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51
It will be seen that the maternal mortality has been persistently
high and has recently shown a slight tendency to rise.
Ante-Natal Service.
Until the autumn of 1934, the ante-natal clinic was held at
the School Clinic every other Wednesday morning by Dr. Bell, but
towards the end of the year Dr. Howell attended on the other
Wednesday morning, and her report is appended here.
In Memorandum 145, certain suggestions were made
which we tried to some extent to carry out and our object in having
a weekly clinic was to move further in that direction.
Memorandum 145 suggested that two kinds of ante-natal
clinics should be established, namely: (a) the consulting clinic and
(b) the clinic for routine examination. In every report great importance
is laid upon the desirability that the doctor who attends
at the confinement should also be associated with the ante-natal
examination of the patient. When the agreement for maternity
beds at the Central Middlesex County Hospital was concluded, this
end was partly consummated. The expectant mother was asked
to attend at the Council's ante-natal clinic, and if the conditions
were found to be favourable for a natural confinement she was
referred to the Medical Superintendent of the Hospital who arranged
for her attendance at the ante-natal clinic held there. But these
cases, do not of course, include all the confinements, and do not
touch those sent up by the doctors and midlives.
In Memorandum 145 it was suggested that a patient should
first attend at the 16th week of pregnancy, unless owing to trouble
at a previous confinement she had been asked to attend earlier.
At this visit a full medical and obstetrical history should be taken,
and if she is prepared a physical examination should be made.
This should include examination of the urine and an examination
of the blood pressure as a standard for future reference. Dental
treatment if found necessary on examination, should be arranged
for. The pelvic measurements should be taken. Recently very
much stress has been laid upon the blood pressure and the weights
of the patient and it is suggested that these should be taken at each
visit. It is advisable, for instance that the blood pressure be taken
weekly during the last month, as a rise of pressure may be the first
sign of a commencing toxaemia. From this time routine examinations
should take place as follows:—At the 24th and 28th weeks,
from then every fortnight until the 36th week, and thence weekly
until she is confined. Under present conditions it would be impossible
to carry out the work effectively, and it was decided that