Pregnancy and women's lives in the twenty-first century: the United States Safe Motherhood movement.

In 1900, a pregnant woman in the United States faced serious threats to her life. Training in obstetrical care was not standardized for midwives or physicians, essentially no medical interventions were available, and ways to prevent a risky pregnancy were limited. Little wonder that maternal mortality was the second most common cause of death for women of reproductive age at the beginning of the twentieth century. On the other hand, these women usually had extended family nearby and experienced mothers, aunts, or other adult women to support them through pregnancy and infant care. By 1950, the situation had markedly changed. Obstetrical care was standardized and provided such “miracle interventions” as antibiotics, safe blood transfusion, and aseptic delivery. Most deliveries occurred in hospitals; maternal deaths became a rare event. Most middle-class women bore their children early and stayed home to raise them. The downside was that the extended family became the nuclear family, with less opportunity for community support, and obstetrical care became so medicalized that it was routine practice to anaesthetize women into unconsciousness during labor and delivery. Now, at the beginning of the twenty-first century, new revolutions have occurred. Late childbearing has become commonplace. Between 1975 and 1997, the rate of first births to U.S. women aged 35–39 years more than doubled from 19.8 to 44.5 per 1000 child-