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Q and A: What Obstetrical Problems Might my Pregnant Puritan Wife Encounter That could Result in Her Death?

27 Oct

Q: In the novel I’m working on, one of the characters is a Puritan whose wife dies during childbirth. I’ve been unable to find any information concerning medical practices in 17th century New England and I’m hoping you might be able to assist. What were the specifics of obstetric practices at that time. Were midwives used? Were husbands present for delivery as they very often are today?

 

A: In the 1600s there were no hospitals and doctors knew very little. How little? It wasn’t until 1628 that Sir William Harvey (1578-1657) published “De Motu Cordis,” his famous treatise, outlining his discovery that the blood actually circulated through the body. Prior to this, physicians lived under the erroneous assumptions espoused by Aristotle, Galen (approx AD 130-201), and Andres Vesalius (1514-1564). The Germ Theory of infectious diseases wasn’t even a flicker in the minds of scientists. It wasn’t until 1870 that Louis Pasteur and Robert Koch developed this concept. Vaccination as a means of preventing disease was over a century away: Smallpox (Edward Jenner, 1796), Anthrax and Rabies (Pasteur, 1881 and 1882, respectively), Tetanus and Diptheria (Emil von Behring, 1890), and Polio (Jonas Salk, 1952). Antibiotics such as penicillin (Alexander Flemming, 1928) did not exist and surgical anesthesia (Crawford Long, 1842) wasn’t around.

Needless to say, childbirth in the 17th Century was a risky proposition. Mothers often died as did the infant. Most commonly from bleeding and infection, since methods to control bleeding were crude and treatment of infections was non-existent. The problems of breech or other abnormal births led to death more often than not.

At that time, few doctors existed, especially in America, and the population was predominately rural. Most people lived on farms or in very small communities and the large majority of these areas did not have a doctor for miles if at all.

Though trained midwives were common in Europe, there were few if any in America during Puritan times. Thus, deliveries were often performed by a member of the community. Perhaps one of the older women, who became a de facto midwife. She would likely travel by horseback or on foot from farm to farm and attend the births.

The deliveries would take place in the home, usually in the bedroom. If the home was a single room cabin, family and friends would wait outside until the ordeal was over. Hot water, freshly washed cloths, bare hands, and a healthy dose of fear and anxiety were the only available tools. An understanding of post-partum infections (called Puerperal Sepsis) wouldn’t be delineated until Ignaz Simmelweis developed sterile delivery techniques in 1847. If severe bleeding or infection occurred, prayer and comfort were the only salves. And if the infant entered the birth canal in an abnormal fashion, such as a breech (butt first) or footling (foot first) presentation, death of the mother and the infant was likely. Obstetric anesthesia and analgesia consisted of a piece of wood or leather the mother could bite down on. Perhaps in some communities alcohol or tincture of opium would be available. Interestingly, both alcohol and opiates tend to diminish uterine contractions with the net effect of prolonging the mother’s ordeal.

The husband would not likely be present during the delivery. That is a more modern invention. The 1600s were very puritanical. Even a physician wasn’t often allowed to undress a female patient for his examination. If he needed to listen to the patient’s heart or lungs, he would place his ear against the patient’s chest. With a female patient, this was rarely allowed. Thus, Rene Laennec invented the stethoscope (1816) to circumvent this problem.

All in all, childbirth was a dangerous, bloody, and noisy affair. Also immensely rewarding, since the very survival of the community depended upon it.

 
19 Comments

Posted by on October 27, 2011 in Uncategorized

 

19 responses to “Q and A: What Obstetrical Problems Might my Pregnant Puritan Wife Encounter That could Result in Her Death?

  1. Allison Brennan

    October 27, 2011 at 10:22 am

    Reading this, I’m stunned the human species has survived! Okay, just joking. But I doubt I’d have had five kids under these conditions. (Someone recently was discussing whether to have “natural” childbirth or use a painkiller. I said, “If God wanted us to continue to suffer through childbirth, he wouldn’t have created the brilliant minds who gave us the epidural.”)

