MATERNAL WELFARE

Evening Post, Volume CXII, Issue 136, 6 December 1926, Page 10

MATERNAL WELFARE

POLICY OF^ GOVERNMENT

AIM OF MINISTER OF HEALTH

SPECIAL WARDS IN BACK COUNTRY CENTRES.

The importance of ante-natal supervision as a means of reducing maternal mortality can hardly be over-estimated. So many of the complications can be foreseen, and can cither be prevented or successfully treated if competent medical advice, is available, that insistence upon pre-natal care has become a truism of obstetric teaching; but the practice of this preventive midwifery unfortunately lags far behind our knowledge of its value. ■ —Sir George Newman, Chief Medical Officer of the Ministry of Health, Great Britain. In his address at the ceremony of laying the foundation-stone of the additions to the Wellington Hospital on Thursday, the Minister of Health. (Hon. J. A. Young) said that an analysis of the New Zealand statistical records revealed the remarkable fact that maternal deaths from puerperal causes showed a higher percentage in rural districts than in the towns. Dr. Janet M. Campbell, Senior Medical Officer for Maternity and Child Welfare, British Ministry of Health, has also drawn attention to the high maternal mortality rates in rural districts in England. "The general impression gained from a study of these conditions is that the problem is largely ono of ignorance and of geography," says Dr. Janet Campbell. "Women in rural con munities are somewhat out of touch with new ideas, and are apt in consequence to be more than usually prejudiced and conservative in their habits. Further, where the jiopulation is sparse, where houses and villages are often remote and difficult of access, where means of communication aro limited and slow, it is inevitable that medical assistance may be unobtainable in time to deal with an obstetric emergency, and unless suitable measures have been taken beforehand the mortality among complicated maternity cases is likely to be high. The remedy seems to lie first in educating tho women by all and any means available to take heed of their health and to secure ante-natal supervision; secondly, in ensuring an adequate supply of well-trained midwives. and by requiring < them to practise ante-natal care; thirdly, in the provision of maternity beds for the mutual advantage of patients and practitioners, if possible in association with existing hospitals." ADDITIONAL TRAINED MATERNITY NURSES. These remarks apply even more strongly to the rural areas in New Zealand, and especially to tho backbloeks; and it will be pleasing to country settlers to note that the Minister of Health announced that it is the policy of tho Government to encourage hospital boards to establish maternity wards in suitable back country centres. As pointed out by tho Minister, the problem of helping^lho expectant mother in country districts is a difficult one. Thin difficulty can, however, be largely ;overcome by the appointment by hospital boards of additional trained maternity nurses for work in the rural areas; and that these nurses should be specially trained in modern ante-natal methods, which include the hygiene of pregnancy and the diagnosis and treatment of the more simple ailments to which the expectant mother is liable; one of the ■main advantages being that the medical attendant may receive early information of symptoms which if not treated promptly might lead to r a serious condition. / In the four chief centres of New Zealand, and in four of tho suburban districts of those centres, ante-natal clinics have been established, and some of the hospital boards are taking measures to extend tho work, and with that object have sought the advice and assistance of the medical officers of the Health Department. Tho Plunkct Society, St. John's Ambulance Society, and the Red Cross organisation have also established clinics. The soundness of tho scheme obviously depends upon three things, the proper training of the nurses appointed to advise prospective mothers; tho proper supervision of the nurses' work by medical practitioners; and the systematic inspection of the clinics by medical officers with special experience and training in this branch of medical science. To further complete tho safeguarding •of motherhood there should bo available nurses and midwives trained in modem methods of nursing, which include a knowledge of asepsis, the only scientific preventive of the dreaded levers connected with childbirth In order that such skilled nursiuoattention may bo available, statutory provision has been made that, except in. cases of emergency, no person shall undertake the duties of a maternity nurso unless registered, and registration brings the nurse under the regulations with regard to method and equipment This will mean as timo goes on the raising of the standard of maternity nursing. ■* ANTE-NATAL CLINICS. The ante-natal clinics already established by the Health Department are conducted by nurses who in addition to the ordinary diploma of medical and surgical nursing also hold the qualification of niidu_ery and ante-natal work. Each nurse acts entirely as an assistant to the patient's medical attendant; and wg the results, forwards to the medical attendant the record of her nh servations for his information, and if necessary for his instructions or treat - Z n*_ .f 1 £ atients are to attend the clinics at least once a month Privacy is one of the principal factor. responsible for the popularity of th. clinics. That there were 7912 attendances at these ante-natal clinics during the past year testifies to the confidence shown in their administration by the expectant mothers and their medical advisers. HOSPITAL PROVISION. Since 1920, when attention was first drawn to tho unenviable position New Zealand occupied in tho sphcro of maternal welfare, there has been a marked improvement, tho total deaths from puerperal causes declining from 194 in 1920 to 131 in 1925. This is regarded as satisfactory taking into consideration the difficulties encountered in dealing with rural areas, but if New Zealand is to equal tho record of Denmark the annual number of deaths must be still further reduced to about 55 Amongst the questions to which the Department of the Minister of Health is devoting its attention are tho provision of more public ante-natal clinics and maternity hospitals by hospital boards, tho improvement of tho training of midwives and maternity nurses the prevention of puerperal infections' The public maternity hospitals or maternity wards attached to New Zealand hospitals number 55, including seven St. Helens or State maternity hospitals and seven hospitals under various charitable and religions bodies. Nearlv'all of these hospitals aro also used as training schools for maternity nurses or midwives. In addition to tho public hospitals there are 220 private hospitals devoted partially or exclusively to maternity work, some of which are subsidised by hospital boards, which find this a satisfactory method of providing the necessary facilities for adequate attendance to women, in country

districts. Those institutions aro, regularly inspected by a specially qualified medical officer and by nurso inspectors attached to the Department of Health. As a result of co-operation between these officers and tho licensees and nurses of the different institutions, the standard of work and tho efficiency of these hospitals has been noticeably raised. One particular in respect of which marked improvement has been shown is in the securing of asepsis during labour and tho lying-in period, which must be regarded as tho most important means of securing a. reduction in tho number of cases of puerperal infection, while skilled and systematic ante-natal care is tho means which must be relied on to reduce the number of cases of eclampsia, tho other principal preventable cause of maternal mortality. The policy announced by the Minister of Health in regard to tho extension to country districts of the facilities outlined above should, in the opinion of medical men bo an important step toward his ideal of safe maternity.