Miscarriage and maternal death
Miscarriage and maternal death in childbirth
In
ancient China, miscarriage and maternal death in childbirth were common
due to poor hygiene, infections, malnutrition (especially during
famines like the Great Leap Forward), and lack of medical care, with
studies suggesting high rates of pregnancy loss (around 14% for
miscarriages/stillbirths) and significant maternal mortality risks.
However, precise historical frequencies vary by period and status, with
evidence pointing to childbirth as a major cause of female death in
reproductive years.
Factors Influencing Frequency
- Disease & Infection: Lack of sanitation led to high rates of infections during and after birth, increasing both maternal and infant deaths.
- Nutrition: Famine exposure, particularly in early life, was linked to higher stillbirth rates in adulthood, highlighting poor maternal nutrition's impact.
- Traditional Beliefs: Traditional Chinese Medicine (TCM) recognized these dangers, developing pregnancy restrictions to protect against "malign influences," stillbirth, and maternal death.
- Socioeconomic Status: Elite women had higher birth rates but also faced significant risks, while poverty in general increased these dangers.
- Parity (Birth Order): Later pregnancies, particularly the second, showed increased risks for stillbirth and neonatal death.
Evidence & Statistics
- Pregnancy Loss: A modern study in China found 13.88% of women experienced pregnancy loss (spontaneous abortion or stillbirth), with 9.06% having miscarriages and 5.69% stillbirths, suggesting high historical baseline risks.
- Maternal Mortality: Childbirth was a major cause of death for women of childbearing age, comparable to annual non-maternal causes in pre-industrial times, with estimates suggesting around 1 in 10 deaths for married women aged 15-49.
- Archaeological Evidence: Finds, like a Neolithic burial with a mother and infant, confirm deaths during or shortly after delivery, suggesting severe obstetric challenges even then.
Miscarriage vs. Stillbirth
- Miscarriage (Spontaneous Abortion): Often linked to maternal health, infections, or congenital issues, with famine exposure being a risk factor.
- Stillbirth: Also caused by infection, complications, and anomalies, with risks increasing with parity (e.g., the risk of stillbirth in the second pregnancy was almost four times higher than in the first)