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I am researching the life of a woman whose mother died in 1615 when her daughter was aged four. I am wondering how likely it is that the mother died in childbirth.

Is there any general information on the proportion of women who died in childbirth before modern times and modern medicine?


Edit from comment:

"She [the woman whose mother died in 1615] probably lived in the parish of Auchinleck in Scotland and her parents were probably minor landed gentry. She had one younger sister."

Lars Bosteen
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user558840
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    Where did this woman live and what was her social class or employment? – RedGrittyBrick Mar 17 '21 at 22:25
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    She probably lived in the parish of Auchinleck in Scotland and her parents were probably minor landed gentry. She had one younger sister. – user558840 Mar 17 '21 at 22:34
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    A much more important and relevant statistic is the mortality at first pregnancy. It is "widely known" that if the first birth was successful, the others will probably be so too. – sds Mar 18 '21 at 02:41
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    Nitpicky but I'll point it out nonetheless: There are three different statistics discussed here. 1. maternal mortality (deaths/live births), 2. proportion of women who died in childbirth (deaths/female population), and 3. Given a woman died, how likely it is that the mother died in childbirth. ( posterior probability given #1 and #2). – stan Mar 18 '21 at 06:53
  • Thanks Stan. And indeed, in my case of interest it is the probability that her death was in childbirth given that she had a child aged 4, which presumably ups the probability considerably. – user558840 Mar 18 '21 at 08:47
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    Worth noting that early "modern" hospitals (and presumably, also "modern" doctors) may have been detrimental to women's health around childbirth. The hospital Ignaz Semmelweis worked in was known for being a death trap for delivering mothers (because the doctors would go from the pathology straight to the birthing room, without disinfection). Traditional midwifery may have been better, explaining the city/countryside mortality difference. It probably is still better today... – Peter - Reinstate Monica Mar 19 '21 at 08:32

2 Answers2

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Short Answer

Due to the limited data (and the limitations of the data which is available), historians have come up with a variety of estimates around the period you are interested in. These estimates mostly range from around 1% to 3% per birth, depending on region and, perhaps, social background. One interesting finding is that maternal mortality appears to have been significantly higher in London than in other areas of England.

However, all of these studies need to be treated with caution, partly due to the often small size of the samples used. Also, most of it is for England though there is some data from Geneva and two locations in France which also falls within the 1% to 3% range. For Scotland, the data is even more deficient than it is for England:

Scottish population history is often a vague and frustrating subject. ...there is too little that can be said with confidence before the eighteenth century.... Deaths, or more likely burials, are the least well recorded events in parish registers of the seventeenth and eighteenth centuries:...


Details

In Milton and Maternal Mortality (2009), Louis Schwartz conveniently summarises the main studies which cover the early modern period in England (Tudor / Stuart). I've arranged these in chronological order of when the studies were published.

1971 estimate = 2.35%

In 1971, Thomas Forbes had reported a rate of approximately 23.5 deaths per 1,000 baptisms for the years 1583–1599 in St. Bartolph’s Parish, London. Since this could only have included live births (stillborn infants were not baptized), it has made sense for historians to assume that the actual numbers were somewhat higher (stillbirths often brought with them fatal complications)

1982 estimate = up to 2.5%

In 1982, in Obstetrics and Gynaecology in Tudor and Stuart England, Audrey Eccles estimated that, according to pilot studies done in the 1970s, the rate of maternal mortality in early modern England might have reached as many as 25 deaths per 1,000 “birth events” (the term covers both live births and stillbirths). In other words, one woman died for every 40 births.

1982 estimate = up to 3%

In his D. Phil. thesis in 1982, Wilson...trying to bring together early estimates of deaths in the case of live births with what he had gathered about stillbirths and other possibly fatal complications, arrived at a rate of as much as 30 per 1,000.

Also in 1982,

1982 estimate = from 2.44% to 2.9%

B. M. Willmot Dobbie estimated from parish records in Somerset rates ranging from 24.4 to 29 per 1,000.

Then, in 1986, evidence of a wide disparity between London and elsewhere.

1986 estimate = around 1%, but up to 2% in London

In 1986, however, Roger Schofield argued, in a widely influential essay entitled “Did the Mothers Really Die?,” that the national rate was actually significantly lower. He based his study on statistics from 13 rural parishes and introduced a new and more accurate way of calculating the effect that the incidence of stillbirth may have had.

Schwartz then quotes Schofield directly:

the “best” estimates suggest that the maternal mortality rate was just under 10 per 1,000 in the late sixteenth century, and just over that figure for the first half of the seventeenth century. The rate then jumps sharply upward to just under 16 per 1,000 in the later seventeenth century, to fall back to just under 10 per 1,000 again in the first half of the eighteenth century.

before adding:

He [Schofield] notes, however, that the rates in London were some 30 to 50 percent higher than in the rural samples he worked with, reaching levels of over 20 per 1,000.

