A Matter of Life and Death (#52Ancestors week 43: Cause of Death)
It was an all-too-common fate of young women. The very act of bringing forth new life was the cause of their deaths. Had I lived a century earlier, I’m fairly certain that fate would have been my own.
Our first baby was due 17 years ago this week: October 28, 2001. We had already come through a scary scenario in early May when I was exposed to parvovirus (more commonly known as fifth disease) while teaching my third graders. By the time I saw the tell-tale red rash on my students’ cheeks, it was already too late and I tested positive for the virus.
Parvovirus infection during pregnancy sometimes affects red blood cells in the fetus. Although uncommon, this may cause severe anemia that could lead to miscarriage or stillbirth. 
By the grace of God, we did not lose our baby to miscarriage or stillbirth, and everything was on track for a healthy delivery.
Five days past his due date, Joshua Ryan Wenger entered the world on November 2, 2001 at 8:10 a.m. after an all-night labor. At 8 pounds, 9 ounces, he was in perfect health.
Eric holding newborn Josh in the delivery room
I did not fare quite as well. The midwife quickly realized that I had developed a large hematoma (a very rare occurrence during childbirth) and a dangerous amount of blood was pooling. After numerous attempts to control the bleeding by both the midwife and a doctor she called in, it was determined I had to go into surgery under general anesthesia. (I should add, the midwife was frightened enough by the experience that when I went to the hospital to deliver our second baby 22 months later and she walked into the room, she exclaimed, "Oh, no! Not you!")
Although being taken away for surgery was not the first day of my baby’s life I imagined, I am immeasurably grateful for the medical intervention I received and was eager to go home and love my baby.
I sometimes stop and imagine what might have been. In an earlier era, not so very long ago, I have no doubt that the type of complication I experienced giving birth to my son could have easily caused my death. Eric would have been a widower at age twenty-five. Josh would have grown up never knowing his mom. Our two younger children, Alexa and Nathan, simply would not exist. Eventually, Eric probably would have remarried, and perhaps Josh would have younger half-siblings. My mind can hardly process the ripple effect that that one major life-altering change would have on our reality.
Researching family history has given me a sobering new appreciation for just how many women died in childbirth or shortly thereafter. As the chart below illustrates, giving birth just 100 years ago was quite a dangerous proposition.
Maternal Mortality Rate chart 
What actually caused death for these women?
Puerperal fever (also called childbed fever or postpartum sepsis, an infection usually contracted during childbirth)
Eclampsia (dangerously high blood pressure and organ damage)
Obstructed labor 
The first two causes could have been extremely likely in my situation.
Below is the death certificate of my great grandfather’s youngest sister, Ida (Norbeck) Jacobs who lost her life at age of nineteen to septicemia, a bacterial infection that entered her bloodstream. 
Death certificate of Ida A. (Norbeck) Jacobs 
Note that doctors frequently used the term abortion for a miscarriage (a spontaneous abortion).  Ida was married and already had one child born in September 1919, so it seems highly probable that she actually suffered a miscarriage and contracted an infection in the process.  The numerical death code 137 correlated to puerperal fever. 
The best source of historic information on this subject is a book called Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800-1950, by Irvine Loudon. (If you are pregnant, whatever you do, do not read this book.) It’s a very serious work, rich in data and graphs and analysis, but you can tell he’s furious about all the unnecessary deaths at the beginning of the 20th century. Here’s how he described puerperal fever: “A woman could be delivered on Monday, happy and well with her newborn baby on Tuesday, feverish and ill by Wednesday evening, delirious and in agony with peritonitis on Thursday, and dead on Friday or Saturday.” During the 1920s in the United States, half of maternal deaths were caused by puerperal fever. For a disease that was “preventable by ordinary intelligence and careful training,” he wrote, “these figures were a reproach to civilized nations.”
Countless women in our families lost their lives while bringing forth another. Unfortunately, many of their stories have also been lost due to lack of record-keeping and the passage of time. I’d like to share just one story that has managed to survive.
