Death Before Birth: Fetal Health and Mortality in Historical Perspective (review)

Robert Woods’s Death Before Birth: Fetal Health and Mortality in Historical Perspective is an intriguing book. Its subject matter concerns fetal health and mortality with a focus on how fetal deaths declined over time. Woods clearly explains the difficulties the topic presents to researchers. Despite the issues faced, Woods deftly applies both demography and history to the subject. The resulting work is a text that will inspire others to take up the history of the fetus, fetal health, and fetal mortality.

Woods notes that historians have looked at multiple actors when studying the history of pregnancy and birth. He points out that researchers have focused their investigations on pregnant women, midwives, professional medical practitioners, and infants. His book, however, concentrates on one of the most important, but overlooked, actors during pregnancy and birth—the fetus. Specifically, Woods explores the history of fetal health and mortality. He concludes that the decrease in fetal mortality was aided by the availability of antibiotics in the twentieth century, disease prevention as a result of vaccination programs, and improvements in obstetrical care.

The author shows that the topic of fetal health and mortality is difficult to study. Woods explains that he faced several issues when approaching the subject matter: the language used to describe fetal health and mortality is varied, there are numerous definitions of various fetal incidents, the recording of age depends on the culture in which it takes place, the registration of fetal deaths differs depending on the purpose of the record and on who is doing the recording, and the causes of fetal death are often difficult to determine. Woods, for example, presents the varied definitions related to fetal mortality via an excellent table; table 2.1 (pp. 15–16) succinctly lays out the multiple words that can be employed to describe fetal health and mortality.

Through the use of history and demography, Woods traces developments in fetal health and mortality. His historical analysis depends on several types of primary sources: parish registers, the case notes of midwives and man-midwives, and the clinical reports of obstetricians. Woods not only analyzes these sources but also includes extended passages from several primary sources for the reader. His inclusion of a selection of observations from Sarah Stone’s A Complete Practice of Midwifery allows the reader into the historical process and shows that, despite being a “neglected area” (p. 1) of study, the history of fetal health and mortality is possible. In addition to history, Woods, a professor of geography, employs demography. He complements his written demographic analysis with graphs and charts. Woods summarizes his methodological approach when he states, “This study is avowedly anti-disciplinary; it does not offer a history in the normal sense, rather it wants to know how and why change occurred in the long term and it will be prepared to use whatever is available and relevant to reach that goal” (p. 9).

Death Before Birth will appeal to a variety of readers. Historians will find a work that focuses on a topic that has been neglected by scholars who specialize in the history of birth and pregnancy. The volume demonstrates that the sources are there to complete further work on the medical history of the fetus and alerts researchers to some of the difficulties they might face. Students of geography also will appreciate Woods’s demographic analysis. Woods has opened a new scholarly avenue and has provided future researchers with the map to investigate further the field of fetal health and mortality.