When it comes to maternal health, we’ve made huge strides
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In 1900, six to nine women in the United States died per every 1,000 live births. Thanks to advances in technology as well as governmental policies that have improved access to maternal care, that number declined by almost 99 percent to .1 per 1,000 live births in 1997 (though the maternal mortality rate in the U.S. increased between 2000 and 2014). While childbirth still isn’t easy, moms today can expect safer births, more pain-management options and the right to control their own reproductive health — thanks in large part to the maternal health advances listed below.
Infection control and antibiotics (early 1900s)
Believe it or not, washing hands with soap and clean water before delivering a baby wasn’t always standard practice for doctors. In fact, back in the mid-nineteenth century, whenIgnaz Semmelweis, a young Hungarian physician working at a maternity clinic in Vienna first suggested handwashing as a protocol to prevent “childbirth fever,” a postpartum infection that often led to death, he was ignored and ridiculed by his peers. He died in a mental asylum, still convinced that he was right: freshly washed hands prevented the spread of infection. He was right, of course — but handwashing was not accepted as standard infection-preventing protocol until many decades later. Infection control has made great strides since then, protecting moms and newborns from once routinely deadly infections. And thanks to the development of antibiotics in the first half of the twentieth century, postpartum infections that do occur rarely kill. The key, of course, is early detection and treatment — and that’s why postpartum checkups (along with good self care and awareness about the symptoms of infection) are so vital.
Labor pain management (1914)
For years, women gave birth at home, attended by midwives and female relatives and friends. According to historian Nancy Schrom Dye, childbirth was seen as an “exclusively female” and a “social affair.” However, by the mid-eighteenth century, as the field of obstetrics developed, women turned to physicians and birth became seen more as a medical issue. By the mid-1920s, at least a third of all births in the U.S. took place at a hospital (by 1960, Schrom Dye says that number rose to 96 percent).
In 1914, two American journalists went to Germany to report on a practice called “twilight sleep,” and raved about it in McClure magazine. Soon after, feminists started advocating for it as a “new and painless method of childbirth.” Doctors used a combination of morphine and scopolamine to dull pain and induce memory loss during childbirth. Unfortunately, it often left women writhing and tied down to hospital beds in a hallucinatory state and later detached from a birth they could not remember. (Remember the Mad Men episode where Betty gives birth to her third child while hallucinating a vision of her parents and a dying Medgar Evans and then wakes up with a baby in her arms and not a single recollection of what happened? That’s twilight birth.)
Advocates formed the National Twilight Sleep Association and the practice was the norm by 1915. Although demand for twilight sleep decreased after outspoken an outspoken proponent of the movement, Francis X. Carmody, died from hemorrhaging during her second pregnancy at a hospital that had adopted twilight birth — it continued as late as the sixties and seventies when women started advocating for more options. It’s a far cry from the wide array of safe and effective options women have today: relaxation techniques (like Lamaze); complementary and alternative therapies, like hypnobirthing and reflexology; epidurals and nitrous oxide (or laughing gas). General anesthesia is reserved for emergencies, and twilight sleep is a distant nightmare.
Maternal and infant vaccinations (early 1914)
Technically, the very first iteration of vaccines can be traced to British doctor Edward Jenner, who, Health Affairs journal reports, performed the first known vaccine in 1796 on an 8-year-old boy by scraping some pus from the lesion of a woman infected with cowpox (similar to smallpox) and injecting it into the boy. (Jenner had seen how milkmaids who had been infected with cowpox later seemed immune to smallpox outbreaks that swept through their communities.) However, vaccines didn’t become widespread until the early twentieth century, with the development of the pertussis vaccine in 1914.
