CHILDBIRTH IN RURAL PUNJAB, INDIA.

Abstract

The high infant mortality of 159/1000 live births in typical rural villages of the Punjab India was due more to environmental causes than to factors related to obstetrical care. Compared with industrialized countries of the West the neonatal death rate was 4 times the expected level whereas the postneonatal rate of the remaining 11 months of the 1st year was 18 times greater. Neonatal death rates averaged 76/1000 live births over a 2-year period and perinatal rates averaged 89/1000 deliveries. 3/4 births were attended by untrained midwives 6% by midwives with a brief elementary course of instruction and 15% by persons with midwifery and brief nursing training. The remaining 3% included delivereis by physicians by friends or relations or unattended. Practitioners of indigenous medicine did not practice obstetrics. The trained village midwife had the best record of accomplishment as judged by perinatal death rates 56/1000 deliveries. Neonatal death rates were almost twice as great for untrained as for trained attendants. Differences in professional qualifications had little influence on choice of attendant at childbirth. With rare exceptions demanded by complications all deliveries were in the home and the attendant in 97% was a midwife of the village where birth occurred. Risk of death for infants as judged by either perinatal or neonatal death rates was greatest among the 1st born and those of late pregnancies. Maternal death rate as estimated for a small sample was excessively high. Tetanus neonatorum was a common cause of death among infants delivered by both trained and untrained midwives. The greatest difference in deaths according to delivery by trained or untrained attendants was in postnatal asphyxia which was 3 times as frequent among infants delivered by untrained midwives. All deaths from cerebral birth injuries were among children delivered by untrained midwives.