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Study of maternal deaths in Chicago
-
~--
~~ CONDUCTED
STUDY
BY FRED
I>. &AIR,
OF MATERNAL
M.D.,
DEATHS
T
-..--~~~~-- ---~~-~ ~CHICAGO,
ILL.
IN CHICAGO
HE Maternal Welfare Committee of the (hicago Gyne4ogi~~al Soeietv stu~lied maternal deaths in Chicago during 19:34, 1935, and 1936. Each hospital deliverData were ing maternity cases was invited to have membership on this (committee. obtained by questionnaire and sent to tile representative of the hospital in whirh the death occurred. In 1936, the Hoard of Health cooperated in this study hy supplying an ohstetrician to investigate all maternal deaths by examination of the records and hy This mateinterviews with the physicians in charge of the cases where possible. rial was then carefully studied hy the Maternal Welfare Committee, and it was found that a large percentage of deaths appeared to have preventable factors. It was therefore decided to invite interested societies to cooperate in plans t,o reduce maternal and ir&nt mortality and morbidity. (College of Surgeons, The following organizations were represented : Arneritan Chicago Hospital Council and its administrative section, Chicago Medical Society, Infant Welfare Society, Catholic, hospitals of the Archdiocese of Vhi?ago, Chicago and the Chicago Hoard of Health. Pediatric Society, Chicago G,vnerological Society, As a result of this meeting a permanent committee was organized and named “The Joint Mat,ernal Welfare Committee of Cook County. ” Pi-. Fred I,. Adair was chairman and Dr. E. I>. Cornell secretary of this committee. Earh organization was represented by two members. Policies and procedures were formulated which were believed to he the minimum requirements essential in the rondurt of a, well-organized mat,ernity division. These were in accordance with t,he highest scientific standards, but at the same time were practical enough to he easily applied in the average hospital. The Chicago Hoard of Health, Herman N. Dundesen. President, then adopted “Regulations for the Conduct of Maternity Hospitals, Maternity Division of Genera1 Hospitals and Nurseries for the Newborn.” The regulations provided for complete physical separation of the maternity unit from the remainder of the hospital and for isolation facilities for the infected patient. They also required a well-equipped nursery for the care of the normal newborn, an isolat.ion nursery, and a formula room. Special provisions were made for the care of premature and immature infants. Minimum equipment for t,he maternity division w~&s outlined including the essentials for the labor, delivery rooms, and nurseries. Maternity hospitals were required to maintain personnel consisting of attending physicians, nurses and others adequate in training and numbers to carry on the proper routine and meet emergencies arising in such institutions. The work of the obstetric department was to be under the control of the obstetric staff-one of the members of which was to act as chairman of the department of obstetrics. He was to be a qualified specialist in obstetrics or obstetrics and gynecology. Each hospital was required to provide a competent obstetric staff for consultation and to eontrol the obstetric procedures in the hospital. 1058
-
MATERNAL
WELFARE
1059
Suggestions were made to the hospitals for the professional qualifications of the Complet,e and detailed case records were required in all cases, inohs#tetric staff. cluding ante-par-turn and detailed hospital records. Visitors in the maternity division were limited to two a day exclusive of the husband. Infants at no time were to come in contact with any visitors, and children under 16 years of age were excluded. All operative procedures and medications were to follow generally accepted in&rations. The delivery rooms were to be conducted in strict accordance with surgical technique. The procedure of the personnel followed the concept that one who comes in contact with any patient should carry out aseptic technique before corning in contaFt with another patient. This precaution is especially important in connection with the care of parturient and puerperal women and newborn infants. The majority of C’hicago hospitals were cooperative and many willingly made many changes in their physical set-up and personnel in order to comply with these regulations. It was evident, however, that in order to assure continued compliance periodit inspections would be necessary. The Chicago Board of Health maintains a staff of physicians and nurses for this work. Monthly inspections are made, problems are discussed, and a written report is made in duplicate to the Board of Health and to the hospital administration. Any difficulties or differences in interpretation or application of the regulations are referred to the Joint lfaternal Welfare Committee of Cook County which acts in an advisory capacity to the Board of Health of the City of Chicago and as a liaison committee between doctors, hospitals, and the Board of Health.
INFORMATION CONCERNING NEW STANDARD CERTIFICATE OF LIVE BIRSTHS AND NEW STANDARD CERTIFICATE OF STILLBIRTHS -HE American Committee on Maternal Welfare has pointed out the great need for additional medical information with respect to all births (live and still). For the reduction of mortality connected with birth, accurate information must be available with respect to prenatal and natal conditions. This information is necessary not only for the reduction of fetal and infant death rates, but also for the reduction of the maternal death rate and for the improvement of maternal and child health. The committee has called attention to the magnitude of the loss of life connected with pregnancy and childbirth. The total loss from these causes in 1935, as shown by the Bureau of Census figures, was 161,249 lives, including 14,296 maternal deaths (l-2,544 deaths assigned to pregnancy and childbirth, and 1,752 deaths in which pregnancy or childbirth was a complicating factor), 77,119 stillbirths, and 69,834 infant deaths in the first month of life, of which 56,262 were due to prenatal and natal conditions. Official State health agencies are urged to adopt the new standard stillbirth and birth certificates including supplementary data. Uniform reporting of stillbirths throughout the United States can only be made possible when every State has adopted a standard certificate of stillbirth and has accepted the American Public Health Association definition of stillbirth, i.e., a stillborn child is one which shows a complete absence of life, no breathing, no a&ion of heart, no movement of voluntary muscles. The supplementary data for all live birth certificates referred to above is as shown in Chart 1.
