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46
Maternal Mortality
Statistically, maternal deaths should be related to all those
women who are pregnant during the period of the review. However,
as this is impractical (for miscarriages are not registerable and
many pregnancies are terminated unbeknown to the authorities),
the extent of maternal mortality is measured against the total of
live and stillbirths registered which gives a reasonably accurate
basis for enumerating pregnancies during the interval of assessment.
Maternal mortality is conveniently defined as the number of
women dying from complications of pregnancy, childbirth or
puerperium during the year. This is then related to the number of
live and stillbirths during the same period to give the maternal
death rate. Abortion, because of the possible criminal element, is
often excluded but, when included, the fact should be stated.
Studies have shown that expectant mothers on a poor pre-natal
diet become greater obstetric risks and the incidence of miscarriages,
stillbirths and premature births increases. Moreover,
subsequently the offspring of such mothers appear more prone to
illness and infection.
in the 5th Report issued by the Department of Health and
Social Security on confidential enquiries into maternal deaths in
England and Wales during the years 1964-1966, it was revealed
that of a total of 579 deaths directly due to pregnancy or childbirth,
some 263 or 45% were probably avoidable. Of the deaths
with an avoidable factor, more than one third were due to illegal
abortion.
There is some satisfaction expressed in the Report to the fact
that the present total is less than ½ of that disclosed by the 1st
Report covering the years 1952-1954.
In assessing present knowledge on this subject, Sir George Godber,
Chief Medical Officer to the government department, states
that the best time for a woman to have her first child is between
the ages of 20 and 25 and that, to minimise the risks, her family
should be completed before her 30th birthday.
The one maternal death recorded for Greenwich during 1968
concerned a multipara of 33 years of age, the cause being attributed
to abortion. A maternal death rate of 0.29 was returned
compared with a figure of 0.54 for 1967.
The current rates for England and Wales and Greater London
were 0.24 and 0.39 respectively, while Inner London registered a
rate of 0.58.