The decline in maternal mortality in Sweden: the role of community midwifery

Abstract

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.

Figure 4

The equipment of a home-delivering midwife in early-20th-century Sweden. Source: Jamtli Museum, Sweden

FIGURE 1—

Percentage of parturients in Sweden delivered by traditional birth attendants, licensed midwives, and in lying-in hospitals during the years 1861 through 1895.

FIGURE 2—

Midwifery service in rural areas in Sweden and maternal mortality (septic deaths excluded) for the years 1861 through 1894.

FIGURE 3—

Observed number of maternal deaths per 100 000 live births and prevented number of maternal deaths by medical technology, midwifery service, and antiseptic technique in Sweden during the years 1861 through 1900 (5-year mean).