I
~--
~~ CONDUCTED
STUDY
BY FRED
I>. &AIR,
OF MATERNAL
M.D.,
DEATHS
T
-..--~~~~-- ---~~-~ ~CHICAGO,
ILL.
IN CHICAGO
HE Maternal Welfare Committee of the (hicago Gyne4ogi~~al Soeietv stu~lied maternal deaths in Chicago during 19:34, 1935, and 1936. Each hospital deliverData were ing maternity cases was invited to have membership on this (committee. obtained by questionnaire and sent to tile representative of the hospital in whirh the death occurred. In 1936, the Hoard of Health cooperated in this study hy supplying an ohstetrician to investigate all maternal deaths by examination of the records and hy This mateinterviews with the physicians in charge of the cases where possible. rial was then carefully studied hy the Maternal Welfare Committee, and it was found that a large percentage of deaths appeared to have preventable factors. It was therefore decided to invite interested societies to cooperate in plans t,o reduce maternal and ir&nt mortality and morbidity. (College of Surgeons, The following organizations were represented : Arneritan Chicago Hospital Council and its administrative section, Chicago Medical Society, Infant Welfare Society, Catholic, hospitals of the Archdiocese of Vhi?ago, Chicago and the Chicago Hoard of Health. Pediatric Society, Chicago G,vnerological Society, As a result of this meeting a permanent committee was organized and named “The Joint Mat,ernal Welfare Committee of Cook County. ” Pi-. Fred I,. Adair was chairman and Dr. E. I>. Cornell secretary of this committee. Earh organization was represented by two members. Policies and procedures were formulated which were believed to he the minimum requirements essential in the rondurt of a, well-organized mat,ernity division. These were in accordance with t,he highest scientific standards, but at the same time were practical enough to he easily applied in the average hospital. The Chicago Hoard of Health, Herman N. Dundesen. President, then adopted “Regulations for the Conduct of Maternity Hospitals, Maternity Division of Genera1 Hospitals and Nurseries for the Newborn.” The regulations provided for complete physical separation of the maternity unit from the remainder of the hospital and for isolation facilities for the infected patient. They also required a well-equipped nursery for the care of the normal newborn, an isolat.ion nursery, and a formula room. Special provisions were made for the care of premature and immature infants. Minimum equipment for t,he maternity division w~&s outlined including the essentials for the labor, delivery rooms, and nurseries. Maternity hospitals were required to maintain personnel consisting of attending physicians, nurses and others adequate in training and numbers to carry on the proper routine and meet emergencies arising in such institutions. The work of the obstetric department was to be under the control of the obstetric staff-one of the members of which was to act as chairman of the department of obstetrics. He was to be a qualified specialist in obstetrics or obstetrics and gynecology. Each hospital was required to provide a competent obstetric staff for consultation and to eontrol the obstetric procedures in the hospital. 1058
-
MATERNAL
WELFARE
1059
Suggestions were made to the hospitals for the professional qualifications of the Complet,e and detailed case records were required in all cases, inohs#tetric staff. cluding ante-par-turn and detailed hospital records. Visitors in the maternity division were limited to two a day exclusive of the husband. Infants at no time were to come in contact with any visitors, and children under 16 years of age were excluded. All operative procedures and medications were to follow generally accepted in&rations. The delivery rooms were to be conducted in strict accordance with surgical technique. The procedure of the personnel followed the concept that one who comes in contact with any patient should carry out aseptic technique before corning in contaFt with another patient. This precaution is especially important in connection with the care of parturient and puerperal women and newborn infants. The majority of C’hicago hospitals were cooperative and many willingly made many changes in their physical set-up and personnel in order to comply with these regulations. It was evident, however, that in order to assure continued compliance periodit inspections would be necessary. The Chicago Board of Health maintains a staff of physicians and nurses for this work. Monthly inspections are made, problems are discussed, and a written report is made in duplicate to the Board of Health and to the hospital administration. Any difficulties or differences in interpretation or application of the regulations are referred to the Joint lfaternal Welfare Committee of Cook County which acts in an advisory capacity to the Board of Health of the City of Chicago and as a liaison committee between doctors, hospitals, and the Board of Health.
INFORMATION CONCERNING NEW STANDARD CERTIFICATE OF LIVE BIRSTHS AND NEW STANDARD CERTIFICATE OF STILLBIRTHS -HE American Committee on Maternal Welfare has pointed out the great need for additional medical information with respect to all births (live and still). For the reduction of mortality connected with birth, accurate information must be available with respect to prenatal and natal conditions. This information is necessary not only for the reduction of fetal and infant death rates, but also for the reduction of the maternal death rate and for the improvement of maternal and child health. The committee has called attention to the magnitude of the loss of life connected with pregnancy and childbirth. The total loss from these causes in 1935, as shown by the Bureau of Census figures, was 161,249 lives, including 14,296 maternal deaths (l-2,544 deaths assigned to pregnancy and childbirth, and 1,752 deaths in which pregnancy or childbirth was a complicating factor), 77,119 stillbirths, and 69,834 infant deaths in the first month of life, of which 56,262 were due to prenatal and natal conditions. Official State health agencies are urged to adopt the new standard stillbirth and birth certificates including supplementary data. Uniform reporting of stillbirths throughout the United States can only be made possible when every State has adopted a standard certificate of stillbirth and has accepted the American Public Health Association definition of stillbirth, i.e., a stillborn child is one which shows a complete absence of life, no breathing, no a&ion of heart, no movement of voluntary muscles. The supplementary data for all live birth certificates referred to above is as shown in Chart 1.
I