Saturday, December 20, 2008

Abortion deaths in 1900

This is the picture the CDC paints in Achievements in Public Health, 1900-1999: Healthier Mothers and Babies of maternal mortality at the beginning of the 20th century:

Maternal mortality rates were highest in this century during 1900-1930. Poor obstetric education and delivery practices were mainly responsible for the high numbers of maternal deaths, most of which were preventable. Obstetrics as a speciality was shunned by many physicians, and obstetric care was provided by poorly trained or untrained medical practitioners. Most births occurred at home with the assistance of midwives or general practitioners. Inappropriate and excessive surgical and obstetric interventions (e.g., induction of labor, use of forceps, episiotomy, and cesarean deliveries) were common and increased during the 1920s. Deliveries, including some surgical interventions, were performed without following the principles of asepsis. As a result, 40% of maternal deaths were caused by sepsis (half following delivery and half associated with illegally induced abortion) with the remaining deaths primarily attributed to hemorrhage and toxemia.

Note, please, that with issues such as doctors not using proper aseptic techniques, lack of access to blood transfusions and antibiotics, and overall poor health to begin with, there was likely little difference between the performance of a legal abortion and illegal practice, and the aftercare for either type of abortion was probably equally unlikely to do the woman much, if any, good.

Maternal mortality rates for the 20th century, according to the CDC, looked like this:

This is all maternal deaths, from abortion, miscarriages, ectopic pregnancies, complications of childbirth, and so forth. You can see that the 20th Century got off to a good start, improving maternal health, but that trend would later level off, and then reverse itself temporarily, before taking the downward trend that would continue for the rest of the century.

Note also the total lack of even the faintest blip on the trends with the legalization of abortion in the beginning of the 1970s.

With that established, let's look at the sample of cases I've been unable to uncover during 1900. Please note that these cases are chosen purely because I could find information about them, and not because I thought a particular woman's story made a particular political point.

  • January 12, 1900: Ida Henry died after an abortion performed by Dr. Paulina Bechtel.

  • January 22, 1900: Barbara Shelgren died of complications of an abortion performed by Paulina Bechtel, who in this case was identified as a midwife -- but elsewhere she was described as a physician. At that time, doctors, especially female doctors, who delivered babies were referred to as midwives, so Bechtel was most likely a physician.

  • March 5, 1900: Alice Koester died from an abortion performed by Maria Janke, who was described as a "professional", but whose specific profession was not listed.

  • June 28, 1900: Mrs. Jorgenson died of an abortion under the care of Anna Pihlgren, identified as a nurse or midwife.

  • July 2, 1900: Sarah Bonda died receiving an abortion under the care of midwife Martha Heisig.

  • August 4, 1900: Mary Borglun died after an abortion performed by Mary Kempfer, who was a nurse or a midwife.

    I analyzed who performed these fatal abortions, as well as those performed 1902-1909 and 1901, and got this picture of who performed the fatal abortions:


  • Doctors - 60%
  • Midwives - 24%
  • Unknown or undetermined - 8%
  • Self - 8%

    This is in keeping with estimates, that roughly 90% of pre-legalization abortions were being done by doctors, made when Planned Parenthood held a conference in 1955. As people turned to doctors for more care, rather than to midwives or to friends and relatives, they'd turn to doctors more for abortions as well. Also, doctors would likely be underrepresented among those performing fatal abortions, if only because they're more likely to be able to come up with a likely alternative explanation for a death.

    For more about abortion deaths in specific years, see this post.

    For more on pre-legalization abortion, see The Bad Old Days of Abortion

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    Kathy said...

    I've looked in some detail at the graph of maternal mortality in the early part of the 1900s and have a couple of theories. Birth at home was the norm at the beginning of the century, but by the middle of the 30s it was 50/50 home-hospital birth; by the 50s, it was about 95% or more hospital birth.

    Bringing in what you've said about better sanitation and health (clean food and water, and more abundant food; cleaning up horribly filthy cities like New York), maternal mortality started to drop from 600/100,000 when it first began to be recorded in 1915; but right after that, influenza killed more people (in 1918 and/or 1919) than all of WWI did, which may account for the spike in those years of maternal mortality -- deaths of new mothers and pregnant women due to complications of the flu being counted in with more direct causes of mortality like sepsis.

    The trend hovered around 600-700 throughout the 1920s and the first part of the 1930s, and it was noted by obstetricians at the time (who were intent on wiping out midwives as birth attendants, and villifying them for being "dirty" and "untrained" while the doctors usually had less training than the midwives although they did operate with so-called "sterile technique") that maternal deaths were highest in the hospital, in the middle in doctor-attended home-birth, and lowest for midwife-attended home-birth. (Btw, their solution was not to promote midwives, but to legislate them out of existence so that they'd have more women to practice on and thus improve their skills.)

