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The death rate from all causes per 1,000 total population is 10.37,
compared with 10.36 in 1947 and 10.80 for England and Wales. Of the
340 deaths, disease of the heart and circulatory system accounted for 189
(55.59 per cent, of total deaths), cancer 63 (18.53 per cent, of total deaths)
and tuberculosis 6 (1.76 per cent, of total deaths).
The maternal mortality rate per 1,000 total births is Nil, as compared
with 1.02 for England and Wales.
For the second year in succession, the Corporation will no doubt
view with satisfaction the record of maternal health as shown by the
previous paragraph. No maternal deaths, that is deaths during pregnancy
from puerperal sepsis or other maternal causes, were recorded during the
year.
The birth rate (14.57), as foreshadowed in the report for 1947, has
continued to decline, and now compares with the rate of 12.63 which
was recorded in 1939, the last year before the war. The importance of
the decline in the birth rate and the effect upon the future population has
been well recognised by His Majesty's Government, who, in 1946, set up
a Royal Commission to report on the problems associated with population.
There was some easing of the position in relation to institutional
midwifery, and it is now found possible to admit for a hospital confinement
all primigravidae. It must be admitted that the need for institutional
care for many cases is obvious. Abnormalities and complications of
pregnancy as well as overcrowding and unsatisfactory home circumstances
in many cases make home confinement impossible.
The Royal College of Obstetricians and Gynaecologists, in their report
entitled " A National Maternity Service " in 1944 made a general recommendation
that all first pregnancies should have institutional delivery.
The Ministry of Health fostered the idea of institutional confinements
even before the war, and in consultation with the Royal College set a target
of 70 per cent, of all deliveries being accommodated in hospital. Undoubtedly,
there is an ever-increasing demand for institutional
confinements, and it is doubtful whether the demand will be satisfied or
reach equilibrium when the target of 70 per cent, has been reached.
The growth of this demand is well illustrated by the available statistics.
In 1927, 15 per cent, of women were delivered in hospital, in 1937, 35 per
cent., in 1946, 54 per cent., and in Beddington and Wallington in 1948,
58 per cent.
Institutional care is not essential for low maternal mortality rates or
for low neo-natal and stillbirth rates. In Holland, 80 per cent, of
confinements are conducted at home, and that country has always shown
very low rates and has an eminently satisfactory domiciliary service.
Overcrowding, bad housing, and the difficulty of obtaining domestic
help are responsible for the growing demand in this country.
One of the main disadvantages of pressing for an increase in hospital
beds for midwifery is their rising cost. Whereas a hospital bed as recently
as 1946 could be provided for £4 a week, the latest estimate from the
Regional Hospital Boards shows that the present cost is about twelve
guineas per week. In the face of an economic crisis and also the shortage
of beds for other classes of patient, there would appear to be no justification
for providing maternity beds for all or even 70 per cent, of
confinements.
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