The maternal mortality rate in early 20th century Sweden was one third of that in the United States due to Sweden's system of highly competent midwives conducting home births. The 19th century decline in maternal mortality in Sweden was helped by the national health strategy of midwives and doctors having complementary roles and involvement in public health policy. The 20th century decline seen across Western countries was enabled by modern medicine but was also aided by mobilizing human resources and developments in public health policy.
The maternal mortality rate in early 20th century Sweden was one third of that in the United States due to Sweden's system of highly competent midwives conducting home births. The 19th century decline in maternal mortality in Sweden was helped by the national health strategy of midwives and doctors having complementary roles and involvement in public health policy. The 20th century decline seen across Western countries was enabled by modern medicine but was also aided by mobilizing human resources and developments in public health policy.
The maternal mortality rate in early 20th century Sweden was one third of that in the United States due to Sweden's system of highly competent midwives conducting home births. The 19th century decline in maternal mortality in Sweden was helped by the national health strategy of midwives and doctors having complementary roles and involvement in public health policy. The 20th century decline seen across Western countries was enabled by modern medicine but was also aided by mobilizing human resources and developments in public health policy.
The maternal mortality rate in early 20th century Sweden was one third of that in the United States due to Sweden's system of highly competent midwives conducting home births. The 19th century decline in maternal mortality in Sweden was helped by the national health strategy of midwives and doctors having complementary roles and involvement in public health policy. The 20th century decline seen across Western countries was enabled by modern medicine but was also aided by mobilizing human resources and developments in public health policy.
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The Decline in Maternal Mortality in Sweden
The Role of Community Midwifery
Ulf Hgberg
Peer Reviewed
The author is with Obstetrics & Gynecology, Department of Clinical Science,
and Epidemiology, Department of Public Health and Clinical Medicine, University of Ume, Ume, Sweden.
American Journal of Public Health
Vol. 94: Issue. 8: Pages. 1312-1320
(Issue publication date: August 2004)
DOI: 10.2105/AJPH.94.8.1312
The maternal mortality rate in Sweden in the early 20th century was one third that in the United States. This rate was recognized by American visitors as an achievement of Swedish maternity care, in which highly competent midwives attend home deliveries. The 19th century decline in maternal mortality was largely caused by improvements in obstetric care, but was also helped along by the national health strategy of giving midwives and doctors complementary roles in maternity care, as well as equal involvement in setting public health policy.
The 20th century decline in maternal mortality, seen in all Western countries, was made possible by the emergence of modern medicine. However, the contribution of the mobilization of human resources should not be underestimated, nor should key developments in public health policy. THE DECLINE OF MATERNAL mortality in Western countries after the 1930s is believed to be associated mainly with the emergence of modern obstetric care, while it has been proposed that public health policy, poverty, and the malnutrition associated with poverty were of relatively minor importance.1 But the maternal mortality pattern before the emergence of modern medical technology was not uniform in all Western countries. In The Netherlands, Norway, and Sweden, low maternal mortality rates were reported by the early 20th century and were believed to be a result of an extensive collaboration between physicians and highly competent, locally available midwives.2 From 1900 through 1904, Sweden had an annual maternal mortality of 230 per 100000 live births, while the rate for England and Wales was 440 per 100000. For the year 1900, the United States reported 520 to 850 maternal deaths per 100000 live births.3 This very high maternal mortality rate, especially if compared with the lower rates achieved in several less prosperous European countries, caused some American obstetricians to express concern.
Fig thumbnail _i1
The equipment of a home-delivering midwife in early-20th-century Sweden.
Source: Jamtli Museum, Sweden
Joseph B. DeLee, commemorated as a titan of 20th-century obstetrics,
studied maternity services in Europe before he established the Chicago Lying-In Hospital and Dispensary in 1895. His aim was to provide delivery assistance to poor women by also offering them the option of having a safe and inexpensive home delivery.4
George W. Kosmak5 visited Scandinavia in 1926 and was reported to have
been very impressed with the medical systems in place there. In an address to the American Medical Association, Kosmak talked about the good results obtained in a carefully supervised system of midwife instruction and practice. He stated, To begin with, the midwife in Scandinavia is not regarded as pariah. . . . One sees, therefore, in the training schools for midwives, bright, healthy looking, intelligent young women of the type from whom our best class of trained nurses would be recruited in this country, who are proud of being associated with an important community work, and whose profession is recognized by medical men as an important factor in the art of obstetrics, with which they have no quarrel.
He concluded, The results of this midwife training are evidently excellent
because the mortality rates of these countries are remarkably low and likewise, the morbidity following childbirth.5
What, then, was the history of this system that turned out to be a good example for the United States before the emergence of modern medicine in the 1930s? The aim of this review is to depict the Swedish intervention against maternal mortality in the 18th and 19th centuries and the decline in maternal mortality in the Western countries in the 20th century.
