Reviewing the progress of obstetrics in the first half of the twentieth century, R. W. Johnstone, an emeritus professor of midwifery at the University of Edinburgh, observed that of all the significant accomplishments in the domain of obstetrics such as the discovery of sulphonamides and penicillin, improvements in the methods and results of caesarean section and the triumph over puerperal fever, ‘the growth of the idea of antenatal care has been the most pervasive influence, and has worked the most widespread changes in the obstetrical outlook’. 1 The main thrust of his argument:

One line along which midwifery has been enormously improved by the antenatal idea is in the practice of the principle of physical examination of the pregnant woman from both the medical and the obstetrical points of view. Abdominal palpation of the presentation and position of the child in the later weeks of pregnancy, investigation of the capacity of the pelvis … routine examination of the heart and lungs … and the regular examination of the urine – all these are innovations of this century. The almost religious attention that is now paid to the diet of the pregnant woman is an outcome of antenatal care. 2