Caring for the Health of the Pregnant Woman

It is true that we ought to regard pregnancy, which lasts nine months, as a normal physiological process; but the truth is that it is not always so, for in the course of these nine months of pregnancy a number of complications may arise which turn this pregnancy into a morbid, abnormal process. Nothing proves this better than the fact that cases of uterine hemorrhage in its various forms, of toxemia, of eclampsia, and of the presence of albumin in the urine during pregnancy have carried off the lives of many mothers. For all this, we cannot consider that pregnancy — which at bottom ought to be a normal physiological process — can remain so permanently.

The same holds for the process of delivery, since various kinds of complications may leave the woman, after delivery, sickly and feeble of strength — if they do not lead to the death of the fetus, or to her own death. Examples of this are many: among them, rupture of the uterus during labor, abnormal positions of the fetus, and laceration of the pelvic organs.

After delivery, the negligence of the birth attendant, and his failure to sterilize the medical instruments used, of whatever kind, may lead to the spread of infection in the blood, and thence, in most cases, to puerperal fever.

We possess no precise statistics showing the number of deaths that occur during pregnancy, at delivery, or after it; the reason is that no governmental or medical body in the Arab countries has to this day undertaken an organized study for this purpose. It is nonetheless established, in a general way, that the number of deaths in these circumstances is not to be made light of — and this for many reasons: among them, that most of our physicians regard childbirth as an ordinary, simple matter deserving no special attention; the scarcity of specialist physicians; and the lack of public maternity homes which the poor women of the nation could enter, benefiting from the care and the modern medical means found in them, which would remove from them the dangers of giving birth in an unmedical, unsanitary setting. Other reasons are no less important than these — such as the ignorance of the midwives, and public opinion's disregard of the importance of childbirth and of the pregnant woman's health, which goes back to the lack of adequate health information on this subject among the general public.

There is no doubt that one of the most important measures of a nation's progress and its renaissance is the amount of care that surrounds the pregnant woman and her unborn child, who is the young man — or the young woman — of the future. The health of the pregnant woman truly foretells what the child's health will be. We do not expect, for example, the child of a pregnant woman afflicted with a disease such as tuberculosis, anemia, or syphilis to be anything but weak and sickly — besides which, her pregnancy in such a case is harmful to her herself.

We may well ask why medicine has stood powerless to keep death from thousands of mothers every year, while it has managed to wipe out various diseases, one after another.

It is true that the blame for a large number of these deaths falls on the women themselves; negligence and ignorance are two powerful factors among those that lead to a great loss of life — a loss that women themselves could avoid. But it is equally true that a large share of this loss can be avoided through progress in the field of obstetrics.

The fact is that only a very small proportion of the women of the Arab countries is given a complete medical examination during pregnancy. By a complete medical examination during pregnancy I mean ascertaining her general state of health; watching the changes that occur during pregnancy, the position of the fetus, the condition of the kidneys and the heart, and the blood pressure; taking the measurement of the pelvis, etc. — all of this at regular, periodic intervals, so that the pregnant woman does not enter the stage of delivery haphazardly.

We are in urgent need of dispensaries in the cities concerned especially with the pregnant woman; of mobile dispensaries touring the villages, accompanied by a specialist nurse or physician; and of maternity hospitals equipped with the newest medical instruments and means, supervised by physicians who are specialists in this art. We must likewise confine the practice of midwifery to specialist physicians and specialist midwives, to prevent the many regrettable accidents caused by the ignorance of unlicensed midwives of the principles of this art.

What, then, have we prepared — in Lebanon, for instance — to meet these needs? I do not deny that there is one small foreign maternity hospital in Beirut, and that there are a few small private hospitals which perform surgery of every kind, and to which admission is open only to a limited number of women able to pay. But you will not be able to find in all Lebanon a single

government hospital devoted to maternity, for receiving pregnant women from among the general public — and what applies to Lebanon applies to all the Arab countries.

It is our duty, therefore, to have public maternity hospitals, receiving free of charge pregnant women from the general body of the people, in which the following medical conditions are fulfilled:

1 — That they be fully equipped with everything the pregnant woman needs, in the way of apparatus for delivery and for the care of the child throughout her stay, and that the physicians and nurses in them be specialists in the art of obstetrics.

2 — That each contain a special wing for women stricken after delivery with fevers of all kinds, chief among them puerperal fever.

3 — That each be provided with a complete medical laboratory.

4 — That in each a record be kept for every pregnant woman admitted, setting down everything that concerns her.

5 — That all deliveries in them be performed at the hands of the obstetrician.

6 — That all nurses be given practical and theoretical instruction during their service there, so that they acquire an experience enabling them to work as maternity nurses in other hospitals, fixed or mobile.

To close this word, I cannot but record here, with deep regret, that our country has not profited to any appreciable degree from the West's progress in the obstetrical branch of medicine during the past quarter-century, and that the means and methods of obstetrics have changed or advanced only a little. Nor am I among those who say conditions can improve unless we look upon the art of obstetrics with a more serious eye, and do everything in our power to protect the pregnant woman from the dangers that threaten her health.