When I was in residency, one of the obstetrics-gynecology faculty asked us, "Women died in childbirth. What did they die of?"
We were silent. Stumped. Infection? Well, when there was no infection control and the male physicians went from room to room with no hand washing, yes... but....
Preeclampsia? No. Not that common. Eclampsia? Ditto.
"What if a woman is in labor and the baby is stuck? What do they die of?"
"The uterus contracts until it ruptures. It contracts until it is thinner and thinner. If there is fetal malposition or a hand presentation or transverse or certain breech positions, the uterus ruptures and both bleed to death."
We were all silent.
When I hear people bemoaning caesarean section and too much surgery and too many interventions.... I remember what women died of. All the stepmother stories. In the 1797 diary I am reading, the "lady" dies of a fever. She is 24 years old. There is no surprise, just sorrow. The author writing is the same age and grew up with her and grieves, but goes on.
We would like to think this is in the past, but it isn't. It still is going on, right now, in poverty stricken areas and war zones where the hospitals have been destroyed, the medical people have left, there are no services...
When I was still delivering babies, I would tell patients: my ideal labor plan is the baby comes out and I hand it to you. And the placenta comes out and the baby nurses and I don't seem to be doing much. But that is not always what happens. I do not have control nor do you. I will only intervene if I think it is your life or the babies life or both....