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Midwives and their role in the reduction of direct obstetric deaths during the late nineteenth century: the Sundsvall region of Sweden (1860-1890).

Curtis S - Med Hist (2005)

View Article: PubMed Central - PubMed

Affiliation: Department of History, Memorial University of Newfoundland, St. John's NL A1C 5S7, Canada.

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Maternal mortality remains a cause of legitimate concern in developing parts of the world where rates often exceed 650 per 100,000 live births—at least twenty times higher than in the developed world, and appears impervious to all efforts to reduce it. 1 Overwhelming poverty, insufficient health care, and the paucity of well-developed and thoroughly integrated programmes to reduce maternal mortality help ensure that these rates are comparable to, if not actually higher than, those found in some of the most unhealthy European cities and regions of the nineteenth century... That said, to assume that whatever the politicians wanted the midwives to achieve is what actually happened, even in the most isolated parts of the country, is rather naïve... It is impossible to prove the authors' conclusion that maternal mortality declined in Europe because of “political commitment, availability of effective techniques, and assistance to most deliveries provided by trained health professionals able to ‘culturally’ integrate such a technology”. 4 Their assertion certainly is not true before the very end of the nineteenth century and perhaps not until the early 1900s... For the country as a whole these rates fell from approximately 780 per 100,000 live births between 1801 and 1805 to about 230 per 100,000 in 1900... By way of comparison, maternal mortality rates in England and Wales remained at almost 480 per 100,000 live births as late as 1900. 10 Despite this general pattern of quite remarkable decline, the increase in maternal mortality from approximately 1860 to 1880 that peaked in the early 1870s indicates that this reduction was subject to quite dramatic, albeit often short-lived, reversals. 11 It is these periods when maternal mortality rates rose, or at least did not continue to fall, that highlight the error in ascribing monocausal explanations such as a greater provision of midwives to general trends... According to the provincial physician, Sundqvist was also responsible for Timrå parish and there she, or perhaps midwives living in the nearby town, attended at least 64 per cent of all births. 52 The markedly different midwife attendance rates in these two parishes illustrates either what doctors claimed was an impenetrable wall of traditional ignorance and culture, or the gradual advances of academic medicine... Between 1882 and 1887, Elisabeth Holmgren, the midwife for the inland parish of Tuna, attended approximately 55 births annually, representing about 50 per cent of all births. 54 It seems that this was well below the average for the area. 55 Sundsvall's district physician, Dr Söderbaum, reported that for most of the parishes under his supervision midwives attended 65 per cent of all births in 1884. 56 Five years later the number of births in his district skyrocketed to almost 800 but the midwives had been called to more than 80 per cent of them... This was well above the national average of approximately 70 per cent of all home deliveries that midwives attended in 1890. 57 One of the busiest of the Sundsvall midwives must have been Anna Westerlund of Skön parish, who attended almost 120 births every year between 1882 and 1886. 58 In some underdeveloped countries today we can assume that a midwife is able to attend and provide post-natal instruction for approximately 150 births annually. 59 To achieve so comparable a number in the rugged terrain of the Sundsvall region during the nineteenth century would have required a substantial effort... Even Augusta Petersson, who had been born in Stockholm, had lived eleven years in Sättna before she started work as parish midwife. 62 Beginning in the 1880s the number of women from other parts of the country who became midwives in the Sundsvall region rose considerably... One of the consequences of this model was that the nutritional needs of their husbands took precedence over their own... Among other dangers, a reduction in nutritional intake increases the likelihood of obstructed labour and this was by far the major cause of direct obstetric deaths in Sweden during the nineteenth century. 82 Women often found work at or near the sawmills during the 1870s but their participation in the paid labour force could not guarantee access to nutritious food for at least two reasons... One of the reasons maternal mortality declined so markedly in the Sundsvall region during the last decades of the nineteenth century was because women were more inclined to call a midwife... In some ways at least this study illustrates the danger of ignoring the influence of traditional cultures if the goal of reducing maternal mortality is to be achieved in the developing countries of today... Government officials may have the will, financial resources may be found to reduce poverty and improve living standards, and trained medical practitioners armed with the most modern skills can be mobilized to ensure safer births.

