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MATERNITY SERVICES
In discussing the local Maternity Services in last year's Report,
mention was made of the fact that certain groups of mothers are
more liable to serious complications of pregnancy or childbirth
than others, and these form the priority categories for hospital
confinements. In the current report on confidential enquiries into
maternal deaths, the Ministry of Health conclude from their investigations
that there are two outstanding factors which stand out
above all others and which are considered avoidable. They are:
(a) the making of an unwise arrangement for a forthcoming
confinement; and
(b) inadequate ante-natal care.
While it is possible that insufficient notice has been taken of
the emphasis which has been given to these important and easily
avoidable factors; nevertheless, the blame should not be laid on
the Doctor or the Midwife; indeed, in many instances the patient
herself aided by well meaning but misguided relatives and friends
provided an apparently insuperable obstacle, especially in the
higher parities and older age groups.
" As an aid to the making of the best possible arrangements for
any confinement it has been usual to list the indications for hospital
care and responsibility on the following lines: —
1. All women who suffer from any illness that in any way
impairs their general state of health. Obvious examples that
ccme to mind are diseases such as valvular disease of the
heart or diabetes.
2. Of equal or greater importance is grand multiparity. Parity
gieater than four is accompanied by a diminishing margin
of safety and over nine the risk of death is very greatly
increased.
3. All primigravidae over the age of 30, and multiparae over
the age of 35 should be confined in hospital. The safety
margin begins to contract over this age.
4. Any woman who has had abnormal previous pregnancies,
labours or puerperia. In this respect the importance of
previous toxaemia is generally recognized but the same
cannot be said of previous post-partum haemorrhage.
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