Dangers of Childbirth and Caesarean Section Around 1920 – A Farewell To ArmsDangers of Childbirth and Caesarean Section Around 1920 – A Farewell To ArmsBernadette Baker, Bashirah Brown, & Masy TincherBernadette Baker, Bashirah Brown, & Masy Tincher

Bloomsburg UniversityBloomsburg University

Dangers of Childbirth

Obstetrics

Mortality Rates

References

Obstetrics is a health profession dealing with pregnancy, childbirth, and the postpartum period, such as caring for the newborn. Physicians shunned obstetrics as a specialty. This caused obstetric care to be provided by poorly trained (or untrained) medical practitioners. Inappropriate and excessive surgical and obstetric interventions were common and increased during the 1920s (“Achievements”).

A Farewell To Arms continued…

Reasons for Ceasarean Section

A Farewell To Arms

As many doctors discovered, anesthesia allowed them to As many doctors discovered, anesthesia allowed them to replace craniotomy with cesarean section (Sewell). A replace craniotomy with cesarean section (Sewell). A cesarean section is the surgical method used to deliver a cesarean section is the surgical method used to deliver a baby. An incision is made in the mother’s abdomen baby. An incision is made in the mother’s abdomen followed by an incision in the uterus. Often, this followed by an incision in the uterus. Often, this procedure is necessary when problems occurs during or procedure is necessary when problems occurs during or before the birthing process. Cesarean sections are used before the birthing process. Cesarean sections are used when it is a safer option than vaginal delivery. when it is a safer option than vaginal delivery.

DangersDangersCaesarian sections were incredibly dangerous in their Caesarian sections were incredibly dangerous in their early history, almost invariably resulting in the death of early history, almost invariably resulting in the death of the mother from either infection or hemorrhage.The the mother from either infection or hemorrhage.The death rate was still high as doctors performed these death rate was still high as doctors performed these surgeries while in their street clothes and washed their surgeries while in their street clothes and washed their hands infrequently between patients leading to sepsis hands infrequently between patients leading to sepsis (Sewell). Early in the 20th century surgeons were also (Sewell). Early in the 20th century surgeons were also afraid to sew up the uterus because internal stitches, afraid to sew up the uterus because internal stitches, which could not be removed, could cause infection; they which could not be removed, could cause infection; they believed that the uterine muscle would contract and close believed that the uterine muscle would contract and close itself (Sewell). They were of course wrong, and many itself (Sewell). They were of course wrong, and many women died of blood loss. This all ended once Marx women died of blood loss. This all ended once Marx Saumlnger introduced silver wire sutures, which had less Saumlnger introduced silver wire sutures, which had less chance of infection (Sewell).chance of infection (Sewell).

Ceasarean Section

Maternity Mortality Rate, * by Maternity Mortality Rate, * by Year United States, 1900-1997 Year United States, 1900-1997

(Sewell)(Sewell)

There were many dangers facing women in childbirth during the 1920s. The four main causes of maternal death were infection, hemorrhage, convulsions (known today as preeclampsia or eclampsia), and illegal abortion (Chamberlain). Poor obstetric education and delivery practices were responsible for the large number of maternal deaths, many of which were otherwise preventable (“Achievements”). The majority of births were done in the home with the assistance of a midwife, as obstetrics was an unpopular specialty amongst physicians (“Achievements”). Over excessive or inappropriate surgical intervention were common (forceps, cesarean sections, induction of labor) and increased in the 20s, and 40% of maternal deaths were caused by result of infection, with the remaining 60% from hemorrhage and toxemia (“Achievements”).

Women could also be in danger during childbirth just from their genetics. Mislocated placenta or premature detachment of the placenta from the uterus leads to bleeding during pregnancy and women are in danger of either going into shock or dying during labor and delivery if not treated promptly (Artal).

• Maternal mortality rates during 1900 to 1930 were the highest.

• Poor obstetric education and delivery practices were responsible for the excessive numbers of maternal deaths that could have been prevented.

• 40% of maternal deaths were caused by sepsis.• remaining deaths caused by hemorrhage and toxemia.

