[Lucy's fatal childbirth? About materno-foetal mortality in the ancient times]. / L'accouchement tragique de Lucy ? À propos de la mortalité maternofœtale de la préhistoire à l'époque médiévale.

OBJECTIVES: Skeletal remains of pregnant woman whit fetus still in the pelvic region are scarce in the archaeological record. We aimed to review the different cases of maternal and fetal death in the ancient times. METHODS: A review of literature using Medline database and Google about mortality during pregnancy in Prehistory, Antiquity and middle age. The following key words were used: ancient times; paleopathology; immature fetus; medieval; pregnancy; mummies; Antiquity; maternal mortality. RESULTS: Thirty articles were found and we added one personal unpublished case. There were 64 female skeletons with mainly infectious abnormalities (10 dental abscesses and 2 pneumoniae) followed by traumatic lesions (2 frontal fractures and 1 femur luxation). There were 48 fetal remains and 3 twins. We noted 8 obstructed labors (3 breech presentations, 4 transverse lies and one possible shoulder dystocia). CONCLUSIONS: The fact that there were only few cases of maternal deaths with fetal remains raises the questions of the cause of death and the relationship between death and obstetric disorders. Beside the underestimation of these archaecological cases, the reasons of both fetal and maternal death must be looking for among several diseases or anomalies of both or of one of them, related with poor environmental conditions (such as malnutrition and high morbidity from infections) and lack of care the mother and fetus need.

Double inhumation in the Medieval Islamic Necropolis of Sahl ben Malik in Granada (Spain).

Despite the high mortality that have been associated with pregnancy and childbirth in past populations, few cases of the remains of pregnant women burials are described in the bioarchaeological reports. This paper is focused on the case of a double inhumation found in the Medieval Muslim Necropolis (11th to 15th centuries) of Sahl ben Malik in Granada (Spain). A complete skeleton of a woman and the skeletal remains of a full-term fetus located under the mother's left femur, were discovered in this burial. None of the evidence for the mother was decisive in determining the cause of death. However, evidence of physiological stress in the woman and possible gynecological complications may have contributed to the death of both individuals. The link between the individuals and their cause of death is examined, discussed and compared with similar archaeological records.

Hip Dislocation and Dystocia in Early Medieval Times: Possible Evidence of Labor Maneuver.

BACKGROUND: In ancient times, maternal mortality would occur frequently, particularly during labor. Evidence of dystocia resulting in the death of a pregnant woman is very infrequent in paleopathologic literature, with only a few cases being demonstrated. CASE: In the early medieval site of Casserres, the skeleton of a young woman with a fetus in the pelvic region was found. Some abnormal findings of the maternal skeleton were evaluated, including a sacral anomaly, femoral head wound, the rare position of the lower left limb with the femoral head dislodged anteriorly and cephalad from the socket, and a fibular fracture. CONCLUSION: Examining the anomalies all together, a case of anterior hip dislocation related to a McRoberts-like maneuver performed during labor is a plausible explanation of the findings.

Biocultural perspectives on maternal mortality and obstetrical death from the past to the present.

Global efforts to improve maternal health are the fifth focus goal of the Millennium Development Goals adopted by the international community in 2000. While maternal mortality is an epidemic, and the death of a woman in childbirth is tragic, certain assumptions that frame the risk of death for reproductive aged women continue to hinge on the anthropological theory of the "obstetric dilemma." According to this theory, a cost of hominin selection to bipedalism is the reduction of the pelvic girdle; in tension with increasing encephalization, this reduction results in cephalopelvic disproportion, creating an assumed fragile relationship between a woman, her reproductive body, and the neonates she gives birth to. This theory, conceived in the 19th century, gained traction in the paleoanthropological literature in the mid-20th century. Supported by biomedical discourses, it was cited as the definitive reason for difficulties in human birth. Bioarchaeological research supported this narrative by utilizing demographic parameters that depict the death of young women from reproductive complications. But the roles of biomedical and cultural practices that place women at higher risk for morbidity and early mortality are often not considered. This review argues that reinforcing the obstetrical dilemma by framing reproductive complications as the direct result of evolutionary forces conceals the larger health disparities and risks that women face globally. The obstetrical dilemma theory shifts the focus away from other physiological and cultural components that have evolved in concert with bipedalism to ensure the safe delivery of mother and child. It also sets the stage for a framework of biological determinism and structural violence in which the reproductive aged female is a product of her pathologized reproductive body. But what puts reproductive aged women at risk for higher rates of morbidity and mortality goes far beyond the reproductive body. Moving beyond reproduction as the root causes of health inequalities reveals gendered-based oppression and inequality in health analyses. In this new model, maternal mortality can be seen as a sensitive indicator of inequality and social development, and can be explored for what it is telling us about women's health and lives. This article reviews the research in pelvic architecture and cephalopelvic relationships from the subfields of evolutionary biology, paleoanthropology, bioarchaeology, medical anthropology, and medicine, juxtaposing it with historical, ethnographic, and global maternal health analyses to offer a biocultural examination of maternal mortality and reproductive risk management. It reveals the structural violence against reproductive aged women inherent in the biomedical management of birth. By reframing birth as normal, not pathological, global health initiatives can consider new policies that focus on larger issues of disparity (e.g., poverty, lack of education, and poor nutrition) and support better health outcomes across the spectrum of life for women globally.

