• Tammy Euliano

Maternal Death in the 1800s

In western North Carolina, mid-1800’s, a young Cherokee woman gives birth (her first) to a healthy baby boy with a Cherokee mid-wife in attendance, but dies in the process.  What might be a reason for her death? 

Then, as now, the most common would be postpartum hemorrhage, hypertensive disorder (preeclampsia/toxemia), embolism and infection. The most dramatic for your story would be hemorrhage. After the baby delivers, the uterus doesn’t contract for various reasons and she bleeds to death. You can decide how long you want her to survive. If you want her to cuddle the baby knowing she’ll die…or lose consciousness much sooner.

Postpartum hemorrhage (PPH) is one of the top five causes of maternal mortality. Worldwide it’s responsible for about 1/4 of those deaths. In the US, it’s closer to 10% and a simple hemorrhage shouldn’t be fatal unless the woman delivers in an area without resources (small hospital without a well-supplied blood bank, at home, etc).

A failure of the uterus to contract down is the most common cause of PPH, whether because it’s “tired” like any muscle after an extremely long labor, high dose pitocin, an overly large uterus (triplets, etc), or from other reasons is hard to know afterward. Other causes would be a tear in the cervix or vaginal wall that can be tough to see clearly to sew up.

The scarier causes are when the blood stops clotting for some reason. Then the only solution is to replace clotting factors. This happens with an “Abruption” when the placenta separates before it’s supposed to, like in a car accident from the rapid deceleration, but also happens unexpectedly sometimes. In this case, blood alone isn’t enough. We need “cryoprecipitate” and/or plasma to replace the missing factors. At a big hospital like mine, we get it, though it can take agonizingly long when your patient is bleeding. In a small hospital, or if the woman has a rare blood type, or has had a transfusion before and has antibodies against many types of blood, then it can be impossible to save her. This is where home births terrify me. If the woman bleeds, and they bring her in without an IV, trying to place one in a patient who’s already lost a lot of blood is a problem, and we’re way behind on fluids and getting blood available, and crossing our fingers she won’t react to the O-negative we always have on hand for pregnant women.

There are other causes of hemorrhage. Recently we’re seeing a lot of women who have had multiple cesarean deliveries and their placenta grows into the scar and won’t detach. They might bleed to death without a hysterectomy, which is difficult to perform on a recently pregnant uterus. Even at my institution, with top-notch gynecologists, they often ask the gyn-oncologists to help because the anatomy is just so different.

Suffice it to say, having a baby may be natural, but it’s not entirely benign and was the leading cause of death for women of child-bearing years for millennia.  That said, I don’t want to scare anyone, just have a good doctor and consider delivering in a place that can handle whatever comes up (preferably with obstetricians, pediatricians and anesthesiologists in-house, even if you choose a natural delivery without pitocin or pain meds).


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© 2020 Tammy Y. Euliano