OBSTETRICAL SERVICES

Press, Volume LXXXIV, Issue 25609, 25 September 1948, Page 8

OBSTETRICAL SERVICES

Maternal And Infant Welfare

RECOMMENDATIONS OF CONFERENCE

(P.A.) WELLINGTON, Sept. 24. However excellent the maternity provision made by many hospital boards might be, there was some ground for uneasiness and uncertainty about the powers of application ana enforcement of standards in certain hospital board institutions, particularly “closed" portions. This opinion was expressed in a report tabled in the* House of Representatives to-day by the Minister of Health (Miss M. B. Howard* of a conference which met in Wellington from June 29 to July 2 to consider general questions relating to maternal and infant welfare. Miss Howard was chairman of the conference. and those present included representatives of the Obstetrical and Gynaecological Society, the Registered Nurses’ Association, hospital medical superintendents, the University of Otago, the Plunket Society, the Hospital Boards’ Association, and the Department of Health.

The conference was satisfied that the requirements of maternity provisions in hospitals were sound and thorough, and had in the main been successful, said the report. The then Director of Maternal Welfare (Dr. Doris Gordon* gave some specific instances which, if proved, could not but be regarded as serious departures from generally accepted standards, and which she considered to be largely caused by the fact that the same supervisory authority which applied to private maternity hospitals did not apply to closed wards of public hospitals.

“The conference was in no position to investigate the instances referred to by Dr. Gordon, and certain of them were emphatically denied by other members. It appeared lb the conference that such imperfections as had occurred had been isolated, and exceptional and due to a necessity to accept admissions in the face of difficulties of accommodation and staffing. There was no evidence that any harm has come to any maternity patient in any of the instances referred to. Such imperfections were in certain cases at any rate temporary and were rectified at the earliest opportunity. Nevertheless. the conference felt that steps should be taken to end any possible confusion, and to correct any anomalies,” said the report, “and it was resolved that every child-bearing mothei and every new-born infant should be cared for under standardised regulations. no matter where they were nursed, and that the existing regulations should be revised."

Staffing Difficul.ies The Director of the Division of Nursing (Miss M. I. Lambie) read a report which indicated that although staffing difficulties had thrown a great strain on nursing staffs and had led to overwork, no breakdown in essential standards had been caused. Reasonable proof of this was afforded by records of maternal mortality, stillbirths, and infant mortality. “This report was completely endorsed by representatives speaking from their own experience in all parts of the country,’’ the report added. “Satisfaction was felt that already some easing of the position was to be noted, and that many of the suggestions made by the 1946 committee had been adopted with considerable success. “Figures presented by the Nursing Division of the Department of Health for the year ended March 31, 1948, showed a total maternity nursing staff of 666 for 702 occupied beds.’’ Abnormal Cases The importance of developing special departments for the handling of abnormal obstetric cases in all hospitals of any size was emphasised by the inference. These units would operate on the “closed” principle, and would be staffed by obstetric specialists. Miss Lambie said that an obstetric section cf the post-graduate course was now giving advanced training to senior midwives aiming at higher charge positions or teaching posts in obstetrical hospitals. Close co-opera-tion was maintained with the Plunket Society’s advisers in matters relating to infant care, and in all maternity training schools at least one sister had Plunket training. The conference was satisfied with the general position, and it was obviously a general feeling that, apart from exceptional instances of faulty methods, a uniform and progressive practice was followed in the training of nurses. After emphasising the potential value of the obstetrical research committee of the Medical Research Council, the conference advised that all obstetrical units should give close co-operation by providing statistical information. One direction in which it was considered the New Zealand service should more generally follow modern overseas practice was in the development of neo-natal units under the care of pediatric specialists. The principle of appointing pediatricians to take charge of all neo-natal units or group units of 30 or more beds, the appointees to work in close co-operation with the obstetricians concerned and to be available for consultation in open wards, was approved by the conference. In smaller units the same general principle should apply. Safeguards Against* Incompetence The conference was asked to consider how to safeguard uhder the law maternity patients and their children from incompetence, or negligence, or malpractice of any doctor. Dr. Gordon referred to seven cases which had come to her notice, which she considered gave evidence of incompetence or negligence by registered medical practitioners. “The conference desires to make clear that it was in no position to investigate these cases, nor was it called upon to do so. It therefore expresses no opinion on them. Dr. Gordon’s remarks did, however, promote discussion on whether or not the existing machinery was adequate to deal with such cases. While the New Zealand Medical Council has full power to inquire into any suspected case of professional impropriety or infamous conduct, and while the council had at times inquired into less grave cases, the'conference felt there was a need for some more clearly-de-fined procedure for investigating, and otherwise dealing with cases of less gravity than those covered by the disciplinary sections of the Medical Practitioners Act. It was resolved that consideration should be given, either to enlarging the functions of the Medical Council, or by some other means bringing minor degrees of incompetence. etc., under investigation and control” Another recommendation of the conference was the advisability of the Minister’s recognising an obstetric council from which the Minister could obtain advice on matters affecting maternity services in New Zealand. Average Stay in Hospital It recommended that the average stay in hospital of maternity patients should be not less than 14 days, but the duration of the stay in individual cases should be the responsibility of the attending practitioner. The conference also recommended “that open accommodation for maternity patients provided by hospital boards shall be open to all practitioners, provided they have signed an agreement with the respective boards. Such agreements shall include an undertaking to maintain the highest standards of technique and methods. It shall also be agreed that one obstetric specialist or senior practitioner shall be responsible for the teaching of nurses.”

It was thought the time had come for a definite statement whether the Government still intended to conduct St. Helens Hospitals on the “closed” principle. The Minister was asked to declare a policy for the future development of St. Helens Hospitals, and it was asked that the recommendation of the 1946 report be given earnest consideration.

“That the hospital boards of New Zealand be urged in hospital planning and future medical appointments to give full consideration to the accepted principles of grouping obstetrical and gynaecological cases in a combined unit with unified staff,” was another