Henry L. Heller and his wife Fannie H. (Rohrer) Heller 
The portrait above was painted in 1954 from the photograph below.
Henry and Fannie (Rohrer) Heller were married on 25 November 1879. 
Mary Kathryn (Heller) Wenger and I comparing the photograph and the portrait of her grandparents, 25 December 2017.
There were no names on the back of the painted portrait found in an attic, but we were able to match the couple in the photograph and identify them.
Eric’s grandma, pictured above, recorded the following information in her family heritage book:
She also included these photographs of her father as a young child.
Records verify all of her statements about what happened to her father after his mother died when he was an infant.
1900 census showing 6-year-old Elmer (bottom line) in the household of his uncle and aunt, Jonas and Selinda/Linnie (Heller) Burkholder in Lancaster City. 
Elmer’s 1917 draft registration card for World War I verifies that he worked on Enos Heller’s farm prior to his marriage. Also note his original signature and his claim for a religious exemption from combat as a Mennonite. 
Although Elmer appears to have been surrounded by a supportive extended family, one has to wonder if he longed to know more about his mother, Fannie.
My research has revealed that Elmer was the third surviving child of Henry and Fannie. She also lost four babies to either stillbirth or miscarriage.
Bertha (26 August 1880)
Infant (19 November 1881)
Landis (23 March 1883)
Infant (31 May 1884)
Infant (18 November 1886)
Infant (6 May 1889)
Elmer (28 February 1894)
Her obituary (below) indicates that she lived three months after Elmer’s birth, rather than three weeks.
Heller.- On the 29th of May, 1894, at Eden, Lanc. Co., Pa., Sister Fanny (maiden name Rohrer), wife of Bro. Henry L. Heller, in her 37th year. She was for many years a faithful member of the Mennonite denomination. Her seat was seldom vacant at church when health permitted, she being at church the Sunday previous to her death, though in poor health for quite a while. Death came very suddenly. She was resigned to the will of God. Only a few hours before her death she said she felt as though she could sleep all night, thus encouraging those about her to think that she was getting better, when in a few short hours she went to sleep to awake in heaven, expiring while in conversation with her husband. Her husband, one daughter and two sons, also an aged mother, one brother, and three sisters are left to mourn the loss of an affectionate one; they have the sympathy of the entire community in their sad affliction, but they need not mourn as those who have no hope, for they have the blessed hope that their loss is her eternal gain. Her remains were laid to rest at Landis Valley. Funeral services were conducted by Bish. Isaac Eby and A. Brenneman. Text, Psalms 23. 
The description of how Fannie died doesn’t directly state the cause. Pennsylvania did not start keeping death certificates (like the one for Ida earlier in this story) until 1906. However, Lancaster County did keep a register of deaths starting in 1893. Pictured below are the pages for Fannie. 
From what I have highlighted, Lancaster County’s death register states that Fanny H. Heller, age 36, died on 29 May 1894 in Manheim Township, Lancaster County. Her cause of death was attributed to “heart failure.” She was buried in Landis Valley Mennonite Cemetery on 2 June 1894. 
It’s difficult to know if heart failure was an accurate diagnosis and if her death was caused by lingering difficulties associated with giving birth to her son. Fannie must have been devastated to realize she would not get to see her baby grow up, but perhaps she knew there were four more babies waiting for her in heaven.
Fannie is buried with her husband and his second wife, Katie 
"There but for the grace of God go I."
 “Parvovirus infection,” Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/parvovirus-infection/symptoms-causes/syc-20376085 : accessed 14 October 2018).
 Laura Helmuth, “The Disturbing, Shameful History of Childbirth Deaths,” Slate (https://slate.com/technology/2013/09/death-in-childbirth-doctors-increased-maternal-mortality-in-the-20th-century-are-midwives-better.html : accessed 14 October 2018).
 “Septicemia,” John Hopkins Medicine (https://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/septicemia_85,P00802 : accessed 15 October 2018).
