An Address on THE WOMAN DAMAGED BY CHILD-BEARING
Authors: J. Young
Journal: BMJ (1929)

THE subject of this address is the case which we all see frequently-the woman who has niever enjoyed good health since the birth of lier children, and, more particularly, since the birth of lher last child.In such cases the last pregnancy or birth is commonly responsible, because, as we know, the factors that make for thie chronic ill health are frequenitly those factors which, at the same timne, make for infertility.When a woman gives a hlistory, for example, of one or more pregnancies witlh a normal slpacing in time followed by a lengthened interval of ill healtlh and stelility, the iniference is very stronlg that we are dealing with some pelvic damage sustained at the last pregnancy of the series.'Wlhere this sequence follows the birth of onie child we have that not inrfrequent source of n;arital anxiety, the one-child marriage.It is true that ill so0me of these cases there may be some general medical disability-such, for example, as heart ol kidlney disease; or there miiay, of course, be inltentional prevenltion of pregnancy but in the great majority of cases the source of the ill hiealth-sterility complex is to be looked for in a local damiiage of the pelvic fulnctions.This morbidity of childbirth is one of the most important p)roblenmls that face the profession and the community at the present time.It is responsible for mulllch individual, family, and economic distress, and to those of us who -are attalched to a hospital this army of shattered lives that swell the out-patient attendances and that crowd our already large waiting lists has becolmie a problem of very serious concern.We know that each year in Great Britain about 4,000 women die during pregnanicy and in childbed.We have no certain knowledge of the numbers who escape death with their health undermined from the same causes.It is probably understatinig the case to say that, for every woman who dies, at least ten live with their systems scarred, giving on a nmoderate estimate about 40,000 annually who pass on to recruit this army of ill health, and who later in many cases fall out by tle way from disease whose origins in the fact of childbirth are often verv imperfectly or not at all revealed on the death certificate.In the majority of suich cases there is obviouis damage of the pelvic or-ganls, and, in general terms, the lesions fou1sd fall under one or other of two hieads: (1) mechaniical, *(2) ilifective.For reasons that are niot far to seek: we often find that the two types -of lesion are combined, for lacerations of the soft structures of the pelvis, ivhich end, it may be, in displacements or cicatricial immobilization of the organs, constitute at the time of birth the nmost imlportant predisposing cause of infection.It thus happens that in such women some of the symptoms are more prolperly to be ascribed to an alteration in the statics of the pelvis, whilst other symptoms spring from tie superadded infection.At tue same time we -lave to niote at the very beginnling of our survey that, whilst a pulely pelvic pathology m-ay in some instances provide a complete explanation of the impaired health, in many more this is by no means the case.In no class of chronic sufferer is there greater need for the broad outlook in diagnosis than in the woman damaged by child-bearinig, for the lesions to which she hias been exposed are pre-eminently of that kind that tend to spread their effects into both adjacent and remote parts of the body.A vaginal prolapse, for example, may lead to diseases of the urinary, the gastro-intestinal, and the nervous systems; a cervical infection may not only cause a uterine or tubo-ovarian inflammation or be the factor behind a persisting urinary sepsis, but it may be responsible for chlronic rheumatism or even progressive heart disease.Again, chronic ill Ilealth dating from childbed 0 Delivered to the Fife Branch of the British Melical Association.