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  2. Laura Mitchell

    October 27, 2011 at 10:24 am

    Even after the advent of anesthesia and pain relief, these were generally not offered to laboring mothers (more or less until Queen Victoria) because of (primarily) because of Biblical injunctions about bringing forth children with great pain and suffering (to pay for Eve’s sin). I would say the odds of a woman surviving childbirth at this time is about 50-50, in the absence of any complications.

    Simmelweis observed that the mortality rate on the midwife wards was much lower than on the physicians wards simply because while the midwives frequently washed their hands, the physicians had a tendency to come from the operating room to the delivery room WITHOUT washing their hands or even changing their clothes. This led to higher rates of puerperal sepsis on the physician wards.

    FYI: I remember the days of ethanol drips for preterm labor. If they weren’t puking, we had the happiest patients in the hospital!

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    • D.P. Lyle, MD

      October 27, 2011 at 11:11 am

      Ah yes, the old alcohol drips. Lead to some interesting conversations on the L&D ward.

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      • Laura Mitchell

        October 28, 2011 at 9:30 am

        I’m dating myself! I also remember “shock” blocks.

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  3. Lewis perdue

    October 27, 2011 at 11:22 am

    Not to mention vaginal /rectal fistulas from a too-small birth canal … Primarily among very young mothers … All but eliminated in the western world but still common in places like Afghanistan, Pakistan,Yemen and other underdeveloped countries where child brides are common

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    • Anonymous

      October 27, 2011 at 3:43 pm

      It isn’t just undeveloped places I am sad to report, still parts of the U.S. In my part of the deep South — a city with no excuse in fact — vaginal/rectal fistulas are QUITE common (as one who has seen the records) AND certain members of the medical records dept. of the major area hospital were not familiar with (or in agreement with) Germ Theory as my husband observed when I irately described their attitude that employees should come back to work a couple of days after coming down with infectious illnesses. (I had been making the point that employees coming in too soon was infecting patients and employees). She Who Was Not Familiar with Germ Theory was a “nurse” doing some of ER oversight.

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    • Laura Mitchell

      October 28, 2011 at 9:29 am

      It’s the size of the pelvic outlet, rather than the birth canal per se. These fistulas usually develop after 3rd and 4th degree perineal lacerations that are poorly repaired or not repaired at all: in a 3rd degree, the tissues tear down to the rectum; in a 4th degree, the tissue tears into the rectum. Even with a good repair, they can still happen.

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  4. gkparker

    October 27, 2011 at 1:15 pm

    I’m curious to know how much better things were in 1900. My latest historical is set in the Owens Lake area of California at a ranch a ways from any cities or towns. A woman who lives on the ranch is a midwife. What kind of equipment might she have on hand to deliver babies? The ranch owner’s wife has twins during the story and I want them all to live. She’s already had 4 children and is still young and in good health.

    And yeah, I have the midwife boot the husband out of before the birth and he’s none to happy.🙂

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    • D.P. Lyle, MD

      October 27, 2011 at 2:34 pm

      Not much changed over those centuries. Almost all advances in medical knowledge have happened since 1900. Healthcare in 1880 wasn’t much different than it was in 1880 BC. A few things had improved but not many.

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    • Laura Mitchell

      October 28, 2011 at 9:13 am

      She probably had a supply of laudanum which would have helped with the pain. As far as equipment, all she had was her hands. Regarding twins, here’s a rundown of some of the problems associated with twin deliveries (and these haven’t changed since we started having twins):

      First, human females are really designed to only have one baby at a time, not litters (e.g. octuplets. Even though I and my L&D nurse colleagues were appalled at the questionable ethics of the fertility doctor, we were pretty impressed that they got the Octomom to 32 weeks gestation. Normal pregnancy is about 40 weeks). Spontaneous twins and triplets do occur, but generally, we have singleton pregnancies (and twinning is more common in women over 35).

      Second, multiple gestation increases the risk of premature labor and birth. The uterus can only stretch so far. Twins also have a tendency to weigh less than singletons of the same gestation because of the finite uterine space.

      Okay, let’s say we get this pregnancy to term. We have to look at what we call “fetal lie.” Are the babies head down (vertex)? If both the babies are head down, a vaginal delivery is definitely an option. If the first baby is head down and the second baby is breech, a vaginal delivery is still an option.

