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4 - THE MISSING CHAPTER? PROLONGED LABOUR AND OBSTETRIC TRAUMA

Published online by Cambridge University Press:  05 April 2023

James Owen Drife
Affiliation:
University of Leeds
Gwyneth Lewis
Affiliation:
University College London
James P Neilson
Affiliation:
University of Liverpool
Marian Knight
Affiliation:
National Perinatal Epidemiology Unit, Oxford
Griselda Cooper
Affiliation:
University of Birmingham
Roch Cantwell
Affiliation:
Southern General Hospital, Glasgow
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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.

Type
Chapter
Information
Why Mothers Died and How their Lives are Saved
The Story of Confidential Enquiries into Maternal Deaths
, pp. 52 - 62
Publisher: Cambridge University Press
Print publication year: 2023

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