The modern iterations look a little different than Jenner’s version, but vaccines have been so successful at eradicating once-common deadly diseases (such as polio and smallpox) that the Centers for Disease Control and Prevention (CDC) called the invention the number one public health achievement of the twentieth century. Maternal vaccinations given during pregnancy help protect infants from pertussis (whooping cough) and flu. Newborns receive the first in a series of Hepatitis B vaccines before leaving the hospital. And at two months, the CDC’s recommended immunization schedule continues with vaccinations against a number of diseases that once routinely affected and sometimes killed children (such as diphtheria, tetanus, pertussis, and polio) — but that are now, happily, preventable thanks to routine immunization.
Third-stage labor management (1919)
Baby’s safe arrival into your arms is definitely the best part of childbirth, but it’s not the last part. In the third stage of childbirth, the placenta is delivered. During this 5- to 30-minute period, women are at risk for a rare but serious complication called postpartum hemorrhage (PPH) — the most common cause of maternal death in developing countries. In 1919, researchers began studying the amount of blood loss during this third stage, and in the mid-1900s, the active management of the third stage of labor — includingusing pitocin (a synthetic form of oxytocin) to induce contractions, early cord clamping and uterine massage — became the standard for prevention of PPH that is still used today to help prevent hemorrhage.
Pap smears (1927)
Cervical cancer used to be the leading cause of death in women, and now it’s number 14. In 1927, Greek doctor Georgios Papanicolaou discovered that cancer could be detected by inspecting cervical cells under a microscope. The procedure to collect these cells became known as the Pap smear, and by the 1950s, annual screenings became routine. The result? Cervical cancer cases plummeted from 37 cases per 100,000 women to about 7.5 cases per 100,000 women — and continue to decline.
Gynecologic laparoscopy (1920s)
Laparoscopic procedures, which originated in the 1920s, have evolved from a diagnostic tool to a simple surgical option for women experiencing infertility. With the help of robotics and advanced medical cameras, doctors now have a non-invasive standard option for managing ectopic pregnancies, treating conditions that can make conception difficult (such as scar tissue in the reproductive tract, fibroids and endometriosis), removing cysts, and even performing hysterectomies.
Gestational diabetes screening (1949)
Diabetes has been around for hundreds of years, but researchers didn’t really start studying gestational diabetes(GD) and its effects on moms and babies until about 1824, when German doctor Henriech Gottlieb Bennewitz recorded a case of severe fetal macrosomia (when a baby is born significantly larger than average) and stillbirth in a 22-year-old woman. (This is widely regarded as the first noted case of pregnancy-related diabetes.)
Still, for a long time, experts didn’t know what caused GD or how to treat it — they just knew the outcomes for moms and babies with GD were grim, with 27 percent of pregnant women with symptoms of GD dying in childbirth in the early 1900s and an additional 23 percent dying within two years of giving birth.
The discovery of insulin in 1922 lowered the death rates for both moms and babies affected by GD, but it wasn’t until the late 1940s that any kind of routine screening for GD was proposed. In 1949, Priscilla White, a doctor working at Boston’s Joslin Clinic wrote what’s called “White’s Classification,” which became a standard rubric by which doctors can distinguish GD from diabetes that occurs before pregnancy. Although the rubric has since been refined and changed over the years, White’s research laid the groundwork for the modern-day glucose screen doctors use to diagnose and treat GD. Today, GD is one of the most easily managed pregnancy conditions and most women with it have perfectly healthy pregnancies and babies.
Fertility treatments (1950s)
While early attempts at artificial insemination began as early as the 1850s — and the first recorded birth of a baby conceived through artificial insemination with donor sperm took place in the late 1880s — there weren’t many effective treatment options for couples suffering from infertility until the last half of the 20th century. In the 1950s, the first baby conceived with frozen sperm was born. A few decades later in 1978, in vitro fertilization (IVF) was introduced. Now, with advances such as better fertility medications, intrauterine insemination (IUI), embryo screening and single embryo transfers, plus improved egg and embryo freezing technology, there are more effective infertility treatments than ever — and higher success rates than ever.
