The Brothers Grimm were obsessed with the archetype of the evil stepmother.
Cinderella was reduced to serving as a scullery maid for her stepmother and stepsisters.
Snow White survived repeated homicide attempts orchestrated by her stepmother.
The stepmother of Hansel and Gretal banished the children into the dark woods where they stumble into the clutches of a cannibalistic witch.
Yikes.
That was a lot of evil stepmothers found in one book of fairy tales. The Grimm brothers were not alone. Nancy Recker of Ohio State University reports that there are over 900 fictional evil stepmothers.
Why so many?
It was a sign of the times. Many women died in childbirth. The children’s fathers would remarry. In a time of poverty and scarce resources, the stepmothers often tried to look after the interests of their own children at the expense of the inherited ones.
Today, we have fewer fictional evil stepmothers. This is better than in the good old days. It reflects the fact that fewer women die in childbirth.
The World Health Organization defines maternal mortality as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes." It is a lot less common than it used to be.
Let’s look at just a few examples of maternal mortality.
Mary Wollstonecraft is often considered the intellectual originator of feminism. In 1792, she published A Vindication of the Rights of Women. Five years later, she died after giving birth to a daughter, also named Mary. The semi-orphaned baby Mary became a more famous writer than her mother. Her first book was called Frankenstein, or the Modern Prometheus.
King Henry VIII of England famously had six wives. In order, they were summarized as divorced, beheaded, died. Divorced, beheaded, survived. Wife number 3, Jane Seymour, was described as “died.” Maternal mortality. Seymour died of infections 12 days after giving birth to the future King Edward VI. Wife number 6 was the one who survived. At least she survived Henry, which was no mean feat. However, shortly after King Henry died, Catherine Parr remarried – to the brother of King Henry’s third wife. Catherine promptly got pregnant and died of an infection after giving birth to a girl named Mary Seymour. The little semi-orphaned girl did not acquire an evil stepmother. Her father, the new King’s uncle, made the mistake of shooting the King’s pet spaniel. He was executed for treason. Lacking an evil stepmother, the baby Mary was put into care of an evil aunt and disappeared. Historians argue whether she was murdered or died of neglect.
Closer to home, consider the women in John Howe’s life. Howe was a United Empire Loyalist and printer who moved to Halifax after the American revolution. His wife, Martha, died in childbirth. His daughter, also named Martha, acquired a step-mother – who was not evil. However, the younger Martha followed the example of her mother by also dying in childbirth.
So yeah. Maternal morality was a relatively common event. Thus the multitude of stepmothers, whether evil or not.
If we go back to near the time of the wives of King Henry VIII, the Biship of Exeter poetically said, “Death borders upon our birth. And the cradle stands in the grave.” Henry established the Church of England. His son, Edward, ordered a Book of Common Prayer to be written. There was a liturgy was for women who had recently given birth. It starts by thanking God for “the safe deliverance and preservation from the great dangers of childbirth”. Maternal death was on folks’ minds.
We don’t have good data on the what the death rates were, but we do know two things. First, maternal mortality rates were high for commoners. Second, they were higher for aristocratic or royal women. Part of this was because they became pregnant more often. The female children of the powerful were married off much younger – partly for dynastic reasons and partly because their families could afford marriage. The young wives of the powerful were expected to produce sons. Failure was not an option. Anne Bolyn, Henry VIII’s second wife, was beheaded after she produced a girl rather than a boy. This was not the only reason, but it was the last one. The other reason that more aristocratic women died in childbirth was because of their importance. The higher the stature of the women, the more doctors were involved. The more doctors, the more dirty hands. The more dirty hands, the more infections. The more infections, the more dead mothers. Two of Henry’s wives died as a direct result of childbirth. Both died from infections.
Record keeping documenting the death of women who were not rich and well-known began to improve in Britain. By the time Mary Wollstonecraft died in 1797, reasonably complete records were being kept in most parishes. Geoffrey Chamberlain reported in the Journal of the Royal Society of Medicine that from 1700 to 1750, every 1,000 deliveries resulted in 10.5 dead mothers. About 1 percent of pregnancies ended in death. This rate dropped to about 7.5 per 1,000 births from 1750 to 1800, and then down to 5 during the next half century. After that, the maternal mortality rate remained fairly constant for almost a century.
Let’s turn to Canada.
In 1927, Dr. Helen MacMurchy, the Director of Child Welfare for the Canadian Department of Public Health, reported that from Dominion Day, 1925 to Dominion Day, 1926, that 1,532 women died as a result of giving birth. This meant a maternal mortality rate of 6 deaths for every 1,000 births. Given that the Canadian fertility rate at this time was about 3.5 babies per woman, this mean that a Canadian woman had about a 2 percent chance of dying because of childbirth.
MacMurchy’s numbers have been confirmed by later research conducted by Jane Vock (who I went to graduate school with at MacMaster University in the 1980s). Vock counted over 1,500 maternal mortality deaths in Canada during 1928.
Then things got better.
