In the distant past, maternal and infant mortality rates were excessive.
The history of childbirth is one of great risks.
Before modern obstetrics, childbirth was one of the most dangerous events in a woman’s life. The risk was so common and visible that nearly every extended family had stories of mothers, infants, or both dying in labor or shortly afterward.
Maternal death rates in Europe and North America before modern obstetrical care were very high – from 1 in 8 to 1 in 18 women died from pregnancy or childbirth complications.
Before modern obstetrics, it is estimated that 1 to 1.5% of births resulted in the mother’s death, or there was roughly 1 maternal death for every 70–100 births.
Because women often had many pregnancies, the lifetime risk of dying from childbirth became very high:
In pre-industrial England (1650–1800), maternal mortality averaged about 10 maternal deaths per 1,000 births (or 1%).
Irvine Loudon, a historical demographer, estimated maternal mortality around 25 deaths per 1,000 births among some “unassisted” populations.
In Sweden and Finland (around 1800), maternal mortality was roughly 900 deaths per 100,000 live births (or 0.9%).
Modern maternal mortality rates:
In stark comparison, today in high-income countries, maternal mortality is usually around 5 to 20 deaths per 100,000 births.
In other words, childbirth in the 1700s was roughly 50 to 200 times more dangerous for mothers than it is today in developed countries.
IN the past, what killed mothers during or after childbirth?
The leading causes were very similar to modern obstetric emergencies — except there was no effective treatment. The major causes were:
- Postpartum hemorrhage (bleeding)
- Puerperal fever/sepsis (infection)
- Obstructed labor
- Eclampsia (seizures from preeclampsia)
- Retained placenta
- Uterine rupture
What made these complications so deadly was the absence of:
- antibiotics
- blood transfusion
- cesarean delivery
- sterile technique
- IV fluids
- anesthesia
- skilled surgical intervention
A woman could survive labor itself, but she might die several days later from infection or hemorrhage.
The real revolution in maternal survival, brought about in modern times, came from:
- antisepsis (hand hygiene)
- germ theory (infectious pathogens caused infection)
- antibiotics (properly treated infections)
- blood banking (replaced severe blood loss from hemorrhaging)
- safer cesarean delivery (delivering twins and breech babies)
- professional midwifery and obstetrics
- prenatal care
One important nuance must be considered: despite the dangers, most women survived childbirth. Even in the 1700s, about 98 to 99% of individual births did not kill the mother. It was repeated pregnancies that multiplied her lifetime risk.
On balance, childbirth was both common and usually survivable, yet it remained one of the leading causes of death for young adult women.
In many ways, modern obstetrics fundamentally changed the experience of womanhood by making pregnancy far less likely to be deadly.
Modern mothers fare better with the risk of childbirth:
The overall U.S. maternal mortality rate in 2024 (most recent CDC national data) was approximately 17.9 maternal deaths per 100,000 live births.
However, serious discrepancies exist in maternal mortality rates by race/ethnicity (2024):
- Non-Hispanic Black women 8/ 100,000 live births
- Non-Hispanic White women 2/ 100,000 live births
- Hispanic women 1/ 100,000 live births
- Non-Hispanic Asian women 1/ 100,000 live births
The most striking disparity is that Black women experience maternal mortality at roughly 3 times the rate of White women.
The leading causes of maternal death in the U.S:
The CDC and maternal mortality review committees consistently identify these as the top causes overall:
- Cardiovascular disease/cardiomyopathy
- Hemorrhage
- Infection/sepsis
- Hypertensive disorders of pregnancy (preeclampsia/eclampsia)
- Thromboembolism
Other important contributors are:
- mental health conditions/suicide
- substance use disorder/overdose
- amniotic fluid embolism
Newborn infants died commonly in the pre-modern years:
Infant and newborn mortality was even worse than maternal mortality.
In many premodern societies 10 to 20% of babies died in the first year of life. In some urban areas, death rates were substantially higher. During this time, stillbirths were common but often undercounted.
