The infant mortality rate under 1 year was 99.16.
The infant mortality rate under 1 month was 52.46.
Maternal mortality rate was 5.97.

An infant welfare program has been carried on in the district for the previous seven years, but practically no organized prenatal work had been done. The infant mortality had dropped, but the mortality rate under one month had steadily increased being 52.46 in 1923. The stillbirth rate was also high. The prenatal demonstration was put on in the nature of an experiment to prove conclusively what could be done by supervision, teaching and preparation during the prenatal period.

A nurse to successfully carry on prenatal work must be able to teach, must have the ability to gain the mother's confidence, must be sympathetic and enthusiastic and have a thorough belief in the work. If she has not these requirements she will fail in putting across to any individual or group what she is trying to do. Entering a home to visit an expectant mother for the first time, especially the mother who has already had children without the benefit of prenatal care, meeting her argument for and against it, succeeding in developing in her mind a new attitude toward her privilege of maternity and her duty to the unborn baby and herself and having her become interested is doing a good piece of health work.

Before the demonstration opened, we visited every physician in the district, telling him of our plans, asking him for his advice and co-operation.

We started our work with 13 prospective mothers and admitted 739 new cases during the two year period. The new cases were referred to us from every source, physicians, nurses, welfare organizations, letter carriers and policemen, but the greatest factor was our supervised mothers. So successful was this demonstration by word of mouth that we had requests for written advice and literature, from Canada, Florida and France.

We tried in every case to work with the family physician,

and to reach the mothers as early in pregnancy as possible, so that we might give her thorough prenatal care. If she was not under her physician's care we advised medical supervision at once teaching the necessity and value of early physical examination. When the mother was under the physician's care we continued on the case, co-operating with him as he desired and reporting the mother's condition by form card or telephone after conference or home visits. Many times a mother realizes the need of medical supervision but cannot afford repeated prenatal visits to the physician. If the cost of the prenatal care was included in the total bill we would have more mothers seeing their physician early.

Our routine care consisted of regular home visits, blood pressure and urine tests and mother's classes. Wasserman tests were advised as indicated. Hospital care at time of confinement or trained nursing care at home was urged in every case. This was possible by co-operating with our hospital and bedside nursing agencies.

One of the most interesting parts of any prenatal program is teaching the mother in her home or in the classroom the preparations for the lying-in period. A mother does not always understand the other aspects of prenatal care, but this part of it appeals to her because she can visualize it and many times knows from past experience how necessary to her safety and comfort proper preparation is. Especially is this true if she is to be confined at home and must consider every detail from a financial viewpoint.

One of the finest forms of teaching is the group method or class work, and our mother's classes were organized at the beginning of the demonstration. These also were in the nature of an experiment, as we were a bit dubious regarding the attitude of the mothers themselves toward this form of teaching. That was definitely and finally answered by the attendance. During the two year period eighty-six classes were held with an attendance of 1983. We started our classes with an attendance of 10 mothers and during the

entire last year of the demonstration the average attendance was 35.

Weekly classes were held in the afternoon with one night class a month for the mothers that worked or were unable to come during the day. A course of 9 lessons was given which consisted of lectures and demonstration on the science of life, the hygiene of pregnancy, proper food and its preparation, correct clothing for the expectant mother, preparation of the room and bed for labor, the obstetrical package and baby's layette, toilet tray, bed and bath. One talk was entirely on infant hygiene, stressing the value and duty of breast feeding; the necessity of medical supervision and periodic examination of the new baby.

Our class routine was as follows:

A hostess for the day had been previously appointed from the class. Owing to the fact that mothers entered the class at different periods of pregnancy, new mothers were admitted each week. The mothers arrived about two o'clock. A new mother was always introduced to every mother in the class. Before the class opened, the general waiting room was arranged forum fashion with a large table in the center of the room and individual chairs grouped about. The demonstration or exhibit for that lesson was assembled on the table and suitable posters regarding the day's work were on display. After the class this table was used by the mothers for cutting patterns and preparing the obstetrical package. Goods at a minimum cost for the obstetrical package were always kept on sale at the conference room. A corner of the room was always prepared for an obstetrical case, as many mothers were unable to come but once and we tried to give them intensive instruction at that time. One half hour was given for the lesson or demonstration of the day. The remaining half hour was given over to a quiz by the nurse and questions from the floor. One mother, or a group of mothers, was then appointed to repeat the demonstrations of the day or the demonstration of the previous week for the class. They took great pride in doing this and

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followed instructions remarkably well. It gave them confidence in themselves and brought out many questions. It also established a feeling of frankness and good fellowship among the women and gave the nurse conducting the class an opportunity of finding out how much of her instruction .the class was really getting. After the lesson, light refreshments were served by the hostess assisted by the other mothers. Each mother was then given the opportunity of a private visit with the nurse. If she was not under her physician's care, she was weighed, blood pressure and urine tests made, temperature, pulse and respiration taken and recorded. We found there were many new friendships formed and much mutual help given through the classes, also that there was some psychologic action in grouping these mothers together for prenatal education. When women see other women seeking this knowledge of Maternity and Infancy they sense better the value and necessity of it and are more anxious for it themselves.

At the request of the school authorities, a modified course in the hygiene of maternity and infancy is yearly given to members of the senior home economics class at the Manchester West Side High School. The teacher reports that the young women look forward to this part of the year's work, they receive it wonderfully well and are intensely interested in it. The course is given during school hours and credits are given for it.

For those mothers unable to attend the classes the same routine of teaching was carried on in the home. Home visits were made as often as the nurse judged necessary.

To the mothers that were to be confined at home, we stressed the use of the sterilized obstetrical package. Demonstrating to the mothers the making and sterilizing of this package gave to the nurse the opportunity of teaching the meaning and value of asepsis and surgical cleanliness, and the danger of infection during the labor and parturition periods.