Frontier nurse-midwives and antepartum emergencies, 1925 to 1939.

This article examines how the Frontier Nursing Service (FNS) utilized nurse-midwives to respond to antepartum emergencies such as preterm birth, eclampsia, malpresentation, and hemorrhage in the women of Appalachia in the years 1925 to 1939. Particular attention is given to the preparation that nurse-midwives received during their midwifery education to prevent and respond to emergencies. Using traditional historical research methods and primary source material from the FNS papers in the Special Collections, University of Kentucky Libraries, Lexington, Kentucky, this article describes the nurse-midwives' experiences and how they implemented skills they had learned during their training in Great Britain. Working in the isolated mountainous area of Leslie County, Kentucky-for the most part without direct assistance from physicians-FNS nurse-midwives decreased maternal and neonatal mortality rates. During their first 2000 births, they had only 2 maternal deaths, whereas the national average maternal mortality rate was approximately 7 deaths per 1000 births. The nurse-midwives performed external cephalic versions on a routine basis. For pregnancy and birth emergencies, they administered sedation, gave general anesthesia, and performed invasive lifesaving techniques in order to protect the lives of the women in their care. During these 14 years, their cross-cultural engagement, assessment skills, clinical judgment, and timely interventions improved maternal and child health throughout the region.

[Institutional iatrogeny and maternal death: Semmelweis and puerperal fever]. / Iatrogenia institucional y muerte materna: Semmelweis y la fiebre puerperal.

Puerperal fever is a disease that becomes epidemic in the eighteenth century as a result of two factors: the urban working masses generated by the industrial revolution and the progressive hegemonization and medicalization of birth care in large public hospitals. Institutionalized maternal death reached figures above 30%, while in the case of birth care provided by midwives, it was than 2%. Semmelweis, an Hungarian physician, sustained that physicians contaminated women in labor due to insufficient hygiene after performing necropsies and established prophylactic measures in the Vienna Hospital that reduced mortality dramatically. However, his ideas were rejected because they affected the institutionalization process of medicine, based on altruism and honor, which would make it impossible to cause harm to patients. He was forced to leave Vienna Hospital and he continued his struggle in Budapest, but the rejection and disagreement of his peers with his doctrine affected his mental health. He died in an asylum, a few years before Pasteur and Koch proved the existence of the bacteria that caused diseases such as puerperal fever.

Iatrogenia institucional y muerte materna: semmelweis y la fiebre puerperal / Institutional iatrogeny and maternal death: semmelweis and puerperal fever

La fiebre puerperal es una enfermedad que asume carácter epidémico en el siglo XVIII como consecuencia de dos factores: las masas trabajadoras urbanas generadas por la revolución industrial, y la progresiva hegemonización y medicalización de la atención del parto en grandes hospitales públicos. La mortalidad materna institucionalizada alcanza cifras superiores al 30%, en tanto con la atención por parteras es menor al 2%. Semmelweis, médico húngaro, postula que los médicos contaminaban a las parturientas por insuficiente higiene luego de realizar necropsias, e implanta medidas profilácticas en el Hospital de Viena, las cuales reducen dramáticamente la mortalidad, pero sus ideas son rechazadas por que afectan el proceso de institucionalización de la medicina basado en el altruismo y honor, por los que supuestamente era imposible que causen daño a sus pacientes. Es obligado a retirarse del Hospital de Viena, y continua su lucha en Budapest, pero el rechazo y la incomprensión de sus colegas por su doctrina afecta su salud mental. Muere en un asilo, pocos años antes que Pasteur y Koch demuestren las bacterias causantes de enfermedades como la fiebre puerperal.

