Intended for healthcare professionals

Rapid response to:

News Roundup [abridged Versions Appear In The Paper Journal]

Vaginal delivery after caesarean section triples risk of uterine rupture

BMJ 2001; 323 doi: (Published 14 July 2001) Cite this as: BMJ 2001;323:68

Rapid Response:

The Myth of our Dead Grandmothers

"I stand by what I concider (sic) the optimum outcome for a
pregnancy, a healthy baby and a healthy mother, a luxury our mothers and
grandmothers did not always have, one we take for granted today." from
Maxine Baxandall

One more myth/fear tactic that deserves to be seen for what it is.

I have read the accessible "A Midvife's Tale - the Life of Martha
Ballard, Based on Her Diary, 1785-1812" (New York Times Best Seller,
Pulitzer Prize winner, Laurel Thatcher Ulrich, 1990, Vintage Press) and
the not-so-accessible "Mother and Child were Saved - the memoirs (1693-
1740) of the Frisian midwife Catherina Schrader" (translated by Hilary
Marland, 1987, Rodopi Press, Amsterdam). Both of these midwives had a
record that would be the envy of any modern obstetrician, physician or

Bottom-Line up-front: obstetric medicine is not responsible for the
gains in maternal or infant mortality/morbidity. Improved nutrition and
diet, and improved sanitation - that is - better public health systems get
the credit.

Historically, especially among women raised in urban English towns,
women suffered from rickets (malnutrition) while still adolescents. This
ailment deformed their pelvis, and created several generations of women
who were essentially unable to deliver their own babies unassisted. This
occurred around the same time that physicians were trying to hurd indigent
women into hospitals to provide "training material" for young interns.
But doctors didn't yet understand the nature of bacteria, and so,
hospitals became a place were women went to die of child-bed fever,
instead of a place were women could birth in safety. Together, the social
conditions and the political structures of England turned childbirth,
which had not previously been a life-threatening event, into just that.
Other regions of the world that have experienced poverty, and therefore
malnutrition and poor sanitation, have experienced this pneomenon in both
modern and ancient times.

The greatest gains in reducing maternal and infant mortality came
with access to proper nutrition and a varied diet that included fruits and
green vegetables. From that discovery, we learned the value of pre-natal
care as an opportunity to instruct pregnant women on how they can grow a
healthy baby. A rising middle class meant that people could afford to eat
better as well. The risk of death for mother and baby were further
reduced with the understanding of how bacterial infection spread, which
led not only to scrupulous sanitation in hospitals, but also to improved
sanitation in cities, towns, and individual homes as well. Thus, the
credit goes to improved public health and improved standard of living.

The proof? Look to those countries that still use midwives and out-
of-hospital birth as the primary people/places for birth. Many (24 post-
industrial nations) have morbidity/mortality rates are significantly lower
than in the US, and so is their C-Section rate.

Competing interests: No competing interests

04 December 2001
Willa Powell
Rochester, NY 14607