MATERNAL MORTALITY.

Otago Witness, Issue 3526, 11 October 1921, Page 37

MATERNAL MORTALITY.

SUBCOMMITTEE’S EXHAUSTIVE REPORT. CLOSER INSPECTION AND SUPER VISION. WELLINGTON, October 8. The Board of Health has approved of the j report of the Hon. (J. J. Parr (chairman) and Drs M'Gavin and Elliott, who were appointed a subcommittee to consider the question of maternal mortality in New Zealand. The issue was raised in May last by the publication of figures in the United States showing that New Zealand was j second on the list of nations in respect of deaths supervening on childbirth. The com- 1 mit tee drew up a report, which was adopted : by the board this week. This report says: J “There is some uncertainty as to the way in which the statistics are compiled in the various countries, and, therefore, it is i.m- ; possible to say whether the place allotted to New Zealand is correct. The committee does think there is a doubt whether our own statistics are rightly classified, and more definite instructions should be given to the doctors. For its own use the committee had a graph of the maternal mortality in New Zealand prepared from 1872 to 1920, which showed four phases. Up to 1881 the mortality was comparatively low, being as little as 3.93 per 1000 in 1880. From 1882 to 1890 there was an increase, the maximum being 7.31. Then there was a fall for 20 years; but from 1913 to 1920 the death rate advanced again, and iast year reached 6.48. It is probable that more accuracy and inquiry account for part of tliis rise, but the plain deduction is that since 1914 there has been a remarkable increase. The principal causes of death arc: (1) Puerperal septicaemia; (2) puerperal albuminuria and convulsions; (3) puerperal hemorrhage; (4) accidents of pregnancy and other accidents of labour. During the last quinquennial period the average annual maternity mortality has been 157 deaths, of which 57 have been due to sepsis. The factors which lead to the occurrence of sepsis in this country must be put down under three main heads; “1. Abnormal violence of the organisms and the diminished resistance of the individuals, due possibly to the conditions during and subsequent to the war period. The lack of domestic help, and the fact of the housing difficulties may well be factors contribu ting to a diminished resistance. It has also been shown that there is an abnormally high death rate due to septic conditions following on attempts ro procure abortion. “2. Unsuitable surroundings, such as seme private houses. Moreover, some private maternity hospitals are not free from conditions which lead to septicaemia and allied troubles. “3. The unduly large use of instruments and ether operative measures at confinements, the use of which is urged by the patients and their friends. A reduction in instrumental delivery is urgently necessary.“ The recommendations of the sub-commit-tee, though having a special application to sepsis as a cause of death, are to a great extent of a general application. 'Hie subcommittee recommends: (1) That the Health Department should consider the present form of the certificate of the cause of death, with a view to seeing whether it could be amended so as to elicit from the medical man concerned a definite expression of opinion—(a) as to the cause of death where there are associated diseases; (b) as to the associated causes, setting out the primary and secondary, etc. (2) That every case'of maternal death shall be forthwith personally investigated by the medical officer of health. (3) That every case of notified puerperal sepsis shall be forthwith investigated by the medical officer of health. (4) That all maternity hospitals, both public and private, make a quarterly return to the department of the morbidity I rate as well as the mortality rate. A temperature of lOOdeg. on two different | days between the second and tenth day i shall be included in the morbidity con- '■ d it ions. ( (5) It is absolutely essential that every ! mother should be attended during con- | finement by a reliable and highly-trained j midwifery nurse. Hie committee reeom- ] mends that facilities should be given to j all practising maternity nurses to take a 1 refresher or post-graduate course at the ; various St. Helen’s Hospitals or other ap- : proved institutions at intervals of two or three years, and that compliance be

niado compulsory. (6) That the Hospitals and Charitable Institutions Act be amended to prevent the admission of one or more oases of confinement into any house for treatment in consideration of payment unless such house be licensed for the purpose. ■ (7) That the committee is strongly of opinion that a more strict and regular inspection of private maternity hospitals is necessary, and that, for this purpose ; more nurse inspectors of proved competence and experience should be obtained. \ Very careful revision of technique should also take place, and the inspection must 1 be directed especially to seeing that the | recommendations are carried out and the ' technique kept up to date. (8) That the committee considers that ; efficiently-equipped private midwifery j wards for paying patients should be established as soon as possible in connection with public midwifery institutions or > other suitable places. i (9) That, while the committee has reason to believe that the system of training midwives in New Zealand is not inferior to that obtaining in other countries, still the committee is impressed with the necessity for improving the present training, especially wit*n regard to the i supreme importance of a thorough knowledge of asepsis. The committee therefore recommends that the syllabus and course training be revised so as to secure 1 greater efficiency. (10) That the importance of sound training in midwifery at the Otago Medical School should be recognised by ihc creation of a professorship instead of j tiic present lectureship. (11) The committee finds from the evidence bet ore if that the use of instiu- ; rnonts in midwifery pi notice is excessive. and suggests that the special attention of 1 ih(-> medical profession be called to this fact, and that. the. co-operation and assist--1 ance of the profession he sought. In this connection tho committee learns with satisfaction that the medical profession, through its organisation, is alive to its rocpuiisibilitiea in tliis matter, and, hat

already taken steps to investigate the question, and very shortly is holding a dominion conference, at which the methods of technique are to be considered with a view to reducing to the lowest possible limit maternal mortality in this country. (12) Tho committee desires to stress the importance of tho use of ante-natal clinics, and, in private practice, the serious importance of an ante-natal examination. It cannot be too widely known that already ante-natal clinics have been established in each of the seven St. Helens Hospitals in New Zealand, and also at the maternity hospitals or wards under the j control of hospitals boards. ; (13) The extension of these establish- | ments is necessary, and the committee is pleased to know that the local hospital authorities are sympathetic to the cause of 1 the further development of this work. The | : Health Department urges all pregnant j | women to seek skilled advice during the | latter months of pregnancy at ante natal , clinics wherever these are available, or ! j at the hands of a medical adviser. Such ; ! examinations should enable a medical man I to detect many abnormalities and to avert j daVigerous complications. , In conclusion, the committee wishes to j strike a note of reassurance that there must | not be any undue alarm because of the statistics, because our statistics include not j only the deaths resulting at or after child- j birth, but also those occurring during tho ; whole course of pregnancy.