The Use of Vital Records in the Reduction of Fetal, Infant, and Maternal Mortality: Operative Procedures for Delivery and Their Effects on Neonatal and Maternal Mortality
The method of collecting medical information bearing on pregnancy and delivery which has been employed in the City of New York since early in 1938 is discussed and the direct and indirect use the Health Dept. makes of this information is outlined. A description is given of the collaboration between the Bureau of Vital Records and Statistics and the special committees of the medical socie- ties in 4 of the 5 counties that comprise the City of New York. Data are presented regarding operative deliveries, based on a sample of 20,479 single, white, $, live first births in hospitals in the city in 1940. In the voluntary hospitals some operative or instrumental procedure was used in half of the deliveries, and the municipal hospitals reported the smallest % of operative deliveries. The most frequently used operative or instrumental procedures were: low forceps, mid-forceps, and Cesarean section. Low and mid-forceps were usually applied because of some form of prolonged labor. The reasons given for the use of Cesarean section were: inadequate pelvis, oversize fetus, elderly primipara, and a medical condition in the mother. Conversely, when some form of arrested labor or fetal distress was encountered, low or mid-forceps were applied. In case of disproportion, Cesarean section was the operation of choice. Children delivered spontaneously, or when only an episiotomy was done, had the best chance of surviving the 1st mo. of life. This chance was small in cases of children delivered by version. The highest maternal mortality rates were associated with Cesarean section and breech extraction,.