MATERNAL WELFARE

Evening Post, Volume CVI, Issue 55, 14 September 1928, Page 11

MATERNAL WELFARE

RECORD OF WORK CHAIR OF OBSTETRICS TO BE ESTABLISHED The announcement in "The Post" last evening that the Government has agreed to make "an extra grant of £ 500 to the Otago Medical School for instruction in midwifery"—a grant which, with tho money already available and a further sum which it is anticipated will be received in connection with tho scheme, and the provision for improving the teaching of midwives —will enable a Chair of Obstetrics to be established. This step has long been urged by the medical profession, is one of the main objects of the New Zealand Obstetrical Society, and will mean a considerable advance in the campaign for maternal and child welfare. In 1921 attention was first drawn publicly to the fact that although New Zealand had an enviable record in respect of most phases of public health work, it was to a certain extent lagging behind in tho important sphere of maternal welfare. Closely associated with this matter are the numbers of stillbirths and the deaths of infants during tho first month of life, as during this period of existence the interests of child and mother are well nigh identical. In that year it was pointed out that the maternal mortality rate in New Zealand was relatively high, being much higher than that experienced by England and Wales, Australia, and particularly by certain other European countries such as Denmark, Holland, etc. A special committee of the Board of Health was appointed in the same year to investigate the matter. Their principal recommendations were:— 1. That tho committee is strongly of opinion that a more strict and regular inspection of private maternity hospitals is necessary, and that for this purpose more nurse inspectors of proved competence and experience be obtained. A very careful revision of technique should also take place, and inspection must be directed especially to seeing that recommendations aro carried out, and that technique is kept up to date. ■2. That while the committee has reason to believe that the system of training midwives pursued in New Zealand is not inferior to that obtaining in other countries, still tho committee is impressed with the necessity of improving the present training, cspecial.ly with regard to the supreme importance of a thorough knowledge of asepsis. The committee therefore recommends that the syllabus and course of training bo revised so as to secure a greater efficiency than at present obtained. 3. That the importance of a sound training iv midwifery at the Otago Medical School should be reeogniscd by the creation of a professorship instead of the present lectureship,_ thus enhancing the status of this subject in the medical curriculum. 4. The committee finds on evidence before it that tho use of instruments in midwifery practice is excessive, and suggests that tho special attention of tho medical profession bo called to this fact, and that tho co-operation and assistance of the profession should bo sought in this connection. The committee learns with satisfaction that tho medical profession through its organisation is alive to its responsibilities in this matter, and has already taken steps to investigate the question, and very shortly is holding a Dominion conferonce at which methods of technique are to be cgnsidered with tho view of reducing to the lowest possible limit maternal mortality in this country. 5. The committee desires to stress the importance of tho use of ante-natal clinics. It cannot bo too widely known that already ante-natal clinics have been established in each of the seven St. Helens Hospitals and also at the maternity hospitals or wards under the control of hospital boards. HEALTH DEPARTMENT CAMPAIGN. It is obvious that^this whole question resolves itself into* a matter of the better supervision of expectant mothers, and of the better training of those whose duty it is to attend upon women in childbirth and labour. The Health Department therefore planned its campaign for the reduction of the undue maternal mortality rate along the lines of providing antenatal care, and improving tho standard of training of maternity nurses and medical students. In New Zealand a comparatively large number of births take place in institutions. In 1928 out of some 28,500 births, 5500 occurred in public institutions, 11,000 in private hospitals, and the balance in private houses. Private hospitals, of course, are registered and inspected in New Zealand, and this has been the case for many years. A staff of specially trained nurseinspectors are charged with the duties of periodically inspecting private maternity hospitals with a view to insuring that the standard of sanitation and attendance is all that is considered necessary. The whole system of the training of midwives was revised; by tho Act of 1925, which provided for two classes of persons who may attend a woman in childbirth, viz., midwives and maternity nurses; the distinction between these two being that the midwife is entitled to attend normal cases without a doctor being in attendance; to hold a teaching post in a trainiug school for midwives; and to bo the licensee or manager of a private maternity hospital. To fit her for these responsible positions, her training is longer, and of a more intensive nature than that giveu to the maternity nurse. Tho presentday maternity nurse, however, is regarded as being at least equal in training to the. midwife under the former regime. ANTE-NATAL CARE. Ante-natal care, as has already been said, is most important. During the last few years, properly equipped antenatal clinics havo been organised in connection with all tho training schools for midwives, of which there aro thirteen located in the principal centres of the Dominion. These clinics serve the dual purpose of providing facilities for proper anto-natal supervision for women in tho vicinity, and also of ensuring adequato means for the instruction of potential midwives and maternity nurses in anto-natal care. At present, every midwife receives a definite series of lectures and a definite amount of practical instruction in this important subject; and at tho end of hcr\traiuing is regarded as competent to supervise the expectant mother. Her training is based on the idea that sho shall be fitted to determine any departure from the normal in the early stages, with the view to the case being referred to the medical attendant for adequato treatment. Tho Plunkot and kindred societies have also organised clinics which aro conducted oniirely by nurses, who, besides being qualified in medical and surgical nursing and in midwifery, have received special training in ante-natal and post-natal work. Patients attending those clinics are examined by the nurse, the history being taken, and the results being record.cd on a chart, a copy of which is sent to the doctor whom, tho patient has engaged to attend her in her confinement.

