MATERNAL MORTALITY

New Zealand Times, Volume XLVII, Issue 10964, 28 July 1921, Page 5

MATERNAL MORTALITY

“UNDULY HEAVY" QUESTION DISCUSSED BY BOARD OF HEALTH. FUTURE STEPS. The supposed excessive lnate-rnal mortality rate in this Dominion in comparison with that' in other countries was given lengthy consideration at a meeting of the Board of Health, held at Wellington yesterday. The Hon. C.-J. Parr, Minister for Health, in introducing tho subject, referred to the somewhat startling' report which had appeared in a publma-' tion issued by the United States Labour Bureau, crediting New Zealand with having the second highest maternal mortality rate in the world. lhe statement, as given by the American report, placed the Dominion somewhat at a disadvantage, as it only referred to one particular year, namely, U 1 ‘ ■ The department claimed that it the figures had been taken for a period ot three years it would have been shovyn that New Zealand should have been placed fourth instead of second on the list of countries classified in the retnrn. If, would seem that we were including under the heading of deaths from puerperal causes some diseases which were rot so included in Great Britain. As to the other countries, he was unable to check the figures. Assuming the statements issued by the departmental officers to be correct, there would appear to be some justification for thinking that our figures would make this Dominion compare with other countries worse than we really should. THE BOARD TO INVESTIGATE. The training of midwives in New Zealand, he added, was longer than m any other country, and the various nursing homes were under departmental inspection. He was satisfied, however, after going fully ' into the question, that there was need for a more careful inspection of these homes, and also that after going through their period of training the nurse-midwives should be given opportunities of keeping their training up to date. He was satisfied that iu New Zealand there was an unduly heavy-mortality due to sep-sis. It would be for the he" "d to investigate the causes of puerp* ’ 1 mortality and indicate preventive i-amedies. Mr Malcolm Fraser, Government Statistician, who was present by request, said, in answer to a question by the Minister, that so far as he could judge the figures given in the United States’ report ‘ for that particular year were correct. All the countries were working along the lines laid down in 'the International Manual as to the nomenclature of diseases, though it was possible that certain disorepenoies might arise due -solely, to- individual opinions differing a® in which particular groups certain disease might be included. Differences might also arise through deaths arising from a primary cause and another disease associated with it -being wrongly classified.. THE FIGURES ANALYSED. VALUABLE INFORMATION.. Some very valuable information and deductions made from the figures supplied by the department in regard to the maternal mortality question as affecting the Dominion were given by Dr. H. J. Jellett, who was for nine years master of the Rotunda Hospital at Dublin, one of the largest maternity hospitals in Great Britain. Dr. Jellett has resided in Ohristchurch for the past eighteen months, and since the publication of the American report has given his attention to a srtudy of the Dominion figures. Taking the total maternal mortality rate as 6.5 per .1000 births, or one death in 154 births, lie found that there were only twenty-five districts concerned, whilst, taking the districts meet responsible for the total maternal mortality rate as one in 100, or greater, as compared with .the average, he found . that they numbered sixteen, with a death rate of one death out of seventy-five births. These figures were based on the returns for 1920. Further, taking the figures for 1916-1920, he found that of the 194 deaths in 1920, 171 came under five headings : Sepsis; Eclampsia; Post Partum; Haemorrhage; Placenta Premia; and undefined cases. causes And remedies. There were three main factors which, in his opinion, and based on his experience, were attributable as to the causes of this mortality; namely, (1) Increased virulence of. organisms during recent years; (2) unsuitable surroundings ; and (3) the somewhat excessive operative -interference oftentimes associated with child-birth. He was of opinion that a reduction of operative midwifery was essential, but it was difficult to see how this could be accomplished owing to the exigencies of practice. To remedy tile present position, he would suggest , the establishment of an obstetrical staff college, where training could be carried out according to the latent ideas, and where it would be possible for a nurse to return for a post graduate course. It was also essential that the technique should he improved and kept up to date hy lectures and demonstrations He woulld also advise the adoption of statistics compiled according to morbidity, as was done at Home now, instead of on' the present .system. The adoption of private houses as maternity hospitals was also to he deplored. They were quite unsuitable. He favoured the establishment of paying maternity wards at hospitals, instead of the present type of small private hospitals which could nob he run efficiently. The status of the teaching of midwifery in tho university- should he also raised he thought. OTHER OPINIONS. Dr. Truhy King (in charge of Child Welfare Department) stressed the necessity for educative measures. The public could he educated up to the fact that operative midwifery was, in a large majority of cases, unnecessary, and even positively mischievous. Ho advised the appointment of an expert midwife lecturer to give educative lectures and addresses to midwives throughout New Zealand. Dr. McLean, at the request of ■ tho Board of Health, gave his view's in regard to the existing conditions in regard to practice generally, and indicated where, in his opinion, improvements in the existing system could he made.

B.M.A. TO ADVISE? After discussing the matter fully bho board agreed to set up. a committee, consisting of the Minister (the Hon. C. J. Parr), Sir Donald MoGavin, and Dr. J. S. Elliott, to review all tho material placed before the board, and to report to the next meeting. It was also suggested that the committee might, in view of the fact tßat the local branch of the medical association had given tho matter attention, invite its opinion as to remedying the present state of affairs-