Factoid of the day take two (Caution: Blood and gore story)

I watched the  BBC series "call the midwife" and it is fairly accurate, but twice the writers had a doctor tell the midwife that a woman's life/pregnancy is now safe due to socialized medicine.

Ah, but is that true?

The "Flying squad" ambulance, that rushed to birth disasters, was actually started in 1933.

The midwives were indeed gov't employees, but the nuns of Nonnatus house (an Anglican order) had been there longer: The senile nun who is the object of one of the shows "took her vows in 1905", and since the order had been started to work in the slums, it sounds like they had been doing the work long before the NHS started in the post WWII period.

The point is that often women delivered with a semi trained midwife, and having a local service was a good thing.
Indeed, a high mortality in the poor due to lack of money was one reason that the federal gov't in the US started the Indian Health Service on the reservations: And they staffed these clinics/hospitals with doctors who were drafted and given a choice between the military and the IHS....

Finally, one of the comments was made when a woman who had ricketts came in to give birth, and the implication was that if there had been socialism she wouldn't have had ricketts (caused by lack of sunlight) and that her previous stillborns were caused by obstructed labor but now due to the wonderfulness of the NHS, she could have a Caesarian section.

Ricketts in the poor was alas seen in northern climates, especially in darked skinned children. Even that old conservative Churchill defended funding milk supplementation in poor areas in the midst of World War II:

There is no finer investment for any community than putting milk into babies. Radio broadcast (March 21, 1943),

But the willingness to do a Caesarian section before a woman was half dead from obstructed labor had changed mainly due to the availability of safe blood transfusions and antibiotics, the availability of which essentially were due to medical advances during World War II.

(We even learned in medical school there was a technique called "extra peritoneal" Caesarian sections, to cut down the incidence of peritonitis in such cases).

Because of the high risk of surgical delivery (and death of the mother due to sepsis after a prolonged labor) these women were delivered by a dangerous high forceps delivery (not the same as the simple "outlet forceps" that we docs still are doing). In the high forceps delivery, the baby is often damaged during extraction, and indeed, often it is dead already from the long labor (or, dirty little secret, sometimes they would have to crush the baby's skull to deliver the kids. And sometimes the child was not dead---so most Catholic doctors would not do this, and were therefore kept out of training for obstetrics in many hospitals)...

In rickets, the opening of the pelvis was shorter from front to back. In contrast, in Africa, the main cause of obstruction was the pelvis that was oval, thin from side to side...the procedure for obstruted labor there was symphysiotomy, cut the pelvic ligaments where they join in front and pop the pelvis open to remove the kid, and then pop it back and put on a tight binder. This could be done by a skilled midwife, but by the time I worked in Africa (1970's)  most clinics were able to transfer to hospital that did Caesarian sections: if there was no doctor, there was even a program to teach midwives and "medical assistants" to do the surgery (medical assistants were essentially nurses who had  the same nursing training but with an emphasis on diagnosis of common diseases. They were paid less than nurses because most hadn't finished high school back then due to lack of high schools in rural areas).

So what did you use for anesthesia? Spinal anesthesia, or local anesthesia could be done if there was no nurse anesthetist. By the 1970's, we were starting to use "Ketamine drips". Yes, the "animal anesthetic"...At one hospital,  we had the flood scrubber adjust the IV drip: we watched the patient's breathing...we gave it until she stopped feeling pain, and then slowed it down until she started moving again...once the floor scrubber had to go outside to fetch something, and the patient stopped breathing, so I had to "break scrub" and stop the IV while "bagging" her with a breathing bag (Ambu bag) until she was okay.

Ah, the "good old days"....