London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1928
[Report of the Medical Officer of Health for London County Council]
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The pre-natal, natal and post-natal mortality according to age of mother per 100,000 live born children was as follows:—
| Age. | Death rates per 1,000 births. | Percentage of total deaths. | ||||||
|---|---|---|---|---|---|---|---|---|
| Pre-natal. | Natal. | Post-natal. | Total. | Pre-natal. | Natal. | Post-natal. | Total. | |
| 15— | .20 | 1.81 | 1.97 | 3.98 | 4.9 | 45.6 | 49.5 | 100.0 |
| 20— | .17 | 1.69 | 1.01 | 2.87 | 6.0 | 58.8 | 35.2 | 100.0 |
| 25— | .24 | 1.91 | .94 | 3.09 | 7.7 | 61.9 | 30.4 | 100.0 |
| 30— | .37 | 2.41 | 1.10 | 3.88 | 9.6 | 62.2 | 28.2 | 100.0 |
| 35— | .73 | 3.32 | 1.42 | 5.47 | 13.3 | 60.7 | 26.0 | 100.0 |
| 40—45 | 1.59 | 7.35 | 3.32 | 12.26 | 13.0 | 59.9 | 27.1 | 100.0 |
It might be inferred from the mortality rates shown according to age of mother
in the above table (col. 5) that the risk of a married woman in childbirth is considerably
greater below 20 years of age than at age 20-25. This is, however, not the
case. The mortality rates for women under 20 are weighted by the high proportion
of single mothers, more than half the total births to women of this age being
illegitimate. The mortality among single women in childbirth may be taken to be
twice that of the married and on this assumption and with the aid of the fertility
rates by ages given in the Registrar-General's Report for 1922 (Text p. 158) the
maternal mortality among married women can be approximately stated, and is
shown in the following table:—
Approximate death rates in childbirth of married women per 1,000 children born alive—England and Wales, 1911-1921.
| Age. | Death rates per 1,000 births. | Percentage of total deaths. | ||||||
|---|---|---|---|---|---|---|---|---|
| Pre-natal. | Natal. | Post-natal. | Total. | Pre-natal. | Natal. | Post-natal. | Total. | |
| 15— | .13 | 1.18 | 1.28 | 2.59 | 5.0 | 65.6 | 49.4 | 100.0 |
| 20— | .16 | 1.52 | .91 | 2.59 | 6.0 | 58.8 | 25.2 | 100.0 |
| 25— | .23 | 1.86 | .92 | 3.01 | 7.6 | 61.8 | 30.6 | 100.0 |
| 30— | .37 | 2.41 | 1.09 | 3.87 | 9.5 | 62.3 | 28.2 | 100.0 |
| 35— | .73 | 3.32 | 1.42 | 5.47 | 13.3 | 60.7 | 26.0 | 100.0 |
| 40—45 | 1.59 | 7.35 | 3.32 | 12.26 | 13.0 | 59.9 | 27.1 | 100.0 |
| 15—45 | .37 | 2.31 | 1.14 | 3.82 | 9.7 | 60.4 | 29.9 | 100.0 |
These corrected figures show that the maternal risk in childbirth is lowest at
ages under 25 years and increases rapidly with age after the thirtieth year. The
high post-natal mortality at the age period 15-20 is entirely due to the far greater
risk of death from convulsions and puerperal albuminuria at this age, and especially
in primiparae (see p. 22).
The mortality under 20 years of age would be considerably reduced relatively
to later years if correction were made for the increased risk to the mother in the
first confinement. In Matthews Duncan's analysis of the Glasgow and Edinburgh
records for the year 1855 it is shown that 88 per cent. of the births to mothers under
20 were first births, and about 50 per cent. at ages 20-25, etc. Applying, faute de
mieux, Matthews Duncan's figures to the rates for England and Wales, 1911-21,
and assuming the mortality in first confinements to be twice that of subsequent
confinements among mothers of the same age, the approximate maternal risk per
1,000 births in primiparae and in multiparae is found to be as follows:—
Age of All First Subsequent
mother. confinements. confinements. confinements.
15— 2.59 2.75 1.38
20— 2.59 3.44 1.72
25— 3.01 5.01 2.51
30— 3.88 7.16 3.58
35— 5.47 10.41 5.21
40—45 12.26 23.73 11.86
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