Women died in childbirth for reasons that are, by modern standards, largely preventable: uncontrolled bleeding, infections introduced by unwashed hands, dangerously high blood pressure, and labor that stalled with no surgical option available. These causes killed women for centuries and still account for roughly 75% of all maternal deaths worldwide today. What changed over time was not the biology of birth but the medical tools available to intervene when something went wrong.
Bleeding That Couldn’t Be Stopped
Severe bleeding after delivery, called postpartum hemorrhage, has always been the single deadliest complication of childbirth. The placenta detaches from the uterine wall after a baby is born, leaving behind an open wound rich with blood vessels. Normally the uterus contracts tightly to compress those vessels shut. When it doesn’t, or when the placenta tears tissue on its way out, blood loss can become catastrophic within minutes.
A pregnant woman’s body carries significantly more blood than usual, which masks the early warning signs. She can lose more than a liter of blood before her heart rate and blood pressure show anything abnormal. By the time visible signs of shock appear, she has typically already lost more than 1,500 mL, over a quarter of her total blood volume. Before blood transfusions existed, there was simply no way to replace what was lost. Even today, hemorrhage remains the leading cause of maternal death globally, particularly in places without rapid access to surgery or blood banks.
Infection From Doctors’ Hands
Puerperal fever, known as childbed fever, was the most feared killer in the hospitals of the 18th and 19th centuries. It was a bacterial infection of the uterus, introduced during delivery by the contaminated hands of doctors and midwives. In its epidemic form, the death rate among infected women reached 70 to 80 percent. During one outbreak at the Westminster Lying-in Hospital in London in 1770, 19 of 63 women who delivered contracted the disease, and 13 of them died. At the Edinburgh Infirmary, an epidemic killed every single woman who became infected.
The tragedy was that the cause was understood decades before the medical establishment accepted it. In the 1840s, a Hungarian physician named Ignaz Semmelweis noticed that women delivered by medical students (who came straight from performing autopsies) died at far higher rates than those delivered by midwives. He introduced mandatory handwashing with a chlorinated lime solution before examinations. Maternal mortality on his ward dropped from roughly 16% to below 2% within months. His colleagues rejected his findings, and widespread adoption of antiseptic technique didn’t come until years later. By the early 20th century, sepsis still caused 40% of all maternal deaths in the United States, split between post-delivery infections and complications from illegal abortions.
The introduction of antibiotics in the late 1930s and 1940s finally broke the pattern. Between 1939 and 1948, maternal mortality in the U.S. fell by 71%, driven largely by the ability to treat infections that had previously been death sentences.
Labor That Couldn’t Progress
Before cesarean sections were survivable, a baby that couldn’t fit through the birth canal meant almost certain disaster. Obstructed labor occurs when the baby’s head is too large for the mother’s pelvis, when the baby is positioned sideways, or when contractions simply aren’t strong enough to push the baby through. Hours of fruitless contractions lead to exhaustion, dehydration, and a dangerous metabolic state. The uterus, strained beyond its limits, can rupture, causing sudden internal bleeding and shock.
Even when the uterus held, prolonged labor created other lethal problems. The baby’s head, pressed for hours against the mother’s bladder and rectum, could destroy tissue and create holes between organs (called fistulas) that led to lifelong disability for survivors. Infection almost inevitably followed prolonged labor, as bacteria had more time to enter the uterine cavity. Uterine rupture was the leading cause of death associated with obstructed labor, followed closely by infection. For most of human history, a woman with a baby stuck in the birth canal had no good options available to her.
High Blood Pressure and Seizures
Preeclampsia, a condition where blood pressure rises dangerously during pregnancy, has always been one of the top killers of pregnant women. When it progresses to its most severe form, eclampsia, the mother experiences full-body seizures. Nearly 1 in 50 women with eclampsia die, and that number is significantly higher in countries with limited healthcare access.
The underlying problem is that rapidly rising blood pressure overwhelms the brain’s ability to regulate its own blood flow. Normally, blood vessels in the brain constrict and relax to keep flow steady regardless of what blood pressure is doing elsewhere in the body. In eclampsia, the pressure becomes so extreme that it forces open blood vessels that should be constricted, flooding brain tissue with fluid and causing swelling. This can trigger seizures, stroke, brain hemorrhage, and in severe cases, fatal brain herniation, where swollen tissue is pushed out of position inside the skull. Without medications to lower blood pressure and control seizures, and without the ability to deliver the baby (which is the only cure for preeclampsia), this condition was reliably fatal.
Rare but Catastrophic Emergencies
Some causes of maternal death were so sudden and poorly understood that they remained mysterious well into the modern era. Amniotic fluid embolism occurs when amniotic fluid, along with fetal cells and tissue, enters the mother’s bloodstream through a tear in the membranes separating her circulation from the baby’s. This triggers an overwhelming immune reaction similar to severe anaphylaxis. The lungs’ blood vessels constrict, the right side of the heart fails under the pressure, and a clotting crisis consumes the blood’s ability to form clots, leading to uncontrollable bleeding throughout the body. Historically, 61% of women who experienced this died. Modern intensive care has brought that number closer to 10-26% in developed countries, but it remains one of the most feared emergencies in obstetrics.
Heart failure related to pregnancy is another cause that went unrecognized for much of history. Some women develop a sudden weakening of the heart muscle in the final weeks of pregnancy or the first months after delivery. The heart loses its ability to pump effectively, and without treatment, the resulting heart failure can be fatal. The exact cause is still not fully understood, though it appears to involve hormonal changes during the postpartum period that damage blood vessels feeding the heart.
What Changed and What Hasn’t
The dramatic decline in maternal death over the past century came from a handful of advances arriving in quick succession: antiseptic technique, antibiotics, safe blood transfusions, medications to control blood pressure and induce labor, and the ability to perform cesarean sections without killing the mother in the process. In the United States, the legalization of abortion beginning in the 1960s contributed to an 89% decline in deaths from septic illegal abortions between 1950 and 1973.
But these gains have not been distributed equally. Globally, hemorrhage, infection, high blood pressure, delivery complications, and unsafe abortion still account for about three quarters of all maternal deaths, concentrated in regions without reliable access to emergency obstetric care. Within wealthy countries, stark disparities persist. In the United States in 2024, Black women died at a rate of 44.8 per 100,000 live births, more than three times the rate for white women (14.2) and Hispanic women (12.1). These gaps reflect differences in access to care, quality of treatment received, and the cumulative health effects of systemic inequality, not differences in biology.
The reasons women died in childbirth were never mysterious. They bled, they got infections, their blood pressure destroyed their organs, and their labors stalled without surgical rescue. What was missing, for most of human history, was the knowledge and infrastructure to do anything about it. Where that infrastructure still doesn’t reach, the same causes produce the same outcomes.