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127
Total Puerperal Mortality.
Having regard to the foregoing facts, all references in this memorandum are to total puerperal
mortality as defined above and rates are calculated on total births, i.e., live and still births together.

The Total Puerperal Mortality Rate for England and Wales of round about 4 per 1,000 has given
rise to much anxiety, particularly as it shows little, if any, tendency to fall. These rates not only tell
of the deaths of women at a very vital period of life but also suggest that a still greater proportion are
more or less permanently disabled as the result of child bearing.
A number of bodies, official and unofficial, have investigated this problem and issued reports,
the most important of which are :—
(1) The Interim Report of the Departmental Committee on Maternal Mortality and
Morbidity issued by the Ministry of Health in 1930.
(2) The Final Report of the same Committee issued by the Ministry of Health in 1932.
(3) The Report on Maternal Morbidity and Mortality in Scotland issued by the
ment of Health for Scotland in 1935.
The reports all come practically to the same conclusion—that approximately 50 per cent, of
puerperal deaths are avoidable.
Causes of Puerperal Deaths.
The Interim Report of the Departmental Committee on Maternal Mortality and Morbidity
issued by the Ministry of Health in 1930 states, on page 105 that these avoidable causes fall into four
groups :—
Per cent.
(а) Absence of ante-natal care 17
(б) Errors of judgment by doctors or midwives 17
(c) Lack of reasonable facilities for effective medical care 5
(d) Negligence of the patient or her friends in respect of
given medical advice 9
Total 48 per cent.
The Report continues :—
" This gives a total of 48 per cent, of deaths which seem to us to have been directly preventable.
It leaves 52 per cent, of the deaths in which no preventable factor actually emerged.
With regard to a number of cases in this last group, it must be said quite definitely that a fuller
knowledge of the exact circumstances of death would probably have revealed a primary avoidable
factor. In summary, our finding is that of the cases of death brought under our notice not less
than one half were preventable."
Reducing the Risk of Puerperal Deaths.
To reduce the risk of puerperal deaths the Committee make four principal Recommendations :—
(1) The better education of the medical student in obstetrics.
(2) The better supervision of pregnancy, particularly by competent medical practitioners
in close touch with practical obstetric work.
(3) Improvement in medical practice. The Committee draw attention to the fact that
in nearly a third of the cases classed as errors of judgment on the part of the doctor the mistake
made was the premature application of forceps for delivery. The Committee further state that
" they have evidence of need for a higher standard of knowledge and skill on the part of the
medical practitioner on the spot as well as for the provision of consultant services and of an
increased number of available hospital beds."
(4) The Co-ordination of Maternity Services.
The Conclusions by the Departmental Committee responsible for the Interim Report are summed
up in the following language :—
" Generally speaking, it seems clear that the cumulative experience of a generation suggest
that the solution to the complex problem of maternal morbidity and mortality will be found in
an all-round tightening up as well as strengthening of each link in the chain of obstetric supervision,
an increased watchfulness over all stages of pregnancy and labour rather than in any single,