I refer to the work in Boston, particularly, as its inauguration by Mrs. Putnam marked the beginning of this branch of public-health work in this country, though to-day the same kind of service is available to expectant mothers in many of the large, and some of the smaller cities. Visiting nurse associations, the country over are giving postnatal and infant care (in some instances, excellent prenatal care, too), often providing for or assisting with the deliveries, and effecting an enormous saving of life and health by so doing. But the number of patients who are cared for by each organization is relatively so small that even the aggregate of the work done reaches a pathetically small proportion of the mothers and babies in the country as a whole who need care.
The first comprehensive effort, in the United States, to meet the need of all expectant mothers in an entire community, was inaugurated in New York City, in 1918, by the Maternity Centre Association, the chief function of the organization being to coordinate the work of agencies already in existence.
This Association was formed as a result of the work of the Maternity Protective Committee of the Women’s City Club and the Maternity Service Association of Physicians and Hospital Superintendents.
The form of organization, purpose and methods of work of this association may be studied with profit, for having been started on a small scale as an experiment, it now constitutes a demonstration of how, through co-ordinated effort, prenatal and obstetrical care may be extended almost indefinitely to expectant mothers in urban districts, and at a low cost.
The purpose and scope of the work are described by Miss Anne Stevens, its former Director, who tells us “that it is the aim of the Association to cover completely the need for maternity care, prenatal, delivery and postnatal, in a given community, by providing for every woman in that community, medical supervision and nursing care from the beginning of her pregnancy until her baby is one month old. This is being attempted, not by establishing another medical and nursing agency, but by establishing a centre through which the maternity work of every hospital, private physician, midwife and nursing agency in the community may be co-ordinated and developed to its fullest extent; a centre at which there will be a complete record of every pregnancy in that district; a centre from which the whole community may be educated to realize the need of and to demand adequate medical supervision and nursing care for every woman and her baby before and after birth.”
It is not, then, an experiment in prenatal clinics, many of which have been conducted, both in New York and elsewhere; but it is an experiment in its attempt to provide adequate care for every pregnant woman in the community from the beginning of her pregnancy until her baby is a month old.
Standards for adequate prenatal care, upon which to base the work, were formulated by the Maternity Service Association of Physicians. The nurses worked with these standards as a guide and gradually developed detailed routines, as a result of frequent conferences over the difficulties and problems arising in the course of their daily work among the patients.
These various adaptations were, of course, approved and authorized by the Medical Board of the Association. Because these routines meet the doctor’s requirements so satisfactorily, and have been evolved out of the experience of many nurses, concentrating their best efforts upon this work, they are copied on pages [423] to 436 with the belief that they will be suggestive, and perhaps save time and effort for those who may wish to inaugurate similar work.
Every effort is made by the Association to reach all of the expectant mothers in the ten zones into which, for the purposes of the work, the Borough of Manhattan was divided by the preliminary committee[[14]] called by Dr. Haven Emerson, who at that time was Commissioner of Health for New York City. This Committee was called for the purpose of surveying the obstetrical facilities of Manhattan, and offering suggestions as to how they might be utilized in an effort to decrease the persistently high infant mortality.
Patients are reported for care by hospitals, dispensaries, clinics, relief agencies, church clubs, settlements and the like and are discovered in various ways by the nurses on their rounds.