Tho doctor is requested to instruct the nurse on any point on which he desires her to pay special attention. After the first visit, the patient attends the clinic once 'a month in the early months of pregnancy, and fortnightly during the last eight weeks of the period. During the patient's whole attendance at the clinic it is the nurse's duty to keep the doctor informed of the progress of the case and tho occurrence of any symptoms of morbidity or abnormality that may develop. The object of the clinic is to relievo the medical practitioner of a great deal of routine work which the mirso can carry out efficiently, and to provide expectant mothers with a sympathetic and well-trained confidant and adviser, who can bo consulted on many small matters which are of importance in maintaining her health, but which she regards as too small to trouble the doctor with. EXTENSION OF WORK. Tho whole aim and object of this work is: (a) To maintain tho health of the expectant mother; (b) to instruct her in her bodily hygiene and habits during pregnancy; (c) to preserve pregnancies the full time; (d) to secure normal labour, resulting in a healthy breast-fed baby and an undamaged mother. At present, as has been already said, the.re are thirteen ante-natal clinics 'at training schools for uiidwives, and an additional number in connection with the Plunket Society, Salvation Army, etc. Tor 1927 a total of 3DIO patients atfended ante-natal clinics, being an increase of 081 over the figures for the preceding year. It is hoped to extend this work within the near future by requiring ante-natal clinics to be established in connection with the twenty public hospitals which train maternity nurses. The Medical School at Dunedin finds itself to a certain extent handicapped in providing practical instruction for medical students in obstetrics on account of the relatively small number of people which utilises the St. Helens Hospital and the other public maternity hospital in that city, which is under the control of the Otago Hospital Board. The Health Department, with tho view of assisting" in this important work, has agreed to medical students being permitted to attend tho St. Helens Hospitals in the other main centres, where they receive practical instruction from the medical officers in charge of those 'institutions. The Health Department has also given its active support to tho proposals for improving the status of the midwifery department in the Otago Medical School. At present the Otago University only pays a lecturer £190 per annum, a?id a tutor £75 per annum. The University Council has appealed to the Government for substantial help in this direction, and it is hoped that a sum will bo placed on the Supplementary Estimates this session for a chair of obstetrics, as recommended by tho Health Department, the New Zealand branch of the British Medical Association, and as strongly advocated by the recently formed New Zealand Society of Obstetrics, and urged by Mr. Victor Bonney, the noted' London gynecologist, and other prominent medical men from overseas. Tho following table shows the number of deaths from puerperal causes, and the rate of such deaths per 1000 births from 1920 to 1927:— Total number Hate per Your. of deaths. 1000 births, lftil) .. l'J4 .. (i.-IS IH2I .. 145 .. 5.08 Wli .. 14!) .. r>.M HIM .. Mil .. 5.11 3021 .. 140 .. 3.00 li' M.. 131 .. 4.0", IM2II .. 120 . . 4.25 1027 .. 137 .. -l.'Jl CHAIR OF OBSTETRICS. Tho Health Department has instituted systems of returns which enable it to acquire speedy information in regard to any outbreak of an infectious nature in public or private maternity hospitals. It also receives reports in detail on all cases of puerperal septicaemia and eclampsia and on all deaths at or subsequent to childbirth. These matters are under tho close supervision of Dr. Jollett, a .recognised authority on obstetrics and tho author of tho wellknown text-book on the subject. Dr. Jellctt occupies the position of Consulting Obstetric'an to the Department, and by means of the returns referred to valuable information is received by him—information which will bs of great advantage to the Department in shaping future policy. Full information on these various matters will be found in the departmental reports published annually by the Health Depai-t-----ment. The medical profession of New Zealand is seized with the importance of this branch of medicine, and is co-oper-ating actively with the Health Department in an effort to reduce the number of deaths of women in childbirth. The recent offshoot of tho British Medical Association, tho Obstetric Society, is recognised by tho profession as being an organisation which will become a most potent, instrument for good, and it can safely be said, that this body will be of immense value in assisting to bring about a reduced maternal mortality and morbidity rate in New Zealand. The important matter of research is not being neglected. At the moment, the Health Department is acquiring a mass of information in regard to morbidity and deaths from various puerperal causes. This information is studied by Dr. Jellett, who periodically publishes tho results of his studies in tho "New Zealand Medical Journal" and in tho reports of tho Health Department. The closely-allied subject of still-births and the first month mortality of infants is also being investigated. The 'Department has appointed a special research officer, whose duty it is to inquire into these particular public health problems. It will be seen from this that tho Health Department, in association with the medical and nursing professions and the Plunket Society, is making :in earnest effort to bring New Zealand's maternal welfare record up to tho enviable position the Dominion holds in other branches of the public health. It will be seen also from tho outline j of the work done that practically all of the important recommendations of the special committee of tho Board of Health in 1921 have been given effect to, including tho establishment of a Chair of Obstetrics.