Maternal mortality

“ There are no general health statistics to tell the full story of the physical ills suffered by women as a result of too great reproductivity. But we get some light upon conditions through the statistics on maternal mortality, compiled by Dr. Grace L. Meigs, for the Children's Bureau of the United States Department of Labor. These figures do not include the deaths of women suffering from diseases complicated by pregnancy. ”

“ The utmost care is taken to conceal the agonies and risks of child-birth from the young. Announcement is rarely made of the true cause of deaths from child-birth. The statistics of maternal mortality have been neglected by departments of health, and the few compilations which have been made have not achieved any wide publicity or popular discussion. ”

“ The death rate from other things, such as typhoid and diphtheria, has been cut in half but between 1900 and 1913 maternal mortality was not lessened but seemingly increased; yet this waste of life is just as preventable as those diseases, for medical science has shown that with proper care the dangers of childbirth can be made very small. ”

“ In November, 1893, Hirst reported 212 operations since 1887, with a maternal mortality of 12.73 per cent and a fetal mortality of 28 per cent. In his later statistics Morisani gives 55 cases with 2 maternal deaths and 1 infantile death, while Zweifel reports 14 cases from the Leipzig clinic with no maternal death and 2 fetal deaths, 1 from asphyxia and 1 from pneumonia, two days after birth. All the modern statistics are correspondingly encouraging. ”

“ Grace L. Meigs, head of the hygiene division of this bureau, has been undertaken as a direct corollary to the infant mortality inquiry. The sickness or death of the mother inevitably lessens the chances of the baby for life and health. A large proportion of the deaths of babies occur in the first days and weeks of life, and these early deaths can be prevented only through proper care of the mother before and at the birth of her baby. ”

“ Pregnancy is usually interrupted when the woman survives the terribly rapid course of the disease. Many women die with the product of conception in the cavity of the uterus. Exceptionally, in the lighter forms of the disease recovery may occur without the interruption of gestation. The causes of premature labor or abortion may be found in the constant hemorrhagic endometritis and the changes in the pressure and constitution of the maternal blood. ”

“ Lady Chelmsford's League for Maternal and Child Welfare in India has ascertained that "the death rate in India among mothers at the time of child-birth is infinitely greater than that in any European country. ”

“ It may be that discouragements from unhappy family conditions or worry over economic disabilities sap the mother's vitality. It may be that taints of blood doom the child and the mother. Whatever the cause, it is reason for deep concern that a great state, like New York, for example, has a rate of infant mortality nearly twice as high as that of New Zealand and ranking eleventh in the twenty-three states of the registration area in which the death of babies is set down with care. ”

“ The statistics, based upon the results of all her reportable pregnancies, show a generally higher infant mortality rate where the mother has had many 134pregnancies, but there is not always an increase from one pregnancy to the next. ”

“ The medical treatment is artificial abortion as soon as the condition is diagnosed in any stage of gestation; but this is, of course, in conflict with the decrees of the Holy Office. Under expectant treatment about 40 per centum of {54} the mothers die, and 66 per centum of the children. Those children that are born alive commonly die within ten days after delivery. The great foetal mortality is due to premature birth and asphyxiation. Skilful obstetricians get much better results, but skilful obstetricians are unfortunately rare. ”

“ If the child is dead the womb must be emptied at once. After the seventh month an expectant treatment is no longer allowable, and authorities declare the pregnancy should be terminated without delay. The mother is in great danger from sudden free flow. This treatment must be given by an experienced hand and only a physician can do it. If the pregnancy is allowed to continue to full term the danger to the woman is very great, as the mortality runs from thirty to sixty-five per cent ”

“ Could the test of confession be always applied, as is, however, manifestly impossible, so many women die during or in consequence of an abortion, without the attendance of a physician and without making any sign, it would be found that many of the cases now reported upon our bills of mortality as deaths from hemorrhage, from menorrhagia, from dysentery, from peritonitis, from inflammation of the bowels or of the womb, from obscure tumor, or from uterine cancer, would be found in reality to be deaths from intentional abortion. ”

“ The foreign mothers, with less education, more numerous and arduous tasks, less opportunity for leisure, and smaller incomes, begin to resume their housework sooner than the native mothers with young babies.
28. Total number of live births less than 50; base therefore considered too small to use in computing an infant mortality rate.
The fact that a mother takes up her housework in the early days of her baby’s life does not necessarily increase the danger of its death. ”

“ Hence modern statistics prove the correctness of the saying of Aristotle, that 'to the female sex premature wedlock is peculiarly dangerous, since, in consequence of anticipating the demands of nature, many of them suffer greatly in childbirth, and many of them die.' As the period from twenty to twenty-five is the least dangerous for childbirth, and as first labors are more hazardous than all others before the ninth, it is important that this term of least mortality be chosen for entering upon the duties of matrimony. ”

“ If every mother were educated to the extent as indicated in the above outline the appalling infant mortality would fall into insignificance. It is not a difficult task nor would it take a long time to carry it out; it is the work for willing women who have time and who perhaps spend that time in less desirable but more dramatic ways. ”

“ Fetal mortality exceeds that of any other period of life. For every four or five labors there is one abortion, and if to this number is added still-births the proportion of fetal deaths to living births is larger. ”

“ During pregnancy all the vital energies of the mother are devoted to a single end: the protection and nourishment of the child. Such wise provision is made for its security, such intimate vascular connection is established between the fœtal circulation and the blood-vessels of the mother, that its premature rupture is usually attended by profuse hemorrhage, often fatal, often persistent to a greater or less degree for many months after the act has been completed, and always attended with more or less shock to the maternal system, even though the full effect of this is not noticed for years. ”

