THE PERIL OF CHILDBIRTH
[To the Editor of THE SPECTATOR.]
SIR,—The varied correspondence provoked by my article confirms me in the conviction that we shall never solve this difficult problem until we " give up hunting for scapegoats, and airing our, several prejudices and predilections." I am glad to have the support of the correspondent who is likely to be most familiar with the realities of the matter. The expe- riences and observations of " A Queen's Nurse " practically coincide with my own—which, for the information of the irate Dr. Cook, I may say extend over forty years of active general practice. I would suggest to this latter correspondent that he read my article a little more carefully ; it may save him a lot of ammunition.
We all know Mrs. Ayrton Gould as a lifelong fighter for the political and economic emancipation of. women, and for the abolition of poverty. We can be sure that anythiiig she says is said with sincerity. ; .it, therefore, deserves sincere examina- tion. I am flattered to learn that ,with almost the whole of my article Mrs. Gould agrees ; and I am the more anxious to give reconsideration to my one inference to which she takes exception. She says that I appear " to have reached the conclusion that there is no particular connexion between malnutrition and maternal mortality " ; and goes on to say : " I suggest, on the basis of the following figures, that there is such a connexion, and a very clear and important one." It is true that, as Mrs. Gould points out, the maternal mortality rate last year in derelict Northumberland was 6.38 per thousand total births ; but in the Isle of Wight it was little less, and in prosperous Bath it' was considerably higher ; whilst in Lincoln the maternal death-rate was more than double that of any of these places. It is hard to believe that differing degrees of malnutrition constituted a main causative factor. Nor do nutritional differences explain the queer disparity between the maternal mortality rates of Rochdale (2.71), Huddersfield (8.81), Cardigan (9.6), and Merioneth (4.8)—as quoted in the House of Commons a fortnight ago-.
That malnutrition is an evil,.hygienic and other, is not open to dispute ; and -that, in spite of the optimistic summaries of our official Health Officers, relative malnutrition exists in many derelict districts at the present time seems proved. We shall, however, not strengthen but weaken the ease for remedying this state of affairs by arguing that malnutrition is primarily responsible for accidents in.ehildbirth, when all• the available facts seem to' show that it plays but a relatively stiuill part in these calamities.
Mrs. Gould suggestS that-the greater mortality rate in many well-to-do districts may well be due to the greater proportion of first births in these areas, it being " notorious ,that- first births are more dangerous than subsequent ones." 'It is, of course, true that first confinements are, on the average, more difficult and more painful than are subsequent ones. Pre- sumably, therefore; they are likely to be more dangerous. The Department df Health for Scotland recently investigated a thousand maternal deaths in order to find out the relative mortality among mothers of varying parity. The results of this limited inquiry showed that although first pregnancies were more dangerous than second confinements, they differed but little in risk from the birth of a third or a fourth child. All subsequent pregnancies showed a progressive rise in mortality rate with' each increase in paritye Evidently, therefore, we cannot find in the growing practice of birth control and limitation of families, any more than in mal- nutrition, an adequate explanation of present-day puerperal
mortality. YOUR MEDICAL CORRESPONDENT.
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