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Seven maternal deaths, excluding the deaths after abortion,
were due to Puerperal Septicaemia. Of all the deaths, nine, or
50% were from this cause. In two of these cases only was there a
history of difficult labour—breech deliveries—necessitating interference
and consequent laceration of the soft parts. In all cases
the temperature rose on the 3rd to 5th days, and in one patient
(who was unmarried) there was a history of rise of temperature
before delivery. Four of the seven cases were delivered
by doctors (two being difficult breech cases) and three by private
midwives. There was a history of some antenatal care in two of
the doctor's cases, and one of the cases delivered by midwives
received regular antenatal supervision. The source of infection
in these normal deliveries is frequently difficult to trace, if one
assumes that labour was conducted with due attention to asepsis
and antisepsis.
Pulmonary embolism and Ante Partum Haemorrhage account
for two deaths which are regarded as true accidents of
child-birth. Two women died immediately after delivery:
delivery in both cases was long, difficult, and instrumental. One
mother was a primipara, the other a multipara (10th). Neither
had received any antenatal care.
Of the two remaining cases both had been seen antenatally at
regular intervals: one died following severe haemorrhage, due
to placenta praevia.
The other death from Acute Yellow Atrophy is interesting
in that no symptoms developed till the 4th day of the puerperium.
Pregnancy was normal—the supervision was conducted throughout
by a competent midwife. An autopsy revealed all the changes
associated with Acute Yellow Atrophy.
In a borough such as West Ham, which is essentially
industrial, with many very poor districts, the maternal mortality
rate of three is low compared with that of the country as a
whole. Of all births, 55 per cent. were delivered by midwives.
There are in this area several big maternity Centres recognized
by the Central Midwives' Board as training schools for pupilmidwives.
These centres have districts attached, in which
patients are delivered and nursed by midwives and pupils under
the same careful supervision that exists in hospital. Further, all
such patients are obliged to receive antenatal supervision. The
private midwives are keen and conscientious, and one finds that
many of them undertake antenatal work or arrange that their
patients attend a clinic. It is hoped that a still closer co-operation
in antenatal work, including co-operation between doctors,
midwives, and clinics, and the patients themselves, may result in
a lowered maternal mortality rate in the Borough.
The analysis of the causes of deaths among mothers during
the last year points to several factors which obtain in causing
the relatively high mortality rate—lack of antenatal treatment or
supervision is one of the most outstanding of these factors.
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