View report page

78
Disappointment is expressed at the failure of the ante-natal
services provided by local authorities to affect anv reduction in
the maternal mortality rate, and many objectors are prepared
to advocate the abolition of the existing services. Their arguments
are apparently based on the assumption that other proposals
must be alternative to the existing ones—as though the present
services act as a stumbling block to the inception of a better state
of affairs, and that the first step must be the elimination of present
activities before the alternative arrangements can fructify.
To those who hold these views, it should be pointed out, firstly,
that the credit, not of recognising the necessity of ante-natal care,
but at least of educating the mothers of its advisability, lies with
the local authorities, and has been made possible only by providing
the services ; and secondly, that in providing the service, the local
authority wishes only to supplement existing arrangements, providing
facilities for those who cannot otherwise obtain them. It
is in no sense acting in antagonism to other services—-for instance,
expectant mothers who are already under the care of their own
doctors can still obtain auxiliary help provided, such as milk or
dental treatment, without attending the ante-natal clinic, provided
one is satisfied that ante-natal supervision in her particular case is
being carried out.
The main grievance voiced against the ante-natal service as
at present run is that it is not in sufficiently close touch with those
who have to carry out the confinement. In last year's report
are outlined the existing arrangements for this area, and the
association effected between the municipal ante-natal clinics and
other agencies. Under the new arrangements for paying the midwives'
fees in necessitous cases, it is hoped that contact with this
body of persons will be brought still closer. The chief defect of the
present local service, as has been pointed out on several occasions,
is that no provision is made for financial assistance for the slightly
abnormal case, who does not desire to be admitted to hospital,
to obtain the care of the doctor who is to attend the confinement.
How far did the deficiencies of the service contribute towards
the deaths of these 14 women ? Three of them had attended the
clinics and all three were admitted to hospital. The first was
admitted on account of domestic circumstances and had a norma
confinement ; the second was immediately transferred to the can
of the hospital authorities on account of contracted pelvis:
the third attended the ante-natal clinic four times with normal
urine, but died three days after the appearance of a trace of
albumin. Three cases were of women who had not treated with
sufficient respect the occurrence of an abortion or miscarriage.
One patient, a midwife's case, developed mental symptoms after a
normal confinement. One ease was already under the care of a