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relatively minor complication of pregnancy or labour

may affect the child and cause lag in mental development,motor awkwardness, or behaviour problems. Each yearcause and effect are established a little more clearly, andthe standard of medical and nursing supervision mustconstantly be raised. But mothers have not been

taught to ask the right questions. Why was pregnancyallowed to go so far beyond term with difficult deliveryor even loss of the child ? Might not these complicationshave been avoided by earlier induction of labour ? Whywas labour permitted to last for thirty-six hours withdelivery of an asphyxiated and shocked baby ? Werethese not reasonable indications for caesarean sectionearlier in labour ? Might not the breast abscess that

developed in the third week of the puerperium have beenavoided had more active treatment been instituted whenthe doctor’s attention was drawn to the cracked nippleand slight breast flare four days previously ? Was it wisefor delivery to take place in a general-practitioner unitwhen labour began six weeks before term ? Would thebaby’s chance of survival not have been better had

delivery taken place in a larger hospital with a properlystaffed premature-baby unit ? Why was the first and

only hxmoglobin check made at the 38th week of preg-nancy ? Had repeated checks been made, would not thishave allowed the anxmia to be recognised and treatedwithout the need for an emergency blood-transfusion ?

NATURAL CHILDBIRTH

Much more interest is shown in the various " methods ’of natural childbirth with their emotional appeal andpersuasive literature. Intelligent preparation for preg-nancy and labour can do nothing but good, but there aredangers here. Perhaps the most important is that pre-paration classes are run in some cases by women withno professional training in midwifery or physiotherapy,and there is no means of controlling what is taught bythese unqualified people. Deep breathing and rapidpanting are encouraged in some methods of naturalchildbirth, and this is not without risk. I have seen

tetany occur through hyperventilation, and in othercases foetal distress has in my opinion resulted from thesame cause. A recent study 5 has shown that hyper-ventilation changes the maternal pH, decreases theumbilical blood-flow, disturbs blood-gas exchange in theplacenta, and lowers the level of foetal oxygenation.Maternal hyperventilation, by producing fcetal hypoxiaand acidosis, may well contribute to the development ofrespiratory distress syndrome, especially in prematurebabies.6-8 It is difficult to design statistical studies to

test some of the claims that are made for methods ofnatural childbirth, but there is no reason why some ofthe potential dangers of the cult should not be exposedto scientific examination. There is also the extraordinaryand unwarranted assumption that kindness, humility,and consideration for women in labour are largely theprerogative of those who practise domiciliary obstetricsor affect the mantle of one of the systems of naturalchildbirth.The emotional side of childbirth has held sway in recent

years, but there are the beginnings of an attempt to redressthe balance-increasing publicity given to national studies5. Motoyama, E. K., Rivard, G.. Acheson, F., Cook, C. D. Lancet, Feb. 5,

1966, p. 286.6 James, L. S. Pediatrics, Springfield, 1959, 24, 1069.7. Cohen, M. M., Weintrob, D. H., Lilienfeld, A. M. ibid. 1960, 26, 42.8. Reynolds, E O. R., Jacobson, N. H., Kikkawa, Y., Craig, J. M.,

Cook, C. D. ibid. 1965, 35, 382.

of the reasons for maternal and fcetal deaths, growingrecognition in lay and medical journals of the relationshipbetween family background, physical health, and successin childbirth, and more recently the occasional article inwomen’s magazines and in the Press questioning theeuphemisms and claims of some of the disciples of naturalchildbirth. The education of the public about maternitymust be taken more seriously by doctors, some of whomare as touchy about readable medicine as certain historiansare about readable history. It is only by means of popularexpositions, some of which demand a great deal of con-centration, that the majority of people can gain some ideaof the main trends in medical advance, acquire a scientifichabit of thought, and be in a position to understandargument and discussion over controversial issues. In thefield of public education no matter is more important thanreproduction.

THE PRICE OF SAFETY

The price of pleasant, safe, and efficient childbirth is aninformed programme of public education, constant

vigilance, and immediate access to the nursing and medicalskills available in advanced countries. Remove any of themedical or nursing props and the lives and wellbeing ofmothers and babies are immediately in peril. This is atime to look critically at unscientific dogma that wouldhave us believe that childbirth is Nature’s unqualifiedsuccess story, that " natural methods " are the best

methods, and that home is the ideal place for confinement.Emotion can cloud judgment, and practical considerationsare liable to be swept aside. And what is best for speciesreproduction is not necessarily acceptable or best forindividual mothers and babies. From the viewpoint ofthe individual, the nearer one gets to Nature the morefrightening reproduction becomes-a rapid sequence ofpregnancies and a mounting toll of morbidity and

mortality.

Medicine and the Law

The Wrong BloodAT an inquest on June 3 on a patient who died at St. Nicholas

Hospital, Plumstead, London, evidence was given that

group-B instead of group-A blood had been transfused whenthe patient collapsed after an abdominal operation.l A staff-nurse said that she did not know the name of the patient, asshe had just come on duty when she went to get the bloodfrom the blood bank. " I made a mistake and picked up thewrong bottle." The patient who died was Mrs. Warner; theblood she picked up had been prepared for a Mrs. Warren.But, said the staff-nurse, it checked with the slip she had forthe transfusion. The staff-nurse gave the slip and the bottleto the house-surgeon to check. The house-surgeon said thathe did not know the patient’s name, but the name andnumber on the bottle checked with the slip. To havemade any further check he would have had to go to the

hospital office and leave the patient, who was seriouslyill. The pathologist said that death was due to shockafter acute peritonitis, an operation, and incompatible blood-transfusion.

Recording a verdict of death by misadventure, the coronersaid: " It does seem to me these errors must be eliminated.This is not the first case I have heard of people with similar-sounding names getting blood intended for the other

person."1. Times, June 4, 1966.