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114
Twenty of the stillbirths occurred in primigravidse ; and of the remaining
28 multipara,eight (29 per cent.) had previous miscarriages or stillbirths.
Of nine previous pregnancies, one woman had seven stillbirths, one miscarriage,
and one living child.
Forty of the forty-seven neo-natal deaths in 1933 were from causes
of intra-natal or pre-natal origin. Twenty-seven were certified as due
to prematurity; and of these twenty-four died during the first week. Of
the infant deaths from 1-12 months, eight were presumably of pre-natal
origin, viz., six from congenital malformations and two from marasmus.
These developmental deaths (48 in all), representing as they do 63 per cent,
of the total infant mortality, suggest some defect in pre-natal health.
Eighteen occurred in primigravidse : and of the remaining thirty multiparse,
six had previous stillbirths.
Routine Steps Taken with View to Possible Reduction in Neo-natal
Mortality.
Since 1929, Health Visitors have been instructed that, on making a
routine visit after a stillbirth or a death under four weeks, they must question
the mother particularly regarding :—
1. Health during pregnancy.
2. Health previous to pregnancy.
3. Previous abortions, stillbirths or premature births.
4. Attendance at ante-natal clinic.
5. Any other ante-natal treatment.
6. Condition of teeth.
7. Existence of vaginal discharge.
The question regarding the teeth is included, not because it is thought
to have a direct bearing on the subject of stillbirths and neo-natal deaths,
but because experience at the ante-natal clinics has shown that an astonishing
number of expectant mothers harbour obvious sepsis in their mouths
and are very difficult to convince that it exerts a harmful effect on their
own health and that of their baby.
Efficient ante-natal supervision is recognised to be a factor in the reduction
of neo-natal mortality.
In order to encourage midwives to send their patients to the municipal
ante-natal clinics, the following steps have been taken :—
1. A report on the patient's condition is sent to the midwife by the Clinic
Medical Officer in every case.
2. If the patient does not keep her appointment, or if any abnormality
develops, the midwife is notified.
3. If the abnormality is such that it is considered necessary that the patient
should be admitted to hospital for her confinement, the midwife is
compensated to the extent of 10s. per case.