DefinitionsDefinitions

• Sepsis (Septicemia): A life-threatening complication of Sepsis (Septicemia): A life-threatening complication of an infectionan infection

• Peritonitis: Inflammation of the thin tissue that lines the Peritonitis: Inflammation of the thin tissue that lines the inner wall of abdomen. inner wall of abdomen.

• Hemorrhage: BleedingHemorrhage: Bleeding• Toxemia (Preeclampsia): High Blood Pressure and Toxemia (Preeclampsia): High Blood Pressure and

swelling during end of pregnancyswelling during end of pregnancy

• Medical Conditions• Infections• Baby’s Health• Larger Baby• Mother’s Weight• Mother’s Age

Achievements in Public Health, 1900-1999: HealthierMothers and Babies”. CDC: Morbidity and Mortality Weekly Report. USA.gov, 2 May 2001. Web. 15 March 2015.

Artal, Raul. “High Risk Pregnancy”. Merck Manuals. Merck & Co, May 2013. Web. 15 May 2015.

"Cesarean section". Encyclopædia Britannica. Encyclopædia Britannica Online.Encyclopædia Britannica Inc., 2015. Web. 15 Mar. 2015.

Chamberlain, Geoffrey. “British Maternal Mortality in the19th and Early 20th Centuries”. Journal of the Royal Society of Medicine 99.11 (2006): 559-563. Web. 15 March 2015.

Hemingway, Ernest. A Farewell to Arms. New York: Scribner, 1929. Print.

Paul, Annie Murphy. How the Nine Months Before BirthShape the Rest of Our Lives. Pregnancy: The S-File, n.d. Web. 15 March 2015.

Sewell, Jane Eliot. Cesarean Section – A Brief History. NIH U.S. National Library of Medicine. USA.gov, 26 July 2013. Web. 15 March 2015.

Infant Mortality Rate, * by Year Infant Mortality Rate, * by Year United States, 1915 – 1997 United States, 1915 – 1997

(Sewell)(Sewell)

In A Farewell to Arms Catherine Barkley went through a difficult labor and delivery and ended up have a caesarean that lead to her hemorrhaging and eventual death. She mentions earlier on in the novel that, “the doctor says beer will be good for me and keep her small” (Hemingway 293), “her” meaning the baby. A little while later she says, “the doctor said I was rather narrow in the hips and it’s all for the best if we keep young Catherine small” (Hemingway 294). Women that are shorter than five feet are more likely to have a small pelvis, which makes the movement of the fetus through the birth canal difficult (Artal). Unfortunately, alcohol would do little to help. Doctors back in the 1920s didn’t know about fetal alcohol syndrome and, “pregnant women were once permitted, even encouraged to drink alcohol by their doctors” (Paul).

• Breech Position• Multiples• Placental Problems• A Previous C-section• Other Complications

Because of her small pelvis, a caesarean section was probably the next best alternative besides forceps, which, though saving the lives of many babies, causes the mother to suffer the rest of her life from tears in the vaginal wall (Sewell). The doctor mentions this himself when describing the two procedures he can use to deliver the baby when he says to Frederick Henry, “there are two things. Either a high forceps delivery which can tear and be quite dangerous besides being possibly bad for the child, and a Caesarean” (Hemingway 321).

Catherine does make it through her caesarean seemingly fine, but after recovery, begins to hemorrhage until she finally goes unconscious and dies. The reason for this could be related to many things. It could have been damage to her uterus from poor surgery, from left over placenta that wasn’t removed during surgery, or from poor contraction of the uterus from the fatigue of labor (Chamberlain). The knowledge of the physiology of labor, especially in the later stages was scanty and often misapplied during the early 20th century, which probably led to Catherine’s death.

The Baby Catherine’s baby was born dead, strangled by his own umbilical cord. This can be a cause of death in children even today. The doctors may have done all they could, but it may appear strange to some why they slapped the baby and hung him upside down once he was removed from the uterus. Back in the 20th century and earlier, doctors believed that holding the newborn child upside down and slapping them would stimulate breathing. That explains why Catherine’s doctor repeatedly slapped the baby, because he wasn’t breathing.

Obstetrical forceps. From André Levret's Observations sur les causes et les accidens de plusieurs accouchemens laborieux, 1750 (Sewell)

Craniotomy. Perforation of the skull, removal of cranial contents, and extraction of the collapsed skull (Sewell)