Dr JWW’s quotes, mostly from 1914 Twilight Sleep book — also NEJM 1985 Prophylactic Cesareans

DrJWW-MdryToday-paragraphs-frm-file_part-2_get-them-2-come Feb 2, 2021

“For the sake of the lay members who may not be familiar with modern obstetric procedures, it may be informing to say that care furnished during childbirth is now considered, in intelligent communities, a surgical procedure.” [1911-D, p. 214] ^79

~The midwife is a relic of barbarism. In civilized countries the midwife is wrong, has always been wrong. The greatest bar to human progress has been compromise, and the midwife demands a compromise between right and wrong. All admit that the midwife is wrong. [1915-C; DeLeeMD.p. 114] ^93

~The question in my mind is not “what shall we do with the midwife?” We are totally indifferent as to what becomes of her…[1912-B, p.225] ^99

Dr. JWW’s plan for the elective hospitalization of healthy affluent maternity patients dove-tailed seamlessly with his self-funding system for general hospital. Patronage of these small and medium hospitals by paying customers generated a reliable revenue stream that allowed these lying-in hospital and hospital maternity wards to gradually update and remodel or expand their hospital buildings. Over the course of 5, 10 or 15 years, many of these little hospitals turned into larger general hospitals that could serve all the surrounding communities.

@@@ NOTE to Self – for Part 1 or 2 – the 3-yr California CNM study nurse-midwife hospital birth in very poor migrant populations in Madera (1963 ??)  with a dramatic reduction in of prematurity rate for childbearing women who received prenatal care and were delivered by CNMs

However, CMA (state chaper of the AMA) killed the study at the end of 3 years, ending nurse midwifery care, and resulting in increased perinatal mortality and prematurity rate that quickly rose to 32%   

 

The prophylactic use of Cesarean NEJM 1984

 

In 1985) a peer-reviewed paper was published in the New England Journal of Medicine entitled “Prophylactic Cesarean Section at Term?” by obstetricians George B. Friedman and Jennie A. Feldman (NEJM, May 1985).

Its authors made a strong case for the routine use “prophylactic” Cesarean at term as a way for obstetricians to permanently eliminate the many dangers that vaginal birth poses to the unborn and newborn baby, while entailing only a minor amount of “excess” or “extra maternal mortality”. (p. 1266)

“….the number of extra women dying as a result of a complete shift to prophylactic cesarean section at term would be 5.3 per 100,000… [emphasis added]

… if it could save even a fraction of the babies at risk, these calculations would seem to raise the possibility that a shift toward prophylactic cesarean section at term might save a substantial number of healthy infants at a relatively low cost of excess maternal mortality.” [emphasis added]

We probably would not vary our procedures if the cost of saving the baby’s life were the loss of the mother’s. But what if it were a question of 2 babies saved per mother lost, or 5 or 10 or (as our calculations roughly suggest) as many as 36 or 360.

Is there some ratio of fetal gain to maternal loss that would unequivocally justify a wider application of this procedure? [emphasis added]

….is it tenable for us to continue to fail to inform patients explicitly of the very real risks associated with the passive anticipation of vaginal delivery after fetal lung maturity has been reached? [emphasis added]

If a patient considers the procedure (i.e. routine CS @ term) and decides against it, must she then be required to sign a consent form for the attempted vaginal delivery?” p. 1267 [emphasis added]

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3. American Journal of Obstetrics and Gynecology: Macer, J. A. 1992:166:1690-7

“It is no longer feasible for individual physicians who have invested 12 years in training at a cost of hundreds of thousands of dollars to dedicate extended periods to observing one normal woman in labor.”

