LETTERS TO THE EDITOR
[Correspondents are requested to keep their letters as brief as is reasonably possible. The most suitable length is that of one of our " News of the TVeek" paragraphs. Signed letters are given a preference over those bearing a pseudonym.—Ed. THE SPECTATOR.]
FOR SAFER CHILD BIRTH
[To the Editor of THE SPECTATOR.] SIR,—The question of our obstinately high maternal (and neo-natal) death-rate, 4.32 per thousand births, is an urgent one, and will not be solved unless all possibilities are courageously and honestly faced. We all admit that a number of deaths are caused by lack of suitable food, and by the appalling frequency of criminal abortion. These cases could be prevented by food and contraceptive advice, but neither malnutrition nor abortion are the primary causes of the problem.
The theory of malnutrition as the primary cause is dis- proved by statements like that of Dr. Fairbairn (in the Lancet). He says, " The maternal mortality rate is lower in the poverty stricken and badly housed areas of all our large towns, and higher in the well-to-do residential areas." The problem is, in fact, a psythological one. The • better educated woman, instead of looking upon childbirth as a natural function, has been encouraged to consider it as a major surgical operation. The poorer woman, having her baby in her own home, is helped by her own familiar sur- roundings and by the common-sense outlook of the well- trained midwife, who comforts her with a hot cup of tea and homely talk of a healthy baby. This is the moment when the right of every Amman is to be the centre of attention —to be loved—to be among her own people, and the emotional effect of being instead one of a wardful, must not be over- looked.
These facts certainly help to explain the splendid results obtained by district midwives and especially by the Queen's Nurses, whose mortality rate of 1.9 is a lesson to the whole country. But if we dispel this atmosphere of normality, as unfortunately it has been dispelled among the wealthier classes, and teach women to dread childbirth as an illness, with all the accompaniments of anaestheties and instruments, we are not only providing entirely the wrong mental atmosphere, but by the action of chloroform in slowing down the muscles we are also making an instru- mental delivery almost unavoidable. The•Departmental Com- mittee for Maternal Mortality tells us that one-third of the mistakes resulting in death, were the unnecessary use of forceps, and the same thing is implied in the Minister of Health's ,recent report. The Chief Medical Officer in this report alsO agrees with the Departmental Committee and with the British Medical Association that normal cases should be confined at home. He quotes the New York doctors who are 'begging healthy mothers to employ a midwife and to stay at home. (In the United States over 70 per cent. of babies are born in hospital, and the mothers' death-rate, 8.3, is the highest of any civilized country.) In hospitals there is a great temptfion to hurry events with forceps instead of waiting for a natural birth : Sir George Newman quotes one hospital where the instrumental deliveries have increased from 1.35 to 18.13 per cent.
But there will always be a certain number of women who, owing either to deficiencies in their own physical condition or because their homes are unsuitable for a confinement, will have to go into a maternity hospital. Their ,,chances of life and health would be enormously increased if the hospitals were not liable to overcrowding by all those cases who shop* remain at home. There is great danger now that hospitals, in order to obtain cases on which to train, their medical students and midwives, may book cases for whom there is not really room, and this results only too often in the sending away of cases actually in labour to find some other hurried shelter. A trained woman almoner should investigate cases who come to book beds, and , where the patients., and the circumstances are suitable, she should suggest that_ they remain at home and employ, certified midwives. This plan, would also encourage midwives to send doubtful cases early to hospital for that ante-natal advice so strongly urged by experts.
The Chief Medical Officer, in his last report, has pointed out how essential it is in order to make the ante-natal clinics a success, to obtain the co-operation of the midwives. At present midwives fear that if they do encourage their patients to attend the clinics, they may lose them, as women may he over-persuaded to enter the municipal hospitals and maternity - homes. In the last Ministry of Health Report the increased entry is said " not to be looked upon with favour by all experienced obstetricians," and this is putting it mildly. In cases where there is a definite reason why the hospital is the best place for any particular woman, the Local Authority should use its powers to pay compensation to the midwife whom she has booked, and in all cases the midwife should be treated with courtesy at the clinic and receive a full report of her patient. The Local Authority should also use its powers of paying the midwife's fees in cases where a suitable patient is too poor to pay it herself. One hundred and sixteen Local Authorities are now using this power, but in most districts all that they will do is to maintain the woman in a
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