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Ante-Natal Activities.
A detailed review has just been made for the five years 1926-1930 of the Ante-Natal
work carried out at the Council's Centres in the Borough, excluding the CamJen Town Centre,
from which a report was not furnished, owing to recent alterations in administration and
re-organisation. The results may be taken as representative, because the review covers a
period of five years and a group of over 2,000 cases. The value of this Ante-Natal service
is clearly demonstrated. The reports have been tabulated and summarised in the following
table which has been prepared by Dr. Pritchard, Assistant Medical Officer.
Both " patients,"—mother and child,—benefit from the service. The examination is
intended to discover if there is any condition present which could interfere with a normal confinement,
that is, both a normal labour and a normal child. It is said, on the authority of the
Medical Research Council, that more than 25 per cent. " of all dead births are due to the accidents
and complications associated with manipulation by a midwife or doctor at birth . . . .
They point to more and better ante-natal supervision of expectant mothers . . . ." The
greater proportion of that 25 per cent. can be, and is being, saved by the early discovery of
abnormalities. It is a well known fact that such conditions as a contracted pelvis or a
malpresentation of the foetus, if unheeded, lead to complicated confinements. These lead to
manipulations at labour, which is of necessity prolonged. The effect is detrimental to the
woman and her child. The endeavour of the Clinic is to make the actual process of delivery
as easy and safe as possible for both "patients" by the early discovery and appropriate
correction of any possible source of trouble.
The figures for St. Pancras are very satisfactory. In the group under review, 8 per
cent. of the 2,098 women examined were found to have some signs of possible danger; that is,
conditions were discovered which are known to be the cause of abnormal terminations of
pregnancy. It is fair to conjecture that, without, the subsequent supervision and treatment
which these 171 cases received, many of them would have resulted in death or injury to either
"patient." There were no maternal deaths and 80 per cent. of the births were of healthy
babies. We cannot measure morbidity in figures, but we can assume that it shares in the
general improvement due to the Ante-Natal care, as seen in the improved mortality.
It is not the function of the Centre to treat the conditions found. These are reported
to the midwife or doctor who has been engaged, otherwise the woman is referred to hospital.
Over 80 per cent. of the abnormalities were treated by Institutions, and over 70 per cent, of
the confinements took place there.
An analysis of the type of labour and the resulting child showed that about 70 per
cent. of the women had a normal delivery. There were 11 inductions for cases with abnormal
pelvis and these all resulted in healthy viable babies. Six of the eight Cæsarean Sections
were performed for the same condition and with the same successful results. Of the 19 cases
of malpresentation found at the ante-natal centres, and subsequently treated, only two required
surgical aid at labour, and one of these gave birth to a viable but short lived baby. The
others were all healthy. Until the early part of last century, it is estimated that about 80 per
cent, of all foetuses which were in an abnormal position, or which were associated with a
contracted pelvis, were born dead. There were 52 such cases under consideration, and only two
of the confinements ended in still-births. A similar table for other areas of activity has not
been brought to my notice, therefore comparison is impossible. The figures collected do show,
without doubt, that the Ante-Natal service in St. Pancras is doing useful work. Its effect
in reducing the Infantile Mortality is recognised, and it is looked upon as the most essential
fighting unit in the forthcoming increased activity to reduce the persistently high Maternal
Mortality.