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Step # 1 in Dr. JWW’s economic plan began by officially suggesting that small hospitals re-brand themselves as dedicated “lying-in” hospitals and for medium and larger hospitals to add a lying-in that ward that provided a private room for the labor and birth. The idea was to replace home births attended by midwives or GPs in the family home. The new better way for the 20^th century woman was to have a hospital labor and birth and traditional 14-day “lying-in” period for the new mother to rest and regain her strength while hospital nurses cared for her newborn in the hospital nursery. The targeted demographic for electively hospitalization was healthy middle- and upper-class (obviously white) patients whose family could pay upfront. The unique “comforts” only available to hospitalized labor patients were “pain-annulling drugs” and “anesthetizing the patient with chloroform”:

“These comforts, it must be borne in mind, include the use of pain-annulling drugs. In this country, it is customary to anesthetize the patient with chloroform, though some competent practitioners prefer ether. We have already seen that the merits of the morphine-scopolamin[e] treatment, inducing the Twilight Sleep, are to be fully tested at the Johns Hopkins Hospital”

What made Dr. JWW’s financial elective hospitalization “scheme” (his word not mine) so dependably profitable was that healthy childbearing women aren’t really “patients”, in the since of being sick or disabled or. Seriously ill or injured hospital patients required time-consuming nursing care, medical and surgical procedures and other extensive or expensive hospital services and sometimes died without paying their hospital bills. Compared to hospital care for critically ill or injured patients, maternity services were very profitable.

With such dependable profitability, hospitals could count on their lying-in wards to generate a dependable revenue stream. This made up for their financial losses in the hospital’s other departments, and even more exciting, it paid for gradually upgrading and expanding their facility. I’m quite sure this was seen as the answer to their prayers by more than one hospital administrator.

The unusually high profit margin of lying-in wards anticipated by Dr. JWW early in the 20^th century is still true. In the late 1990s, one published author noted that for every dollar that hospitals received in patient revenue, their maternity departments averaged 38 cents profit (approx. 4O%), while the profit margin for cardiac care units only was only five cents on the dollar (5%). This make maternity care 8 times more profitable.

However, the biggest and most critical question was “how to convince enough women to patronize their lying-in wards to finance Dr. JWW’s plan ”

The financing for every other aspect of Dr. JWW’s enormous, multi-generational plan for a nationwide system of general hospitals was totally dependent on the willingness of childbearing women as paying customers to patronize the lying-in wards of hospitals and without knowing it, become part of Dr. JWW’s plan for financing new general hospitals. However, Dr. JWW and owners of private hospital knew their whole plan would go down in flames without sufficient patronage of lying in wards hospitals.

The only other option would be the dreaded publicly (ie. government) funding, but the AMA would never let that happen. The US would be stuck with an outmoded hospital system for generations to come, making us the laughingstock of all the other industrialized countries.

It also meant that medical school would not be able to provide clinical training programs to their student. Doctors graduating with this kind of hands-on experience would still have to travel to Europe and no doubt, become the brunt of jokes by their European counter-parts about our backward system.

Before these was  a nationwide system of general hospitals in the US, most medial schools we not able to provide clinical training to medical students as no high-volume patient wards were available that would allow them to recognize the symptoms of uncommon disease process, have an opportunity to hone their diagnostic abilities or develop technical skills such as palpating body parts, suturing lacerations, performing minor surgeries or using obstetrical forceps under the watchful eye of their clinical professor. Medical students from wealthy families solved this problem by enrolling in clinical training programs in some of Europe’s best regional hospitals, which less well-off new graduate MD tried to piece together their clinical skill as “one-the-job-training” after having opened up their own private practice.

While I don’t claim to know Dr. Williams personal thoughts, I have read, re-read and studied hundreds of documents by and about Dr. JWW’s life and his contemporary world over the more than 40 years I have spent studying the childbirth practices of obstetrics and midwifery. I believe  I can to some extent surmise his personal feeling based on the big picture of his life, which in general was highly ethical and leads me to surmise with some confidence his feeling about the possible failure of his high-stakes plan for a much needed general hospital system, for which failure was not an option but somethings unthinkable, something he just couldn’t let happen.

Dr. JWW knew that without an effective system of general hospitals, all Americans who didn’t live in one of a couple dozen metropolitan areas would not have timely access to a well-equipped general hospital within reasonable driving distance. For decades to come, millions of these people would be doomed to unnecessary pain, would suffer preventable life-long disabilities (turning a healthy husband and father into a crippled beggar while his wife and kids starve) and of course, uncountable numbers of needless deaths – all because the US, unlike other industrialized countries around the world, wasn’t able to provide this essential services to his own people. This would be a shame and a humiliation.

