My first child is due in April. I stand at the end of an unbroken line of mothers, who nourished a single cell as it unfolded into a tiny person within their own bodies, who pushed their infants out screaming into the world, who successfully raised their children to adulthood.
But for hundreds of thousands of years, childbearing would have been a terrifying roll of the dice. It’s hard to know how many women died giving birth, but where data exists on preindustrial societies, probably about 1% of live births led to the death of the mother. When the average woman gave birth 4 or 5 times, this meant a 1 in 20 lifetime risk of dying in childbirth.
And giving birth to a living child was no guarantee of seeing them grow up. Nearly half of all children born would die without reaching adulthood, and infancy was particularly dangerous; around a quarter of those newborn babies died before their first birthday. Almost all parents would lose at least one child.
Nowadays, in America, less than 1 in 3000 women will die as a result of pregnancy and childbirth. Going into this pregnancy, I am not particularly afraid.
And I can expect, with very high likelihood, to see my child live to adulthood. In America less than one in a thousand infants will die in their first year. Other countries are still worse off, but taking the global average, 96% of children will live to see adulthood.
What changed?
The risks of giving birth were mostly of obstructed labor, uncontrollable bleeding, or postpartum infection. With fetal monitoring and modern surgical techniques, a C-section can be offered before obstructed labor poses any risk to either mother or baby, and is safe enough that some parents choose to schedule one in advance. Blood loss can be quickly treated with fluids and blood transfusions, and bleeding can be stopped with drugs and if necessary emergency surgery.
Infections actually became more common during the first decades that labor and childbirth began to happen in hospitals rather than homes. In 1847, decades before germ theory would be widely accepted, Ignaz Semmelweis worked in a hospital where laboring women could be attended either by trained doctors like himself, or by theoretically less skilled midwives. And yet, the death rate from infection was three times higher in the doctors’ ward; women would beg not to be admitted. After his friend died of infection from an accidental scalpel wound during an autopsy, Semmelweis wondered if the doctors might be carrying the poison of infection from autopsies to the maternity ward. Half a century before antibiotics were available, he was able to drastically reduce the death rates by requiring handwashing, albeit with a caustic chlorinated lime solution that left the doctors’ skin painfully dry and made Semmelweis an unpopular colleague.
It took thousands of people and many decades to spread this knowledge and practice to everyone in need of it – but in the modern US, only around 1 in 30,000 women will die of infection.
Meanwhile, infants and children in the past frequently died of malnutrition, disease, or an inextricable tangle of both. Living in a modern developed country, I barely worry about either. My child will never be seriously weakened by hunger, will drink clean water, will be vaccinated against most common childhood diseases. If she has an infection, a doctor can prescribe antibiotics; if she ends up seriously ill anyway, we’ll all have a bad stressful time, but most babies who need to be hospitalized survive and recover.
In America, the top remaining cause of death in infants is congenital anomalies. Thanks to the power of modern medicine, we were able to basically rule out chromosome abnormalities when I was only 10 weeks pregnant, neural tube defects at 15 weeks, and other major birth defects at the 20 week scan. When babies do have birth defects, many of them are now treatable with surgery, sometimes even still in the womb.
Prematurity is the next most common cause of death, but it’s more and more survivable every decade. A few centuries ago, a baby born even a month or two early – with basically functional organs, but not quite big or strong enough to breastfeed or keep warm – was likely to die.
Martin Couney was one of the people who helped change this. He provided incubators and skilled nursing care to thousands of babies, free of charge to their families, and funded these efforts by running the incubators as a carnival attraction and selling tickets to see the tiny infants. Ironically, he may not have been a qualified medical doctor at all, but he became one of the best-known experts in caring for premature infants, taking in babies from across the US and saving over six thousand lives.
And the advances haven’t stopped, both in innovating cutting-edge treatment for premature babies and in making sure it’s available to as many people as possible. I am at 21 weeks’ gestation, slightly over halfway through pregnancy. The world record holder for the most premature baby to survive to date was born in 2020, at 21 weeks and 1 day. By New Years, when I hit 24 weeks, my child’s odds of surviving to go home will be two in three. By 30 weeks, 98% of premature babies can be expected to survive.
And, you know, probably that won’t happen! Most babies are born healthy, and most birth parents go through an un-fun but basically uncomplicated pregnancy and labor. Even the un-fun part is mitigated a little; there are drugs for morning sickness, and epidurals exist. Also, just as an aside – I’ve said “women” and “mothers” a lot here, because “gestational parent” is a mouthful, but here’s a shoutout to my transmasc and nonbinary friends who carried their babies.
Sadly, our success isn’t the same everywhere. In much of the world, prenatal and infant care are still very limited; many women do die of complications that would be easily-treatable in a hospital, and many children do still die of hunger and illness. But it’s important to see it against the backdrop of the past, when only half of all children lived to grow up. In Somalia, the country with the highest infant mortality rate, only one in seven babies will die before adulthood - far too many, but less than before, and hopefully less and less every year.
As I follow in the footsteps of my ancestors, I have the privilege to feel more or less uncomplicated anticipation, something I can only imagine thousands of generations must have seen as an impossible dream. Going into parenthood is still scary in plenty of ways, and the future my child will grow up in is full of uncertainty and unknowns, but mostly not on the question of whether I’ll be here, next year’s Solstice, with a baby to introduce to our world.
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