Hidden Maternal Mortality? Under-Registration of Maternal Mortality in Maastricht, 1870–1910

Maternal mortality rates in the 19th-century Netherlands were low compared to other European countries. But was this due to high-quality midwifery care or under-registration? This study examines maternal mortality registration in Maastricht by comparing data from 1870–1879 and 1900–1909 across three sources: municipal reports, individual-level causes of death from the Maastricht Death and Disease Database, and mortality rates based on women who were linked to births up to one year prior to their death. The results indicate under-registration of maternal mortality in the municipal reports. Half of the women who died within 42 days postpartum were recorded with causes unrelated to childbirth. In Maastricht, suspected cover-up causes like peritonitis and fever were not the most commonly used. Instead, tuberculosis, heart disease, and pneumonia were frequently recorded when pregnancy-related factors were omitted from the cause of death.