The Evolution of Maternity Care


The Evolution of Maternity Care

Historically, giving birth has put a mother and child at significant risk. Recent advances in the fields of maternity care, including midwifery and obstetrics, have helped reduce mortality rates and make delivery a much safer process. In the early to mid 1800s, maternal mortality rates were 400 to 500 per 100,000 births. The greatest cause of death at the time was puerperal fever, which is a fever caused by uterine infection after childbirth, followed by hemorrhage and eclampsia (seizures during pregnancy and birth). These three conditions represented 90 percent of all maternal deaths from childbirth, yet a simple discovery by an Italian physician named Ignaz Philip Semmelweiss led to a 90 percent decrease in mortality from puerperal fever alone. This was achieved when obstetricians began washing their hands after delivering a baby. Other medical discoveries and improved obstetric care have led the way to more stable and successful pregnancies.

The importance of advances in modern maternity care cannot be understated. They have helped ease the process of pregnancy at all stages, and increased the chances of a healthy mother and child. Over the years, much of maternity care was handed over to family doctors who practiced obstetrics. There were several key innovations that led to today’s safe and effective maternity care.

Use of Male Midwives

Male midwives helped lead the way to modern maternity care. Before the 17th century, doctors would rarely attend to expecting mothers. Instead a midwife would be summoned to the woman’s home, where the baby would be born. Before this time, many felt that men shouldn’t attend childbirth because of modesty issues. During the 1600s, France would lead the way in “man-midwifery.” Male doctors, who were typically only contacted out of desperation, began to investigate and publish books and theories based on their education and medical experience, leading to advancements the field of obstetrics. It would not be until the 20th century, however, before the term “obstetrics” would be used, even in the medical community.

Invention of Obstetric Forceps

Until the 1600s, instruments had largely been for extracting a baby when no other option was available. These allowed the mother to live, but often at the cost of the baby’s life. One family of obstetricians, the Chamberlen family, invented the use of shaped forceps, which they used secretly for over a century. This tool amounted to a scissor-like device with grips that were curved so that they could gently grasp the head of the baby. Even though the forceps were a simple shape, they could mean the difference between life and death. Finally, still in its crude form, the obstetric forceps idea was leaked around the start of the 18th century, allowing William Smellie (1697-1763) to refine their form and usage. Subsequently, several other variations were invented, and many are still in use today for operations like the cesarean section (C-section). Obstetric forceps continue to make childbirth safer and easier.

Elimination of Puerperal Fever

As the general public began to trust centralized birthing hospitals over in-home midwives, new problems arose from the presence of disease. Puerperal fever was a very real problem from the late 18th century through the end of the 19th century, causing 55 percent of maternal mortality. At the time, it was believed that miasma, or “bad air,” was the cause of disease. After Dr. Semmelweiss’ obstetrics students began washing their hands, the rate of infection fell from 11.4% in 1846 to 1.27% in 1848. Unfortunately, these results were not received well by other doctors, such as Carl Edvard Marius Levy, who insisted that such a small contamination could not account for the effects of the disease. The germ theory of disease would not gain wide acceptance until the 20th century. A vaccine for puerperal fever would have to wait until 1935, when the first antibacterial, Prontosil, was released. In the meantime, however, this single discovery in the field of obstetrics would save millions of mothers and children.

Increased Use of the Cesarean Section

The C-section was actually invented very early in history. The name is thought to come from the Latin word “to cut.” Until anesthetic and antiseptic procedures were available, survival for the mother was rare due to the infection that would normally follow surgery. These practices would gain acceptance near the end of the 19th century, making the lifesaving C-section procedure safe. Even before the turn of the century, doctors experimented with better surgical procedures, enabling decreased blood loss and infection rate. Spinal and epidural anesthesia, which became available in the 1960s and 1970s, allowed for lower maternal mortality rates and increased mother-child bonding.

Use of Family Doctors as Obstetricians

In the early 1980s, obstetric health care was in high demand, and the medical community was unable to meet it. The need for proper maternity care was especially felt in the rural parts of the country, where specialists were too far away to care for many families. In 1984, Dr. Paul Mozley, a University of Alabama professor, recognized this issue and began a postgraduate fellowship for training professional family doctors in obstetric care. The increased number of practitioners eventually made maternity care available to nearly everyone in the United States. Today, over a quarter of million babies are delivered by family physicians yearly, and 64 percent of pregnant women receive some type of maternity care from a family doctor.

There are many benefits to using a family doctor as your personal maternity care provider. For instance, family doctors have expertise in a variety of fields, and are equipped to deal with a variety of health scenarios. Our Marysville branch provides personalized obstetric care for expecting mothers at every stage, as well as mothers with newborns. Schedule an appointment with one of our family doctors.