From 1917-1979, the maternal mortality in the Rhineland Women''s Clinic was investigated based on 136,084 live births. From 1917-1921, it was 10.1% and decreased to 0.16% in the period from 1973-1979. The maternal mortality in association with cesarean section, which was 11.8% in the period from 1917-1921 with a frequency of cesarean sections of 2.5%, decreased to 0 since 1973 with a frequency of 6.3%. A cesarean section preceded more than 50% of the deaths since 1962. Most of the deceased (24.4%) were in the group of 30-34 yr of age, and 48.3% aged more than 30 yr; 51.5% were primiparas and 14.6% of the women were at least para 4.8. From 1917-1936, infection was the main cause of maternal mortality with 39.6%; from 1957-1966, thromboembolism advanced to the leading cause with 27.3%. Since 1960, 4 of 35 deaths were anesthetic deaths. During all examined periods, nonspecific reasons of maternal mortality were an important factor with more than 30%.