Dying from Pregnancy

Telling it straight, then and now

Watching the Vice Presidential debate a few weeks back, I was reminded that the firestorm around abortion has become a war over words. What counts as a “fetus”? What about a “baby” or “child”? What is the definition of “personhood”? Is abortion “birth control” or “healthcare?” It is a war where words are also made into weapons disguised as charm, where a politician like JD Vance can feign sympathy and imply that women make certain “choices” because they don’t have the proper resources to choose differently.

The US, says Vance, has let women down. Listening to Vance, watching him pile on the smarm, I was reminded of a certain parenting trick. If you’ve ever been a parent of a recalcitrant toddler, maybe you’ve done this: you give your kid two “choices,” each of which would be acceptable to you. The kid makes a choice, feels autonomous and independent, you happily proffer a cookie, then calmly go about your parenting day, smug in the knowledge that, either way, the toddler did what you wanted. Everyone wins.

So here goes Senator Vance: Give women an array of “resources,” and surely they’ll make the “right” choice. And the cookie? Motherhood!

In the Vice Presidential debate, Vance gave us pure doublespeak. Dangerous, but also strangely obvious, even if you haven’t read Orwell since high school half a million years ago. Sorry, Senator Vance, women aren’t toddlers. We see what you are doing.¹

But this moment in the Vice Presidential debate got me thinking about words, about what is said and what is not said. Vance and Walz, for instance, traded words about women who are dying because they can’t get the care they need during miscarriage or incomplete abortions. But I also noticed what they didn’t talk about: that maternal mortality often stems not from miscarriage but from complications of the pregnancy itself. The statistics on this are especially horrific for Black women, who are three times more likely to die from complications in pregnancy than white women. Three times.

Pregnancy kills.

A woman who becomes pregnant, and who has good access to health care, will likely visit her doctor more frequently during her pregnancy than a person afflicted with a chronic illness will visit their own. In pregnancy, a person’s body reacts and shifts and fights as it does in illness; the body needs to be tended and monitored. And there are many ways to suffer in pregnancy, many ways a pregnancy can kill. This is why the abortion question isn’t really about birth control - it’s about women’s healthcare. That is, as long as you see a pregnant woman as a person whose body deserves healthcare.² And that’s the question, isn’t it?

What is said, what is not said — and also what is said, but perhaps just a little bit incorrectly. I’m thinking about how often this happens. I’m also wondering whether getting it just a little bit wrong shapes our thinking about women and pregnancy, both past and present.

Take, for instance, the phrase “died in childbirth.”

If you read history, you encounter that phrase a lot. I have reached for it myself a number of times. Childbearing was far more treacherous in the past than in the present, even with the current laws on the books, and so enormous numbers of women died in the process. And because so many women died, we see that phrase over and over again — “died in childbirth.” But something happens in the constant repetition. We become immune to its meaning. “Childbirth” becomes a category we can slot women’s death into. It becomes vague, predictable, and weirdly sanitizing. It seems to explain something but, at the same time, says very little.

And often it’s not even the right phrase to use.

What does it mean, exactly, to die “in childbirth”? Here are just a few examples. All these women died “in childbirth,” and all just a smidgen differently from each other:

• In England, the sixteenth-century Jane Seymour, Henry VIII’s third wife, didn’t die during the birth itself. Instead, she died a few weeks after the birth of her son. She didn’t die of puerperal fever, as many historians assume. Instead, Jane seems to have died of a “flux” — some sort of hemorrhage.

• Katherine Parr, the last of Henry VIII’s wives, died several days after giving birth to her daughter, likely from some kind of puerperal fever — a bacterial infection of the uterus that left her drifting in and out of consciousness before she succumbed in the midst of a high fever. We don’t know what caused her illness.

• In 16th-century Florence, Madeleine de la Tour d’Auvergne, the mother of Catherine de’ Medici, also died of something that historians describe as puerperal fever. But in her case, we know the infection began because her body did not shed the placenta entirely. She likely died of sepsis, the same way that recent reporting has revealed that women like Amber Thurman, in Georgia, died for lack of a D&C.

• More than two centuries later, the English Mary Wollstonecraft, the eighteenth-century feminist philosopher and mother of the author Mary Shelley, died of an infection after giving birth. In her case, the infection may have come from a doctor who failed to wash his hands before reaching into her to help remove the afterbirth.

There are so many ways for pregnancy, childbirth, and postpartum to go wrong. Even puerperal fever can have many causes. The devil is in the detail — but it is the detail that kills the woman.

A famous portrait of Mary Wollstonecraft by John Opie, made a few months before she died. Mary is pregnant with the future Mary Shelley in this picture.

Historians can’t always dig into these details. We have word counts to stick to, short reader attention spans to keep in mind. And sometimes we just don’t know what caused a woman’s death other than that it had something to do with bearing children. This is especially true of women who weren’t royal and noble, for which there exist few, if any, detailed records.

