Maternal mortality and manpower. Comparisons in relation to anaesthetists, obstetricians, and paediatricians in England and Wales and in Japan.

In 1982 maternal mortality in England and Wales was given seven per 100 000 compared to 18 per 100 000 total births in Japan. This represented 160 more deaths in Japan. Perinatal mortality rates were similar in England and Wales and Japan, being 11.3 and 10.1 per 1000 respectively. The prevalence of obstetricians and paediatricians per 100 000 total births are approximately similar in England and Wales and in Japan, whereas the rates for anaesthetists are five times less in Japan. In England and Wales, 13% of maternal deaths were related to anaesthetic misadventures, but the Japanese incidence is not known. However, more than 50% of anaesthetics for Caesarean sections in district hospitals in Japan are administered by obstetricians. A pilot study in Japan would be necessary to determine the precise role of anaesthetic provision on maternal mortality. Maternal mortality may prove a useful indicator of anaesthetic service deficiency.