 Pennsylvania Department of Health, Certificate of Death no. 27394, Ida A. Jacobs, 15 December 1920, Philadelphia County; viewed at "Pennsylvania, Death Certificates, 1906-1966," database with digital images, Ancestry (https://www.ancestry.com : accessed 15 October 2018); citing Series 11.90: Death Certificates 1906 -1966, Record Group 11: Pennsylvania Department of Health, Pennsylvania State Archives, Harrisburg.
 Andrew Moscrop, "Miscarriage or abortion? Understanding the medical language of pregnancy loss in Britain; a historical perspective," US National Library of Medicine (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841747/ : accessed 15 October 2018).
 "United States Census, 1920," database with images, FamilySearch (https://familysearch.org/ark:/61903/1:1:MNM5-MHX : accessed 15 October 2018), Ida A Jacobs in household of Charles Jacobs, Philadelphia Ward 41, Philadelphia, Pennsylvania, United States; citing ED 1532, sheet 8A, line 12, family 190, NARA microfilm publication T625 (Washington D.C.: National Archives and Records Administration, 1992), roll 1642; FHL microfilm 1,821,642.
 “International List of Causes of Death, Revision 2 (1909),” Wolfbane (http://www.wolfbane.com/icd/icd2h.htm : accessed 15 October 2018). Note that another revision was made in 1920, but it is possible the doctor was still using the most recent prior code.
 Laura Helmuth, “The Disturbing, Shameful History of Childbirth Deaths,” Slate (https://slate.com/technology/2013/09/death-in-childbirth-doctors-increased-maternal-mortality-in-the-20th-century-are-midwives-better.html : accessed 14 October 2018); citing Irvine Loudon, Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800-1950 (Clarendon Press, 1992).
 Henry Heller and his wife Fannie (Rohrer) Heller, portrait painted from a circa 1879 photograph in 1954, original in possession of Joyce Wenger, a great granddaughter, in 2017.
 Lancaster Mennonite Historical Society, genealogical card file, “Heller, Henry L.,”; “Lancaster, Pennsylvania, Mennonite Vital Records, 1750-2014,” database with digital images, Ancestry (https://search.ancestry.com/search/db.aspx?dbid=60592 : accessed 15 October 2018) > Heavel, Christian – Herchelroth, John > images 2468-2469 of 3887.
 "United States Census, 1900," database with images, FamilySearch (https://familysearch.org/ark:/61903/1:1:M33F-8YP : accessed 15 October 2018), Elmer Heller in household of Jonas Burkholder, Lancaster city Ward 6, Lancaster, Pennsylvania, United States; citing enumeration district (ED) 56, sheet 3B, family 59, NARA microfilm publication T623 (Washington, D.C.: National Archives and Records Administration, 1972.); FHL microfilm 1,241,424.
 “World War I Draft Registration Cards, 1917-1918,” database with digital images, Ancestry (http://www.ancestry.com : accessed 15 October 2018), Elmer R. Heller, serial no. 1364, draft board no. 24, Lancaster County, Pennsylvania; citing World War I Selective Service System Draft Registration Cards, 1917-1918, NARA microfilm publication M1509; Family History Library Roll No. 1893479.
 Herald of Truth, Vol. XXXI, No. 13, July 1, 1894 pages 206, entry for Heller, Fanny; transcribed online by Mennonite Church USA Archives (http://mcusa-archives.org/MennObits/1894/jul1894.html : accessed 15 October 2018).
 “Lancaster County Death Registrations, E-H Deaths, 1893-1907,” browsable images, Lancaster County Archives (https://co.lancaster.pa.us/DocumentCenter/View/8376/E-H-Deaths-1893-1907 : accessed 15 October 2018), images 111 and 112 of 182.
 Find A Grave, database and images (https://www.findagrave.com : accessed 15 October 2018), memorial page for Fannie H Rohrer Heller (1857–1894), Find A Grave Memorial no. 108390782, citing Landis Valley Mennonite Cemetery, Lancaster, Lancaster County, Pennsylvania, USA ; Photograph by cleemiller (contributor 47763842) .