Statistics Canada reports that in 2022 there were 22 deaths in Canada meeting the WHO’s definition of maternal mortality (dying within 42 days of giving birth from problems arising from the pregnancy or delivery). Another 8 mothers died from pregnancy related causes before the child’s first birthday. That’s a total of 30 tragedies.
I’ll do the math for you. Even after expanding the WHO’s definition to include all maternal deaths within a year of delivery, there’s been a 98 percent decline in the number of dead mothers in just under a century.
That’s something better than in the good old days. Over 1,500 fewer dead mothers in Canada every year.
Why did mothers die?
Childbirth is intrinsically risky for human beings because of our evolutionary design. We have big brains – and thus large heads. We walk on two feet. This means a pelvic structure with a narrow birth canal. Big things moving through small openings means a lot of pressure and tearing of flesh. A lot of strain and a pain. Obviously, I’ve never experienced this, but I’ve seen it. It is no mystery to me as to why the birthing process can be fatal.
Chamberlain reports that the three biggest proximate causes of maternal mortality, historically, have been infections, hemorrhages, and shock. He uses different words, but I’m keeping it simpler because I assume that most readers don’t know Latin or have a medical dictionary at hand. So – the comic book version for maternal mortality is that:
Germs get into the woman’s body through the torn flesh and kill the woman. Symptoms such as fever begin 3 to 10 days after the birth. If the infection gets into the pelvic veins or fallopian tubes, it was usually fatal before sulphate or anti-biotic drugs,
Severe bleeding can occur when the Placentia separates from the uterus. Tearing of flesh as the baby’s head emerges can also cause bleeding, but historically this was not as fatal since the site of the bleeding was more visible to someone assisting with the birth, and
Pain can cause shock. Shock can raise blood pressure to levels that can kill.
How were death rates reduced?
While they basically agreed on the number of maternal mortality deaths a century ago, MacMurchy and Vock disagreed on a basic reason.
MacMurchy argued that many women died because there were not enough doctors present at delivery.
Vock argued that the opposite – that there were too many doctors involved in the birthing process.
If we look at what was happening a century ago, the facts are on Vock’s side. A century ago, births attended by midwives killed fewer mothers than births attended by doctors. The reason was infections. Doctors tended to be both dirtier and more interventionist. They mucked around more with scalpels and forceps. This created deadly infections.
It took a long time to convince doctors that their work could kill their patients. In the 1790s, a Scottish doctor named Alexander Gordon lost 77 women to infections after he “helped” deliver their babies. Gordon wrote, “it is a disagreeable fact that I, myself, was the means of carrying the infection to a great number of women.” Gordon recommended that medical personnel fumigate themselves before helping with a birth. For his observational power, inductive logic, and practical solutions Gordon was run out of Scotland by his colleagues. He joined the British navy to make a living. No babies to deliver there.
On this side of the Atlantic, Harvard medical professor and poet Oliver Wendell Holmes wrote in 1842 that “the disease known as puerperal fever is so far contagious as to be frequently carried from patient to patient, by physicians and nurses.” This conclusion made Holmes about as popular as a skunk at a garden party with his colleagues in the medical profession. It almost cost Holmes his teaching position.
A few years later, an Austrian physician name Ignaz Semmelweis documented the number of women who died after being “helped” to deliver their children by medical students who went straight from dissecting corpses to delivering babies. Semmelweis recommended that doctors wash their hands with carbolic soap before helping with a delivery. The medical profession ran him out of Vienna.
In 1879, Louis Pasteur demonstrated the link between dirty hands and death. About the same time, Joseph Lister (for whom Listerine was named after) developed practical sterilization techniques.
Despite this, change came slowly to the medical profession. For example, wearing face masks and sterile gloves during deliveries did not become standard practice until the late 1920s. Vock’s research shows how, in Canada, 1928 was a crucial tipping point. A federal government study documented the extent of deaths from infections. Doctor’s organizations realized this could create a “crisis of legitimacy” since “many practitioners were accused of disinterest in maternal cases, and they were held responsible for maternal deaths because of their poor obstetrical procedures and practices.” Doctors began to pressure other doctors to, literally, clean up their act.
Engaging in radical practices such as washing hands before delivering babies cut the maternal death rate by preventing infections. In 1936, the first sulphate drugs to CURE infections were introduced. Penicillin became widely available in 1945.
Prevention and cure. It was a great combination for keeping mothers from dying of infections.
While doctors had a worse record than midwives for infections a century ago, they did a bit better on deaths from bleeding and shock. Doctors had better – and improving – techniques for stopping bleeding. Chloroform to control pain began to be used in the 1890s. By the 1920s, doctors discovered that regular blood pressure tests during pregnancy allowed them to predict which women were most susceptible to shock. Prediction spawned prevention.
All in all, the 1920s were a turning point the number of women dying because of childbirth. Maternal mortality rates began to drop dramatically.
And there was one other thing going on as well.
Last week, I talked about the drop in the infant mortality rate. Fewer dead babies meant fewer dead mothers because women did not have to get pregnant as often.
We have fewer stories of evil stepmothers than in the good old days. Fiction is not as Grimm. Things are better.
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