 Until germ theory was accepted in the mid-1800s, it was assumed that puerperal fever was either caused by a variety of sources, including the leakage of breast milk into the body and anxiety, rather than by a pathogen that was transmitted by the dirty hands and tools of doctors.That misconception was likely responsible for the high prevalence of puerperal fever.The home births facilitated by trained midwives produced the best outcomes from 1880 to 1930 in the US and Europe, whereas physician-facilitated hospital births produced the worst.