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category of causes that could have been prevented. All
four cases died in hospital.
As a preventive service the Local Authority provide
among other services, ante-natal clinics, maternity hospital
accommodation, an obstetrical specialist for emergency
cases, and under the Midwives Acts the services of
a doctor in a midwife's emergency. The problem of
maternal mortality must lie in the hands of the skilled
midwife and the skilled doctor, but more important than
all, the patient herself must practice the principles which
make for a healthy pregnancy. There is still too much
interference with pregnancy and the undermining of the
mother's health by the prevalence of the use of
abortifacients. Abortion is treated too lightly by the
unthinking mother, and the mother still neglects to
accept the advice and care until late on in pregnancy.
The other extreme is the mother who takes so much care
that she creates an anxiety neurosis and fear of motherhood.
Between the two extremes lies the happy medium;
the skilled advice and supervision throughout pregnancy
and the provision of accommodation for an abnormal
confinement.
One feels that under the present system there is lack
of co-ordination in the maternity services for the
necessitous patient. I believe the remedy lies in making
the practising midwife a state service; the ante-natal period
of all cases under the supervision of the medical
practitioner; maternity beds being reserved for the cases
selected by the doctor and those showing possible
complications, while the normal case can safely be left in
the hands of the skilled midwife. There is a tendency to
hospitalise the normal case, which is brought out by the
fact that in 1934 forty-four per cent. of cases admitted to
the Maternity Hospital were accepted as midwives' cases.
Our efforts as a local authority should be to promote a safe
confinement in the home with a reservation of beds for
the complicated, or likely to be complicated, case.
III—MATERNITY AND CHILD WELFARE.
The Maternity and Child Welfare services consist of
the following:—