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10
The council view the high infant mortality rate in the borough with concern and have given
much time to the consideration of measures which might help in its reduction. The details of each
individual infant death are scrutinised month by month by the maternity and child welfare committee
in an attempt to gain possible further elucidation into the causes of the persistently high death rate.
In addition to re-organising the medical service, the council have very largely increased the supply
of free milk to children up to three years of age, and have decided to grant free cod liver oil or its
equivalent whenever necessary.
At the end of the year, the maternity and child welfare committee appointed a sub-committee
to investigate still more closely the prevalence of enteritis which adds so largely to the high infant
death rate. This sub-committee is now engaged on the problem before them.
Maternal Mortality.
There were five deaths of Kensington women directly associated with childbirth in 1935, representing
a maternal death rate of 2.2 per 1,000 births. The corresponding rate for England and
Wales is 3.93.
Four out of these five were cases of abortion resulting in sepsis and death; only one
Kensington woman died after confinement during the year and this death occurred in hospital after
a serious operation (Caesarean hysterectomy). The latter patient had attended one of the borough
ante-natal clinics when she was six months pregnant and, on account of previous difficult labours,
was advised to enter the hospital to which she was promptly referred. She received ante-natal
supervision at that hospital and was under the care of the visiting obstetrician during her labour.
Despite the unfortunate issue of this case, it is clear that all possible facilities had been employed to
render the confinement as safe as possible.
The apparent prevalence of induced abortion is a matter for serious concern and an effort has
been made by the council's officers with the assistance of the staff of the welfare centres to awaken
public opinion to the dangers of this practice. Some progress already has been achieved in this
direction and it is hoped that this avoidable cause of maternal mortality and morbidity may soon be
greatly diminished.
The prevention of difficulty in labour and the improvement of the expectant mother's health and
nutrition are sound principles on which to work in securing the reduction of the mortality rate;
and the ante-natal service is the most important means to attain this end.
The percentage of Kensington women who received ante-natal supervision at the borough centres
and at the clinics attached to Queen Charlotte's Hospital and St Mary Abbots Hospital during the
year is difficult to calculate with accuracy, as many women attended both borough and hospital
clinics, but it is probably about 85 per cent, of the total births; this is a satisfactory figure as many
of the remaining births occur in better-class families where the mother receives ante-natal care
from her own doctor or from a specialist.
The ante-natal work of the borough has been carefully developed and organised and now reaches
a high standard. The year's record includes few unusual cases, obstetric abnormalities having been
detected and referred for treatment in their early stages, dramatic complications thus being avoided.
Out of 17 cases of contracted pelvis only two needed Caesarean section, six being delivered by forceps
and the rest having normal confinements. It is interesting to notice in a large proportion of these
cases showing definite pelvic contraction that no obstetric interference was necessary; this illustrates
the importance of avoiding meddlesome midwifery.
The rectification of malpresentations by external version in the clinics has produced good results.
Out of 46 cases, 41 were turned successfully and had normal confinements. In five cases of extended
breech presentation, version was found to be impossible. These were all referred to hospital; in
three of the cases version was successfully performed under an anaesthetic and these patients had
subsequent normal confinements ; the two cases in which version was not performed were delivered in
hospital, but in spite of skilled attention at birth both babies were stillborn. This result shows the
success of version in cases of malpresentation in saving infant life : the 44 babies in which this antenatal
manoeuvre had been performed were born alive, whilst the two babies born in the abnormal
presentation were stillborn.
There has been a number of recorded cases in the clinics of albuminuria of pregnancy, hyperpiesis,
pyelitis, heart disease, tuberculosis, and so forth, but of insufficient general interest to warrant
a detailed report. All the mothers eventually did well.
Six patients were advised with regard to sterility ; two of those who attended for this advice in
1934 have already become pregnant. Many women have also been seen by the council's ante-natal
medical officer for various psychical and menopausal disorders and after reassurance were referred
to the appropriate agencies for treatment.
It must be clearly understood that no medical treatment is carried out in the council's clinics,
patients who need curative treatment being referred to private doctors or to hospitals. The council's
health services are established for the prevention of illness and not for its cure.
Although midwifery forms the essential nucleus of ante-natal work, the latter extends beyond the
limits of obstetrics and the ante-natal clinic should be conducted with a view to the future welfare of
both mother and child, and not limited to the immediate confinement. Particular attention is paid
to the nutrition of the expectant mother in the borough clinics and free dinners, milk, adexolin and iron
are granted by the council when necessary. The advantages and practicability of subsequent breastfeeding
of the infant are stressed in the interview with each patient. Advice to obtain dental treatment
is meeting with an increasing response and the dental sessions attached to the centres are
becoming crowded ; the provision of free dentures by the council is proving of much benefit.
Not the least important work which is being done in the borough ante-natal clinics is the removal
of fear in the pregnant mother, this fear being so common a cause of uterine inertia and
difficult labour. The psychical treatment of the pregnant woman is of very great importance and is a
recognised factor in preventing those cases of obstetric shock and post-partum haemorrhage which
are too frequently a cause of maternal death.