Physicians cannot ignore the fact themselves that the instruc tion that medical students receive in obstetrics and obstetrical asepsis is inadequate. We cannot belabor the mid-wife and gloss over the defects in our own practice and teaching.
The women themselves need instruction in the necessity for good care at the time of confinement and prior thereto. Husbands must learn that money spent to safeguard the life of their wives and children at this critical time is spent wisely and for a stern necessity. Such service is worth a respectable fee, a consideration which prevents many from employing the services of a competent physician and nurse. Their meager circumstances only permit them to secure the uncertain assist ance of a mid-wife. This is largely a problem of urban popula tions. The best solution appears to be through the agency of prenatal and maternity clinics.
Prenatal and maternity clinics are designed for the welfare of both the mother and child who without assistance would not receive adequate care prior to, during, or subsequent to con finement. They are of equal value in the elimination of infant mortality. They are variously maintained, either by hospitals, philanthropic organizations or health authorities. By educa tional propaganda efforts should be made to inform women of the assistance available and they must. be encouraged to present themselves to the clinic some time prior to confinement for careful examination. If serious conditions are found arrange ments for continuous observation and care must be made. In any event the prospective mother receives instructions in the proper physical care of herself and in making suitable arrange ments for her anticipated child. Satisfactory results from attendance during the prenatal period are only secured where arrangements permit judicious home visiting to ascertain that the advice given has been understood and is being acted upon. Advice upon diet, clothing, exercise and care of the breasts is especially needed. At the time of confinement arrangements are made for the medical care of the mother if she is unable to provide for it herself, or if the presence of complications necessi tates hospital care, to provide admission to the maternity wards.
The prenatal work of the clinics very largely relates to the proper care of the infant, and as such will be considered under infant hygiene. Co-ordinated cooperation with other chari table agencies is frequently necessary to enable an indigent mother to receive proper food.
Another group of women in entirely different circumstances usually fail to receive adequate care at this period. Usually the difficulty is not a question of good or bad obstetric care or inability to provide for a physicians services, but rather the inaccessibility of any assistance at all during this time. This is the condition which many women in rural districts must face, particularly in the extreme north and west where pioneer conditions prevail. Many children are born with no other attendant than the husband, a relative or neighbor. The nearest physician may be located many miles away and a hospital many miles further. With inadequate roads and means of communication it is not possible to notify the physician in time. Under these circumstances the cost of a physicians services may seem unnecessarily great and is frequently fore gone. The problem of these women is difficult, but a solution seems available. It probably can satisfactorily be accom plished along these lines; (a) The establishment of a rural nursing service centering at the county seat, with nurses especially trained to discern the danger signs of pregnancy.
(b) An accessable county center for maternal and infant welfare at which mothers may obtain simple information as to the proper care of themselves during pregnancy as well as of their babies.
(c) A county hospital with provision for maternity cases, for the proper care of abnormal cases and of normal cases when it is convenient for the women to leave their homes for confinement.
(d) Skilled attendants at confinement available to each woman.