He apparently felt driven to do whatever it took, whatever he could, even if he had to invent a ‘creative spin’ that included a lot of white lies to cover up one very big, very black lie. It was the only chance to kick the ball over the goal posts. Besides, he many have mused, if I’m successful the women I lied to will still be OK, I just tricked them and their families into having a hospital birth. This is so much better than having a baby at home with poorly educated midwives or a backwoods doctor that I don’t see anything wrong with it.

As his book promised, these hospitalized labor patients would be immediately medicated with the Twilight Sleep “cocktail” of morphine and scopolamine, so they wouldn’t even remember being in labor. Then they’d be given a general anesthetic, which guaranteed that they would, in Dr. JWW’s own words be “oblivious” during the birth of their child.

What could be the harm in that, especially when paired with the enormous good it would do – the profits from their lying-in fees would underwriter the development of a general hospital system that would be able and ready to treat every man, woman and child when they most needed it. The good doctor himself remarked that men (as well as children and the elderly) would benefit from the profits generated by the elective hospitalization of healthy maternity patients as paying customers.

We must take into account that Dr. JWW’s stratospheric social status. He was a wealthy, upper-crust, university-educated, socially and politically influential white male medical doctor in a very patriarchal, chauvinist, classist, sexist, and racist society. And Much of what was said about women and about childbirth in Dr. JW’s book was filtered thru the lens of all those “-isms”, which unfortunately for the American public, were simply not true but acted on as if they were. This was particularly the case for sexism and the desire by Dr. JWW and many his contemporaries to see the traditionally prejudice against obstetricians and the general low status of the obstetrical profession in the hospital hierarchy be elevated to and giving the respect accorded to other surgical specialties.

In 1914, women did not have the right to vote, which officially gave men the right to decide what was best for them, without asking their opinion or permission, and against their voiced objections.  The consensus among obstetricians was that women didn’t know what they were talking about when it came to childbirth. They certainly didn’t understand that the obstetrical profession believed that its rightful role was to be the gate keeper over the reproductive life of women, with total control over childbirth-related services of any kind.

And as a visionary, he was simultaneously bold and undeterred.  He is plans for financing a general hospital system were truly extraordinary for their scope, ingenuity and multi-layer complexity and, for the most part, he apparently delivered on his promises.

He was also a meticulously practical man who drilled down to the smallest of details to make sure that his goals were ultimately achieved, which is an important element of his success. One of the most of critical these ‘details’ was his aggressive public relations campaign to promote the elective hospitalization of healthy, well-off childbearing women.

Personally, I wish Dr, JWW could have risen above the “isms” and other prejudices of his day that objectified childbearing women in a very unfavorable light. But in the last frame, he either couldn’t or he just didn’t want to, we will never know which.

With that kind of profitability, hospitals could count on their lying-in wards to generate a dependable revenue stream. This made up for their financial losses in the hospital’s other departments, and even more exciting, it paid for gradually upgrading and expanding their facility. I’m quite sure this was seen as the answer to their prayers by more than one hospital administrator.

The unusually high profit margin of lying-in wards anticipated by Dr. JWW early in the 20^th century is still true. In the late 1990s, one published author noted that for every dollar that hospitals received in patient revenue, their maternity departments averaged 38 cents profit (approx. 4O%), while the profit margin for cardiac care units only was only five cents on the dollar (5%). This make maternity care 8 times more profitable.

As note earlier, Dr. JWW’s claims were based on one big, black lie invented by him for this specific purpose and supported by a bevy of less egregious lies and half-truths. Together they wove a dark and deeply menacing story that now goes against our common sense, direct experience, and all the scientific facts.

Specifically, Dr. Williams claimed that these economically secure white mothers-to-be were not getting enough narcotics and hallucinogenic drugs during labor, and not enough chloroform and ether during the birth, not enough episiotomies, not enough forceps deliveries, not enough manual removals of their placentas and not enough stitches after giving birth vaginally.

