Cottage maternity units passing

Press, 21 December 1978, Page 4

Cottage maternity units passing

New Zealand’s "‘cottage” maternity hospitals are slowly becoming a thing of the past — and it is rural residents who are mourning the loss.

This situation is also a major concern to hospital boards throughout the country and the Department of Health.

The declining number of midwives willing to work in country areas and the lack of practical experience in obstetrics by young qualified doctors, are at the centre of the staffing problems. Because of this lack of specialised staff, hospital boards throughout the country are experiencing difficulties in keeping open some smaller maternity units. Since 1970, 28 small units have been closed.

Some “cottage” maternity units have been in existence since the turn of the century and local feeling and interest quickly rise when the service is threatened.

Deputations and petitions to higher authorities by residents have meant “a stay of execution” in some areas, while the situation has been reassessed. Units are closed only after considerable discussion between the board concerned and the department, and after an application has been made to the Hospitals Advisory Council, which is the statutory body set up to advise the Minister of Health on such matters. Then, only if an alternative service is within a reasonable travelling distance is a unit closed. In most cases, this is a provincial base hospital. Such matters are the concern of the Board of Health Maternity Services Committee. With the closure, hospital boards Use the building for health-related uses where possible. Former “cottage” maternity hospitals have been converted to geriatric homes, community hospitals, a St John Ambulance

depot, a long stay unit for physically handicapped young people, a home for intellectually handicapped children, and several have become surgery and residence for the local doctor. Others have been sold or leased to private individuals when the need for the building in a healthrelated field was superfluous.

The huge expenditure needed for the country’s health services and the change of emphasis to preventative medicine in the community has highlighted the cost factor. Bed occupancy rates are a contributing element in the final analysis. An annual cost for a registered midwife, three staff nurses and one hospital aide, the basic staffing requirements in such units, is approximately $75,600. This figure does not take into account the extensive additional annual running costs of such a unit.

Boards and the department are now striving to ensure that the change in circumstances, caused by the present staffing problems, does not mean a lowering in the availability or standard of the maternity facilities.