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Chapter LII.
Maternal Mortality—Preventive Work.

About the middle of 1921, the matter of maternal mortality began to be a subject of discussion, especially by the Board of Health; and investigations were being made by the Health Department into the cause of the high rate of deaths due to child birth. In New Zealand this worked out to six per thousand, though in the St. Helens hospitals it is only four per thousand, in spite of the fact that cases are often admitted at the last moment when doctors are in difficulties outside, or when no ante-natal treatment has been given, and women are brought in in a state of eclampsia, or other complications.

Rather a panic ensued on account of the publication of unfavourable statistics regarding maternal mortality, and comments by Dr. Truby King, whose campaign against infantile mortality is so well known.

The Council of the B.M.A., deprecated his statement that for every 100 women sacrificed, 1,000 were gravely damaged and that of the 30,000 children born each year, 1,000 were damaged by precipitate midwifery, and it considered that such statements were absolutely contrary to fact, and seriously and unnecessarily alarming to the expectant mother.

The Department of Health, greatly with a view to reassuring the public, went into the matter carefully. Dr. Jellett, who had recently arrived in New Zealand from Dublin, where he had for years held the office of the Master of the Rotunda, the famous maternity hospital, page 245 and whose text books on midwifery for students and nurses are so well known, was appointed to inspect maternity hospitals, and advise methods of improvement. Several nurse inspectors were added to the staff, and more frequent inspections of private maternity hospitals and midwives were made. Strict regulations regarding aseptic procedures were drafted and sent out.

The equipment of the St. Helens Hospitals was improved, and the owners of private maternity hospitals were obliged to obtain equipment deemed necessary.

An important part of the preventive work was the development of the ante-natal care which had, since their establishment, been carried on by the St. Helens Hospitals where not only patients who were booked for the hospitals were urged to attend, but women generally were invited to come for examination and advice. Dr. Eleanor Gurr, who had worked in London in a similar way, was appointed special officer for ante-natal work, nurses were given special training and an examination was set for them and they were then given charge of the clinics, which the medical officers attended. This was all thought to be a new thing, but as I said above, the St. Helens Hospitals had all given ante-natal advice to their own patients. During the War, when there was an acute shortage of doctors in most towns, we found that many women were coming in to the hospitals in extremis, owing to neglect of symptoms which ante-natal care should have treated. The Department of Health then decided to throw open the advantages given to the patients booking to enter St. Helens for confinement to those who did not intend to enter and who had engaged private doctors, or lodge doctors. I remember preparing notices and circulars which were published in the papers, and sent to private practitioners, and to Friendly Societies offering free ante-natal page 246 advice to any women who desired it and guaranteeing that, if found in any way suffering from abnormal conditions, she would be referred to her own doctor.

Sad to say, this offer met with little response and it was only when the alarm caused by the publication of maternal mortality statistics became general, that the clinics were able to accomplish much good. However, the results have been shown since then and women came readily for advice and accepted treatment which has certainly obviated or lessened some of the causes of death, such as eclampsia, and placenta prævia, for which so much can be done by early diagnosis and care.

In 1922 the Health Department arranged for a course of special lectures and meetings to be held by Dr. Truby King, at that time Director of Child Welfare, in the Department. He was to be assisted by a visitor to the Dominion, Miss Jentie Paterson, a trained nurse and midwife, who had worked with Dr. Truby King at the Mother-craft Hospital, London.

These meetings were held in various parts of the Dominion, and demonstrations were given of the care of infants and of the establishment of breast-feeding, and the supplementing where mothers' milk was not sufficient. At one of these lectures, given in the Red Cross rooms at Wellington, Dr. King made some statements regarding the practice of a midwife, which I felt he should be called upon to substantiate, and to give me the opportunity of looking into the matter. I think in his eagerness to impress he must rather have exaggerated the case he was illustrating, as repeated requests from me drew forth no reply, or statement of facts.

Besides these lectures, a number of lectures were given to midwives generally, by the Medical Officers of the St. Helens Hospitals during a Post-Graduate week held.