MATERNITY HOSPITAL SERVICES

Dominion, Volume 31, Issue 243, 11 July 1938, Page 12

MATERNITY HOSPITAL SERVICES

Inquiry By Committee; Conclusions And Recommendations

REQUIREMENTS OF TOWN AND COUNTRY

Central Obstetrical Institution In Wellington Advocated

The report of the committee of inquiry which investigated the maternity services of the Dominion was released at the week-end by the Minister of Health, Hon. P. Fraser. A detailed review of the conditions existing and facilities available in all hospital distiicts and recommendations arising out of the needs o each lyticula locality form one complete section of the report. Ihe second section is devoted to a general survey and the committee s conclusions and recommendations of a general nature. A condensation of these is given in a well-prepared summary at the end of the report. Recommendations are made by the committee whereby a complete and uniform maternity hospital system may be developec suited to the varying needs of the country districts, larger towns and main cities. This involves building on the existing structure The establishment in Wellington of a central maternity hospital capable of dealing with both normal and abnormal cases is recommended by the committee, which also regards the provision ot a public maternity hospital in the Hutt district as a matter of urgency. The need and opportunity for more modern private maternity hospital facilities in Wellington is also referred to The members of the committee are: Dr. D. G. McMillan, M.I. (chairman), Dr. Sylvia G. de L. Chapman Mrs. Janet Fraser J.P, Mrs. Amy M. Hutchinson, J.P., Mrs. N. G. Kent-Johnston, Dr. F. F. Corkill, and Dr. T. L. Paget.

“The committee found that the preference in New Zealand is for attendance by both doctor and midwife, or doctor and maternity nurse, in all cases, normal or abnormal, rather than for attendance by midwives in normal cases with the doctor acting in a supervisory capacity and available in abnormal cases,” states the report of the committee. “The former system is advocated by the majority of doctors in New Zealand, and is favoured by the majority of women, although, at present, mainly owing to financial circumstances, a considerable proportion of women are attended on the midwife system, especially in the St. Helens hospitals and the annexes to public hospitals. “Full consideration was given to this matter because it is recognised that in some countries with very efficient maternity services the midwife system operates. It is the opinion of the committee, however, that, while the midwife system can give a safe and efficient service, the combined system of doctor and nurse attendance can give 1 a still more efficient and a more satisfying service.

Extension of Principle.

“The extension of this principle Is therefore advised, and certain recommendations have been made whereby such a combined service might be brought within the reach of all by the appointment of house surgeons to act in conjunction with the senior staff in all the main public maternity hospitals an'd iu the larger maternity annexes, by hospital boards making provision for the doctor-attendance of indigent cases in smaller hospitals, and by the incorporation of provisions for doctor-at-tendance in any national health insurance system which may be developed. "The committee fully recognises the importance of thoroughly competent medical attention, and is in complete sympathy with all steps which will lead to the most efficient practical training of medical students in this work and to the encouragement of the special practice of midwifery by those to whom it appeals. While in isolated districts all general practitioners must of necessity engage in obstetric practice, the committee is in accord with the tendency in larger communities for the midwifery to be undertaken by those who, through partial or full specialisation in. this branch of medicine, are best fitted to give the service. The Relief of Pain. “In New Zealand, perhaps more generally than in most countries, the demand for the more extensive use of the measures of pain relief which are known to be available is being made by some women’s organisations and by individual women. , The committee has reason to believe that there are few countries where the use of some measures of pain relief is more general than New Zealand, but found that there were very considerable differences of practice,among doctors and hospitals both regarding methods and the extent to which these agencies were used“The committee is satisfied that any conservatism in the introduction of these measures has not been due to any lack of sympathy with suffering, but mainly to genuine doubts as to their safety from the point of view of both mother and child, and also to a feeling that where such measures were extensively used the necessity for artificial assistance in labour was increased with certain possible risks. Tile committee is, however, convinced that there are now various methods whereby under suitable conditions a satisfactory degree of pain relief can be very generally used with complete safety. "The majority of the committee is of the opinion that pain relief can only be developed to the most satisfactory degree if the doctor, in addition to directing the details of the use of sedatives during the earlier stages of labour, is also present to give, or to supervise the giving of the anesthetic in the final stages. Nevertheless the committee is of the opinion that, pending this development, the practice now adopted in a number of public maternity hospitals operating under the midwife system where sedatives are given under the direction of, though not necessarily in the presence of. a responsible medical officer could quite safely be made more general, thus very considerably supplementing the limited amount of anesthetic which the midwife is able to administer.”

