[To the Editor of THE SPECTATOR.]
SIR,—Just a very few lines to remove a small misunderstanding from the minds of one or two of your correspondents. Both Dr. Cook and Mr. Walker seem to assume that I consider,* hospital, rather than a home, to be the best place for a normal confinement. I expressed no such opinion. Indeed, I am rather inclined to think that really normal confinements can be satisfactorily completed almost anywhere. I have attended parturient women in gipsy-tents, circus caravans. East-end slums and country mansions, with equally good results. That a properly equipped and properly staffed hospital is the safest place for the conduct of abnormal labour is on the other hand, as obvious and well-proved a fact as that it is the best place for a major surgical operation. The point I made, however, was that, whether for good or for evil, women are increasingly choosing to be confined in hospitals.
In a large practice with which I am familiar, the number of women attended at childbirth in"their own homes twenty years ago averaged from four hundred to five hundred a year. The practice is, today, as large as ever ; but the number of confinements attended last year was twenty-nine— nearly all the women in the district having got into the way of going to hospital to have their babies. This hospital- ization of midwifery is general throughout the country. One result, as I pointed out, is that the younger general practitioners of today get very little experience of what used to be a very important part of their work. There is, in my opinion,• little likelihood that mothers will stop at home in future in order to give these young doctors the opportunitl of learning their trade. I am not arguing as to whether this is a fortunate or an unfortunate thing. I merely say thlit it is a fact, and one that we shall be wise to take into account. The final paragraph of Mr. Walker's letter is really too ingenuous. Of course, the figures of ,operative midwifery— including Caesarean Section—are many times " worse " than those for normal unassisted deliveries. The on.y useful comparison would be between operative deliveries and similarly abnormal confinements unassisted by the obste- trician. The mortality figures of the scattered rural districts of Wales and Scotland, remote from the possibility of operative assistance, are, at any rate, suggestive. Mr. Walker writes from Cambridge. Last year the Maternal Mortality figure for his county was 8.49 (will Mrs. Gould please note ?), whilst that for London was 3.55. In which administrative county, in Mr. Walker's opinion, were operative obstetric procedure's carried out in greater proportion ?—Yours, Youa MEDICAL CORRESPONDENT.
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