Birth Story

Babies don't care what the weather is like when it's time for them to be born.

Baby Lucia Pruss was born on Thursday in an improvised birthing center at a storm refuge at Redlynch State College in Cairns, Queensland, Australia, during the 170-mile-per-hour rampage of Cyclone Yasi.

Little Lucia enjoyed what a local official called "a very natural birth in the most unnatural of circumstances."

British midwife Carol Weeks, in Cairns with her husband, Andrew, on a vacation to celebrate their 25th wedding anniversary, assisted at the three-hour labor of mother Akiko Pruss. Christian Pruss is Lucia's father.

Yasi, called a cyclone in Australia, a hurricane in the Western Hemisphere, is one of the strongest storms ever to hit Australia, officials said. Yasi tore across sparsely settled northern Australia, which was recently hit by catastrophic flooding.

Frederik, the crown prince of Denmark, and his wife, Crown Princess Mary, brought their newborn twins home from Rigshospitalet in Copenhagen today.

The boy and girl were born on Jan. 8. In the custom of Danish royalty, the babies will receive their names at their christening, which could be as long as three months from now.

“I’ve just been told that they were born on Elvis’s (Presley) birthday,” the prince said at a press conference just after the birth. “Then we’ll call one of them Elvis.”

The birth started spontaneously and lasted about five hours, said Princess Mary’s obstetrician, Dr. Morten Hedegaard. The birth team also included midwife Birgitte Hillerup, who said the princess, 38, had an epidural for pain. Frederik attended the birth.

The twins, along with older siblings Christian, 5, and Isabella, 3, are expected to visit their mother’s native Australia this year, perhaps for Christmas. The prince met the princess, nee Mary Donaldson, the Tasmanian-born daughter of a math professor, at a Sydney pub during the 2000 summer Olympics.

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The first European society for scientific inquiry was probably the Academy of the Mysteries of Nature, which met in the home of Giambattista della Porta, in Naples, Italy, beginning in 1560. Membership was open to anyone who could produce an original discovery in the field of natural science.

Della Porta was the author of Natural Magic, a 20-volume encyclopedia of popular science, written in Latin and published first in 1558.

Della Porta had the idea that much of what had come down through the ages as magic actually represented early, and often unwitting, incursions into areas that science was only then beginning to explain.

He and his society undertook to test various magical cures and activities to see if they had any merit. The academy would endorse only practices it had vetted. In other words, its members were practicing a rudimentary form of the scientific method.

The Academy of the Mysteries of Nature was short-lived. It was ordered closed by the Catholic Church after the Inquisition charged that the academy was involved in sorcery.

Not only did della Porta comply with the order, but he also became a Jesuit brother before his death in 1615.

The Black Plague, which wiped out perhaps a third of the population of Europe, demanded an explanation, and the medical establishment of the time responded as well as it could.

The most popular conjectures about the pestilence were variations on the miasmic theory of disease, an idea that went back at least to the ancient Greeks — that disease was essentially bad air. ("Miasma" was the Greek word for pollution.)

Hundreds of treatises about the epidemic survive, many of them written in the mid-14th century, when the plague was at its height. One written by members of the faculty at the medical school at the University of Paris, in response to a request from their king, Philip VI, mixed humoral and miasmic theories: The planets had aligned in such a way as to poison the air.

Another theory held that a series of earthquakes in Europe had released corrupt air from the middle of the earth. A third had the plague wafting in on noxious winds from the equator.

The cause of the plague was actually Yersinia pestis, a murderous bacterium spread by the bite of rodent fleas in the primary, "bubonic" phase, characterized by swollen lymph nodes and other symptoms. The plague can also be spread by infected droplets exhaled by its victims in a less common but deadlier "pneumonic" phase.

The plague was a catastrophe for Europe, but it did usher in reforms. It pushed the medical community toward a more professional approach to its practice, an increased emphasis on public health and the establishment of hospitals that would treat the sick, rather than merely warehouse them away from the healthy population, according to The Black Death: Natural and Human Disaster in Medieval Europe, by Robert S. Gottfried.

