"New operational obstetrics" by Max Hirsch

Hirsch (Zeitschr, 1. Geb. and Gyn. Bd. 91, 1927), on the basis of statistics on the mortality of mothers and children in Germany, tries to prove that this mortality during normal obstetric operations remains almost stationary for several decades and that an improvement has begun to be noted only with a broad introduction to obstetric practice of abdominal caesar section. Denying all vaginal operations, except for the exit forceps and simple extraction of the fetus, N. reduces all operational obstetrics to the production of an abdominal Caesar section, with the help of which a greater number of mothers and children can be saved. The production of internal research and any operations outside N.'s clinic does not allow. Hirsch's ideas were decisively rebuffed by Winter (Centr. F. Gyn., 1928, No. 1), who showed that Hirsch's statistical justifications are incorrect, Caesar section gives a greater mortality rate than vaginal operations, and, in addition, in obstetric practice, there are often complications arising during childbirth and requiring immediate assistance on the spot. To improve the formulation of obstetrics, W. considers it necessary: ​​1) examination of each pregnant woman 4 weeks before childbirth and referral to the clinic in case of the possibility of serious complications; 2) increasing the educational qualification of midwives; 3) delivery to the clinic of all severe cases (eclampsia, placenta previa, narrow pelvis, tumors and scars of the soft birth canal, elderly first-born women, transverse positions, atopic bleeding during previous childbirth); 4) increasing obstetric knowledge among doctors (the VIII All-Union Congress of Obstetricians and Gynecologists also spoke not in favor of Hirsch’s proposal. Ref.).