Puerperal fever is a disease that becomes epidemic in the eighteenth century as a result of two factors: the urban working masses generated by the industrial revolution and the progressive hegemonization and medicalization of birth care in large public hospitals. Institutionalized maternal death reached figures above 30%, while in the case of birth care provided by midwives, it was than 2%. Semmelweis, an Hungarian physician, sustained that physicians contaminated women in labor due to insufficient hygiene after performing necropsies and established prophylactic measures in the Vienna Hospital that reduced mortality dramatically. However, his ideas were rejected because they affected the institutionalization process of medicine, based on altruism and honor, which would make it impossible to cause harm to patients. He was forced to leave Vienna Hospital and he continued his struggle in Budapest, but the rejection and disagreement of his peers with his doctrine affected his mental health. He died in an asylum, a few years before Pasteur and Koch proved the existence of the bacteria that caused diseases such as puerperal fever.

Hemorragia posparto, muerte materna y monumento al amor / Postpartum hemorrhage, maternal death and monument to love

La hemorragia que puede ocurrir durante el parto y el posparto constituye una de las principales causas de muerte materna directa. En el presente artículo se realiza una reseña de la historia real, que data del año 1607, cuando un príncipe de tan solo 20 años de edad, heredero del Gran Imperio Mongol, conoce a una joven persa-musulmana llamada Arjumand Bano Begum más conocida posteriormente como Mumtaz Mahal de quien se enamora profundamente, y de la muerte que le ocurrió dando a luz a su 14ta. hija, de forma repentina, por una hemorragia. También se hace la historia de lo que significa el Taj Mahal, con sus visiones y leyendas, imponente conjunto que se erigió en su honor, con su naturaleza romántica, cuya construcción necesitó del esfuerzo de los mejores constructores (unos 20 000 obreros), de las mejores joyas, las mejores piedras; incluso, se desvió el río Yamuna para que el Taj Mahal pudiera reflejarse en sus aguas. Y allí, tras dos décadas de construcción, en el 1648, fue enterrada Mumtaz Mahal. Junto a ella, fue enterrado años después el propio emperador para que ambos reposaran siempre juntos eternamente. En el año 1983 el Taj Mahal fue declarado por la UNESCO como Patrimonio Nacional de la Humanidad y una de las nuevas siete maravillas del mundo(AU)

Bleeding, which may occur during delivery and postpartum, is a major direct causes of maternal death. In this article a review of actual history, dated 1607, when a prince of only 20 years old, heir to the Great Mongol Empire, meets a young Persian-Muslim girl, named Arjumand Bano Begum, better known later as Mumtaz Mahal. This prince fell deeply in love, and death suddenly happened when Mumtaz Mahal was giving birth to their 14th child. She died due to bleeding. Also we comment the story of what Taj Mahal, means, with visions and legends, as an awesome construction built in her honor, its romantic nature. This construction required the effort of the best builders (about 20,000 workers), the best jewelry, the best stones. They even diverted Yamuna River so that Taj Mahal could be reflected in its waters. And there, after two decades of construction, in 1648, Mumtaz Mahal was buried. Beside her, the emperor was buried years later so they both could be together forever. In 1983, Taj Mahal was declared a UNESCO National Heritage Site and one of the new Seven Wonders of the World(AU)

Mrs Killer and Dr Crook: birth attendants and birth outcomes in early twentieth-century Derbyshire.

After the passing of the 1902 Midwives Act, a growing proportion of women were delivered by trained and supervised midwives. Standards of midwifery should therefore have improved over the first three decades of the twentieth century, yet nationally this was not reflected in the main outcome measures (stillbirths, early neonatal mortality and maternal death). This paper shows that there was a difference in the risks associated with delivery by the different attendants, with qualified midwives having the best outcome, then bona-fide (untrained) midwives and lastly doctors, even when account is taken of the fact that doctors were called in cases of medical need and may have been booked where a problematic delivery was expected. The paper argues that the lack of improvement in outcome measures could be consistent with improving standards of care among both trained and bona-fide midwives, because increased attention to the rules stipulating when midwives called for medical help meant that a doctor was called into an increasing number of deliveries (including less complicated ones), raising the chance of unnecessary and dangerous interventions.