The narrative woven Dr. Williams claimed that the normal pain of uterine contractions in healthy middle and upper class (white) women had recently become acutely pathological in nature due to the negative effects of modern civilization on the evolutionary process. At that point he referred to the newly embraced Darwinian theories of evolution as support for this conclusion.

In plain English, he clearly and specifically was referring to white, economically-secure, educated, intellectually stimulated, well-mannered, socially astute and emotionally “delicate”. Unfortunate for us modern readers, Dr. Williams’ little book never technically defines the characteristic he called ‘delicate’, but my best guess it is women who frequently feel faint or become emotionally “overwrought’ when looking at pictures of starving children or wounded soldiers.

Exactly how these “intelligent (ie. formally educated) and economically better-off white women became ‘delicate’ or how you can tell a delicate woman from one who isn’t, Dr. Williams does not say. But as a former professor of obstetrics and chief of the Johns Hopkins University Hospital department of obstetrics, he was assumed to have insider information beyond any question as to its authenticity.

So no one questioned his claim that particular cohort of childbearing women suffered from a “pathological level of pain associate with an otherwise normal labor. The adjectives he used to identify this unfortunate cohort of women included: cultured, civilized, intelligent, sensitive, delicate. But his own words are the best explanation of this pathological pain syndrome, who it affected and the how and why of it:

Dr. JWW must have assumed that people would not notice the direct correlation between a woman’s supposedly “sensitive and delicate” status that he insisted was proof that she suffered from his pathological pain syndrome, and would have to be hospitalized so she could be medicated with Twilight sleep drugs only afflicted the specific demographic of childbearing women whose husbands could afford to pay for hospital-based childbirth services.

His book was the blueprint for public relations onslaught that simultaneously trashed midwives, promoted hospital birth as the ‘new norm’ and only “appropriate” place for women to give birth. However, from a PR perspective, it was still going to be a long slough with no guarantee of success. It was not until 1938 that over 51% of birth occurred in a hospital and 1969 before more that 99% of babies were delivered in hospitals, so clearly it was a uphill journey.

The economically critical issue that everything else hung on was successfully convincing “the little woman” – each pregnant woman and her family, one by one, to –

• No longer labor in the comfort and familiarity of her own home surrounded by family and close friends
• Suddenly eschew the intergenerational tradition of being attended by a midwife that she had a personal relationship with who would to see her through the labor and birth of her baby at home while she was surrounded by family and friends
• Have her husband drive many miles, often in the middle of the night, to take her to the hospital when she went into labor, kiss her goodbye at the Labor Room door, drive back home in the dark and wait for the hospital to call to tell him the baby was born, it’s a boy (or a girl) and his wife is alright but he can’t see her because she is still unconscious from the anesthesia
• Get her husband to agree to pay the much more expensive bill (compared to midwifery care) for a hospital birth and the 14-day lying-in period for mother and baby.

It should be noted families didn’t have to pay a hospital bill for “lying-in” services when the new mother was at home in their own bed for the traditional 14 days after giving birth, attended by family and friends who also cared for her newborn baby without the additional cost and problems that frequently plagued hospital nurseries such as cross-contamination, infections, mixing up babies, mistakes in making up or proper sterilization of baby formula.

After being given a made-up reason to afraid, husbands were given the really good news – all they had to do was take their delicate, intelligent wife to the hospital as soon as she went into labor and she would be given Twilight Sleep drugs (morphine and scopolamine) she’d never feel a thing or wouldn’t remember anything until long after the baby was born.

Based on his “labor pain as a pathology”, Dr. JWW proclaimed that healthy middle and upper classes white childbearing women in the US were suffering because they were not getting enough medical and surgical interventions during their normal labor and births. This was the reason that influential obstetrical leaders, with the financial and political backing of the AMA, executed a PR campaign the claimed   that the care of midwives was dangerous as they were both untrained and unclean and should be immediately discarded as old-fashioned. According to the obstetrical profession, only doctors should attend birth.

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… able to speak authoritatively from his own professional experience that the perfect maternity patient as paying customers was white, well-off stay-at-home married women whose with husbands that were employed full time or independently wealthy.