Around the 1700s, neonatal mortality (death in the first month) may have been roughly 30 to 100 per 1,000 births. Overall infant mortality often exceeded 150 to 250 per 1,000 live births in parts of Europe.
Back then, in practical terms, families expected some children would not survive. It was common to have many pregnancies partly because childhood death was so frequent.
Modern newborn infant mortality rates much improved:
Currently, the overall U.S. infant mortality rate is approximately 5.5 deaths per 1,000 live births.
Infant mortality by race/ethnicity (CDC)
Non-Hispanic Black infants 10.9/ 1,000 live births
American Indian/Alaska Native infants 9.1/ 1,000 live births
Native Hawaiian/Pacific Islander infants 8.5/1,000 live births
Hispanic infants 4.9/ 1,000 live births
Non-Hispanic White infants 4.5/ 1,000 live births
Non-Hispanic Asian infants 3.5/1,000 live births
Similar to maternal mortality rates, black infant mortality remains 2 to 2.5 times the rate of White infant mortality.
baby breastfeeding
The leading causes of infant deaths:
Currently, the main causes of infant mortality in the U.S. are:
- Congenital malformations/chromosomal abnormalities
- Disorders related to prematurity and low birthweight
- Sudden infant death syndrome (SIDS)
- Maternal complications of pregnancy (e.g. infection, placental insufficiency, diabetes)
- Unintentional injuries
Important current themes in US maternal and infant mortality.
Several themes consistently emerge in recent CDC and review committee analyses:
- Most pregnancy-related deaths are considered preventable
- Cardiovascular disease has overtaken hemorrhage as the leading maternal killer
- Black maternal mortality disparities persist even after controlling for income and educational level
- Prematurity and low birthweight remain the major drivers of infant mortality disparities
- Access to prenatal care, postpartum care, and high-level obstetric/neonatal services strongly influence outcomes
Conclusion
Few areas of medicine have achieved greater progress than obstetrics and newborn care. For most of human history, pregnancy and childbirth carried substantial risks for both mother and baby, and nearly every family experienced the loss of a mother, infant, or young child.
Advances in hygiene, prenatal care, obstetric surgery, blood banking, antibiotics, fetal assessment, and neonatal intensive care have transformed childbirth from a frequent cause of death into an event that is overwhelmingly safe in developed nations.
While today’s healthcare professionals continue to work toward eliminating preventable maternal and infant deaths and addressing persistent disparities, the remarkable decline in mortality over the past three centuries stands as one of the greatest achievements in medical history.
References
Loudon I. Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800–1950. Oxford: Clarendon Press; 1992.
Loudon I. Maternal mortality in the past and its relevance to developing countries today. American Journal of Clinical Nutrition. 2000;72(1 Suppl):241S-246S. doi:10.1093/ajcn/72.1.241S
Schofield R. Did the mothers really die? Three centuries of maternal mortality in “The World We Have Lost.” In: Bonfield L, Smith R, Wrightson K, editors. The World We Have Gained. Oxford: Blackwell; 1986. p. 231–260.
Wrigley EA, Schofield RS. The Population History of England 1541–1871: A Reconstruction. Cambridge: Harvard University Press; 1981.
Wrigley EA. Infant and child mortality in early modern England. In: The Cambridge World History of Human Disease. Cambridge University Press; 1993.
Woods R. Death Before Birth: Fetal Health and Mortality in Historical Perspective. Oxford University Press; 2009.
Rosenfield A, Maine D. Maternal mortality — a neglected tragedy: Where is the M in MCH?
Lancet. 1985;2(8446):83–85. doi:10.1016/S0140-6736(85)90188-6.
World Health Organization. Trends in Maternal Mortality: 2000 to 2020. Geneva: WHO; 2023.
Tew M. Safer Childbirth? A Critical History of Maternity Care. London: Chapman & Hall; 1990.
Leavitt JW. Brought to Bed: Childbearing in America, 1750–1950. New York: Oxford University Press; 1986.