      Now it’s time to have babies: Baby A is delivered just fine, no problems. Now it gets a little dicey. Regardless of the position of Baby B, the uterus may not have gotten the message that there’s another baby and might stop contracting (I’ve had to start oxytocin on many occasions to get Baby B delivered). At this point, there’s also a chance that Baby B’s umbilical cord will prolapse (so not a good thing). I would hazard a guess that until the 20th century, healthy twins were the rare exception. Also, in some cultures, twins are considered bad omens.

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  5. Diana Hockley

    October 27, 2011 at 1:54 pm

    Oh boy, this account makes me want to cross my legs very firmly! The poor things must have suffered so much. Thank you for the information – not that I’m likely to want to use it in my novels, but everything one learns is important. 🙂

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    • Lewis Perdue

      October 27, 2011 at 3:49 pm

      I agree about the horror of it all. My newest novel (Die By Wire … out next month) deals, in part, with people trying to end a child-bride smuggling ring into modern-day Europe. Sadly, it is based on fact. And those girls — some as young as 9 or 10 are old enough to get pregnant, and too young for the birth canal and hips to have matured for safe childbirth. But they’re brought there illegally, can’t take the risk of exposure by going to a doctor, and all-too-frequently die in the squalor of a slum apartment.

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  6. Brenda

    October 27, 2011 at 3:51 pm

    Thanks for this most interesting account. I find medical history most fascinating. Your blog is always great. I’ve noticed more and more how many women died in childbirth, guess the miracle is that more didn’t considering these practices. I’ve learned that more than one of my ancestors died in childbirth (or soon enough after for it to have been related) and at least one of my husband’s did. I really have to wonder how just many single women decided to be so after becoming aware of the pain and risks childbirth entailed.

    Where can I find the statistics on how many women die in childbirth these days in the various Western countries?

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    • D.P. Lyle, MD

      October 27, 2011 at 4:28 pm

      Google it and you’ll find all sorts of info.

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    • Laura Mitchell

      October 28, 2011 at 9:23 am

      I’m not sure if this is clinically true or a “wives” tale, but the conventional wisdom is once a girl gets pregnant, her skeletal growth is done.

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    • Laura Mitchell

      October 28, 2011 at 9:40 am

      I don’t think the perils of childbirth weighed that heavily in the decisions of many women who elected to remain unmarried. It may have been a dearth of eligible men, but I think the primary reason was legal. Up until the last years of the 19th century, a woman ceased to exist as a legal entity once she married (she became what was called “femme covert”). She had NO legal identity and she was literally the property of her husband. If she was well off, all her assets became his and she had NO legal right to those assets. Her husband could do with her whatever he wanted: take all her money, abuse her, etc. and the law gave him that right. Divorce was incredibly rare and she risked losing her children, as well has her money.

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  7. Elle Druskin

    October 27, 2011 at 7:17 pm

    I don’t have expertise in obstetrical care in this time period, but in general, the most common cause of maternal death was infection or hemorrhage since there was no effective treatment for either one. Other problems that are common (but can be treated today, although even today, they can lead to serious complications, damage, etc.) include toxemia, (eclampsia) placenta previa or abruptio placenta. Likewise, in that time period, gestational diabetes would also be highly problematic The high maternal death rates explain why men married more than one time (not the only reason but certainly one of the reasons) and the high death for children often led couple to want many children Not having contraception probably aided in the high conception rate.

    Elle

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  8. G.M. Malliet (@GMMalliet)

    October 28, 2011 at 7:24 am

    Just frightening. I’m so grateful be here when you consider the odds.

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  9. eleanorsullivan

    November 9, 2011 at 6:18 am

    Have you read The Midwife’s Tale by Laural Thatcher? It’s the diary of an actual midwife in the late 18th century. My just released book, Cover Her Body, features a 19th century midwife as the protagonist and includes lots of details about births in that time. As Doug says, little changed in childbirth until discovery of the germ theory so these 2 books would reflect your Puritan’s practices.Hope this helps! Eleanor Sullivan

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