MATERNAL MORTALITY

Waikato Times, Volume 106, Issue 17835, 7 October 1929, Page 9

MATERNAL MORTALITY

ITS PREVENTION. EDUCATION A NECESSITY. INSUFFICIENT IN THE PAST. 11. Tiie following article was prepared for Ihe Press at ihe request of the president of the Australian Medical Association Conference recently held in Sydney, and is published at the request of the New Zealand Department of Health. If both the medical practitioner and the midwife are to carry out their duties! their education in maternity | matters must be as thorough as it is ,1 possible to make it—a fact which, until recent years, has been more obvious than accepted. The obstetrical education of both medical student and midwife throughout the British Empire has been in the past wholly insufficient, and still is incomplete. There is no special failure in Australia or New Zealand. As a matter of fact j it is probable that Hie advances made I in the education of the medical student j at the Sydney University, and of mid- | wives in New Zealand, are at least as great, if not greater, than in the other parts I have mentioned of the Empire. Still, the fact remains that, while in New Zealand the period of education of a midwife is sixteen months, in Holland it is three years, and that even Ihe most devoted efforts of Professor Windeycr have not enabled him as yet to bring the teaching of medical | students up to the standard of Utrecht University. The Dutch systems were ! not built in a day, and time and oppor- | tunity will enable British—l use the word in its widest sense—systems to rival them. Ante-natal Care and Diagnosis. Ante-natal care and diagnosis should ho wholly a matter for the medical I practitioner. Actually, at the present ! time, it has been found necessary to ! delegate much of it to midwives. I There are many reasons for this, not ; the least important of which are, | j first, the impossibility of persuading I Mhe public that such care is essential; secondly, the economic question, which makes it difficult for a practitioner to give tiie time lie would like lo duties for which often he is unpaid. The importance of ante-natal care cannot be exaggerated. There is one disease of pregnancy, (be mortality of which, by constant observa- j tion, can he reduced to a tenth of what ! it ordinarily is. There arc others in j which the reduction is almost equally j striking. Again, ante-natal diagnosis is essential to the welfare of the abnormal woman during labour, and can reduce the mortality of the so-called accidents of labour to a third. Together with ante-natal care I believe it can reduce the total maternal mortality rate’ by a figure between 1 and 1.5 per 1000. Still, the indifference j of the public to the importance of care and diagnosis is almost incredible. It is possible that in the past the modi- J cal profession, too, may not have j recognised their extreme value, but j at the present lime practitioners for j . Ihe greater part arc thoroughly i; awake to it, and cannot be blamed for \ the general failure to obtain their < benefits. !

Suitable Environment. I By suitable environment I mean ! everything in the surroundings of the patient which tends to promote the practice ol' asepsis, and which makes any necessary intervention in obstetj rical emergencies safe and easy.- The i value of suitable environment thcorctl- ! eally varies according to the circumstances and the nature of the case. ! Thus in a normal confinement, normi ally managed, in a private house, enj vironment is possibly of small importance, since intervention should never be necessary. Jn hospitals, public or private, environment is all important ! on account of the increased risk of j infection due to the presence of other j patients. In abnormal cases, whether iin public or private, environment is l again all important. So much is prob- : ably right in theory. in practice, however, seeing that unexpected corn--1 plications may occur and necessitate | ' intervention, suitable environment is i always necessary. The conditions under which a confinment is carried | out must be similar to those of a ! surgical operation if the greatest I possible degree of safety from infection is to be obtained. Some or . the necessary operations of midwifery are even more prone to the risk of infection than in what is commonly called | a major operation. Yet the public j mind fails either to grasp the necessity J for preparation or to agree to the | slight extra expense which preparation i entails. It is possible that in the past j the medical practitioner has failed to | drive home the necessity for asepsis j and the obligations which its rccogni- j fion. implies and has allowed himself i to be forced to perform maternity j operations under conditions in which j lie would hesitate to remove a diseased ! tonsil. Here, too, however, reform is j coming, but it cannot be sufficient | unless the common sense of the j patient supports it, and she does her | share in its establishment. Over- ! furnished bedrooms, dusty carpets and j hangings, insufficient accommodation I for the necessary medical appliances j and basins are no more permissible in 1 ttie confinement room of a private j house than they are in the operating : theatre of a hospital. It is false j reasoning to think that because child- i birth is a normal and physiological function its environment is a matter of no importance. Childbirth under the circumstances which surround it in civilisation is so far rorn normal that the function has become pathological. Some day it is possible that it may again return to the normal, but in the meantime 1 am afraid we must act under the belief that there is hardly an incident in its course which is not opposed to the normal. For this tradition and civilisation arc responsible, hot the medical profession.

Summary. I have possibly exceeded the space placed at inv disposal, hut before J end I would like briefly to summarise my views. I think that the reduction of" maternal mortality can best he obtained by gradual efforts to . bring about the following changes:— 1. The recognition by the public of the fact that the valuable time and skill of the medical practitioner should he utilised for the essentials of midwiferv and not for the non-essentials That he should be regarded as wholly responsible for ante-natal care and diagnosis, the management of abnormal labour, and the post-natal care of I he patient. That tie should be relieved from the servitude of attending norma! labour to which it is economically impossible for him to give the required time and medically unnecessary, 2. The recognition by the public of

the essential necessity for ante-natal care and diagnosis. ;i. The recognition by all concerned that the education of medical students and of midwives must reach the highest standard. 4. The recognition by the public that the environment of women in childbirth, both in hospitals and in private houses, must he brought into as close resemblance to that, of a surgical operation as is possible. Medical Profession Will Assist. If tiie public can he brought to assimilate the ideas and to consent to (tie changes they involve I do not think tiie medical profession will be found backward in agreeing to them. I have necessarily had to condense my views in this article. I have, however, dealt with the matter with greater fullness in a recent book on the causes and prevention of maternal mortality, which, though primarily intended for the medical profession, may also he of use to those who are assisting in the great work of reducing maternal mortality. Assuming my views to be right, what should he the logical preparalion in this country of their adoption? I think it may be summed up in two words—more education. There Is (lie education of the general public necessary to enable them to understand the need for, and to demand, a maternity system which is based on knowledge and experience, not on tradition and the fancied claims of civilisation. There is the education of the medical profession in the obstetrical art, tooth as medical students and as members of a profession which spends its life in learning. There is the education of the midwife which will enable her to take her necessary place in (he management of maternity. Finally, (here is the education of everyone to enable them to realise that the problem of the reduction of maternal mortality is their own as well as their neighbour's, and that to them, too, belongs In part the responsibility for its solution. I