Dr. Ransom S. Hooker

With the assistance of the New York Obstetrical Society and the support of the Commonwealth Fund, the Academy began its major maternal mortality study in 1930. Under the auspices of the Academy’s Public Health Relations Committee, Dr. Ransom S. Hooker (1874–1957) was appointed director of the study and set up a Subcommittee on Maternal Mortality and an Obstetrical Advisory Committee. From 1930 to 1932, the city’s Health Department provided, and the Advisory Committee analyzed, 2,014 case reports on women’s deaths from childbirth as well as deaths of pregnant women. For each case, the physician was interviewed, and if the death took place in a hospital, that institution was inspected.

The analysis found huge gaps in perinatal care and obstetrical practice, partly among midwives but chiefly among physicians. The report’s chief recommendation was for increased education and training, both popular and professional. Prospective mothers should know and be able to ask for what they needed in perinatal care. Both generalist physicians and the newly forming specialist obstetricians should receive better obstetrical training in medical schools and through hospital internships. The report called for a reduction in surgical interventions “undertaken merely to alleviate pain or shorten labor.” It recommended that hospitals provide separate obstetrical clinics, wards, and delivery rooms, overseen by trained obstetricians, with rigid rules to maintain asepsis, including masking. Based on the data—which showed better results for midwife-assisted births—the report supported the practice of home delivery. Nonetheless it called for more training and greater supervision of midwives, preferably by physicians. The report concluded that “the rate of death was unnecessarily high . . . [and] two-third of all the deaths studied could have been prevented.”

The Commonwealth Fund published the landmark study on November 20, 1933. The Academy published a summary in its publication Health Examiner. Iago Galdston, secretary of its Medical Information Bureau, provided a précis of the study, “Why Women Die in Childbirth,” to major press outlets. One sign of its reach: the January 1934 meeting of the Maternity Center Association, attended by over 500 people, discussed the report and emphasized public education in the search for improvement. Four years later, Galdston adapted the study for lay audiences, including results from Philadelphia and the U.S. Children’s Bureau, as Maternal deaths—the ways to prevention (1937), also published by the Commonwealth Fund.

Immediately after the study’s release, however, obstetricians—and especially those of the New York Obstetrical Society, which helped guide the Academy’s research—thought that their authority and expertise were being questioned. In April the society released a “counter-report” upholding its members’ obstetrical abilities against the “unskilled hands” of general physicians and midwives. Some obstetricians raised their objections within the Academy, both on the report and the popular publicity around it; the ensuing investigation confirmed the results of the report and the manner of its release. And even as it objected to the report, the Society came together with the Academy in March 1934 to jointly advise the city’s Department of Health on productive ways forward.

In the 1950s, the Academy’s work resulted in two further studies: Infant and Maternal Care in New York City: A Study of Hospital Facilities (1952), with Dr. Edward Henry Lewinski Corwin as general director of the study; and Perinatal mortality in New York City: responsible factors; a study of 955 deaths (1955), with Dr. Schuyler G. Kohl of SUNY Downstate as the chief author. Some 60 years later, the Academy continued its work with the 2018 New York Maternal Mortality Summit.