It is commonly thought that the safest and best time to have a first baby is between the ages of 16 and 20. The first report of the British Perinatal Mortality Survey showed that this is not true. It is safer, so far as the baby is concerned, for the first baby to be delivered when the mother is between the ages of 20 and 24. The nest safest age group is when she is between 25 and 29, and the third safest when she is under the age of 20. The table below indicates the relative danger or safety of producing the first, second, third or fourth child during the various age groups, from which it will be seen that, from a purely statistical point of view, it is better to have first, second, third and fourth children between the ages of 20 and 24, or the second, third and fourth child between the ages of 25 and 39, or the second child between the ages of 30 and 34. Most obstetricians nowadays, therefore, no longer advise that teenage is the ideal time for pregnancy and they would advise that, if it is reasonably possible, a married woman should have her first child before she reaches the age of 30.
The table shows the average risk of death to a baby depending upon the mother’s age and size of family, when it is compared to an average risk of 100. Those figures below 100 are the most favourable whereas those above 100 are least favourable, e.g. the risk to the first-born baby of a woman of 42 is 3 times greater than if she were 3 2, and is 5 times greater than that to a second child of a 27 year old woman.
The term perinatal death is a fairly recent concept and it includes all those babies who are stillborn or born dead as well as all babies who die during the first week of life. The incidence of perinatal death has fallen greatly over the past 50 years. In 1976 the figure was 17.6 per thousand which means that out of every thousand deliveries, over 18 babies were either dead at birth or died during the first week of life. Quite a large number of these babies were premature while others suffered from severe congenital abnormalities that were not compatible with their continued survival. The other side of the coin shows that 98.6 per cent of all pregnancies that reach the 28th week do result in delivery of a live baby who survives beyond the first week of life, after which the chances of anything adverse happening to him are very small indeed. Extensive enquiries are carried out and detailed surveys made by the authorities whenever a baby fails to survive.
While no one would dream of being complacent, it must nevertheless be admitted that quite a large proportion of the 17.6 babies per thousand who die shortly after birth (neonatal death) do so because of some factor that is entirely unpreventable. This does not stop every effort being made to increase the overall survival rate of every baby but it has resulted in a greater realization that not only must babies survive but they must also be healthy.
The decline in the perinatal death rate over the years has been due directly or indirectly to improvements in antenatal care. The whole range of improvements for maternal welfare have exerted an influence upon the production of a greater number of live healthy babies. The advent of antibiotics in the control of infection, the understanding of blood groups and blood transfusion, the better treatment of anaemia, heart disease, diabetes, lung disease and kidney disease, together with the control of pre-eclampsia and eclampsia, are all major factors in the reduction of the perinatal death rate.
Probably the most important step that will be taken over the next few years will be a greater understanding of the causes of prematurity and improved care of the premature baby who really does require very expert nursing. Improved care with more rigid and better antenatal supervision is certainly the most potent factor in the prevention of prematurity, stillbirths and neonatal death.
It is an unpalatable and unfortunate fact that babies do occasionally die but it is also true that behind the scenes the authorities devote very considerable time, trouble and money in research to find out why these catastrophes occur. All doctors and midwives are keenly aware of the problem and do their utmost to ensure the welfare of those under their care.
Indeed one might reasonably suggest that this book has been written as a contribution towards the next logical step in the health and welfare of the pregnant women of this country and their babies—better and more complete co-operation in antenatal care. If pregnant women are to be asked to accept more stringent supervision during their pregnancy then they must understand the reasons for any inconvenience which they may undergo and they must realize that everything they are asked to do is for their own and for their babies’ benefit. Above all, the mother and all the members of her family must realize that they must accept the final responsibility for her welfare and that of the unborn child. The care of the baby throughout its intrauterine existence is the major factor in determining its future life.