From home to hospital: The evolution of childbirth in the United States, 1928–1940

Abstract

This paper examines the shift in childbirth from home to hospital that occurred in the United States in the early twentieth century. Using a panel of city-level data over the period 1927-1940, we examine the shift of childbirth from home to hospital and analyze the impact of medical care on maternal mortality. Results suggest that increased operative intervention on the part of physicians and a resultant greater risk of infection increased maternal mortality prior to the introduction of sulfa drugs in 1937. However, the introduction of sulfa enabled doctors to reduce maternal mortality by enabling them to do potentially life-saving procedures (such as cesareans) without the risk of subsequent infection. Regressions estimated separately by race suggest that the impact of medical care on maternal mortality differed for blacks and whites. Relative to whites, hospitals posed a greater risk for black mothers prior to the availability of sulfa drugs in 1937, and were less beneficial for them afterwards, suggesting that blacks may have received lower quality medical care.

Maternal health and the baby boom

“…Further information can be found at http://www.ssa.gov/history/ childb1.html. 15 Thomasson and Treber (2008) showed that the hospitalization of childbirth had a positive effect on maternal mortality between 1927 and 1937 in the United States. Loudon (1992a) showed that in England, than two-thirds of all maternal deaths were preventable and that many physicians were found to lack the most basic obstetric knowledge (CDC (1999)).…”

Modern Medicine and the Twentieth Century Decline in Mortality: Evidence on the Impact of Sulfa Drugs

“…In the other cases, MMR improvements increased life expectancy by much less. For example, MMR fell dramatically in the United States around 1936 after the introduction of sulfa drugs (Thomasson and Treber 2004). However, life table calculations suggest that the elimination of maternal mortality in the United States increased female life expectancy by less than 0.5 years at most (Retherford 1972).…”

The Captain of the Men of Death and His Shadow: Long-Run Impacts of Early Life Pneumonia Exposure

“…They are also robust to controlling for maternal mortality, which declined sharply after 1937 as a result of the sulfa drug revolution (Thomasson and Treber, 2008;Jayachandran et al, 2010). Using a more flexible specification that allows for differential impacts by age of exposure, we do not find any noteworthy long run health or socioeconomic gains from reductions in pneumonia for cohorts born before 1937, who were at least a year old when sulfa drugs were first introduced.…”

“…Furthermore, maternal mortality rates fell sharply in 1937 (Thomasson and Treber, 2008;Jayachandran et al, 2010). To account for this we control for maternal mortality rates, allowing their impact to break in 1937 (i.e.…”