Swedish maternal mortality in the 19th century by different definitions: previous stillbirths but not multiparity risk factor for maternal death

Abstract

In conclusion, this study shows that the mother's reproductive history was the most important risk factor measured for all definitions of maternal death. Grand multiparity did not increase the risk of maternal death. Maternal mortality ratio varied threefold in the study population, depending on the definition used. The high mortality ratios found in this study, only declining by the end of the century, should be interpreted as a general condition of the society since no significant differences could be perceived regarding social class, while unmarried women were more at risk.

Obstetric ectoscopy: an eye-opener for hospital-based clinicians

“…Rather, if investigated mothers are stratified socio‐economically, it emerges that it is not parity but poverty that kills . In an overview over historical Sweden regarding the degree of risk attributable to multiparity per se for adverse pregnancy outcome (3), we found essentially the same thing: that grand multiparity is not a risk factor for maternal death. A similar approach was used in Bangladesh where birth intervals per se were not found to be associated with increased risk of maternal mortality (4).…”

Effects of nutritional stress and socio-economic status on maternal mortality in six German villages, 1766–1863

“…In nineteenth-century Britain, maternal mortality demonstrated a 'reverse' social class relationship, being higher amongst the middle and upper classes than the working classes (Loudon 1986b). A study of a sample of Swedish parishes in the nineteenth century (Andersson et al 2000) showed that maternal mortality was higher amongst the wives of white-collar workers than amongst the wives of farmers, although this finding was not highly statistically significant. We expected our study to show that higher status mothers were at greater risk of maternal mortality.…”

“…Logistic regression was preferred to hazard parametric and semi-parametric models (Allison 1984), since all the covariates are time-invariant within the 42 days of childbirth (Andersson et al 2000;Hammel and Gullickson 2005).…”

“…The number of previous births is an important determinant of maternal mortality (Fedrick and Adelstein 1973;DaVanzo et al 2004DaVanzo et al , 2008. Most studies show that the risk of maternal death is high at parity 1 (Andersson et al 2000), decreases from parity 2 to parity 4, and then rises again (Knodel 1988;Hammel and Gullickson 2005). First births may be associated with an increased risk of obstetric haemorrhage and obstructed labour (Rush 2000).…”

“…The number of child deaths a mother has suffered reflects her overall health status and her personal, family, and environmental circumstances (DaVanzo et al 2004(DaVanzo et al , 2008. Evidence from historical studies documents the higher risk of death run by pregnant women who have experienced the death of a previous child or children (Andersson et al 2000). A discrete variable, Number of previous child deaths, was included in the set of models relating to mothers who had borne more than one child, to take account of the number of child deaths a mother had experienced before her current pregnancy.…”