MATERNITY.

Auckland Star, Volume LIX, Issue 77, 31 March 1928, Page 11 (Supplement)

MATERNITY.

ROYAL INTEREST. THE SEPTIC RISK. NEW ZEALAND FIGURES,

(By H.A.Y.)

The Queen has expressed her sorrow that thousands of English mothers die annually from septic conditions following confinement, and the medical profession is called upon to discover causes and prevent these deaths. Institutional treatment does not give an absolute security, indeed there may be a strictly local "run" of such cases, and the blame is not easily apportioned. Experts say that the perfection of aseptic surgery in maternity will not protect patients who carry with them the seeds ox disease, as many do. There is a gleam of light showing since it was found that the injection treatment (arsenical) for venereal infection had a curative effect in puerperal fever. A blood infection can be reduced only by blood treatment or the production of a resistant medium in which the offending micro-organism cannot live.

The fact that thousands of women are safely delivered in the most unpromising surroundings, and with a minimum of care, is due to the infectionresistinc constitution of the patient as much as to a "good time" (easy confinement). The hard-muscled, athletic woman is no better subject for maternity than her weaker sister, except that athletic training often involves a method of life conducive to the making of pure blood and the formation of healthy habits. Puerperal fever cases have been classified, but the mildest variety is so much in line with severe forms that it is reasonable to suppose the patient's degree of resistance is the arbiter of her fate. The rapid reduction of temperature which follows antiseptic treatment often promises, but does not secure, recovery; and treatment by serum acts in a similar way. Again and again the temperature will fall and rise, until the patient is exhausted.

In England it is suggested that obstetric training i 9 at fault, or that ante-natal supervision is lacking, or there is too much interference—or not enough, but the fact remains that the most experienced and most skilful men have septic cases, and the most carefully managed nursing homes have been closed down in consequence of septic infection. The trouble is far more general than is commonly believed, and "temperatures" in confinements are by no means unusual. If all cases were carefully charted for ten days before and after labour, it might be found that the patient with a steadily normal temperature for that period was exceptional

In this matter New Zealand has no reason to be congratulated, for she stands below ten other countries (three below England and Wales) in her death rate from all puerperal causes, with nearly five deaths per thousand births. In 1920 the rate was 0.48, so there has been some improvement since then. In definite severe cases of puerperal fever, the deaths have dropped from 67 in 1920 to 39 in 192(5. In 1920 there were 40 deaths from haemorrhage, in 1926 only nine. This may indicate that there has been less neglect, and a more watchful attitude amongst nurses and a greater readiness to call for surgical help on the part of midwives. From all puerperal causes there were 124 deaths in 1919 and 121 in 1926, the two best years of the last ten. One has to allow for deaths in remote districts which may not always reported, or accurately reported, as, for instance, deaths from pneumonia of puerperal origin reported as pneumonia. Everybody connected with a septic case shrinks from publishing the fact, and this will continue until it is generally understood that nobody concerned is necessarily worthy of blame. The clumsy accoucheur, the neglectful nurse, the hasty, irritable midwife, should all be banished from maternity practice, for no cases in the medical profession call for greater care, observation, patience and sympathy than those in midwifery.