H.—3lA.

This spasm causes marked slowness and, in extreme cases, even failure of dilatation, and results in a prolonged and painful labour. Further, it has been shown that deliberate relaxation of the voluntary muscles produces corresponding dilatation to proceed normally without excessive pain. To quote Dr. Dick Read, an eminent exponent of physiological labour : ' Fear, therefore, produces tension, tension pam, pain, increased fear. . . . Confidence is the arch enemy of fear , the two cannot exist at the same time in the one mind, and there is no better way of obtaining confidence than by teaching progressive relaxation during the last three or four months of pregnancy. . . . And, further, this method allows of the birth of the child without any deep aneesthesia ; in fact, in many cases, the woman herself will prefer to go on fully conscious so that she may appreciate the mysteries of natural child-birth.' " Two important considerations arise out of the foregoing quotation, firstly, fear arising from a mistaken view of pregnancy and labour produces an actual obstruction to the progress of labour, and must at all costs be replaced by a mental attitude of calmness and confidence; secondly, the psychological relationship between mother and child is in every way as close and as real as the physical relationship, and to deprive a woman of consciousness, or of memory of the birth of her child, is to inflict on that relationship a loss which, while difficult to estimate, is none the less actual. "It is clear that some system which will induce relaxation, and at the same time improve the tone and efficiency of the voluntary muscles, will be of great benefit to the patient. An attempt in this direction is being made at St. Helens Hospital, Wellington, where the system of exercises designed by Margaret Morris has been in regular use for six months. While it is too early as yet to express any opinion of value, it is thought that these exercises are having a definitely beneficial result in improving the general health of patients and in shortening labour and rendering it less painful, thus diminishing the need for sedative drugs. The voluntary statement of many patients who, on getting up for first time exclaim • ' I have never felt so well after a confinement,' has been a pleasing feature, and in the post-natal clinic it is thought that uterine displacements are definitely less frequent than was formerly the case." No less important is the question of diet in pregnancy, and attendance at the ante-natal clinic gives the medical attendant valuable opportunities for instructing patients on this matter. It is now generally accepted that a correct diet is necessary not only to the health of the mother during pregnancy, but to the development and future health of the child. Further, certain workers in England have suggested that the susceptibility to puerperal sepsis is undoubtedly influenced by diet, and, while the effect of unsuitable diet in the production of the toxemias of pregnancy is disputed, there can be little doubt that diet plays an important role in connection with these diseases Many women are ignorant of the essentials of a properly balanced diet, and illinformed articles in popular magazines serve to intensify rather than dispel this ignorance. The growing practice of prescribing certain mineral and vitamin substances m highly concentrated form, while necessary in cases of true deficiency, is less desirable than supplying these elements in the form of fresh, wholesome food, and it is desirable that patients should have a working knowledge of what these constituents are and m what foodstuffs they are present. It should be emphasized that a wholesome and sufficient diet is not necessarily an expensive diet. Further, all who visit the homes of the people know that all too often good food is ruined by bad cooking. Instruction on these points should form an important part of mothercraft training. The Present Position oe Ante-natal Care In New Zealand. The Committee finds that ante-natal supervision is very generally practised throughout New Zealand and that there is very general appreciation of its value both by the members of the medical profession and by the women of the country. It is obvious to the Committee, however, that there are wide variations in the standard of service given, partly due to difference in keenness and efficiency on the part of those giving the service, and partly owing to difficulties of access. This is also manifest from the fact that, as in Great Britain, while in certain hospitals and practices the influence of ante-natal care is clearly apparent in improved results, the general statistics for the whole country have not improved in the manner which was expected, especially in regard to the toxaemias of pregnancy. The death-rate from eclampsia and other manifestations of the_ toxemias of pregnancy has remained at practically the same level from 1927 to 1936 in spite of the efforts begun in 1924 and continued since to reduce it, through the application ot more scientific and up-to-date methods of ante-natal investigation and treatment both by the general body of obstetricians and through hospital clinics (see graph and Table No. 1, pages 70, 71).

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