Data briefing: Maternity services at 60: the birth of a new era

John Appleby, Ruth Thorlby

For pregnant women, the birth of the NHS meant the family doctor's advice could be sought freely without incurring expense, according to the 1949 Ministry of Health report.

Publication:  Health Service Journal
Reference:  Health Service Journal, 5 June 2008

This brought GPs and hospitals into a service that had been dominated by midwives - mainly employed by local authorities - whose role was to 'conduct normal confinements' and summon medical aid if there were problems in labour.

The ministry reported some early problems: easier availability of GPs, consultant obstetricians and hospital facilities was 'failing to produce that co-operation between doctor and midwife which was the object of those responsible for the [NHS] scheme'. The challenge, summarised in the 1949 report, was curiously reminiscent of the Darzi review: 'The task of the moment is... proper co-ordination of these various facilities and in developing a team spirit [considered] from the point of view of the patient's needs.'

Some concerns are no longer an issue today: the delay in building new antenatal clinics because of a 'shortage of steel'; the problem of 'the unmarried mother and her child'. In 1948, 5.4 per cent of births were classed as illegitimate. Today around 45 per cent of all births are to unmarried women. One theme that resonates was a growing demand from mothers for 'institutional confinement'. The proportion of births in hospital rose from nearly 40 per cent in 1937 to over 62 per cent in 1951. Today it is over 97 per cent.

The ministry's 1950 annual report speculated that one factor was purely economic: 'Whereas the woman confined in hospital has all her attendance and treatment free, the one confined at home may incur additional expenses'.

The 1950 report noted that 10 days was regarded as a minimum 'confinement'. The average now is around 1.6 days. While hospital births rose, there were moves to reduce length of stay. 'Early ambulation' experiments in Scotland, 'appreciated by the patients', increased turnover and 'the strain on the nursing staff'.

By 1951 the annual report on the nation's public health was able to reflect on 50 years of progress. Maternal mortality rates stood at 500 deaths per 100,000 births in 1899 and only 87 per 100,000 in 1950. This had been achieved by 'better management of pregnancy and childbirth by routine antenatal supervision and greater obstetric care', and penicillin and blood transfusions from 1935 on. After 60 years the maternal death rate fell to 5.3 - one hundredth of the rate at the turn of the 19th century.