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birth control -other than abstinence- was not invented and/or popularized until the 60s. mostly families had lots of kids because the mother was fertile or there were multiple sequential wives, and also infant mortality was 70+%. until recently, after the 60-s catholics (my family) or Mormons had tons of kids. not so much anymore.
my daughter had her first/only so far baby at 35 and had to have all kinds of tests. the things they can test for now that are so dangerous for older mothers would have killed her or the baby earlier. and better general health care in my opinion is the reason for so many twins, who are not IVF.
I love the way Diana has incorporated those historical facts into the books, and Claire’s ability to bring modern (for her time) methods to use back then