Isle of Man Homebirth Abstract

Lancet, vol 347, number 9009, Saturday 27 April 1996

A study of childbirth-related deaths on the Isle of Man between 1882 and 1961 shows that doctors may have had a role in increasing maternal mortality in the early part of this century. CG Pantin's conclusion (Med Hist 1996; 40; 141-72) follows an analysis of the registers of death and the Chief Registrars' annual reports. As the health of the community improved, maternal mortality fell, but only until 1911. By 1926, maternal mortality was at the level it had been 30 years earlier, due to the increasing activity of intervention-prone doctors. Only after the island's maternity home opened in 1927 did maternal deaths fall, reaching zero by 1961.

Pantin attempts to reconcile his findings with I. Loudon's study (Death in Childbirth; an international study of maternal care and mortality 1800-1950, Oxford: Clarendon press, 1992), in which maternal mortality plateaued in almost every western country between 1850 and 1936. Loudon noted that two factors contributed to maternal death maternal health and obstetric care. What happens, he asked, if only one of these determinants changes? The Isle of Man provided such a situation, since up to 1911 maternal health improved without a change in childbirth management.

To explain the England and Wales plateau, Pantin notes that the effects of better health would have been nullified by the increased mortality due to the increasing intervention at births by doctors (which had begun earlier than on the Isle of Man). Fewer mothers, he says, would have died in childbirth in the countries with Loudon's plateaus "if doctors had let well enough alone instead of supplanting the midwives". 

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