Ultrasounds (late 1950s)
Today, ultrasounds are a standard part of prenatal care and screening, but they’ve only been around since the mid-1950s. While the number of ultrasounds you receive during pregnancy may vary depending on where you live, whether your insurance company covers the cost and your doctor’s personal philosophy, the 20-week ultrasound is standard and perhaps the most important one you’ll receive. It not only allows you to get a first clear look at what your baby looks like (it’s also when parents can find out the sex of their baby, if they choose), but it also a key tool your doctor will use to measure your baby’s growth, make sure nothing is amiss and scan for abnormalities. If any are found, your doctor can recommend specialists or work with you to schedule follow-up testing, develop a birth plan that will be safe for you and your baby and monitor your baby’s health.
Birth control pills (1957)
About 10 million women in America use the pill, making it the most popular form of birth control. Arguably the most socially impactful modern maternal health care advance, the birth control pill was initially approved in 1957 for treating menstrual disorders and then a few years later for use as a contraceptive in 1960. Women today still use the pill for a wide variety of conditions — including polycystic ovary syndrome (PCOS), endometriosis, anemia, amenorrhea and primary ovary insufficiency (POI), as well as lowering the risks of endometrial and ovarian cancer. And of course, the pill gave women much more control over family planning, which has had huge social and economic implications. Studies showthat when women are in control of their reproductive choices, they’re more likely to graduate from high school and college, are less stressed, have fewer children and take better care of the kids they do have.
Preeclampsia screening (1960s)
In the 1800s, women who were suspected of having preeclampsia (which for a really long time was considered to be caused by a “wandering womb“) were treated with “blood-letting” (AKA having blood removed by a surgeon). By the twentieth century, however, doctors began more closely monitoring the condition through the entire pregnancy, and by the 1960s, screening for preeclampsia was routine. Preeclampsia prevention and treatment includes careful monitoring, which allows doctors to catch it early. Today, most women with preeclampsia have healthy pregnancies and babies.
The Pregnancy Discrimination Act (1978)
Before the Pregnancy Discrimination Act of 1978, pregnancy and its related conditions were not protected in the workplace. When it was signed, employers could no longer refuse to hire pregnant women, require pregnant workers to take involuntary leave or otherwise treat pregnancy any differently than any other condition legally considered a disability.
Postpartum depression screening (1987)
For a long time, postpartum depression (PPD) wasn’t well understood. Like many conditions that affected women, doctors initially lumped it under the umbrella diagnosis of “hysteria.” For a while, it was also known as puerperal insanity (that eventually became known as postpartum psychosis, which is very rare) and lactation insanity. In the nineteenth century, women who exhibited symptoms of PPD or postpartum anxiety were seen as “refusing the role of wife/mother, a role that most nineteenth-century Americans saw as the ‘essence of true womanhood,'” Nancy Theriot, a women and gender studies professor at the University of Louis, wrote in a 1989 paper for the journal American Studies. As a result, women were often confined to the house, given tranquilizers or institutionalized.
In the 1930s, electroshock therapy was introduced and was used to treat a variety of conditions, including depression and PPD. The treatment was initially largely unregulated and quickly garnered a bad reputation, though it is still used to an extent today.
Nowadays, doctors screen moms for PPD both as a part of prenatal care and postpartum care. The Edinburgh Postnatal Depression Scale was developed in 1987 to help doctors predict the onset and severity of depression in mothers after birth. The American Academy of Pediatrics (AAP) also now recommends that pediatricians screen women for signs of depression at their baby’s one-month, two-month and four-month well-baby visit.
Noninvasive prenatal testing or NIPT (2000s)
Prenatal screening is a practice that is constantly evolving. The relatively new noninvasive prenatal testing (NIPT), a blood test, can be done as early as the 9th week of pregnancy and can screen for chromosomal abnormalities in baby. Unlike amniocentesis, NIPT carries no risk of miscarriage. Early diagnosis of chromosomal disorders, including microdeletionsensures that affected babies receive the care they need as soon as possible.