HOSPITALS FOR MOTHERS

Press, Volume LXXXIII, Issue 25282, 6 September 1947, Page 10

HOSPITALS FOR MOTHERS

INCREASING STATE PROVISION * MATERNITY SERVICE TRENDS From Our Own Reporter DUNEDIN, September 5. “While it is desirable that there should be private maternity hospitals, provided always that they conform to well-recognised standards of efficiency, it is very evident that there must be in the future an increasing provision by the State, either centrally by the Department of Health or locally by hospital boards, of hospital accommodation for maternity cases,” said Professor J. B. Dawson, of the chair of midwifery and gynaecology in the Otago Medical School, when he discussed modern trends in New Zealand of obstetrical and gynaecological services in an interview with “The Press.”

Consideration and analysis of the trends of u e services to the pubilc during the last 25 years suggested at least two dominant factors, the steady increase of the demand for hospital accommodation for the confinements of mothers and the importance of linking maternity work closely to the sister science of gynaecology (the study and care of the diseases peculiar to women), said Professor Dawson. It was safe to say that probably 40 per cent, of the work of a geneacologist was caused by child bearing, and neither obstetrics nor gynaecology could be properly studied or conducted when divorced from the other.

“More than 90 per cent, of New Zealand infants are born in hospitals, and at the moment the number of beds is quite inadequate,” he said. “It is a well-recognised principle that maternity cases must not be mixed with ordinary medical and surgical cases, but treated in special hospitals and annexes. designed and staffed for their specific purpose. At present in New Zealand this is not possible, and the undesirable and dangerous alternative of using parts of general hospitals for maternity cases is enforced by necessity.” Local Control Preferable It was the generally accepted opinion that public provision of maternity hospitals should be a matter for hospital boards and that local control was preferable to central control by the Health Department. It was certainly true that such locally-controlled maternity hospitals were more popular than the St. Helens hospitals controlled by the Health Department. All publically provided hospitals should, of course, make full provision for thorough "nte-natal and post-natal supervision of patients. The recent discussions about the public provision of maternity hospitals was inevitable, said Professor Dawson. An important matter was whether they should be “open” or “closed”—that is whether they should have an appointed medical staff responsible for the care of all patients or whether they should be “open” so that any reputable medical practitioner might attend his patients in them. “The answer to that is there should be both.” he said. “If there is to be any continuity in the supply of properly trained midwives, maternity nurses, and medical practitioners, it is obviously necessary that provision must be made for practical training and education. For this, some ‘closed’ hospitals are necessary so that this training can be conducted by a permanent carefully selected staff of competent obstetricians who have themselves been specially trained and possess higher oualifications in their chosen snecialitv. Further, such ‘closed’ hospitals, with their highly trained staffs, are necessary to deal adequately and safely with complications and emergencies. Special Staffs Needed

“At the same time, there is no need to deprive the medical practitioners of the country of all obstetrical work, and so provision should be made of open’ hospitals of recognised competence and standards. The staffing of close- hospitals and the supervision of open hospitals is a matter of great importance. The staffs must be carefully chosen from practitioners who have had considerable post-graduate experience both in New Zealand and overseas and who. preferably, have obtained special and higher qualifications in obstetrics and gynaecology.” More than once it had been pointed out that New Zealand was losing numbers of her first-class medical graduates who had spent time and money seeking special experience in Great Britain, because there were scanty opportunities for the employment of this expert training, he added. It was natural and proper that a young man who had. often at considerable personal expense, delayed his career so as to perfect himself in some special branch of medical practice, should expect to find opportunities for the exercise of his knowledge. It was to such men that the hospital authorities should look to staff existing and future maternity hospitals and annexes, to give the public the best possible services and also attract back to New Zealand the best of her medical graduates. “Behind the .Times” “Some of the more important hospitals of New Zealand have been slow to recognise the importance of the close association of the two subjects of obstetrics and gynaecology,” said Professor Dawson. “Since the beginning of this century,, all British, American and Australian hospitals of any importance have had fully developed combined units of obstetrics and gynaecology, yet New Zealand has lagged behind, so much so that it is fair to say that some of her important hospitals are, in this respect. 40 or more years behind the times and well-es-tablished professional opinion. It can only be detrimental to the public and to the medical profession to divorce these closely allied and interdependent subjects.” In all hospitals of more than 200 beds there should be a combined unit staffed by specially trained practitioners. he said. That would create throughout the country foci where the highest standards of practice would be maintained. That would be of great and obvious benefit to the women of New Zealand and provide the attraction necessary to bring New Zealand’s oversea post-graduate scholars back to their country. “It is important that these combined units of obstetrics and gynaecology should be in close proximity to a general hospital,’’ said Professor Dawson. “They should, wherever possible, be housed in a separate building and have their own nursing staff, but be sb accessible to a general hospital that all facilities for observation and treatment are available without delay. “Obstetrics cannot any longer be regarded as a subject apart, but must be regarded as one of the important branches of medicine for which all facilities such as X-rays, - bacteriological and pathological investigations, and supplies of blood for transfusion must be always near at hand. Obstetric emergencies present the gravest and most urgent problems of any branch of medicine; crises can arise in which minutes of delay may be disastrous, so it is imperative that all obstetric units should be linked to a general hospital from which these facilities can be readily obtained. Mortality Rate Improved A gratifying reduction in the deaths associated with child-bearing during the last 15 years had ’ ?en recorded but. great though the improvement had been, there was still room for more, said Professor Dawson. Surprise was sometimes expressed at the trouble and care taken to give adequate services in pregnancy and childbirth, which, it was claimed, were natural functions better left alone and without interference. There might be some justification for that view if child-bearing were always normal and natural, but. unfortunately, the people did not live under natural conditions and women had to suffer the artificial factors of so-called civilisation which had gravely disturbed natural physiological processes. “Very ordinary care can ensure safety in normal pregnancy and labour, but very extraordinary care is needed to avoid disasters with the abnormal,” he concluded. “It is pos-

sible further to reduce loss of life from child-bearing and it is by the most meticulous care of the abnormal that this can be achieved. Obviously, it is the abnormal that contributes to the loss of life, the tragic loss of life for there are few deaths so distressing as that of the young mother. It is only by providing hospital accommodation and medical services of the highest possible standards, experience, and competence that even the occasional disasters can be avoided.”