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By the late nineteenth century childbirth was firmly established in the domestic sphere. However, in the early years of the twentieth century different forms of maternity clinics were established where normal, as well as complicated, deliveries could take place. The aim of this dissertation is to analyse the institutionalisation of maternity care in a local urban context, the role of women in confinement in this process, and its impact on infant mortality. The geographical setting of the thesis is Sundsvall, a town in northern Sweden. The study concentrates on the period spanning from 1900 to 1930, when local communities, rather than federal agencies, were charged with creating and implementing community standards for maternity care.

In order to lower the mortality rate of illegitimate infants, and to improve delivery conditions for unmarried women, a maternity home was opened in Sundsvall in 1913. Moreover, a maternity ward was established at the local hospital in 1920. In this study it is clear, that when institutional maternity care became available, the transition was rapid and unhesitating. When analysing the local practices it is possible to highlight the central role women played as part of this process. Initially indigent women and women bearing children out of wedlock accepted the institutional alternative, but shortly thereafter married women of means turned to the newly created wards. As a result of this early acceptance, these institutions were soon filled to capacity.

During the period in question a significant reduction in infant mortality rates can be noticed in the Swedish towns. A reasonable assumption is that the institutionalisation of maternity care improved infants chances of survival. In the study it is suggested that the institutionalised maternity care made an impact on neonatal mortality, as well as on post-neonatal mortality. The study shows that local practices of care played a key role in infant survival.

This dissertation reveals the value of examining local practices in order to understand the rapid changes of maternity care. Childbirth changed from being a private matter, taking place in one’s home, to be a public concern, taking place in the institutional setting. At the 1937 Parliament (Riksdag) the responsibility for institutionalised maternity care became a public and a State concern, and maternity care became a part of the Swedish welfare system.