Childbirth Deaths or “Accidents of Pregnancy”

After watching Sybil die from eclampsia on Downton Abbey nearly two weeks ago I started thinking about how many women died in childbirth in the past. So, naturally, I went to my go-to source for information on deaths, Michigan's annual reports on registrations of births, marriages, deaths and divorces. Maybe I'm just weird, but I find these reports fascinating. I've learned about some of the diseases children in my family died of (diphtheria and whooping cough, for example) as well as things I never went searching for like poisonous cheese. But, I digress. Here's what I found about childbirth related deaths in Michigan.

References for Graph: 1-9

The above graph shows deaths associated with childbirth from all causes. There is no obvious trend here, though it appears that rates of death resulting from childbirth actually increased between the 1870s and the early 1900s. This is more likely due to more accurate recording of deaths (see below) and to an alteration in the classification scheme for causes of death than to an actual increase in incidence. The term “accidents of pregnancy” first appeared in the 1898 Annual Report on Births, Marriages, Deaths and Divorces. [2] Under the new Bertillon classification of causes of death it includes “abortion or miscarriage (death of the mother); hemorrhage during pregnancy; uncontrollable vomiting; rupture of tubal pregnancy.” [2] This was often lumped together in the tables with “other accidents of childbirth” which included such things as Caesarian section, rupture of the uterus and retention or detachment of the placenta. [2]

References for graph: 1-12

Above I present the data for deaths from puerperal fever. We now know that death in these cases was the result of an infection contracted at the time of childbirth because of unhygienic conditions and a lack of hand-washing. I was surprised to note that there was no apparent decrease in death rates after the emergence of the germ theory of disease in the 1880s.

References for graph: 2-9

Back to Sybil, I present data from the early 20^th century for puerperal eclampsia which includes albuminuria, nephritis of pregnancy, convulsions of women in pregnancy and uremia. Though I have not run the numbers through a statistical analysis there is likely no significant difference between them as the rate of death from eclampsia for all of these years hovered around 3/100,000 population in the state. [2-9] My primary purpose in including the graph was to show the number of women who perished in this manner. Though the actual number of deaths was relatively small, if these deaths were anything like what was dramatized on Downton Abbey that would be pretty traumatic for the bystanders. It seems clear from perusing the reports that physicians were aware of eclampsia as early as the 1880s. However, from the presentation on Downton Abbey it seems there was very little if anything that could be done to treat the condition. Even if Sybil had survived a Caesarian section there is no guarantee that she would not have contracted an infection and died anyway. This seems especially true after noting no noticeable decrease in the rate of puerperal fever as late as 1917 when, in my opinion, those attending at births should have understood the importance of hygiene in preventing such infections.

One thing to note for all of the data I have presented is that we can't directly compare these deaths over time (though I combined them in the graphs for ease of viewing). The primary reason we cannot draw comparisons is that laws regulating the registration of deaths changed, affecting the accuracy of reporting deaths. Effective in 1897 the number of deaths recorded in Michigan was much more accurate than in previous years, because death certificates were now required prior to removal or burial of a body. [2] This change was a source of pride for Michigan and I'll write more about that in a later post. Another factor making it difficult to compare data over the years was that the classification system for causes of death was also altered in 1897. One good thing about the new, more rigorous system was that if a cause of death thought to be related to childbirth was vague a letter was sent to the physician to clarify it for accurate classification. [2]

All in all, I'm glad I live in an age when at least some of these issues have been dealt with.

Sources:

1. Secretary of State of Michigan. Twenty-Ninth Annual Report Relating To The Registry And Return of Births, Marriages And Deaths, In Michigan For The Year 1895, By the Secretary Of State Of The State Of Michigan. (Lansing, Michigan: Robert Smith Printing Co., 1897), 152, 158.
2. Secretary of State of Michigan. Thirty-Second Annual Report of the Secretary of State on the Registration of Births And Deaths Marriages And Divorces in Michigan For The Year 1898. (Lansing, Michigan: Robert Smith Printing Co, 1900), lxxv, ccxxxi.
3. Secretary of State of Michigan. Thirty-third Annual Report of the Secretary of State on the Registration of Births And Deaths Marriages And Divorces in Michigan For The Year 1899. (Lansing, Michigan: Wynkoop Hallenbeck Crawford Co., 1902), lxv.
4. Secretary of State of Michigan. Thirty-Fifth Annual Report of the Secretary of State on the Registration of Births And Deaths Marriages And Divorces in Michigan For The Year 1901. (Lansing, Michigan: Robert Smith Printing Co., 1905), xlvi.
5. Secretary of State of Michigan. Forty-First Annual Report of the Secretary of State on the Registration of Births And Deaths Marriages And Divorces in Michigan For The Year 1907. (Lansing, Michigan: Wynkoop Hallenbeck Crawford Co., 1909), 23.
6. Secretary of State of Michigan. Forty-Second Annual Report of the Secretary of State on the Registration of Births And Deaths Marriages And Divorces in Michigan For The Year 1908. (Lansing, Michigan: Wynkoop Hallenbeck Crawford Co., 1910), 27.
7. Secretary of State of Michigan. Forty-Third Annual Report of the Secretary of State on the Registration of Births And Deaths Marriages And Divorces in Michigan For The Year 1909. (Lansing, Michigan: Wynkoop Hallenbeck Crawford Co., 1911), 27.
8. Secretary of State of Michigan. Forty-Sixth Annual Report of the Secretary of State on the Registration of Births And Deaths Marriages And Divorces in Michigan For The Year 1912. (Lansing, Michigan: Wynkoop Hallenbeck Crawford Co., 1914), 28.
9. Secretary of State of Michigan. Fifty-First Annual Report of the Secretary of State on the Registration of Births And Deaths Marriages And Divorces in Michigan For The Year 1917. (Lansing, Michigan: Wynkoop Hallenbeck Crawford Co., 1920), 28.
10. Secretary of State of Michigan. Fourteenth Annual Report Relating To The Registry And Return of Births, Marriages And Deaths, In Michigan For The Year 1880, By the Secretary Of State Of The State Of Michigan. (Lansing, Michigan: W.S. George & Co., 1884), 234.
11. Secretary of State of Michigan. Seventeenth Annual Report Relating To The Registry And Return of Births, Marriages And Deaths, In Michigan For The Year 1883, By the Secretary Of State Of The State Of Michigan. (Lansing, Michigan: W.S. George & Co., 1885), 193.
12. Secretary of State of Michigan. Twenty-Second Annual Report Relating To The Registry And Return of Births, Marriages And Deaths, In Michigan For The Year 1888, By the Secretary Of State Of The State Of Michigan. (Lansing, Michigan: Robert Smith & Co., 1890), 154.