Indirect deaths result from diseases made worse by pregnancy. Their importance increased as reporting improved. In 1991 Michael de Swiet became the medical assessor to the Enquiries. Initially heart disease was the main concern. Rheumatic heart disease may follow streptococcal rheumatic fever. Women can live with it but pregnancy puts a strain on the heart and death may occur during childbirth. In 1952-4 the deaths from heart disease included 37 women giving birth at home. The disease diminished due to penicillin and better social conditions. Women with congenital heart disease were warned against pregnancy but cardiac surgery reduced the risk and obstetricians learned to work with cardiologists. The pattern of disease changed due to smoking and obesity, and myocardial infarction became the main cause of cardiac death. After 1997-9 Indirect deaths outnumbered Direct deaths. Reports highlighted the inadequate management of epilepsy, with poor communication between maternity carers and neurologists, particularly for women in deprived circumstances. The Enquiries’ findings helped to create a new specialty and the Obstetric Medicine Society now runs its own training programme.