MATERNAL MORTALITY

Evening Post, Volume CVII, Issue 143, 18 June 1924, Page 4

MATERNAL MORTALITY

PRE-NATAL CARE | VIEWS OF RECOGNISED j AUTHORITY ENLIGHTENED PUBLIC OPINION WANTED, During the last twenty years the infant mortality has fallen to one-half in ajmost every town and county,• th,e mortality of mothers in childbirth has remained almost unchanged, states the journal, " Maternity and Child Welfare," the official organ of the Central Council for Infant and Child Welfare, London. " There was, indeed, during the years 1920-21 a menacing rise in the maternal mortality rate. " These facts," states the same journal, " are only just beginning to attract the attention of thoughtful people, N,ew Zealand especially having suddenly awakened to the realisation that, whereas everything was very well with its babies, things we not at all so well I with the'mothers. America is in no better plight than we are,' and the maternal mortality thermometer, shown three years ago by the Children's Bureau at Washington, set out tlio naked facts." We simply must prevent this lamentable loss of life and energy. DR. JANET CAMPBELL. "The Ministry of Health is bring-

ing all its resources to bear upon an investigation of the causes of this mortality. The report of Dr.-Janet Campbell (of London, and a recognised authority on the subject), which has just lieon . issued, follpws .on her two earlier reports dealing respectively with the education of the medical student and the training of the midwife in obstetrics. "In a foreword, Sir George Newman a.sks us to note, writ large, on the pages cf this report, the fact that ' no sound progress can be made in'the reduction 6l maternal mortality apart from antenatal supervision.', All the available evidence goes to show that a lack of this ante-natal care, from whatever cause it may arise, lies at the rop.t of the whole problem of maternal mortality, and that all other causes are probably secondary to it. A great merit qt Dr. Campbell's work is that, while she collects and sifts the evidence, it is all recorded for the reader to draw his or her own conclusions, without suggestion of praise or blame. A great many people of various ranks and calling^ wait on tho expectant mother, and it is well that all of them should study the evidence-, and put on their thinking caps. . HURRIED MIDWIFERY AND SEPSIS. •" One thing seems fairly certain — that there is a definite connection between hurried mid-wifery and sepsis. The midwife is bound by her *ules to stand by during the whole of- th,e third stage of labour; the busy practitioner is often inclined to save time and trouble to his patient and himself by quickening tjiis stage pf labour. A cor- | respondent sends us the following comparison. Maternal mortality is the highest in the United States, in Australia, in Canada, and, until a year ago, in Scotland, where there are practically no raid^vives; if is lowest in Denmark, Italy, Germanyi Hussia, and. Holland, where the midwives deliver nearly all normal cases. England, whero mid- | wives no.w deliver about half the cases, takes an intermediate, place between the two. Tlie suggestion has indeed been made —not, we hasten to add, in Dr. Campbell's report—that all normal midwifery, whether for rich or poor, should be conducted by midwives, supervised and assisted in abnormal cases by competent consultants, the role of the general practitioner being limited To that of anaesthetist. The same end would be reached by making of the general practitioner a competent consultant, hence the insistence laid by the General Medical Council upou the improved education of the medical student in the principles and practice of obstetrics and gynaecology. To deprive the medical practitioner, if this were thinkable, of 4 fair sharo of normal cases'vfould simp«Bpr ' ' '

ly shelve the difficulty, not solve it. Moreover, even in the abnormal cases, the early discovery of abnormalities by ante-natal care would largely reduce the nnmheT of cases requiring instrumental delivery, and so reduce the opportunities for s,epsis. SUGGESTIONS. " The suggestions made by Dr. Campr bell herself for securing a "reduction in the excessive maternal mortality group themselves under three headings. First* an improvement in'the quality oi the professional attendance, as'regards bqlh medical stndonts. and mid^ves. Secondly, action through the public health department of the local authority with j a view chiefly to securing adequate antenatal and post-natal" care of all pregnant I women, \vhether in an institute or in their own homes, thirdly, v^ripus social and educational .measures' in which the help of the community as a whole is called in. ... " There will be some difference of opinion as to the best methods of carrying out these recommendations'. " Discussion should be full and free. Dr.. Campbell has at least given a ]cad, and it may be hoped that the publication of her support will tend towards the formation of an enlightened public opinion, without which no scheme' for the benefit of the mother in' childbirth can i)avq the. hest chance of success^" BRITISH DOMINIONS. Of particular interest in this connection is a table appearing in " Health," the official jo.urnal of the Coromqnwealth Department of Health, compiled by'the Commonwealth Bureau of Census and Statistics, Melbourne, 2nd April, 1924, setting out the mortality ' from puerperal causes per 100,000 births in Great Britain and the Dominions. This table is ;;s follows:—

AN UNENVIABLE POSITION. It will be noted that New Zealand occupies an_ unenviable- position in regard to mortality from puerperal albuminuria, viz., 121 per 100,000, as compared with 69 per 100,000 in Australia,' and 25 per 100,Gvi0 in South Africa, Puerperal albuminuria is one of the conditions which could be detected in its incipient-stages by proper ante.-nata.l supervision. We have here justification for the emphapis recently placed upon this a.spect~of the master by the Minister of Health, in his speech at Pajmergtiin North.' "' It is generally admitted that most of the cases certified as dying' from puerperal phlegmasia, albp dolens, embolism, and sudden death are really cases of puerperal septicaemia.' If "we take the sum of columns 4 and 5 in the above table,_ it will be noticed that Scotland occupies the worst position, with, a mortality from this .cause of 233 per 100,000, while New Zealand is not much" better with a rate of 220 per 100,000; while Canada-, is in the most favourable position with a mortality rate of "only 131. . In accepting these figures it must be remembered that their accuracy depends on the accuracy of medical certification in the countries in question. With this qualification, they may be ta.ken as reasonably comparable. AN EXPLANATION: NEW ZEALAND CASES. The system of compilation of the returns of maternal mortality in New Zealand and other countries leaves room for minor differences, but it is difficult to imagine, remarks a responsible "official, any discrepancy as would materially affect the figures. The term "maternal mortality" includes the deaths of all women from the time of conception till the birth of a full-term child from any of the causes listed under the headings given above.' KELVIN INQUIRY. Mrs. Rhodes, one of those who asked for what is known as the "Kelviij Inquiry," writes as follows to the Auckland "Star" :—"Kelvin Inquiry. (To the Editor.) Sir, —I would be much obliged if you will allow me to make a statement re. the above. I would have asked you to publis.li it sooner pijly I have been too ill to <k> so. I feel very keenly all the blame being put upon Dr. Hughes, who was not treated with the proper frankness his position required. He certainly did not know Mrs. Carter had septicaemia when my daughter was admitted on 4tn November, and he certainly did hot know of either case until Mrs. Muir was infected (on 9th November), and then npt until the next day, IQth November. To put all the legal and moral blame upo.n the health, officer seems tome the last cruel act of a fearfully cruel business.—l am, etc., S. M. Rhodes."

MORTALITY FROM PUERPERAL CAUSES PER 100,000 BIRTHS. 1 2 3 4 5 0 7 8 Total, st? ■=« -s". B | -ihi A '** _=« Country. g= gr -gj So S|°| o 2= ft 2g2 "g 11 fel si1? P |"aI-§ |l || Igf5 -=11 Australia (1922) ... OS 06 63 li3 sq "' 09 7 " feilS^K 45 5 1'9 tt J?i ? •- SS "Vales 39 " 83 193 5 » 19 .- «» eluding > Quebec) 111 63 71 H2 10 10S 30 ... 5 ] 4