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The interplay of changes in society, reproductive habits, and obstetric practice in Scotland between 1922 and 1972.

The last half century has seen great improvements in the standard of living of the British people and in their level of health and physique. This has been accompanied by changes in attitudes to sex, reproduction, family size, and the status of women in society. At the same time the standard of obstetric care available has improved greatly as a result of the National Health Service and advances in knowledge brought about by research. In the early days of the present century social conditions were still very bad in Britain, as demonstrated by the very poor physique and health of young men conscripted to the armed forces in 1917. Conditions deteriorated still further because of the crippling cost of the war, social unrest, and finally the worldwide depression between 1926 and 1934. At that time most births took place at home with a 'handywoman' in attendance. She called a general practitioner to deliver the baby if and when she judged this to be necessary. The teaching of obstetrics to medical students was inadequate and there was no postgraduate training, so that family doctors had to acquire the necessary special skill by trial and error. The mother was at risk of serious injury to her health and even of death. In the early 1930s over 400 mothers died in childbirth each year in Scotland. The maternal mortality rate did not begin to fall until 1936 after the discovery of 'prontosil rubrum' which was effective against the haemolytic streptococcus, the most important cause of maternal mortality at this time. The second world war was largely responsible for the rapid development of blood transfusion services which prevented many