Book contents
- Why Mothers Died and How Their Lives Are Saved
- Why Mothers Died and How Their Lives Are Saved
- Copyright page
- Contents
- Contributors
- Foreword
- Foreword
- Introduction
- 1 Historical Background
- 2 THE FIRST STEPS: 1900–1939
- 3 How the Confidential Enquiries Evolved
- 4 THE MISSING CHAPTER? PROLONGED LABOUR AND OBSTETRIC TRAUMA
- 5 HOW THE CHANGE BEGAN: THE STORY OF SEPSIS
- 6 Haemorrhage Then and Now
- 7 HYPERTENSION: ENQUIRIES, TRIALS AND RECOMMENDATIONS
- 8 The Story of Abortion
- 9 CHALLENGING TRADITION: THE STORY OF EMBOLISM
- 10 Pregnancy and Illness
- 11 Maternal Death due to Anaesthesia
- 12 Psychiatric Illness
- 13 THE MOTHERS WHO DIED: SOCIAL DETERMINANTS OF MATERNAL HEALTH
- 14 THE LEGACY IN THE UNITED KINGDOM: THE CONCEPT OF ‘NEAR MISS’ AND THE NEED TO KEEP SAVING LIVES
- 15 International Maternal Health: Global Action
- 16 International Action: Personal Views
- Figure Permissions
- Further Reading
- Index
4 - THE MISSING CHAPTER? PROLONGED LABOUR AND OBSTETRIC TRAUMA
Published online by Cambridge University Press: 05 April 2023
- Why Mothers Died and How Their Lives Are Saved
- Why Mothers Died and How Their Lives Are Saved
- Copyright page
- Contents
- Contributors
- Foreword
- Foreword
- Introduction
- 1 Historical Background
- 2 THE FIRST STEPS: 1900–1939
- 3 How the Confidential Enquiries Evolved
- 4 THE MISSING CHAPTER? PROLONGED LABOUR AND OBSTETRIC TRAUMA
- 5 HOW THE CHANGE BEGAN: THE STORY OF SEPSIS
- 6 Haemorrhage Then and Now
- 7 HYPERTENSION: ENQUIRIES, TRIALS AND RECOMMENDATIONS
- 8 The Story of Abortion
- 9 CHALLENGING TRADITION: THE STORY OF EMBOLISM
- 10 Pregnancy and Illness
- 11 Maternal Death due to Anaesthesia
- 12 Psychiatric Illness
- 13 THE MOTHERS WHO DIED: SOCIAL DETERMINANTS OF MATERNAL HEALTH
- 14 THE LEGACY IN THE UNITED KINGDOM: THE CONCEPT OF ‘NEAR MISS’ AND THE NEED TO KEEP SAVING LIVES
- 15 International Maternal Health: Global Action
- 16 International Action: Personal Views
- Figure Permissions
- Further Reading
- Index
Summary
In 1952-4 the caesarean section rate was under 2% and many women died of complications of vaginal birth. The Report listed 190 deaths in an appendix under various causes including 'contracted pelvis', once common due to rickets. Pelvic measurement was part of antenatal care. In doubtful cases 'trial of labour' often ended in forceps delivery. A 10% fetal loss rate was considered acceptable. Home births could end in forceps delivery by GPs who had no postgraduate training and relied on their student experience. In the 1955-7 Report, 33 women died after forceps delivery at home or in a maternity home. In the 1960s 'prolonged labour' (> 24 hours) was blamed on 'inco-ordinate uterine action'. In 1969 in Dublin Kieran O’Driscoll introduced 'active management' for first-time mothers in hospital, showing that normal labour could safely be achieved with an intravenous oxytocin 'drip'. Early CEMD Reports criticised GPs but in the 1960s their comments became more constructive. The BMJ ran a series of articles, 'Obstetrics for GPs', written by leading obstetricians. By the late 1970s only 2% of births were home deliveries and the Reports no longer discussed place of birth.
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- Why Mothers Died and How their Lives are SavedThe Story of Confidential Enquiries into Maternal Deaths, pp. 52 - 62Publisher: Cambridge University PressPrint publication year: 2023