Jim Pearson

Obstetrician behind ‘count to 10’ charts

Jim Pearson, who has died aged 72, was one of the most inventive clinical obstetrician/gynaecologists of his generation. With JB Weaver in 1976, he devised foetal “count to 10” charts, and with JP Calvert in 1982, graphs for plotting the growth of a baby by using a tape measure over the mother’s abdomen, both of which are still in use in nearly every antenatal clinic in Britain.

Doctors and midwives had long recognised that sick babies tend to kick less frequently in the womb before they die, but no one had found an easy way to count the movements. The problem was that normal babies move many hundreds of times in a day, and pregnant women have better things to do than to monitor them constantly. Jim’s idea of counting just the first 10 movements in the day, and recording the time when that point was reached, meant that mothers of healthy babies could stop after an hour or so. Women were instructed to call in if their baby had not moved 10 times by the evening. The charts were an immediate success – I found them in use in Africa in the early 1980s – and many thousands still use them every day.

Checking the size of the baby was also an inexact science before the wide availability of ultrasound. Doctors either palpated the abdomen and estimated the baby’s weight, or measured the woman’s girth. Jim suggested that it would be better to measure the height of the uterus (fundal height) using a tape measure, and drew up the necessary charts. The method immediately entered widespread clinical practice, not only as way to predict sick, small babies who might be better off delivered early, but also as a method to warn doctors if a baby was larger than expected.

Neither I, nor the poor woman involved, will ever forget an unwise forceps delivery that I conducted as a junior obstetrician in Cardiff. Both mother and baby were traumatised, and Jim rightly ticked me off the following morning. But he also showed me how I could have anticipated the problem using his chart, a method that survived even the widespread introduction of ultrasound. In most clinics today, a tape measure is used to screen low-risk women so that those with a suspected small or big baby can be selected for ultrasound scanning.

Jim’s parents had both started work in the Lancashire cotton mills at the age of 12, and his father and grandfather had walked from Lancashire to London in search of work on the new Wembley stadium. The family had settled there and Jim, the eldest of five boys, was born in Wembley, attending Catholic grammar schools in Gunnersbury and Finchley, north-west London. He qualified in medicine at Charing Cross hospital, and, as a junior doctor in Birmingham, worked with J Selwyn Crawford, the founder of obstetric anaesthesia in Britain.

Jim was a conservative in an era of increasing intervention in childbirth. In the 1970s, techniques for starting off labour with automated drug infusion pumps were being perfected by Alec Turnbull in Cardiff, and a vogue developed for a practice called “active management”, which involved breaking the waters early and administering drugs to speed up slow labour, as well as making sure that women were never left alone. Jim was initially an enthusiast, and had indeed been appointed as a consultant in Cardiff in 1972 specifically to develop this sort of active approach. However, he increasingly came to agree with Selwyn Crawford that, so long as women were given adequate pain relief, patient observation was usually the better course. Although he failed to test these ideas in randomised trials, he encouraged others to do so, and was eventually proved right.

A number of universities would have been delighted to have appointed Jim to a chair, but he would never leave Cardiff – he remained in post until his retirement in 1999 – partly to avoid disrupting the life of his daughter Vicky, who had suffered from birth from a severe learning disability. He is survived by his wife Denise, his daughter and three sons, who played Honky Tonk Train Blues at his funeral and remembered him as a jazz pianist, flyer of kites and explorer of first world war battlefields.

• James Francis Pearson, obstetrician, born October 16 1935; died July 19 2008

Jim Thornton Reprinted from The Guardian, Thursday 2 October 2008