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Ratios of females to midwives in Sweden, Västernorrland, and the Sundsvall region, 1861–1890.Sources: Demographic Data Base (Umeå, Sweden); Riksarkivet, Sundhets Collegium and Medicinalstyrelsen, Series E5A, ‘Årsberättelser från Provincialläkare’, reports from Sundsvall and, after 1870, from Wifstavarf district physicians.
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f2: Ratios of females to midwives in Sweden, Västernorrland, and the Sundsvall region, 1861–1890.Sources: Demographic Data Base (Umeå, Sweden); Riksarkivet, Sundhets Collegium and Medicinalstyrelsen, Series E5A, ‘Årsberättelser från Provincialläkare’, reports from Sundsvall and, after 1870, from Wifstavarf district physicians.

Mentions: From c. 1870 the government gradually succeeded in increasing the supply of midwives, albeit somewhat variably, as the ratio of females to midwives for Sweden as a whole, the province of Västernorrland, and the Sundsvall region demonstrates. The provision of midwives in the latter compared quite favourably both to the country and to the province for much of the period under investigation (Figure 2). The lone exception was during the early 1870s when unprecedented economic and demographic growth in the area clearly undermined the state's efforts to provide an adequate number of midwives. Despite this minor reversal there can be no doubt that the overall picture is one of marked improvement. In 1861 each of the region's ten midwives had to attend to the needs of slightly more than 1,400 women. By the early 1890s the number of midwives had almost tripled and the ratio of females to midwives had fallen to just over 1,000:1. The improvement in the supply of midwives is even more pronounced if the town of Sundsvall itself is examined. In 1860 it had just two midwives for a population of 2,330 females but in 1890 there were ten midwives for the town's 6,700 females.46


Midwives and their role in the reduction of direct obstetric deaths during the late nineteenth century: the Sundsvall region of Sweden (1860-1890).

Curtis S - Med Hist (2005)

Ratios of females to midwives in Sweden, Västernorrland, and the Sundsvall region, 1861–1890.Sources: Demographic Data Base (Umeå, Sweden); Riksarkivet, Sundhets Collegium and Medicinalstyrelsen, Series E5A, ‘Årsberättelser från Provincialläkare’, reports from Sundsvall and, after 1870, from Wifstavarf district physicians.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC1172292&req=5

f2: Ratios of females to midwives in Sweden, Västernorrland, and the Sundsvall region, 1861–1890.Sources: Demographic Data Base (Umeå, Sweden); Riksarkivet, Sundhets Collegium and Medicinalstyrelsen, Series E5A, ‘Årsberättelser från Provincialläkare’, reports from Sundsvall and, after 1870, from Wifstavarf district physicians.
Mentions: From c. 1870 the government gradually succeeded in increasing the supply of midwives, albeit somewhat variably, as the ratio of females to midwives for Sweden as a whole, the province of Västernorrland, and the Sundsvall region demonstrates. The provision of midwives in the latter compared quite favourably both to the country and to the province for much of the period under investigation (Figure 2). The lone exception was during the early 1870s when unprecedented economic and demographic growth in the area clearly undermined the state's efforts to provide an adequate number of midwives. Despite this minor reversal there can be no doubt that the overall picture is one of marked improvement. In 1861 each of the region's ten midwives had to attend to the needs of slightly more than 1,400 women. By the early 1890s the number of midwives had almost tripled and the ratio of females to midwives had fallen to just over 1,000:1. The improvement in the supply of midwives is even more pronounced if the town of Sundsvall itself is examined. In 1860 it had just two midwives for a population of 2,330 females but in 1890 there were ten midwives for the town's 6,700 females.46

