Board of Health reports on maternity services

Press, 3 August 1976, Page 15

Board of Health reports on maternity services

PA Wellington Beside developments in obstetrics, it was important there was a constant awareness of the broad, emotional peeds of patients, their husbands. and families, said the Board of Health in its report on maternity services. Such a concern would run parallel to an increasingly scientific approach to medicine and echo a public interest in the "human dignity” of hospital patients.

The report considered two major categories of antenatal clinics those in the small number of major obstetric units where there was a medical clinic under specialist supervision for public patients, and clinics which ran parallel with private doctors’ care simply to use patients attending hospital in assisting in nursing training with no doctor attending the clinic. “On the whole, the latter, being small and leisurely, ran well with good human relations,” the committee said. “However, we found several which were unattractive and which did not reach a desirable standard. As a result, patients preferred not to attend. “At the larger public clinics, we formed the impression that the attitude of lay clerical staff was not always as helpful to the patient as it might be. The fact that the patient is always under emotional stress when in a hospital situation is sometimes overlooked by clerical officers who, talking down to the patient, tend to increase difficulties rather than smooth them out.” There appeared to be excessive congestion in some clinics.

The report said that virtually no New Zealand delivery unit had adequate dayroom facilities in the delivery suite for patients in earlv labour. It was still regarded a? routine for a pa-

tient to lie on her back in | a tidy bed for labour to continue. The report said the investigating team was delighted Ito find that medical and nursing staff had generally accepted the principle of a husband's presence in the delivery room. Family planning services lat hospitals are negligible |in New Zealand, and there is considerable difficulty obtaining sterilisation in many parts of the country, said the board, in another facet of its report. "Hospital boards have Ifound difficulty in keeping in touch with present attitudes on family planning, sterilisation, and therapeutic abortion,” the report said. “They have been slow to provide family-planning clinics in response to advice from the Health Department.” There were considerable difficulties in many areas in obtaining sterilisation . . “particularly of the male, and some boards have produced extraordinarily conservative impressions of the interpretation of the Hospital Act to avoid providing hospital service for male sterilisation.” Equally, boards had been in some difficulty in considering the possibility of termination of pregnancy. “In some cases, the boards have been pressurised by minority groups from without to limit their activities in some of these directions,” the report said. It was essential that fam-ily-planning services in the wide sense were fully available in the boards’ institutions. “Time is short for the full implementation of an adequate family-planning programme to avoid the necessity, which would be regretted by many, of a programme of abortion on demand or request.” The report recommended that each hospital board re-

i ;gion providing major services -'should have an emergency isystem available for providing expert help to mothers 1 with obstetric or gynaecological conditions. 'i Only a limited number of 1 (mobile emergency units travelling by road, air, or water, to provide expert help, in- ’ [eluding 'blood or incubators, ! |were available in New Zealand. "Clearly, it is preferable whenever possible, patients be referred in anticipa- - Ition of an emergency and that I the booking of patients in ‘ 1 isolated units ' ith a past his'jtory of caesarian section, or ’ third stage of labour troubles. ’ is clearly highly undesirable. “We believe, however, that ' each hospital board region : providing major services { should have an emergency ! system available.” said the report. This would provide : both expert help and resus--1 citative measures to a mother * with an obstetric or a gynaeI cological condition or provide * an incubator to transport a ; small neonate under resusci- ' tation by expert help back to ’ the base hospital.” Other points made in the report are: » 1 The rate of births by caes- ! arean section is 4 per cent — 1 a reasonable figure by world standards. ’ Of known marital status. ' 32 per cent of maternal deaths J were non-married compared ’ with 13 per cent in the repro- ' ducing population; and 43 per cent were non-European * compared with 14 per cent in ' the reproducing nation of known race. One-sixth of maternal I deaths are associated with 3 road accidents and one-tenth . a result of malignant disease. Twin pregnancies represent . five times the national risk of . maternal deaths. Smokers are known to have a higher perinatal mortality 1 and a higher incidence of - babies with low birthweight.