Wednesday, July 3, 2013

Childbirth in the good old days

Medievalist web has an article on maternal death in Anglo Saxon days.

full article HERE.

Oakington is the site of an early Anglo-Saxon cemetery in Cambridgeshire (AD 450–700). Excavated in June 2011, grave 57 contained a woman with a descended foetus across her pelvic cavity, a position unlikely to result from post-mortem extrusion. She was aged between 25 and 30, had congenitally absent teeth and occupational wear on her hands and feet. She was buried supine in full dress with a cruciform brooch and two small long brooches. The foetus lay low and transverse across her pelvis, which was probably the cause of this double fatality (. Even today transverse lie pregnancy is a dangerous malpresentation for both mother and foetus, almost always resulting in Caesarean section.
 yes, transverse lie means the kid is sideways. Usually this is found in women with a weak uterus (a woman who has had many pregnancies) although it can also occur in the second twin, where after the first one delivers, the second twin flops sideways in the now roomier uterus.
the relationship of the long axis of the fetus to that of the mother; see also presentation.
longitudinal lie a situation in which the long axis of the fetus is parallel to that of the mother; in presentation, either the head or breech presents first.

The only way to get the baby to deliver is to rotate it first, or do a Caesarian section.

If the uterus is soft, you might be able to rotate it externally, by using pressure to change the baby to head down (or buttock down).  Th.e baby will then deliver normally

An alternative is to put your hand inside and rotate the baby around, then either let him deliver normally or grab his leg and pull him out as a breech birth.

Sometimes you first recognize the transverse lie with the kid's hand pops out.

I wrote about this at Xanga: a story told by one of our old Sisters in Africa. She was a teacher who did first aid, and was called to the village because there was a problem with a woman in labor, and the women there didn't know what to do.

The woman quickly relaxed when she saw sister, and went on to deliver a nice girl baby, but then a hand popped out. Sister Gervasia, a farmer's daughter, knew that this meant trouble but wasn't sure what to do. So she told the family: We sisters have to pray now, but I'll be back in a little while after our prayers.  So she rushed home, got the first aid book out, read up on the problem, and returned to the village. She managed to push the hand back and externally rotate the baby, and voila, a baby boy.

The mother was lucky: You can rupture the uterus turning a child, and sometimes the uterus is lax after the delivery and mom dies of post partum hemorrhage (usually we give ergotrate for this, although nowadays we use pitocin).

I doubt many US docs have seen the problem, unless mom has an abnormal uterus, but it is still seen in Africa, as this journal article shows.
Eighty percent of the women were delivered abdominally; and 63.33% of these were cesarean deliveries. Vaginal
delivery was achieved in 13.33% of the women, vaginal route destructive operations and delivery in conduplicatio corpore on two occasions each
 If you want the gory examples of that last part, check here (Not safe for work or kids or for those with a queezy stomach). it's from a book by Maurice King, who has written other practical books for docs working in really isolated hospitals in Africa. King's stuff tends to be very pragmatic, and if you are a survivalist, you might want to download the book.

Again, these things are very very dangerous to mom, so don't try them at home. 

another resource would be Hesperian.

home birth types in the US need to watch the BBC series "call the midwife" to see all the stuff that can go wrong in even low risk "home births"...I don't recommend it, even though 80 percent of women could give birth without problems...

Back to early England.

There is the possibility of other women who died in Childbirth:

There are other examples of women with in situ foetuses from Anglo-Saxon cemeteries. However, in archaeology the dominant interpretation for extruded and partially extruded foetuses is currently a phenomenon known as coffin birth: the post-mortem extrusion of a foetus into the grave
 A couple years back, a gruesome murder case of a pregnant woman was verified when the baby was found on the beach near to where the husband had buried his pregnant wife whose body had been weighted down...why these deliveries? It's the gas...(don't ask).

There are also stories of children being taken from mom's womb when she died, (MacDuff was from his mother's womb untimely ripped"), the idea being that maybe the kid would live, and also to baptize the kid.

One suspects such cases are rare, since usually the baby dies of exhaustion before mom dies of exhaustion, but in cases of amniotic fluid embolism or heart attack in a mom with a damaged heart, it could happen.

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