View Article: PubMed Central - PubMed

Affiliation: Department of History, Memorial University of Newfoundland, St. John's NL A1C 5S7, Canada.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Maternal mortality remains a cause of legitimate concern in developing parts of the world where rates often exceed 650 per 100,000 live births—at least twenty times higher than in the developed world, and appears impervious to all efforts to reduce it. 1 Overwhelming poverty, insufficient health care, and the paucity of well-developed and thoroughly integrated programmes to reduce maternal mortality help ensure that these rates are comparable to, if not actually higher than, those found in some of the most unhealthy European cities and regions of the nineteenth century... That said, to assume that whatever the politicians wanted the midwives to achieve is what actually happened, even in the most isolated parts of the country, is rather naïve... It is impossible to prove the authors' conclusion that maternal mortality declined in Europe because of “political commitment, availability of effective techniques, and assistance to most deliveries provided by trained health professionals able to ‘culturally’ integrate such a technology”. 4 Their assertion certainly is not true before the very end of the nineteenth century and perhaps not until the early 1900s... For the country as a whole these rates fell from approximately 780 per 100,000 live births between 1801 and 1805 to about 230 per 100,000 in 1900... By way of comparison, maternal mortality rates in England and Wales remained at almost 480 per 100,000 live births as late as 1900. 10 Despite this general pattern of quite remarkable decline, the increase in maternal mortality from approximately 1860 to 1880 that peaked in the early 1870s indicates that this reduction was subject to quite dramatic, albeit often short-lived, reversals. 11 It is these periods when maternal mortality rates rose, or at least did not continue to fall, that highlight the error in ascribing monocausal explanations such as a greater provision of midwives to general trends... According to the provincial physician, Sundqvist was also responsible for Timrå parish and there she, or perhaps midwives living in the nearby town, attended at least 64 per cent of all births. 52 The markedly different midwife attendance rates in these two parishes illustrates either what doctors claimed was an impenetrable wall of traditional ignorance and culture, or the gradual advances of academic medicine... Between 1882 and 1887, Elisabeth Holmgren, the midwife for the inland parish of Tuna, attended approximately 55 births annually, representing about 50 per cent of all births. 54 It seems that this was well below the average for the area. 55 Sundsvall's district physician, Dr Söderbaum, reported that for most of the parishes under his supervision midwives attended 65 per cent of all births in 1884. 56 Five years later the number of births in his district skyrocketed to almost 800 but the midwives had been called to more than 80 per cent of them... This was well above the national average of approximately 70 per cent of all home deliveries that midwives attended in 1890. 57 One of the busiest of the Sundsvall midwives must have been Anna Westerlund of Skön parish, who attended almost 120 births every year between 1882 and 1886. 58 In some underdeveloped countries today we can assume that a midwife is able to attend and provide post-natal instruction for approximately 150 births annually. 59 To achieve so comparable a number in the rugged terrain of the Sundsvall region during the nineteenth century would have required a substantial effort... Even Augusta Petersson, who had been born in Stockholm, had lived eleven years in Sättna before she started work as parish midwife. 62 Beginning in the 1880s the number of women from other parts of the country who became midwives in the Sundsvall region rose considerably... One of the consequences of this model was that the nutritional needs of their husbands took precedence over their own... Among other dangers, a reduction in nutritional intake increases the likelihood of obstructed labour and this was by far the major cause of direct obstetric deaths in Sweden during the nineteenth century. 82 Women often found work at or near the sawmills during the 1870s but their participation in the paid labour force could not guarantee access to nutritious food for at least two reasons... One of the reasons maternal mortality declined so markedly in the Sundsvall region during the last decades of the nineteenth century was because women were more inclined to call a midwife... In some ways at least this study illustrates the danger of ignoring the influence of traditional cultures if the goal of reducing maternal mortality is to be achieved in the developing countries of today... Government officials may have the will, financial resources may be found to reduce poverty and improve living standards, and trained medical practitioners armed with the most modern skills can be mobilized to ensure safer births.

Show MeSH