Penurunan Kematian Ibu di Swedia
Peran Kebidanan Komunitas
Penulis adalah dengan Obstetrics & Gynecology, Departemen Ilmu Klinis, dan Epidemiologi, Departemen Kesehatan Masyarakat dan Clinical Medicine, University of Ume, Ume, Swedia.
American Journal of Public Health
Vol. 94: Isu. 8: Pages. 1312-1320
(Tanggal publikasi Issue: Agustus 2004)
DOI: 10,2105 / AJPH.94.8.1312
Tingkat kematian ibu di Swedia pada awal abad 20 adalah salah satu ketiga yang di Amerika Serikat. Tingkat ini diakui oleh pengunjung Amerika sebagai sebuah prestasi perawatan bersalin Swedia, di mana bidan sangat kompeten menghadiri pengiriman rumah. Penurunan abad ke-19 di kematian ibu sebagian besar disebabkan oleh perbaikan dalam perawatan obstetrik, tetapi juga dibantu oleh strategi kesehatan nasional memberi bidan dan dokter peran pelengkap dalam perawatan bersalin, serta keterlibatan yang sama dalam menetapkan kebijakan kesehatan masyarakat.
Penurunan abad ke-20 di kematian ibu, terlihat di semua negara-negara
Barat, ini dimungkinkan oleh munculnya kedokteran modern. Namun, kontribusi mobilisasi sumber daya manusia tidak bisa diremehkan, atau harus memasukkan perkembangan kebijakan kesehatan masyarakat.
Penurunan angka kematian IBU di negara-negara Barat setelah tahun 1930-
an diyakini terkait terutama dengan munculnya perawatan obstetrik modern, sementara itu telah diusulkan bahwa kebijakan kesehatan masyarakat, kemiskinan, dan gizi buruk terkait dengan kemiskinan yang dari importance.1 relatif kecil tapi pola kematian ibu sebelum munculnya teknologi medis modern tidak seragam di semua negara-negara Barat. Di Belanda, Norwegia, dan Swedia, angka kematian ibu yang rendah dilaporkan oleh awal abad 20 dan diyakini hasil dari kolaborasi yang luas antara dokter dan sangat kompeten, yang tersedia secara lokal midwives.2 Dari tahun 1900 melalui 1904, Swedia memiliki kematian ibu tahunan 230 per 100 000 kelahiran hidup, sementara tingkat untuk Inggris dan Wales adalah 440 per 100 000. untuk tahun 1900, Amerika Serikat dilaporkan 520-850 kematian ibu per 100 000 hidup births.3 kematian ibu yang sangat tinggi ini tingkat, terutama jika dibandingkan dengan tarif yang lebih rendah dicapai di beberapa negara Eropa kurang makmur, menyebabkan beberapa dokter kandungan Amerika untuk mengekspresikan keprihatinan.
thumbnail _i1 ara
Peralatan dari bidan rumah-melahirkan di awal abad ke-20-Swedia. Sumber: Museum Jamtli, Swedia
Joseph B. DeLee, diperingati sebagai titan kebidanan abad ke-20, dipelajari
layanan bersalin di Eropa sebelum ia mendirikan Chicago Berbaring-In Hospital dan Dispensary pada tahun 1895. Tujuannya adalah untuk memberikan bantuan pengiriman ke perempuan miskin dengan juga menawarkan mereka pilihan memiliki yang aman dan murah rumah delivery.4
George W. Kosmak5 mengunjungi Skandinavia pada tahun 1926 dan
dilaporkan telah sangat terkesan dengan sistem medis di tempat sana. Dalam pidato American Medical Association, Kosmak berbicara tentang hasil yang baik diperoleh dalam sistem hati-hati diawasi instruksi bidan dan praktek. Dia telah menyatakan,
Untuk mulai dengan, bidan di Skandinavia tidak dianggap sebagai paria. . . .
Satu melihat, oleh karena itu, di sekolah-sekolah pelatihan untuk bidan, cerah, sehat tampak, wanita muda yang cerdas dari jenis dari siapa kelas terbaik dari perawat yang terlatih akan direkrut di negara ini, yang bangga dikaitkan dengan pekerjaan masyarakat yang penting, dan yang berprofesi diakui oleh orang-orang medis sebagai faktor penting dalam seni kebidanan, yang mereka tidak berselisih.
Dia menyimpulkan, "Hasil pelatihan bidan ini jelas sangat baik karena tingkat kematian dari negara-negara ini sangat rendah dan juga, morbiditas setelah melahirkan." 5
Apa, kemudian, adalah sejarah sistem ini yang ternyata menjadi contoh yang baik bagi Amerika Serikat sebelum munculnya kedokteran modern di tahun 1930-an? Tujuan dari kajian ini adalah untuk menggambarkan intervensi Swedia melawan kematian ibu di abad ke-18 dan 19 dan penurunan angka kematian ibu di negara-negara Barat di abad ke-20.