    The MMR began dropping in the mid-30s, right after the White House issued a report condemning overuse of surgery and other interventions, and calling on doctors to lessen their use of them. Part of the problem of maternal mortality, and particular sepsis of the day, was that far too many women were having C-sections, but also that most if not all women giving birth in hospitals (and possibly some of those giving birth at home attended by doctors) were knocked unconscious (with definite risks of its own), given major episiotomies (cutting of the opening of the birth canal, obviously a risk of infection, especially w/o antibiotics) and having their babies dragged out by forceps. This practice did not change until sometime in the 60s (and my mom had it with all 4 of her births in the 70s, in a rural hospital).

    So, had doctors not been so knife-happy, MMR would have been much lower throughout the first part of the century, and the deaths from sepsis associated with childbirth, especially, would have been much less.

    Christina Dunigan said...

    I'm not sure what impact the flu pandemic had. There doesn't seem to be any particular spike up or down for 1918. I'd thought that WWI might have had some sort of impact -- men coming home from the war bitter and disillusioned, seeking solace in sex but not feeling up to dealing with the resulting babies. But the leveling off was before the war, and the climb was begun during the war.

    One thing I find interesting, when you mention the doctors' war on midwives -- the claim by abortion advocates that this war on midwives was the "real" reason doctors started to oppose abortion in force. But wouldn't they have instead legislated for physician-only abortions, rather than for a ban? They'd want to take the business away from the midwives without taking it away from themselves. If the goal was to put all obstetric and related care in doctors' hands, BANNING a major source of business for themselves would be a stupid move. But if, as the prolifers say (and as many physicians put into practice at the time) the concern was growing awareness of unborn lives, then part of the war on midwives might have indeed been due to midwife-abortionists, but not as competitors for business, but as "dirty and ignorant" women who didn't understand that abortion was killing babies. If you look at that perspective -- that they thought of midwives as dirty and as abortionists -- then it makes sense. They wanted to squash the midwives because they were, in the physicians' view, bringers of death to both mothers (through supposedly dirty and ignorant birthing methods) and babies (through being abortionists).

    Kathy said...

    What I've read about the war on midwives did not mention abortion much if at all (it was only in passing as a reason for maternal mortality -- either being high or falling -- that once women got birth control pills and greater access to abortions, they had fewer children with less resulting maternal mortality, in combination with improved standards of living, antibiotics, etc., etc.).

    The quotes that I've read (, the historical section) dealt solely with midwives, doctors, and birth.

    I agree with your assessment about why doctors started to oppose abortion. Over the weekend, I read an interesting book on abortion from a pro-life perspective; it was written in 1985 so much of the information was outdated, but they had a section on the history of abortion. In brief, it said that abortions used to be so dangerous that there was no reason to outlaw it, being a stupid thing for the woman to do, and about as likely to bring on her death as not, so why legislate against it? Then as methods (or concoctions) improved and it was less deadly to the mother, laws began to be passed to protect the babies. Interestingly, the Hippocratic Oath originally included a proscription against doctors inducing an abortion; and early Church Fathers also had similar injunctions against it. From another historical thing on abortion I read (which you gave me the link originally), it demonstrated that there were laws even in the Dark Ages against abortions. Both the book and the website said that one difficulty in prohibiting early abortions is that it was difficult to tell if a woman was pregnant early on, and therefore nearly impossible to prove that she had had an abortion; but the website included cases in the 1200-1600s brought against women who had abortions and/or the women who induced the abortions (since women were the primary care-givers for other women in matters related to pregnancy).

    Moving on in history, when a woman first feels the baby move in the womb, it is called "quickening", which you understand if you've ever read any old English (such as the King James version of the Bible, or if you've ever cut a fingernail too deep and gone down to "the quick") that that refers to being alive, and was thought by scientists to be when the fetus became alive. The book pointed out that many laws against abortion only dealt from "quickening" on -- showing that it was not illegal (or at least, not as bad) to have an abortion before the baby was alive (according to their understanding), but that it was homicide after that point. And, as scientific understanding of fertilization, pregnancy, genetics and life grew, so laws against abortion became more and more stringent -- the only possible reason being to protect the living child in the womb. Since as you point out doctors did the majority of abortions (as they grew to become OB/GYNs, taking over "female" business from midwives), they would be killing the goose that laid the golden egg if they were to outlaw abortions, rather than just legislate midwives out of performing abortions, the way they legislated them out of attending births.

    Doctors had the power -- they were wealthier than midwives, and had more social status being supposed to be better educated and better trained. They successfully prohibited non-doctors from attending births in the name of "women's health"; they could have even more easily kept them from performing abortions, in the name of "women's health", while still keeping abortion legal for themselves to perform.

    Historically, there may have been some basis for the "beef" that abortion advocates have with ancient laws -- they claim that midwives were sometimes treated like witches and burned at the stake if women died in childbirth or if they induced an abortion. I haven't investigated the legitimacy of the claims. But even if they're right, we're still talking "burning at the stake" or the 1600s or before -- what basis does that have in the late 1800s or even the early 1900s? IOW, it's not logical that doctors from the 1880s-1940s would work to make abortion illegal because a handful of ancient midwives got burned at the stake for killing women by inducing abortion. Just doesn't make sense.