitudes toward Pregnancy

Poorly trained midwives were not the only cause of the high mortality rates. The philosophy of the medical world of the day was that childbirth was a "physiological function" and nothing to worry about. General practitioners attended about two-thirds of the births, and a surprising number of physicians knew very little about it. Although obstetrics and pediatrics grew as medical specialties during the 1920s, obstetrics was still given short shrift in medical schools. At the end of 1929 the Council of Medical Education of the American Medical Association reported that of 1,491 interns in approved teaching hospitals, 334 graduated without having delivered any babies and 235 had not even observed deliveries. By 1931 there were only about 8,000 obstetrical specialists in the country, the majority of them in the Northeast.

The Childbirth Profession

The medical profession regarded the midwives who still existed in the early 1930s as only a temporary expedient until all patients could be delivered by physicians, and midwifery laws gradually legislated them out of existence. The concerns over the high rates of maternal mortality encouraged higher standards of medical obstetrics and gynecology as well as the elimination of the untrained general practitioner-surgeon. Ironically, the emphasis on obstetrics as a specialty contributed to some of the deaths from "other causes," as obstetricians became enthusiastic—sometimes overenthusiastic—surgeons. By 1930 caesarean section was a fashionable method of childbirth, both because of improvements in technology and safety compared with an earlier generation and because of the increasing number of patients who sought obstetrical services in hospitals. Between 20 to 25 percent of hospital deliveries in New York and Philadelphia in the early 1930s involved operative procedures, especially for private patients. Any physician could legally perform surgical obstetrics, and there was a high correlation between maternal mortality and operative interventions.

Board Certified

Except in ophthalmology and otology, where the specialty boards were long established, hospitals had no guidelines to evaluate the abilities of their staffs. In 1930 the American Board of Obstetrics and Gynecology was established to detach the two specialties from general surgery and to make sure that no part-time specialists would be certified. Candidates were required to limit their practice to obstetrics and gynecology. The board defined specialist boundaries, and the general practitioner was rejected from board certification. The overt function of certification was to establish recommended patterns of training, and, since the boards were professional organizations, to decide on acceptable modes of practice and behavior, thus reducing maternal mortality rates. But the GPs continued to resist any attempt to give the specialists exclusive privileges over obstetrical work and continued, with relatively little training, to deliver babies.

CATCHING THE COLD VIRUS

To make a preventive vaccine for a virus, you have to catch it first. But the common-cold virus was invisible under the best microscope and so tiny it slithered right through the finest-grained porcelain filter. In 1935 Dr. Alphonse Raymond Dochez, a professor of medicine at the College of Physicians and Surgeons at Columbia University, announced he had isolated the cold virus. First he took throat washings from victims, then he filtered out bacteria and left the virus floating in the sterile water.

Next Dochez had to find at what temperature the viruses thrive and in what medium they thrived. On a chicken embryo diet they multiplied rapidly. Thus, for the first time in medical history, Dochez cultivated the virus outside the body. Making a preventive vaccine was the next step. Dochez worked on it, and so, to this day, have many others!

Source:

"MEDICINE: N.Y. Doctor Finally Discovered Common-Cold Bug," Newsweek (9 November 1935): 42.

Sources:

Mary Sumner Boyd, "Why Mothers Die," Nation (18 March 1931): 293-295;

Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), pp. 223-224;

Rosemary Stevens, American Medicine and the Public Interest (New Haven: Yale University Press, 1971), pp. 99-100, 180, 200-204;

Frank H. Vizetely, ed., The New International Year Book for the Year 1936 (New York: Funk & Wagnalls, 1937), p. 154.