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40
Maternity and Nursing Homes.
The Nursing Homes Registration Act, 1927, came into force on 1st July, 1928.
Although, as regards the County of London, the London County Council was made the local
supervising authority, power was given to delegate all or any of the duties to the Metropolitan
Boroughs, other than the power to make by-laws.
Representations were made to the London County Council, stating that on grounds of
efficiency, economy, and the avoidance of overlapping, the Metropolitan Boroughs should have
delegated to them all the powers under the Act, other than the power to make by-laws.
The London County Council did not accede to the representation.
Maternal Mortality.
Six deaths occurred during the year either "in or in consequence of" childbirth,
giving a Maternal death rate of 1.8 per 1000 live births.
Considerable attention was given to this subject during the year, not only by the
Ministry of Health, Maternity and Child Welfare Authorities, Medical Practitioners, etc., but
also by the general public.
In June a circular was issued by the Minister of Health to all Maternity and Child
Welfare Authorities, stating that it was desirable that there should be an investigation in every
area by a competent and experienced Medical Officer of all Maternal deaths and of all cases of
Puerperal Fever, with a view to ascertaining more exactly the actual causes which lead to
Maternal Mortality, in order to provide further means of prevention.
The Minister also set up a representative Maternal Mortality Committee, whose duties
included the consideration of the scope of the investigations to be made, and the collation and
classification of the information obtained.
A form of inquiry was subsequently drawn up by the Committee to serve as a guide in
making investigations.
Normally these inquiries, which are somewhat detailed, are undertaken by the Medical
Officer of Health or by the Assistant Medical Officer, but in cases where it is considered
desirable investigations can be referred to either of the two consulting Obstetric Surgeons
who have been appointed by the Borough Council.
The popular interpretation of the meaning of the term "Maternal Mortality in Childbirth,''
is the risk incidental to an average full time confinement, and this meaning is
emphasized by the fact that the rate is always expressed as so many deaths per 1000 live
births. Attention should be directed to the fact that official statistics with reference to
Maternal deaths include, not only the deaths incidental to full time pregnancies, but also the
deaths resulting from Abortions, Ectopic pregnancies, and other affections and accidents
incidental to pregnancy in its early stages.
As the rate is expressed as so many deaths per 1,000 live births, the inclusion of deaths
arising in consequence of abortions, etc., unduly swells the maternal mortality rate.
It should also be pointed out that many cases of Sepsis and other fatalities associated
with abortion, etc., are not normal risks of pregnancy, as they are frequently induced by
deliberate interference, due to a desire to terminate an unwanted pregnancy, and as a result
of this many of these cases are the subjects of Coroner's Inquests or Post-mortem investigation.
It would appear to be desirable that, in order to obtain satisfactory statistics with
reference to maternal mortality in childbirth, the cases mentioned above should be excluded,
as they cannot be regarded as part of the ordinary risk associated with childbirth. It would