MATERNAL MORTALITY

Evening Star, Issue 19274, 12 June 1926, Page 10

MATERNAL MORTALITY

IH THE DOfnlfllOfl THE CAUSES ANALYSED INTEREST]NG CONCLUSIONS. ' In ilio ‘New Zealand Medical Journal’ ior April there appeals a very interesting article by Ur Doris C. Gordon, of Stratford, on comparative obstetrics. Although, of course, primarily intended for perusal by medical practitioners, and therefore containing a .mod deal of detail which can hardly bo repeated in a lay newspaper, there is much in the article that is o( public interest, and which should give food for serious thought.. Indeed, in opening her subject, Ur Gordon says; “The fact that New Zealand loses annually some 157 mothers a s the result of childbirth has become an urgent problem not only for our profession, but aim for our country.” And sho then asks why our infant mortality rate, which is so good as to be unrivalled, should be contrasted with a painfully high rate of maternal mortality, ... Sho divides her inquiry into three questions: (1) Is it the fault of the medical profession? (2) Is it that the women of New Zealand are more susceptible to the dangers of maternity? (,'j) Are the international statistics published not a true indication? In regard to the medical profession, after comparing training in Now Zealand and in England and other European countries, Ur~Gordon concludes that in aseptic technique in midwifery the New Zealand student is working at an advantage; but in the matter of practical experience at a disadvantage, entirely due to thofabsence of patients, particularly in ante-natal clinics, in this country. It is from the ranks of pauperism, and worse, in the older countries that the class ’of patients is drawn which provides practice for the student, and, fortunately, in Now Zealand these classes arc non-existent. LOWEST PAID WORK.

Then, again, midwifery, while one of the most exacting forms of a general practice in New Zealand, is the lowest paid, and there aie, therefore, practically no obstetrical specialists available for a general practitioner to turn to in an emergency, as there would bo in older countries; while for a doctor to express a desire for further export advice is to run the risk of being considered nervous or incapable. Is it any wonder, asks Ur Gordon, that so many practitioners drop midwifery as soon as they can alford to do so? The weak spot in the New Zealand medical service, in both private and hospital work, is the small amount of ante-natal supervision which is usually found possible. It is here that patients can help by accepting such supervision, not as the mere whim of a fussy doctor, but as a very real and important part of the duty of their medical attendant. _ As regards nurses, Dr Gordon is convinced that the general standard of New Zealand nurses is as high as anywhere in the world, though, of course, in older countries, whore many of the maternity cases are conducted entirely by nurses, they are prepared for this responsibility by longer training. Giving details of bar own observations in Dutch and Austrian hospitals, Dr Gordon was astonished at the lack not only of the aseptic technique upon which stress is laid in the New Zealand training, but also the absence of what we consider to bo the ordinary amenities and decencies of life in those institutions, many patients, students, and nurses being in the one ward, with not even a screen around a, patient s bed. “ Beyond the fact that with onr scattered population our hospitals arc less accessible for emergency cases, we saw nothing in our travels to suggest that the maternity hospitals of New Zealand arc responsible for onr hign mortality return,” proceeds Dr Gordon, “ Bed for bed. and in theatre equipment, we found that our .snudi hospitals compared more than 'ayorably with the average hospital in Jtngland and Holland. . . . .Infinitely

tho best and most uniform _ maternity hospital system wo saw was in Vienna. Yob the Austrian returns are higher than the Dutch, which again verifies the conclusion that the hospitals poi so are not a determining factor in the returns of tho various countries diso.usscd here.’

ARE OUR WOMEN MORE SUSCEPTIBLE?

There remains the second part of l'r Gordon’s inquiry. Are the women of New Zealand more susceptible to the dangers of maternity? Loving uiug. such healthy conditions, this would seem most unlikely, yet the doctor maintains that this is the case, ana instances three classes of disorders mot with more frequently in New Zealand than in England, Holland, and Austria. Curiously enough, it is because ol their robust health and the ideal living conditions in which they are brought up m New Zealand that women here are more susceptible to septic complications. Those who live in less-favored conditions obtain immunity by unconscious contact with and absorption ot pathogenic organisms. In this country the fatale legislates our housing conditions, our public health systems, stands between us and our infectious_ diseases; our Education Department instructs us in the laws of personal hygiene; our dentists and our throat specialists deprive u s of the daily inoculation of minimal doses of microbes that our ancestors acquired from septic teeth and ton.sis ” Ro. whoa all these benefactors have done 'their duty, the superciviliscd woman, product of modern preventive medicine, conics to her doctor in her hour of need “so hypcrseusifcised by the very processes that otherwise benefited her,” that she now has no resistance to the microbes of septicaemia that may assail her in childbirth. While epidemics of puerperal sepsis are preventable, Dr Gordon submitted strong evidence to the effect that isolated cases _ of_ sepsis usually have their origin within the patient herself, and concluded that the desired reduction of this typo is not likely to occur, “seeing that the whole trend of modern science is to make the parturient woman more and more susceptible to infection.” UNRELIABLE STATISTICS. Concerning statistics, it is obvious that comparisons between New Zealand and the older countries lead to erroneous conclusions, there being no doubt that in several countries visited the maternal mortality records are not collected with the same meticulous care which characterises the work here. “ The attitude wo should adopt,” Dr Gordon rightly concluded, “ is not how does New Zealand compare with America, Holland, or England; but rather we are losing annually so many mothers, which is far more than we can afford to lose. By what methods and organisation cam we reduce this loss?” Few will disagree with her conclusions: Firstly, that the loss of 150 to 160 mothers annually calls for the earnest co-operation of practitioners, public health official?, and the public themselves; and, secondly, that the increasing dangers of modern midwifery constitute a call to the best of our doctors to take up the difficult work, and necessitates a public enlightenment that will bring not only financial remuneration proportionate to ihe responsibility of the work, but also that sympathetic lay co-operation without .nidi progress is impossible.