Reservations by Two Members

Reservations are made by Drs. Sylvia G. de L. Chapman and T. L. Paget to the preceding observations of the committee. They state: —

"There can be no doubt that, under the conditions of an ideal maternity service, the doctor responsible for the ante-natal and post-natal care of the patient would also attend at the confinement in order to supervise both the conduct of labour and the administration of the optimum degree of analgesia. This ideal is, in fact, attained by many obstetricians in town practice. „ , “In many parts of New Zealand. liow.ever, this ideal is impossible of attainment. We are of opinion that it is unite impracticable for the majority of general practitioners in country districts to bold themselves in readiness for repeated visits during the 12 to 2-1

To be used by the British Phosphate Commission at Nauru Island, a 28ft. motor-boat launched last month by Collings and Bell has had successful trials on the Auckland Harbour. The boat, which will be engaged in the passenger r. 'd mail service between steamers in the roadstead at Nauru Island and the shore, will have to negotiate a ,surf-bound gap in a reef, and for this reasc.i she lias been built to an unusual design. She will be taken to the island from Auckland this month.

hours during which a normal labour may last, and that to try to force this upon the medical practitioner would inevitably result, in his being placed in the position of having either to neglect other patients, who have an equal, or perhaps superior, claim to his attention, or to hasten delivery by the use of instruments. We consider that the competent and specially trained midwife is capable of administering sedatives and analgesics safely ami effectively when acting on the instructions of a responsible medical practitioner. Midwife’s Judgment Sound,

“Evidence which, to us, was convincing was placed before the committee that a competent and specially trained midwife, while acting under a doctor’s instructions, could be trusted to use her judgment in the administration of these drugs, and that the results so obtained were excellent/ In our opinion, therefore, the implication that every woman should be attended at intervals’during labour and at delivery by a doctor postulates a system which in isolated districts in New Zealand is impracticable. We believe that, with further research into the use of sedatives and analgesics, and with particular care in training the midwife in their use, a midwife service with a doctor on call for emergencies would give results equal in. every respect to the service advocated by the committee. “We submit, further, that the usual fee of £4/4/- to'£s/5- is only sufficient to remunerate the doctor for full antenatal and post-natal attendance and for the limited attendance at normal labour specified above, and that to impose upon the medical attendant duties which in normal cases can be carried out equally well by the midwives would, since these duties must be paid for, have the effect of burdening tbe service with an unnecessary cost.”

UNMARRIED MOTHERS

Satisfactory Provision For

Their Care

TRANSPORT TO CLINICS

Facilities for tlie care of unmarried mothers were investigated by the committee of inquiry into maternity services. It considers that very satisfactory provision is made throughout the Dominion. “The work is mainly in the bauds of the Salvation Army and certain other charitable organisations whose institutions in addition to caring for these women at confinement, ropvide accommodation for a period before and after,” says the committee’s report. "There can be no doubt that in the majority of cases arrangements of this type are highly desirable. A hospital for married women has also been developed in connection with a number of these homes, aud a very high standard of maternity attention is shared by married and unmarried mothers alike. A commendable feature is that in the majority of these hospitals the same measures of pain-relief are also used. “Where it is possible to make satisfactory arrangements elsewhere for the mother beforehand, and for mother and baby subsequently, the St. Helens hospitals can take the unmarried mothers for the actual conTinement period. This also applies to the majority of hospital laiard annexes, and, of course, similar arrangements can he made-with private maternity hospitals.”

Other Social Aspects,

Other social aspects of maternal welfare were also considered by the committee. "Difficulties of'transport to aud from clinic ami hospital were found to constitute a hardship in a number of tbe more isolated country districts,” says the report. "To assist tbe position the committee lias recommended the establishment of small maternity hospitals in some districts which are not at present provided with such facilities, the greater use of district nurses to assist the doctors and clinics by giving ante-natal supervision in the homes of country mothers, and, in some eases, the provision of suitable waiting accommodation near tlie maternity hospitals to obviate the necessity for difficult last-minute journeys.

"Some complaints of inadequate telephone facilities were made. The committee found that, on the whole, the telephone service was very complete, lit a few instances public telephones are needed to bring the residents within reasonable distance of this channel of communication, and the difficulties occasioned by the night and holiday closing of certain rural exchanges might be met by better arrangements for emergency calls.”