Postpregnancy Genital Tract and Wound Infections

Nell Tharpe, CNM, CRNFA, MS


J Midwifery Womens Health. 2008;53(3):236-246. 

In This Article

History of Obstetric Infection

In the 18th to mid-19th centuries, recorded death rates from postpartum endometritis or "childbed fever" ranged from 2% to 100%, with the lowest infection rate associated with unattended domiciliary birth, and the highest rates found during epidemics at "lying-in hospitals".[7] The primary cause of postpartum endometritis was described in 1843 by Oliver Wendell Holmes as cross-contamination from the birth attendant's hands or clothing: "The disease known as Puerperal Fever is so far contagious as to be frequently carried from patient to patient by physicians and nurses."[1] In his paper, Holmes collected multiple reports of serial maternal deaths and critically reviewed various essays of the time addressing the subject. Holmes' work represents a significant analysis of the wide-ranging case data presented in the European and American journals of the time.

Nearly 20 years later, Ignaz Semmelweis independently noted that women attended during birth by midwives had a much lower rate of puerperal fever than women whose births were attended by physicians. Semmelweis concluded that infection was carried by physicians from the autopsy suite to the birth room. He instituted strict hygienic measures, including hand antisepsis using a chlorinated lime solution, and noted a dramatic decrease in maternal mortality related to postpartum endometritis.[8] Over the next 50 years, the incidence of maternal morbidity and mortality related to puerperal fever continued to fall, following widespread institution of specific recommendations for hand washing and the development of aseptic techniques by Joseph Lister.[8,9] This first successful change in medical practice was followed decades later by the introduction of effective systemic antimicrobial drugs.[2]