Good antenatal care provides comprehensive care for mother and baby to ensure the best possible outcome for both. We take this for granted in modern society.
Maternity care as we now know it was first developed in the early 1900s by the great reforming Liberal government of Asquith and Lloyd George, which also introduced social insurance and pensions for workers.
The initial driving force behind better maternity care was not the medical establishment, which had reservations about government involvement, but the army. Generals, appalled at the poor health of recruits in the Boer War, wanted higher calibre soldiers.
In the US there was less enthusiasm. The American Medical Association, paranoid about federal involvement in healthcare, allied with anti-suffragists and "anti-Bolsheviks" to resist attempts to provide organised antenatal care.
In 1919 it condemned proposed legislation as a socialist invasion of family privacy and as "a piece of destructive legislation sponsored by endocrine perverts, derailed menopausics [ sic] and a lot of other men and women working overtime to devise means to destroy the country".
Here, Noel Browne's 1951 Mother and Child antenatal scheme was halted by an unholy alliance of Church and medicine.
In our society maternal morality is now rare, but even when a normal birth and healthy baby is expected, occasional birth calamities occur unexpectedly, with death of the baby or physical or mental consequences on survival.
Although many of these events are unpredictable and nobody's "fault", bitterness and litigation are almost inevitable. It's no wonder obstetricians pay the highest medical defence subscriptions in the medical profession.
I was recently reminded of some infamous obstetrical disasters which changed the course of history when I met a feisty octogenarian who had spent her working life in tough and rough East End pubs pulling pints for characters who made the Mitchell brothers look like wimps.
Notes from her previous practice revealed that she had had a tactile experience in common with Queen Elizabeth II. She had once been seen at an outpatient clinic by Sir John Peel, who for many years was accoucheur to HM. I have no doubt that Sir John was a practitioner of the highest quality, unlike some of his predecessors whose antenatal care left a lot to be desired.
In 1554, England was in the grip of the Reformation. Queen Mary I, a Catholic who was anxious to produce an heir to preserve England for Rome, married King Philip II of Spain. Soon after, her periods stopped, her abdomen began to swell and her breasts began to secrete milk, all highly suggestive of pregnancy.
Her medical advisers confined her to her chambers and prescribed a diet of toast, gruel and wine - a regime hardly conducive to good antenatal care.
The pregnancy went on and on. When it continued into an 11th month, her physicians admitted that she was not and had never been, pregnant. King Philip lost patience, returned to Spain and never saw his wife again.
The conventional view was that Queen Mary had pseudocyesis, a psychological disorder whereby a woman desperate to be pregnant develops appropriate signs and symptoms in the absence of the real thing. However, recent historical research has suggested that she may have had a pituitary tumour as she also complained of increasing visual difficulty at the time.
Such tumours can cause endocrine disorders and can also impair vision by pressure on the optic nerves. Had she really been pregnant, an Anglo-Spanish Catholic dynastic alliance would have altered the course of world history.
Queen Anne (1702-14) had 17 pregnancies, only one of which was successful, a boy who died from smallpox aged 11. It is postulated that she may have had rhesus incompatibility or other conditions where the mother's body develops antibodies fatal to the foetus, conditions unknown at that time, which her doctors were powerless to treat.
In 1817 George IV's daughter Princess Caroline, the next in line to the throne, was pregnant. It was her bad luck to be so during a turf-war between the traditional midwives and the "men-midwives" (now obstetricians), when the latter decided to muscle in on lucrative home births among the gentry - in sharp contrast to today's obstetricians, most of whom become apoplectic at the thought of a home birth.
Caroline hired an ambitious, social-climbing man-midwife who left her in labour for three or four days. He refused to use a newly designed forceps offered by a colleague for fear that the colleague would get credit for the birth. The exhausted, dehydrated Caroline eventually gave birth to a stillborn baby and later that day died from a fatal haemorrhage.
The succession passed to the girl later known as Queen Victoria. She was more fortunate in her choice of obstetricians, had nine successful pregnancies and popularised obstetric anaesthesia by using ether in her later confinements. When told she could have no more children because of medical reasons, she is said to have replied: "Oh doctor, can I have no more fun in bed?" One wonders if Sir John Peel heard anything similar.
Dr Charles Daly is a GP practising in Dungarvan, Co Waterford.