ANTENATAL CLINICS. In Great Britain, at the begin ning of the 20th century the only antenatal clinic was that of Dr. J. W. Ballantyne at the Edinburgh Royal Maternity hos pital. It was not till 1915 that a definite scheme was initiated to promote the antenatal supervision of the expectant mother and her unborn child, which is now recognized as the fundamental basis of all successful maternity and child welfare work. In 1915 experimental antenatal clinics were attached by the National League for Health, Maternity and Child Welfare to six existing London infant welfare centres, and on the lines then laid down similar clinics have since been established by local authorities and voluntary infant welfare institutions in all parts of the coun try.
By the end of 1917 there were 122 antenatal clinics at work, caring for approximately 10,300 expectant mothers (only 1.5 per cent of those to whom children were born during the year). By 1925 the number of clinics had risen to 675, while at the end of 1926 there were 772 antenatal clinics in England and Wales alone. They are attended voluntarily by pregnant women who desire to obtain medical advice and instructive help in the manage ment of their health throughout pregnancy, with a view to the ultimate production of a normal child. A medical practitioner, with special qualifications for the task, attends to make all neces sary examinations and give the advice required, in order that due precautions may be taken and preparations made, if any difficulties are foreseen in connection with the confinement. From I0–I5 mothers are usually seen at each session. Close co-operation between the local medical practitioners, midwives and public health officials has proved essential. Dental supervision has also done much to improve the health of expectant mothers and to facilitate subsequently the natural feeding of their infants. In most cases the antenatal clinic is linked up with appropriate hospitals or other institutions where treatment can be obtained, since the clinic itself is for preventive advice and not for cure. Simple talks and demonstrations are given on hygiene, clothing, food, etc., and the mothers are shown how to prepare the neces sary layettes and cradles.
Dame Janet Campbell, of the Ministry of Health, says "Until antenatal supervision is accepted by patients and their advisers as the invariable duty of the professional attendant engaged for the confinement, we shall never make substantial progress towards the reduction of maternal death and injury." In all countries where maternity and child welfare work is carried on, antenatal clinics also find a place, though they are neither as popular nor as well attended as are the post-natal clinics, or infant welfare centres. The early Victorian shyness on the subject has still to be overcome. That there is need for greatly increased antenatal supervision, is shown by the fact that the deaths of mothers in childbirth and of children under one month of age (which are usually due to antenatal defects) are not decreasing in any country in the same proportion as the mortality rate of children under one year of age.
The Federal children's bureau came into existence in April, 1912, but at first antenatal clinics organized under its direction were merely sporadic. Realization that many of the 23,00o esti mated deaths in childbirth in 1918 were preventable led to the introduction in 1919 of the Act which has done more to establish antenatal clinics in the United States than anything else, "An Act for the promotion of the Welfare of Maternity and Infancy." It was modelled closely upon the English Maternity Act and, after two attempts, was passed in 1921 with the weight of public opinion behind it created by the National League of Women Voters, the General Federation of Women's Clubs, the National Congress of Mothers and Parent-Teachers associations, some 15 other national agencies and many State and local organizations. It is popularly known as the "Sheppard-Towner Act" after the senator and congressman who respectively introduced it. (See MATERNITY AND INFANT WELFARE.) The funds released by this Act made possible permanent antenatal clinics. The number con ducted at the end of the fiscal year 1927 by the Federal Bureau, in co-operation with the various States was about 29o, of which 205 were combined prenatal and child health centres. During 1923-27 approximately 30,00o conferences were held at which some form of prenatal care or advice was given. About 340,000 expectant mothers were reached through personal contact at con ferences, or centres, through home visits made by nurses and other avenues. Over 90,00o sets of prenatal letters were sent out by the States in the two years 1926-27.
According to figures (192 7) supplied by the American Hospital Association, 1,992 hospitals report out-patient departments, prac tically every one conducting in some form or other antenatal clinics; 756 were general hospitals, approximately all with exten sive antenatal clinic service; 200 clinics emphasized prenatal care. In addition, 8o medical colleges conducted antenatal clinics and 26 were held independently or connected with lying-in insti tutions.
Many institutions maintain antenatal clinics in addition to some 1,150 conducted by the authorities, hospitals and medical colleges—the American Red Cross, for instance, the General Federation of Women's Clubs and some 5o other organizations. In its survey of 86 cities the American Child Health association found that in 1923 antenatal clinics were operated entirely under private auspices in 19 cities and by the municipality in 16; and an official survey of the loo chief cities in 1923 reported that of prenatal activities carried on in 73 cities, voluntary agencies spon sored them in 32, official agencies in and municipal and volun tary support in '0. As example, the privately supported Mater nity Center association, New York city, established in May, 1918, carries on a most outstanding piece of work. Formed in response to a call issued by the Commissioner of Health to various official and other representatives, this association has formulated stand ards of nursing technique and a plan of work used widely in the States. During 1922-27 about 2,200 nurses spent periods there ranging from one week to four months either in observation work or training.
The sparsely populated territories with their great distances are still entirely without antenatal clinics and many expectant mothers suffer great hardship. An attempt was made to meet the situation with "healthmobiles," automobiles outfitted as centres with a physician and a nurse or two in attendance, but it has been discontinued.
BIBLIOGRAPHY. See Mrs. Max West, Development of Prenatal Care Bibliography. See Mrs. Max West, Development of Prenatal Care in the United States (Transactions, American Association for the Study and Prevention of Infant Mortality, 1914) ; Reports on Public Health and Medical Subjects, No. 25, Maternal Mortality (H. M. Stationery Office, 1924) ; Dr. S. Josephine Baker, Child Hygiene (Harper's Association, 1925) ; Municipal Health Department Practice for the year 1923 (Public Health Bulletin No. 164, 1926) ; Annual Reports of the U.S. Children's Bureau 1914-27; Publications of the U.S. Children's Bureau, 1914-27; Harry H. Moore, American Medi cine and the People's Health (1927).