These healthy, wealthy white women were suffered from an evolutionary fluke that was a side-effect modern civilization, As a result women in the demographic were unable to tolerate the normal pains of labor and spontaneous birth. If they were not provided with Twilight Sleep drug and the ‘blessings of forgetfulness” via general anesthesia, they risked having a mental breakdown the might literally drive them crazy.

The labor patient’s experience under Dr. Willians’ scheme for electively hospitalizing as a source of revenue for his “plan”

“When it’s time for the baby to be born, these wealthy white motherd-to-be are rendered unconscious by general anesthesia, and the typical litany of surgical interventions is performed — episiotomy, forceps, manual removal of their placenta, significant suturing of the perineal incision, the ‘husband’ stitch, etc.

After the birth, the new mother will be sent off in one direction to recover from the profound state of unconsciousness, while her newborn — still a sight unseen by its new mother — is sent to the NB nursery, to be appreciated by the dad and gathered family members. However, it will be hours before the mother gets to see her own baby.”

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Chapter 8 of “Simple Discoveries in Painless Childbirth”

The answer seems almost ridiculous in these days of large financial enterprises.  For we are told, on competent authority, that the paltry sum of $200,000 would suffice to enlarge the present buildings devoted to the obstetrical and gynecological departments at Johns Hopkins Hospital, and that $300,000 more would suffice as an endowment for the maintenance of the additional patients. 

Half a million dollars, then, entrusted to the wise stewardship of the Johns Hopkins authorities, would suffice to establish a woman’s clinic, in which matters that vitally concern the twenty million mothers of America would be investigated, as they are being investigated nowhere else in this country.

DRAFT  {?? 8 ??} The childbearing woman’s experience of hospital-based obstetrics in 1914

Dr. Williams apparently believed that economically secure white mothers-to-be were not getting enough narcotics and hallucinogenic drugs during labor, and not enough chloroform and ether during the birth, not enough episiotomies, not enough forceps deliveries, not enough manual removals of their placentas and not enough stitches after giving birth vaginally.

What this meant to the unlucky childbearing women, her husband and family

Elective hospitalization for obstetrical care began with a late-night drive through the dark to a hospital that often is 20 or more miles away as the laboring woman’s contractions got longer and stronger and more painful. After the couple arrived at the hospital’s emergency room entrance, the mother would be put in a wheelchair and an orderly escorted them to the labor ward.

Upon reaching a set of swinging doors marked “NO ADMITTANCE ~ Authorized Personnel Only” in big black letters, a nurse would come out and instruct the new mother-to-be to kiss her husband good-bye, as husbands and other family members were never ever allowed in the ward for fear of being in germs and also because it was seen as “indecent” for men to observe other men’s wives in labor or be present while their own wife was giving birth and of course, the hospital wouldn’t let the family’s midwife within a hundred miles of a hospital L&D.

Then the newly admitted labor patient was put in a hospital bed in the labor ward, surrounded by the beds of other laboring women who had already been heavily medicated with Twilight Sleep drugs. They seemed to take turns moaning and cried out with each contraction; sometimes these heavily medicate women let out a blood-curdling scream or tried to climb out of the bed to in an effort to get away from the pain.

As soon as the admission process was finished, the nurse would inject her newest labor patient with the same powerful Twilight Sleep drugs — morphine or other narcotics and scopolamine — which produces amnesia and hallucinations.  After that, this about-to-be new mother would remember nothing at all.

When it was time for her baby to be born, she would be taken by stretcher to the delivery/operating room and rendered unconscious under general anesthesia. After being put in lithotomy stirrups, the doctor would preform a “routine” episiotomy and use forceps to deliver the baby. Then he would reach his gloved hand and 5-6 “ of his lower arm up into the mother’s vagina (about 12”) to her uterus to first separate the placenta from the uterine wall using his finger tips and the manually withdraw the placenta with his hand. The fourth and final of these surgical procedures – suturing the episiotomy incision – was done while the mother was still stepped in the waters of forgetfulness, having been “saved” from “agonies of tortured humanity” by the “beneficent anesthetic vapors” of chloroform or ether.

