Maternal mortality signifies the deaths of women that take place during pregnancy, labor, or the puerperium, once frequently referred to as “deaths in childbirth.” Despite past claims, in the context of total deliveries, maternal death was a rare event compared with death from disease. Even in the worst periods of the eighteenth and nineteenth centuries, the mother survived in at least 98 percent of deliveries. Nonetheless, a death rate of 1 to 2 percent is high when the average number of deliveries per day is about 2,000, as it was in England and Wales by the end of the nineteenth century. In the United States during the 1920s, for example, death in childbirth claimed some 15,000 to 20,000 lives a year, and it was second only to tuberculosis as a cause of death in women of childbearing age.

This essay is about the historical epidemiology of maternal mortality — the distribution and determinants of maternal mortality in different populations at different periods. The epidemiological approach to the history of maternal mortality is not, of course, the only one, but it is the method that makes the greatest use of statistics to attempt to discover why the mortality rate changed at different periods, and why one region or one country suffered more maternal deaths than another. It is necessary to examine a broad range of clinical, social, political, economic, and geographic factors, all of which affected childbirth in different countries and at different times. Although this is a historical exercise, some of the answers are undoubtedly relevant to obstetric problems in certain parts of the Third World today.