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the healthier her baby will be, and the quicker will she recover from her
confinement. I am not convinced, however, that malnutrition has any
real connection with maternal mortality. Correct nutrition of the expectant
mother must be an important consideration, and I am glad to say that it is
a point to which all medical officers in Stepney give special attention. After
April 1st, 1935, expectant mothers will be able to receive extra nourishment
through the Council's scheme from the beginning of the 4th month of pregnancy
instead of, as now, only from the beginning of the 7th.
I do not wish it to be thought that I am minimising the seriousness of
the situation, but it would appear that the actual maternity services in Stepney
are adequate and efficient ; that however does not mean that further improvements
should not be made.
There is one point which my analysis brings to light very definitely. I
refer to the apparent lack of intelligent co-operation on the part of so many
expectant mothers, and this is apparent more in multiparae than in primiparae.
I suppose that a mother having been piloted successfully through her first
confinement thinks she can pilot herself through the others. Until all
expectant mothers realise the wisdom of seeking the early help of a pilot on
every occasion, the maternal mortality will never sink as low as we would all
like to see it.
Again, and I do not want to be misunderstood, I have often wondered
if the much improved Maternity Schemes have been as futile as they are
made out to be. Have deaths as a result of early abortion always been
included as Maternal Mortality and are such abortions not on the increase ? It
has come to the pitch now that Local Authorities are judged by the Maternal
Mortality rate in their district, and it is very unfair that these deaths should be
allowed to swell the total upon which they will be judged. Women who wish
to procure an abortion will hide the fact that they are pregnant and will
certainly not attend an Ante-Natal Clinic. Deaths from abortion might be
considered to point to foolishness on the part of certain mothers in the district,
but should not be counted as a black mark against the maternity services of
the Local Authority. They should certainly be noted as a separate item, but
should not be included in the list of deaths which are due to child-birth.