END  Here at the beginning of the 21st century, our obstetrical system still has an over 90% medicalization rate which routinely include seven or more medical or surgical interventions for women who give birth in hospitals. In addition to the cornucopia of obstetrical interventions, and our sky-high Cesarean section rate, the newest 21st addition to “no such thing as too many interventions” is the obstetrical profession is now recommending that the labors of all healthy pregnant women be routinely induced @ 39 weeks (a week BEFORE their baby is even due!).

END  Based on the average US birth rate over the course of the 20th century (from 2-4 million annually or average of 3 million on average for the last 100 years ), well over 300 million American women received a risky, painful, frequently humiliating and unproductively expensive form of care that did not include fully ‘informed’ consent, but did include a dramatic increase in preventable morbidity and mortality of new mothers and babies.

It’s not a stretch of the imagination to say that Dr. JWW’s 1914 book, as the subtitle suggests promoted “Simple Discoveries in Painless Childbirth“, mainstreamed the idea that ‘modern’ childbirth in the 20th century “was now, in intelligent circles, a surgical procedure” to be “performed” by physician-surgeons.

The ‘proper’ role of the surgical ‘patient’ was to lay perfectly still under the influence of powerful narcotics during the pre-op or “waiting” period (normal labor) before the doctor was called, and then for her to lie unconscious on the operating room-delivery room table under general anesthesia while the doctor performed the surgical procedure of “vaginal delivery”, using whatever manipulations or surgical instruments he required or preferred to use to extract the baby from the mother’s inert body. Everybody in the delivery room got to see her baby be born except for it’s mother!

Dr. JWW’s promotion of Twilight Sleep and general anesthesia was NOT a goal in and of itself, but an important a part of a process for achieving a much bigger and more important goal. As a result, the second half of Dr. J W Williams’ book goes way beyond just describing or promoting the new obstetrical preferences of his era. As the true purpose of his book, chapters 5 thru 8 give voice to his dream, identify his motives and promote an innovative new business plan for American hospitals that he personally invented and promoted, ultimately brought to fruition and under which we currently organize our hospitals as social and economic entities.

In the simplest terms, Dr. JWW’s “plan” was the social, economic and political ‘capture‘ of normal childbirth services for healthy women as a profit-generating revenue stream for American hospitals.

Maternity patients, as profitable paying customers, would make up for the many unprofitable situations that hospital sometimes found themselves in, the biggest being the uncollectible debts of critically ill or injured patients who inconveniently died without paying their hospital bills.

But even better, this new and dependable revenue stream would easily pay for upgrading, remodeling and expanding the hospital’s facility. allowing them to put in a new department of surgery, clinical laboratories and more spacious administrative offices. It also would underwrite the purchase of capital-intensive equipment such as x-ray machines, autoclaves, microscopes and big operating room lights. Just as Dr. JWW predicted, this would allow thousands of the small, doctor-owned 2-to-10 bed hospitals and minor surgeries to eventually upgrade to the status of an acute-care general hospital.

Dr. J. Whitridge Williams and other influential obstetricians of this eliminated physiologically-based care of normal childbirth in healthy women as provided by midwives and family practice physicians and replaced it with a hospital-based model that normalized an ever-lengthening list of interventions and invasive procedures.

This is part-1 of an eight-part series that covers the historical aspects of this topic to the modern-day consequences of Dr. Williams’ quite obviously successful plan.

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Parking/barking lot

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This was particularly the case for sexism and the desire by Dr. JWW and many his contemporaries to see the prejudice against obstetricians by other members of the medical profession and the general low status of the obstetrical profession in the hospital hierarchy get the same respect accorded to other surgical specialties.

How do we get women to go to the hospital to give birth? 

As so often is the case, almost everything comes back to the song sung by Liza Manali in the movie Cabaret “Money, Money, Money”. Like many other areas of life, Dr. JWW’s plans started and ended with money — how did you get it and what did you do with it? 

… and give its administrators an attractively appointed executive office suite and nice annual bonus.

I and many others activists describe this as ???

???? Mission Impossible ????

Note to self – somewhere in this introductory part, description of how infection became the primary killer of childbearing women during the pre-antibiotic era and in contemporary times developing countries without timely or dependable access to antibiotics, or individuals who have access but reject the use medical care, including antibiotics.  