Sometimes historians are writing about other events. The medical why of a woman’s death might seem incidental and beside the point: what matters to the sweep of history is that this woman died. (Perhaps. Although sometimes I wonder if the detailed why of women’s deaths matters more to the sweep of history than we realize).

But when we do know how a woman died, maybe we should take the time and spend the words to say it right, especially since so many women in history — especially in the far-distant past that I write about — were valued mostly for their ability to conceive and give birth.³ Getting their deaths right is a way of acknowledging the individuality and personhood of these women — and, by extension, acknowledging the personhood of pregnant and childbearing women today. After all, historical women are not just characters in books. They were real people. They suffered and died the same way that pregnant women today will suffer and die — are suffering and dying — without medical intervention.

Our lives in the 21st century feel so different from the lives of women in the past. But our bodies haven’t changed. The dangers that our bodies face in pregnancy and childbearing connect us. Modern medicine has allowed us to forget that. But maybe not for long.

I am thinking of the young queen I wrote about in my last book. In a way, I did both right and wrong by Elisabeth de Valois, just twenty-two years old when she died in 1568. I wanted to write a history that was experiential, for lack of a better word. So I wrote through the scene of her death slowly, and tried to describe her symptoms as best I could based on the sources I had. I wanted the reader to be in that room with her, to feel her suffering just a little bit.

But I never pulled back entirely from the narrative, back to a bird’s eye view, to name what was happening to Elisabeth in terms that we understand today. I wish I had, somewhere in the book. A few more words in the introduction, in a footnote, or in the scene itself would have done the trick. If I had pulled back just a bit further, maybe it would have been all the clearer to us, in the 21st century, what exactly had happened to her in the 16th. So I’ll add those words now.

Elisabeth de Valois didn’t “die in childbirth,” as some histories have put it.⁴ She died of pregnancy.

In her late teens, Elisabeth suffered at least one terrible miscarriage, and probably others. She had been ill off and on since her early teens with vague but debilitating symptoms. Whatever this illness was may have affected her ability to conceive and carry a pregnancy to term.

Elisabeth’s first full-term pregnancy, which began when she was nineteen, went smoothly, as did the birth. But one year later, her second full-term pregnancy gave her trouble in the final months. After this child, a daughter, was born, Elisabeth quickly got pregnant again, hoping for son.

But the symptoms that had started in her previous pregnancy never went away. Instead, they got worse. Headaches, swellings in her limbs, excruciating pain down her side and back, graininess in her urine that indicated her kidneys were failing. Her doctors desperately tried to save her. They failed not because medicine can’t save everyone — but because those doctors didn’t have the understanding of anatomy, or the medicine, or the technology to save her.

Five months into her pregnancy, as she lay dying, Elisabeth miscarried. The fetus did not survive. Elisabeth herself died only a few hours later.

She didn’t die in labor, she didn’t bleed out. She didn’t die of sepsis or puerperal fever after giving birth. Elisabeth died because the pregnancy itself was more than her body could bear.

Today, Elisabeth — the wife of a king — would have had the best medical care. Given her history, I suspect a doctor would have warned her of the dangers of getting pregnant again. Or, if she had proceeded with this pregnancy, a doctor would have monitored every symptom and intervened with the life-saving technology that modern medicine affords.

That technology includes abortion. Perhaps, today — or at least before Dobbs — a doctor would have advised Elisabeth that, for the sake of her own life, maybe it was time to end this pregnancy. She could choose this, if she wanted, because this is the 21st century and not the 16th. She had every right to want to live.

There were devastating personal and political consequences to Elisabeth’s death, but I won’t go into that here. I don’t feel the need to show that women’s lives and deaths matter. Of course they do.

I will say only this, for the record: Elisabeth de Valois died of pregnancy. Somehow, saying it this way — plainly, starkly — gets it right. It lays bare a certain truth about Elisabeth’s life, about her body, about what it meant to be a woman then, what it means to be a woman now. It stares the dangers of being a woman straight in the face.

And in this war of words, saying it plainly is the least I can do.

1. This section of this post has gone on a bit longer than I originally intended, for which I apologize. I couldn’t help myself.

2. This Substack, and this particular post, is largely dedicated to women. But I want to say here that everything I have to say about pregnancy and abortion affects all people, of all genders, who are capable of becoming pregnant.

3. This is especially the case with royal and noblewomen in the early modern period in Europe. The circumstances were a little different for middle class and peasant women. Women’s experiences then followed certain patterns, as they do today, but the particularities were diverse — as they are today.

4. Admittedly, this phrase often appears when Elisabeth is a secondary or tertiary character in a history book or article. It’s a convenient way to get the point across quickly. But it’s not quite right.