Frustration with the utter failure of the medical establishment to discern the pandemic's cause, stop its spread or treat it effectively helped create an environment from which the scientific method emerged.

The Black Death came to Europe in the 14th century, probably mostly aboard merchant ships from the Crimean peninsula in the Black Sea, though soldiers returning from late, intermittent Crusade-type forays likely contributed to the pandemic as well.

One early episode in this notorious outbreak of plague demonstrates that its victims had the misfortune to learn firsthand that the disease could be transmitted from person to person.

In 1346, a Tartar army laid seige to Caffa, a port in Crimea, now an autonomous republic just south of Ukraine. Caffa, now called Feodosija, was then held by Genoa, a mighty Italian city-state and commercial power. The seige lasted three years, and the residents and refugees in Caffa were in a bad way by the end. But then the Tartars began to die in great numbers from a horrific disease, and the tide appeared to be turning.

The remaining Tartars got the idea of catapulting the rotting corpses of their plague victims into the walled city of Caffa. Apparently, the Tartars' hope was that the "intolerable stench would kill everyone inside," according to an account by the Italian notary and writer Gabriele de’ Mussi. At the time, "miasmas," or noxious airs from rotting organic matter, were thought to be one source of disease.

Soon, even though the cadavers were dumped into the sea, people began to die in the besieged city. And then, the survivors began to flee.

De' Mussi writes:

Among those who escaped from Caffa by boat were a few sailors who had been infected with the poisonous disease. Some boats were bound for Genoa, others went to Venice and to other Christian areas. When the sailors reached these places and mixed with the people there, it was as if they had brought evil spirits with them: every city, every settlement, every place was poisoned by the contagious pestilence, and their inhabitants, both men and women, died suddenly. And when one person had contracted the illness, he poisoned his whole family even as he fell and died, so that those preparing to bury his body were seized by death in the same way.

De' Mussi was not an eye-witness to the events in Caffa. However, his account preserved not only the details of what has been remarked upon as an early instance of biological warfare, but also what the survivors learned about how diseases can be transmitted.

The germ theory of disease, which holds that certain diseases are caused by living organisms, occurred to people thousands of years ago, but  it was proved only in the 19th century.

In the western tradition, the Roman scholar Marcus Terentius Varro first laid out the germ theory in his book, On Agriculture, a practical guide published in about 36 B.C. In it, Varro advises the farmer against building near swamps because “certain minute animals, invisible to the eye, breed there and, borne by the air, reach inside the body by way of the mouth and nose and cause diseases that are difficult to get rid of.”

Varro was a prodigious scholar and well known public figure, and his works were highly influential. However, at least some of his contemporaries, apparently including the writer/philosopher/statesman Marcus Tullius Cicero, considered his germ theory a crackpot idea.

It is worth noting that the Atharva Veda, the first Indian book that addresses medical topics, includes a fairly detailed germ theory. The book identifies a number of living organisms that were deemed responsible for causing various diseases, and prescribes cures to kill the organisms. The Atharva Veda was written down about 200 B.C., but its ideas may date as far back as 1,000 B.C.

From the issue of The Lancet published today:

There is little hope of obtaining precise estimates of maternal mortality rates, as we do for under-5 mortality, for instance. The sources of data are heterogeneous, data quality varies substantially, and the issue of death after induced abortion remains important in countries where it is illegal. It seems a better strategy to separate estimates of obstetric deaths for countries with vital registration, and pregnancy-related deaths for countries that rely on surveys, to increase internal consistency and produce more reliable trends.

Maternal deaths and pregnancy-related deaths are not necessarily the same thing, the article states. A maternal death is one that "could have been prevented by proper antenatal and obstetric care," while a pregnancy-related death "can include infectious, non-communicable, and external causes."

The article's authors, Michel Garenne and Robert McCaa, also say that "one could note a decline in maternal deaths despite an increase in pregnancy-related deaths when confounding with other causes is very strong, as is the case in countries with increasing death rates from HIV, tuberculosis, accidents, and violence."