Next,

1992 estimate = 1.5 to 1.6 in rural areas, 2.1% in London

In his 1992 study of maternal mortality in Europe, the United States of America, and Australia, Irvine Loudon notes the same historical rise and fall of the rate as Schofield, estimating that, before the decline, maternal mortality in early modern England was about 15 to 16 per 1,000 in rural areas and about 21 in London.

Then, in 1995, Wilson again:

1995 estimate = from 1% to 2%, depending on region

drawing on Schofield and on some research of his own, later estimated that rates for different parts of England could fall anywhere between 10 and 20 per 1,000.

Finally in England, a 1998 study of maternal mortality among British aristocrats 1600 to 1649 found that 6.8% of women from a sample of 175 died in childbirth. These women had, on average, 5 children, giving a maternal mortality rate of 1.36% per birth. However, unlike some of the other numbers cited above, this includes maternal mortality involving still births. When the author excluded stillbirths, the mortality for women born before 1700 was around 1%.

On the reasons for fluctuations over time and the significantly higher London mortality rates,

Historians are unsure just why rates rose in the seventeenth century and why they were worse in the city.

but we should certainly consider that

Birth was, in addition, experienced under highly septic conditions, the densely populated city providing a breeding ground for highly infectious diseases such as influenza, smallpox, tuberculosis, and plague. This made London a particularly hostile environment in which to be pregnant.

Source: Schwartz

Elsewhere in Europe, the French Wikipedia article Taux de mortalité maternelle cites reserach on 17th century Geneva giving a maternal mortality rate of 1.5%.

Finally, two studies mentioned in La mortalité maternelle en France au XVIIIe siècle for the second half of the 17th century show rates of 2.86% for Mogneneins in the east of France and just over 1% for Rouen in the north of France.

Lars Bosteen
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    So...getting pregnant used to be about as much of a diceroll as catching covid, in terms of your odds of survival. Maybe a bit worse. – J... Mar 18 '21 at 13:41
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    @J... Probably considerably worse, if you include stillbirths. What is also not clear from these statistics is whether that include deaths due to pregnancy that occurred before labor began. These are significant also, but from their descriptions, it sounds like many of these statistics did not include them. – RBarryYoung Mar 18 '21 at 15:10
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    @RBarryYoung as an example, ectopic pregancy affects of the order of 1% of pregnancies and can be fatal without treatment (which wouldn't have existed). Without looking into it further I don't know what proportion would lead to a rupture untreated, but that 1% could be taken as an upper limit assuming the risk factors are unchanged (a big assumption, as many of them are affected by modern lifestyles, though perhaps not as many as for pre-eclampsia which can also lead to severe complications – Chris H Mar 18 '21 at 15:44
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    @J... No not really as women giving birth back then were quite young. 1/100 birth vs 1/10000 covid. Math is weak, but 10000% worse. – paulj Mar 18 '21 at 17:36
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    @paulj Yes, absolutely - it was mostly as an order-of-magnitude ballpark to frame it in a context that modern people have some sense of. I guess the point was only that it was at least as bad, and even worse, than a modern threat which has ground the global economy to a nub. What we now consider an absurd level of risk was just daily life not so long ago, I guess is where I was going. Not to trivialize covid either, of course - just that we really are a lot better off now than humans have historically had to endure. – J... Mar 18 '21 at 17:47
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    The way people talk about deaths during labor, I thought it was much higher. – Azor Ahai -him- Mar 18 '21 at 18:18
  • @AzorAhai-him- A 3% risk of dying sounds small until you're the one facing that risk. That's like taking 1300 flights a day every day for nine months and hoping you won't be in a fatal crash. – J... Mar 18 '21 at 19:14
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    @J... I mean, sure, but your point would be better made with an example that isn't absolutely absurd – Azor Ahai -him- Mar 18 '21 at 19:30
  • @AzorAhai-him- 61 Skydives a day for nine months? The point is that it's a much bigger risk than it sounds when you compare it to things that normal people get nervous about but are actually much safer. – J... Mar 18 '21 at 19:52
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    @AzorAhai-him- If you consider that it was common to have 6-8 children, suddenly the overall probability of dying in childbirth goes toward 20%. –  Mar 18 '21 at 21:31
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    @Servaes possibly, although we don’t know that it was consistent. It’s possible that after your first pregnancy you’ve better or worse (or the same) chances... – Tim Mar 19 '21 at 00:53
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    @Servaes Not really, because deaths usually happened in first pregnancy. – rs.29 Mar 19 '21 at 09:35
  • @Servaes No. Chances don't add up like that. Even if the probabilities are independent, six dice rolls do not increase the likelihood of a 6 to 100%. In this case, the probabilities are certainly not independent. In particular, after dying, the probability of dying again is zero. – gerrit Mar 19 '21 at 10:27
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    @gerrit Note that 1-0.97^7=0.19 and 1-0.97^8=0.22. Of course the probabilities are unlikely to be independent, as previous commenters already note. But it should give an indication that even the 'small' mortality rate of 2-3% per childbirth still implies a much higher mortality rate per woman. –  Mar 19 '21 at 10:32
  • @rs.29 Right, though the probabilities averaged out to 2% or thereabouts, which implies the mortality rate for first births was significantly higher. Though I can find nothing about your claim one way or another...everything I google focuses on infant, not maternal, mortality. – Gort the Robot Mar 19 '21 at 16:29
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    @GorttheRobot Well you could search on the net something like "first childbirth riskier than subsequent" . Tons of articles explaining why, though they are mostly about the risk for the child, not for the mother. – rs.29 Mar 20 '21 at 08:37
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I don't think we really know this.

