Recognizing the Dangers and Pains of Childbirth


12th Century Childbirth Depiction via McMaster University mw.mcmaster.ca

I read a response from Heather Corinna about a young female’s pregnancy fears and, while she did an excellent job addressing sexual anxiety and giving pregnancy information, I felt there was something missing from the discussion: the very real dangers of childbirth.

Realistically, I’m not sure mentioning maternal mortality rates to someone experiencing unfounded pregnancy fears is necessary. But in the past year I’ve been reading more reports on maternal death and pregnancy complications and noticing the silence surrounding this in sex education.

The big reason is simple: modern Western medicine saves countless lives of mothers giving birth. We very rarely hear of women in developed countries dying from childbirth because they can give birth in hospitals. But was not the case historically nor is it the case in some places of the developing world.

No birth among mammals (save for maybe hyenas) is as dangerous as human birth. Walking upright and possessing complex brains meant humans developed smaller pelvises and larger heads. This is major source of childbirth complications: fitting a bigger cranium through a smaller passageway. Aside from the extreme pain, obstetric fistulas, and death from hemorrhaging, infections and sepsis are serious childbirth issues.

Before modern medical technology giving birth meant risking death. Figures for maternal death are hard to come by prior to the 19th century, but historian Irvine Loudon says the rates were 400-500 per 100,000 birth during the 19th century and states maternal death “was a bit higher at the beginning of the 19th century and was up to perhaps 1000 per 100000 births in the early part of the 18th century.” (Read Loudon’s article here, especially the discussion section.)

That means 1 out of 100 births resulted in the death of the mother in the 1700s. We can’t be sure what figures were before then, but looking at trends in respect to medical care access suggests maternal mortality, not to mention morbidity, were high.

Lack of access to medical care and skilled birth assistants is only one factor contributing to maternal death and morbidity. Youth and pelvic shape also play a role. Young women and and those with narrower pelvises will have more delivery complications.

Yet sex education materials leave this information out.

"Mother and Child" -Gustav Klimt

Earlier in the summer, I was at a former professor’s BBQ and a drunken discussion came up about women’s wombs. “Women are sacred!,” he exclaimed. “When they give birth, they risk death to do so!” I stood there with two other females and we laughed and smiled at the adulation, but the significance never sunk in until I read “Half The Sky” recently.

As I pored over statistics and read anecdotes of obstetric fistulas and mothers dying in poorly-staffed rural hospitals (or even in the middle of a bustling marketplace) I found a ever-growing respect and compassion for females. We create monuments for soldiers killed in battle, have parades to honor those dead in service to our country, yet we fail to honor women’s birth-related death and suffering in order to further human history.

In the absence of advanced medicine, maternal suffering and death was so commonplace, Cotton Mather (a 17th century American minister) advised pregnant women that, “Preparation for death is that most Reasonable and Seasonable thing, to which you must now apply yourself.” Imagine being pregnant and receiving that suggestion these days. “Get ready, you might die.”

Kristoff and WuDunn’s book “Half The Sky” (where I found the preceding Mather quote) contains an illuminating passage about attitudes towards women and childbirth:

In most societies, mythological or theological explanations were devised to explain why women should suffer in childbirth, and they forestalled efforts to make the process safer. When anesthesia was developed, it was for many decades routinely withheld from women giving birth, since women are “supposed” to suffer. -Half The Sky, page 116

But now many of us do not have to suffer. We have the technology to stop massive hemorrhaging, deal with infections and stitch up vaginal tears. In this brave new world, we forget the inherent dangers of pregnancy and childbirth.

Let’s not. Instead, bring the dangers into the conversation along with the modern solutions. This is especially important in youth sex education when pregnancy is the leading cause of death for 15-19 year-old females (stat found via). In that light, maybe it is necessary to mention the dangers of and modern medicine to deal with pregnancy to a young women experiencing that anxiety.

7 thoughts on “Recognizing the Dangers and Pains of Childbirth”

  1. I love this!

    For sure, it’s not something I’d bring up with someone already having pregnancy anxiety as it is, especially someone like that young woman who wasn’t even engaging in any activities where pregnancy is a risk. I purposefully avoided talking about this with her because she wanted help reducing her anxiety.

    But I think this is really important, as is talking about maternal mortality in sex ed. It often comes up when we discuss abortion, and how much safer it is, but I think we can probably find some other interactions to discuss it with, too.

    Thanks for adding to the conversation!

  2. We have the technology to stop massive hemorrhaging, deal with infections and stitch up vaginal tears.

    I’m not sure about the US, but certainly in the UK there’s a massive movement by midwives and other factions promoting as natural a birth as possible. Including minimising analgesia.

    1. Natural birth is fine and dandy, as long as the birth attendant is skilled and there is a hospital nearby to deal with post-birth complications. If you read the link to Irvine Loudon’s study of 18th and 19th century to maternal morbidity, one of the most striking parts is the comparison between a doctor-dominated hospital and a nurse-dominated hospital. He found that maternal mortality was *higher* in the one run predominately by doctors, most likely because they were performing surgery unnecessarily.

      ‘My cousin is a midwife and I’m curious to ask her about her stance on painkillers. Personally, I am pro-analgesic. I don’t see how pain is necessary.

      And, yes, according to a recent article in “Time” magazine, natural childbirth is trending in the US: http://www.time.com/time/magazine/article/0,9171,2011940,00.html

  3. One great place to start, by the way, might be Penny Simkin’s Pain Medication Preference Chart (http://juliwalter.com/binder/class3/MEDICATIONSPREFERENCESCALE.pdf) a tool she uses to help patients figure out what they expect, what they want, and (more important) how their caregivers and birth partners can help them navigate their choices.

    Short of Shulamith Firestone’s dream of artificial wombs I don’t know if childbirth can ever be completely pain and risk free. But we can do a heck of a lot more to combat the notion that it’s not just likely to hurt but that it ought to.

    The notion of inevitable suffering in childbirth, or the virtue of it, let alone the notion of divinely mandated suffering(!), can lead to all manner of unnecessary complications, abuse, and outright medical violations by caregives, and passive acceptance by victims.

    figleaf

  4. Thanks for writing this post! I agree, there isn’t enough discussion in sex ed about the inherent dangers of pregnancy and child birth. I’m curious to know how this issue could be taught in sex ed versus a maternal child health course?

  5. Once upon a time Dr.’s went straight from the morgue where they examined the dead bodies to the maternity wards without washing their hands which contributed to many deaths of women from infection passed from dr. to patient…

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