“ But may it not be that the relationship between a large number of births and a high infantile death-rate is the reverse of that which we have suggested? Is it not possible that the great mortality among children may be the cause of an increase in the number of conceptions, pregnancies, and births? It is true that certain purely psychological factors may contribute to such a causal sequence. To a certain degree a high infantile death-rate has such an effect. ”

“ If they have no feeling for the fruit of their womb, if maternal sentiment is so callous in their breasts, let them know that such produced abortions are the constant cause of violent and, dangerous womb diseases, and frequently of early death ”

“ Here we also find large numbers of married women, who are under age—in Durham over 23 per cent.—and the highest infant mortality. The infants born to these working girls have the highest mortality from premature birth, deficient vitality and all congenital defects; and all these working mothers have such a high death rate from all causes among their neglected children, that the increase of births, which results from this employment of young women, is wholly undesirable and results in deterioration of the population. ”

“ Descent of the womb and vagina may be thrown into the general group{366} of ruptures; of which hereafter. The following comprehend most of the fatal diseases and accidents during the puerperal state.
Abortion and Miscarriage; Uterine Hemorrhage, or Flooding. Abortion or miscarriage, or premature exclusion of the fœtus, may happen through every month of pregnancy. Early miscarriages between the third and fifth month, though not recorded in the burials, are notwithstanding far more numerous than in the latter months; but are infinitely less hazardous to women. ”

“ Vacuum aspiration is considered particularly safe. The procedure's mortality rates for first trimester abortion are, for example, 5 to 10 times lower than those associated with carrying the fetus to term. ”

“ There is no system in the treatment of mothers; and often not the most elementary care in the treatment of the infants. It is scarcely surprising that though the general infant mortality is excessively high, the infant mortality of the workhouse babies is two or three times as high as that among the general population. ”

“ A relation may exist, but on the other hand the difference in the mortality rate may be due to the fact that the mothers could afford to give consideration to their condition and escape some of their heaviest tasks as their pregnancy approached its end, and were members of families who were thoughtful of them and relieved them of these tasks or employed extra household assistance at such times. ”

“ Prenatal care, clean deliveries, and intelligent motherhood will go far toward solving the problem of a high maternal and infant death rate, and these require not widespread care, alone, but widespread teaching as well—impressing upon women and their families the importance of care and precautions in connection with childbirth. Important as it is for men to study and inform themselves in regard to the problems of finance and cattle raising, for example, it is still more important for both men and women to study and appreciate the problems of expectant and actual motherhood. ”

“ The number of the pregnancy affects the danger to be expected from lying-in. It has been declared by excellent authority, that the mortality of first labors, and of childbed fever following first labors is about twice the mortality attending all subsequent labors collectively. After the ninth labor the mortality increases with the number. ”

“ The general conclusion reached by the writer in an elaborate official report on the subject is that “the quality and availability of skilled assistance before, during, and after childbirth are probably the most important factors in determining the remarkable and serious differences in respect of mortality from childbearing shown in the report.”—“The differences are caused in the main by differences in availability of skilled assistance when needed in pregnancy, and at and after childbirth.” ”

“ Twisting of the cord, hydramnios, syphilis, an acute infectious disease in the mother, poisonings of the mother by metals and the like substances, maternal cardiac and renal diseases, chronic inflammations and displacements of the womb, and violent emotions are some of the causes of abortion. In certain women a slight exertion, a misstep, a fall, a ride over a rough road, the debitum conjugale, and similar causes bring on abortion; in other women almost no shock is enough to make them miscarry. ”

“ But we must recognize that the minimum so obtained is nevertheless still too large, because among the consorts of the long-lived fathers and mothers, some died early with the result of increasing the infant mortality. The infant mortality with the 85-year-old fathers and mothers is found to be 11.2%-15.4%, average about 13%. The total child-mortality reaches 31-32%, of which the 13% make about 40%. ”

“ To the mother there may happen correspondingly frequent and serious results. Not alone death, immediate or subsequent, may occur, from metritis, hemorrhage, peritonitic or phlebitic inflammation, from almost every cause possibly attending not merely labor at the full period, comparatively safe, but miscarriage,—increased and multiplied by ignorance, by wounds and violence; but if life still remain, it is too often rendered worse than death. ”

“ The death-rate of mothers is less than five per thousand births, and the [Pg 167] mechanical obstructions which a century ago would almost certainly have brought about the death of both mother and child, are now so dealt with that more than half of both mothers and children are saved. ”

“ A woman thus affected will subsequently bring more weakly children into the world; the mother whose health is poor is unable to give as much time and pains to the rearing of her children as she would if she were well and strong; many women whose health has been broken by unduly frequent pregnancies die during a subsequent pregnancy or delivery. ”

“ We know, too, that among the mothers, abortion, miscarriages, toxæmias, difficult or impossible labors may be largely prevented through prenatal care; while among babies, the enormously high death rate, during the first month of life from causes which begin to operate before birth, convinces us that we must begin to take care of the baby nine months before he is born, if he is to have the greatest benefits of present available knowledge. Such early care reduces still births and injury during labor ”

“ Nor must, at the contemplation of this enormous number of women who died of child-birth fever, the still larger number of those be lost sight of, who, as a consequence of child-birth, are permanently crippled in health, and die prematurely. ”