Obviously, then, only a few—too few—American women are receiving the minimum of care that makes child-bearing a reasonably safe adventure.
Perhaps it will be well for the nurse to pause just here for a fresh reminder that the end really to be desired through prenatal care is not so much the mere prevention of death among mothers and infants, as the promotion of health, as well; our charges must be not only saved but saved to mental and physical health, vigor and well-being, capable of being useful, productive citizens. Happily, both life and health are conserved by the same measures, and effort toward either end helps to accomplish both.
Although the inhabitants of a prosperous country like the United States should be a hardy people, the results of medical examinations by the draft boards, during the war, gave us a rude awakening to the fact that they are not.
An appallingly large number of young men who were passing in every day life as normal were found to be physically unfit for military service. And we know that a large part of this unfitness resulted from inadequate care, of some kind, during the weeks and months that comprise the beginning of life.
It can scarcely be doubted that the most critical period in the life history of the individual is the first ten months—the nine months of intra-uterine life and the first month after birth. Good care, then, during this critical period is indispensable in the building of a healthy race. The difficulty in the way of giving this care, at present, seems to be fourfold: educational, economic, social and professional, and may be summed up somewhat as follows:
1. From the educational standpoint, almost universal ignorance of the need of skilled obstetrical care. 2. From the economic standpoint, financial inability of the average woman to afford such care. 3. From the social, or administrative, standpoint, a fairly general failure on the part of public authorities to recognize the situation as one of grave national importance. 4. From the professional standpoint, inadequacy of available obstetrical service, both medical and nursing.
In many of the large cities women have access to excellent obstetrical and prenatal care; both those who can pay for it and also the poor woman who cannot, though very many in both groups still fail to take advantage of the opportunities that are open to them.
But the city women of moderate means, and those in small towns and rural communities are in general unprovided for. And it is their babies who grow up and later constitute the backbone, weak or strong, of the nation.
Certain foreign countries which have evinced more concern for the welfare of mothers and babies than has the United States have demonstrated that widespread prenatal care is entirely possible and practicable, and they regard it also as an imperative measure toward promoting the national welfare.
The actual origin of this prenatal care is somewhat difficult to locate. There are the consultations for pregnant women instituted in Paris several years ago by Dr. Budin. But Dr. Ballantyne, of Edinburgh, is generally regarded as the father of the prenatal work because of his work on abnormalities of pregnancy and his insistence upon the importance of what might be accomplished through intelligent care and supervision of all women, not alone abnormal cases, throughout pregnancy.