It looks like in 1990 the worst rates of maternal mortality in the developing world were around 1%-2%. That's maternal deaths per live births. These places were generally in equatorial African countries. That might be helpful, as the poorer health access there back then might come the closest we have to mimicking pre-medicine conditions. However, its also true that conditions in the tropics and in London are going to be rather different.

If I'm reading this abstract correctly, in 1700's London it was more like 2.5%.

I did find that a couple of researchers have a model for prehistoric maternal mortality, based off the same relatively modern data I linked to above. I don't have access to it myself, and don't know how good its reputation is.

T.E.D.
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  • Thanks for this. It is much lower than I would have guessed. – user558840 Mar 17 '21 at 22:45
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    Same. But then if you are going to have a lot of pregnancies (as people back then did), those 1% chances of death can really stack up. – T.E.D. Mar 17 '21 at 22:46
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    My suspicion is that basic hygiene, which was likely far more of an issue in pre-modern Europe than modern "developing" countries, makes the comparison inappropriate. – Gort the Robot Mar 17 '21 at 22:59
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    Note that the link above reports mortality rates of 3.6% (midwives' ward) and 9.8% (doctor's ward)! – Gort the Robot Mar 17 '21 at 23:01
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    @GorttheRobot - Yeah, early hospitals (before, incredibly, doctors learned to wash their hands!) were really dangerous places to give birth. Like much more dangerous than not going at all. – T.E.D. Mar 18 '21 at 00:10
  • The earliest statistics I can find in Google Books are from the 19th century, specifically around mid-century (so long after the time period OP inquires about). If I read the data correctly, maternal mortality rate per birth was 0.87% for an Austrian statistic, 0.85% for a Scottish statistic, and 0.5% for a German statistic (the report on the last one remarks on the unusually low mortality, stated to be due to a lower than usual numbers of cases of puerperal fever). – njuffa Mar 18 '21 at 02:39
  • The article on Ignaz Semmelweis lists between 0.4 (after people started disinfecting their hands) and 31% mortality rate: https://en.wikipedia.org/wiki/Historical_mortality_rates_of_puerperal_fever#Mortality_rates_at_the_Vienna_General_Hospital – Michael Mar 18 '21 at 07:02
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    @T.E.D. Doctors did wash their hands. That they didn't is a common misconception. They just didn't use diluted bleach to do so, and regular handwashing — even thoroughly — is insufficient when performing surgery or giving birth. – Konrad Rudolph Mar 18 '21 at 08:14
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    Note this is maternal deaths per live births. If you include stillbirths, which were also much more common back then, the numbers might be different. It could go either up or down, depending on whether there's more cases where both mother and child died or more where the mother lived and the child didn't. – Darrel Hoffman Mar 18 '21 at 16:20
  • @GorttheRobot If only the worst cases are brought to the doctor's ward, you expect the mortailty rate to be far higher there. Why would you otherwise go to the doctor for that? – pipe Mar 19 '21 at 05:26
  • @pipe We know exactly why there was a higher mortality rate in the maternity wards I referenced. It was what led to the germ theory of disease and the use of hygiene in medicine. – Gort the Robot Mar 19 '21 at 16:22
  • @GorttheRobot there could be multiple reasons. For example, the chances of a COVID patient dying in ICU are much higher than them dying out of ICU. That’s not because ICU kills them, but because they were in a bad way to end up in ICU at all. It’s likely the same applies here. – Tim Mar 20 '21 at 21:52
  • @tim I suggest you read the link in question We're talking about a very specific case here. – Gort the Robot Mar 21 '21 at 16:03
  • @GorttheRobot again, I didn't say washing hands wasn't a factor. Re-read the first sentence of my previous comment! But it's not necessarily entirely down to a lack of hand washing. – Tim Mar 21 '21 at 16:11
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    If you are talking the original question, sure. If you are talking about Ignaz Semmelweis's findings in particular, then I'm not sure you understand them... – Gort the Robot Mar 21 '21 at 17:12
  • @user558840 Really I find it astonishingly high--considering that "death in childbirth" should be a strong selective mechanism in a species where the young are entirely reliant on adults. – user3067860 Mar 22 '21 at 16:54