The Health bulletin [serial] - University of North Carolina at Chapel Hill

February, 1955 The Health Bulletin 11have died."How Shall They Survive?" Our mandateis clear. The importance of earlyand adequate prenatal, natal and postpartalcare emphasized through publichealth services such as education of thecommunity, and through evaluated surveysfor the education of physiciansand hospitals, demands a high priority.Where the need exists, direct servicesmust be provided.We take for granted that pregnancyis a normal physiological process; yetthe need for continuity and adequacyof care throughout the gestational cycleis frequently overlooked. We fail to recognizethat a healthy birth is predicatedon being born of a healthy normalmother and that poor health of themother may precipitate a serious, if notfatal, outcome to mother and/or child.It is imperative that preparation formotherhood begin long before theculmination of the miracle itself. Premaritalguidance and guidance in maritalproblems must be incorporated ina program of salvage which shouldalso include measures encompassingthe physical and mental condition ofthe mother.Priority should be given to a programof educating the mother toseek medical care, observation and directionas early in pregnancy as possiblein order to harvest the full benefitof adequate prenatal care. We mustemphasize this point in all our healtheducational activities, and particularlyin those areas where medical facilitiesare lacking must some provision bemade to make such a program andfacilities available.Adequate prenatal care is essentialand must include a complete historyand physical examination with provisionfor periodic examinations atstated intervals. The examination isnot complete unless it includes serologicaltesting for syphilis and determinationof the Rh status. An X-rayof the chest should be mandatory, certainlyhighly desirable. Educationalefforts to stimulate the mother to reportany irregularities or symptomatologymust be expended, and any untowardsigns or symptoms should beexplored immediately.Recent research projects in the fieldof nutrition during pregnancy point upthe fact that nutrition today is morethan a counting of calories. Maternalnutrition must meet the demands ofboth mother and child. We have reasonto believe that where nutrition is goodand deficiencies corrected by supplements,the incidence of toxemia islower than where nutrition is inadequateor deficiencies occur. Also, fetaland neonatal mortality rates showed adecrease where diet was adequate, andthe incidence of premature birth wasdecreased. The studies further pointout that toxemias of pregnancy aremore apt to occur in the overweightmother and that prematurity and toxemiaare more prevalent in the underweightthan in the mother whoseweight remains within average limits."How Shall They Survive?" To preservethe health of mothers and infants asound nutritional program must be promoted.The prospective mother must be protectedagainst syphilis and tuberculosis.A diagnosis of existing syphilis by prenatalserology calls for all-out effortsto cure or arrest the disease in themother, which efforts, in turn, willin almost all instances protect thefetus. A diagnosis of tuberculosis callsfor close medical observation, supervisionand education throughout pregnancy,and the removal of the infantfrom the maternal environment immediatelyafter birth.Control measures for the preventionof German measles must be institutedin view of what is known of the roleof this disease early in pregnancyand its effect on the child.Basically then "How Shall They Survive?"In maternal hygiene the primeobjective is the conservation of lifeand health of the expectant motherand her developing infant. The objectiveleads us to promote a programwherein medical care is made availableto every pregnant mother and themother is persuaded to obtain itthroughout the maternal cycle. It is