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39
Whenever there is a case of maternal mortality, and even in cases where the
death is following abortion or where death is associated with pregnancy or childbirth
but primarily due to intercurrent diseases such as nephritis, tuberculosis, heart
disease, etc., full investigations are carried out and confidential reports communicated
to the Ministry of Health.
After many years experience I cannot very well but hold the opinion that
maternal mortality is a term very difficult to define, and that its interpretation
may vary in different areas. This of course invalidates statistical information so
far as its value for comparison is concerned.
The problem of maternal mortality continues to be one which, though tackled
from many sides, has not been solved. It is indeed complex, and though each
advance in knowledge is in turn applied in the effort to reduce the unfortunately
large number of maternal deaths the level remains approximately unchanged, Is
it possible that the "advance" of civilisation also undermines in one way or another
the constitution of those who "enjoy" its benefits? And can the Great War, with
the inevitable nervous strain and the shortage of some essential foods, be held to
contribute to the mortality of those young mothers who were born or who were
young children during these years ?
That some accidents are inevitable is accepted by all, and in analysing the cause
of deaths, just under 60 per cent, have been classed as "avoidable" (Scottish
Enquiry): the term avoidable is here used in a wide sense and represents a
probability rather than a certainty. One-third of these cases are attributed to
negligence or ignorance of the patient. Nearly half the avoidable deaths were
attributed to lack of care or to not seeking, or ignoring advice given during pregnancy,
and half to faults arising during delivery. The proportion of deaths
attributed to midwives and doctors cannot be used in general condemnation—
a proportion of the patients are accident-prone.
It is regrettable that there still are women who do not avail themselves of the
facilities provided, who only seek help when they find that some abnormal condition
has arisen, or who will not act upon advice given.
The maternal mortality rate includes deaths due to causes associated with
pregnancy, parturition or the puerperium but not directly due to this state, and
so may prove at first sight misleading.
The risk to mothers varies widely with age and the number of previous pregnancies
: adverse home conditions seem to have a definite association with the death
rate.
Puerperal sepsis accounts for about half the cases of maternal mortality, and is
very little lower since aseptic technique has been introduced. Epidemic puerperal
sepsis is on the wane, but sporadic cases continue to arise.