The vast majority of births that have occurred on the People Planet, both before and after the hundreds of thousands of years before the germ theory of infection disease and discovery of antibiotics to treat such infections were normal and mothers and babies not only surviving, but were normal and healthy afterwards.

Before Pasteur’s scientific “germ theory of infectious disease” was accepted by the medical profession in 1881, being healthy and having a normally progressive labor and timely spontaneous birth (classic wisdom: “the moon should not rise twice on the same labor”) that no one had any reason to insert their unwashed and ungloved fingers up into the laboring woman’s vagina in an attempt to figure out what was ‘wrong’. While this was a well-meaning and helpful attempt by a trained birth attendant that would be characterized as “due diligence”, it nonetheless exposed the laboring mother to deadly bacteria and other “germs” (i.e. pathogens).

Before we human discovered the potentially-pathological nature of microscope organisms and developed the principles of antisepsis and the use of sterile surgical technique and used disinfectants,  germicides, sterilizing of instruments, putting anything into a laboring woman’s vagina no matter how well-meaning – examining fingers, crochet hook to rupture membranes, douching solutions or forceps to pull the baby out  – was easily the difference between a long happy life with one’s new baby and the rest of one’s family and dying horribly of puerperal sepsis.

The single most frequent reason that women died in childbirth during all of human history — before the discovery of the germ theory was infection – the blood poisoning or “septicemia” . Sometimes this was because the water broke days before labor started and the mother developed a raging infection that killed both mother and baby.

But far more often the deadly infection was introduced from the outside as a result of a relatively simple problem or possible complication prompted the birth attendant — midwife, family doctor, professor of obstetrics, medical student — do vaginal exams, or insert something in the vagina — Holy Water, other solutions, objects such as a hook to “break the water” or forceps to drag the baby out. This either introduced bacteria from the external world, or bacteria on the skin the vagina and lower third of the mother’s birth canal would be seeded with potentially lethal bacteria

Childbirth is unconscionably, unacceptably dangerous in the pre-scientific world (prior 1881), in contemporary third-world countries and anywhere in the world (including rich countries like the US) where social, economic or political circumstances prevents people from accessing healthcare or they reject medical care, including life-saving drugs like antibiotics, for ideological reasons. My observation is the Mother Nature really is a b-i-t-c-h and that the “background” rate of maternal mortality rate is enough to break your faith in God as an all-wise, all loving Creator.

REDO maternal mortality rates this for state of Indiana stats on childbearing women who were members of the “Church of the First Born“

Childbirth in pre-antibiotic United States had on maternal death out of very 80 births –  1.2 %, the majority of which were from fatal infection of puerperal sepsis or in more contemporary terms, septicemia often called “blood poisoning”. The second most frequent cause of maternal death was postpartum hemorrhage, a complication that also can be successfully treated with a hormonal drug first marketed in 1953 called Pitocin that cause the uterus to contract to stop excessive bleeding.

Dr. JWW knew that without an effective system of general hospitals, all Americans who didn’t live in one of a couple dozen metropolitan areas would not have timely access to well-equipped general hospitals able to provide comprehensive medical and surgical services.

Dr Williams’ Plan for lying-in hospitals for paying customers amounted to a “grand slam” that provided the lynchpin for his brilliant self-funding scheme by parlaying the profits generated by medically unnecessary (and often harmful) services into a reliable method for financing a nationwide system of general hospitals without relying on a single penny of federal money or government interference – surely this free enterprise at its very best!

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Incisentical research excerpt of the very first hospitals (369 CE) in  western Europe during the Dark Ages::

St Basil of Caesrea in Cappadocia was a pioneer in establishing hospitalization and care of the disabled and sick. In 369 CE he founded the Basilica, comprising a hospital which apparently has as many wards as there were diseases, including a section for leaper who previously had been kept in isolation and for the first time were really cared for. The hospital also had extend quarter for medical staff, workshops, hospice for travelers and the poor as well as an industrial school

Researchgate.net/publication/272336179_Yhe_evolution_of_hospitals_from_antiquity_to_the_Renaissance