My new novel is about a midwife’s daughter in the old American west. The peril pregnant women underwent, then and now, became all too vivid once I became a parent

Childbirth in the 19th century was a dangerous affair. Women routinely came down with puerperal fever, an infection of the uterus that could lead to sepsis and death. Others suffered a postpartum haemorrhage: heavy bleeding that, if not stopped, could also claim their lives. Some experienced eclampsia, a condition in which skyrocketing blood pressure could cause fatal seizures. In 1900, six to nine women died for every 1,000 births, more than 30 times the rate today.

I learned these facts when I started researching my latest novel, Outlawed, an alternate history following a midwife’s daughter on the run across the American west in 1894. I needed a working understanding of obstetrics and gynaecology of the era to give it verisimilitude. So I read about the history of the C-section, which, at least in Europe, was generally a fatal procedure until about the 1880s, though there are reports of women surviving it as early as the second century CE. I learned about the discovery of egg cells, which was the subject of heated debate in the 1670s between the Dutch doctor Reinier de Graaf (who demonstrated their existence by dissecting rabbits shortly after mating) and his rival Jan Swammerdam (who liked to travel with a human uterus and other “items of genital anatomy”). I studied the composition of early baby formula, which, in 16th and 17th-century Europe, often consisted of bread soaked in milk, fed to infants from a “pap boat” that was unfortunately hard to clean and prone to accumulating bacteria.