I would say two things about this article's thesis. First, in a country ravaged by HIV/AIDS and war, some women who are stricken with illness or murdered will be pregnant, but how those deaths are pregnancy-related is a mystery to me. A pregnancy-related death to me would be a woman murdered by her husband for being pregnant, or a woman whose pregnancy contributed to her death from swine flu, for example.

Second, just as a note, it's pretty grandiose to say that "proper antenatal and obstetric care" can head off every true pregnancy-related disaster, like amniotic fluid embolism, for example. Sometimes, in spite of the best efforts, women die.

Oh, well, the authors' point is a good one: Precise estimates of maternal mortality are hard to come by.

The African nation of Malawi will take a new tack in its campaign to improve its maternal-mortality statistics.

Almost immediately after his return from the United Nations meeting in New York on the Millennium Development Goals, President Bingu wa Mutharika lifted a ban on traditional birth attendants.

The fifth MDG is to cut the number of women who die in childbirth worldwide by 75 percent by the year 2015. Malawi, along with a number of other countries, has experienced disappointing progress on Goal 5.

Malawi shares Africa's dismal statistics on maternal mortality; a mother's lifetime chance of dying in childbirth there is 1 in 36, according to the latest figures from the World Health Organization. (HIV/AIDS is a major factor in Malawi.) Not only that, but decreases in the rate of deaths, presently 510 per 100,000 births, have only been running about 3 percent per year since 1990.

Banning TBAs was part of an earlier effort to get more women to deliver their babies with assistants trained in modern medical techniques, who would be able to recognize and respond to emergencies. Only 54 percent of Malawi women delivered their babies in a health-care facility in 2005.

However, one result of the ban has been that more women have delivered their babies without any kind of real birth attendant, traditional or modern, or with TBAs working under the threat of fines.

Dorothy Ngoma, executive director of the National Organization of Nurses and Midwives in Malawi, told The Nation, a daily newspaper in Malawi, "They [TBAs] never really stopped.... What happened is that they went underground."

It appears that President Mutharika decided after the UN summit that training TBAs to be part of the solution made more sense. The president married Callista Chimombo last spring, and the new first lady appears to be taking an active role in addressing the country's poverty.

The Nation reported that her Safe Motherhood Foundation will train 20 TBAs from the countryside next year in modern birth methods. They will then return to serve their communities as midwives.

Healthcare facilities tend to be concentrated in Malawi's cities, while 70 percent of the nation's 15 million people live in rural areas. There are reportedly two doctors for every 100,000 Malawians.

"We should not abandon TBAs, as they are very important to our program of safe motherhood," President Mutharika was quoted as saying in The Nation.

"There is not a corner in Britain where this formidable disease has not made many mourners,”  John Mackintosh, an Edinburgh, Scotland "man-midwife" wrote of puerperal or "childbed" fever in the 1820s.

This bacterial disease of the upper genital tract typically began within the first three days after childbirth with abdominal pain, fever and respiratory difficulty, and very often ended with the new mother's death.

Medical writers had been remarking on childbed fever at least since Hippocrates, but in the early modern era, it began to attract attention for a number of reasons. For one, it began to appear in epidemics, with very high mortality rates. For another, accounts of outbreaks were written about and published. And at least some of the new, scientific man-midwives themselves were spreading the disease by going straight from autopsies to the birth chambers of homes and especially of hospitals, without cleaning up at all in between.

There were terrible epidemics of puerperal fever in the German city of Leipzig  in 1652 and 1665, at the Hôtel Dieu in Paris, France, in 1745 and 1746, and at the British Lying-In Hospital in London, England, in 1760. It is possible that these were the first ever epidemics of childbed fever.

The Girl Effect, the Nike Foundation's initiative to highlight the critical role women play in the well being of their societies, has a new video, "The Clock Is Ticking," that argues that education can make a huge difference for young women in developing counries.