N.Z. Maternity Service; Findings of Royal Commission

Northern Advocate, 11 July 1938, Page 6

N.Z. Maternity Service; Findings of Royal Commission

lSpecial to “Northern Advocate.”] WELLINGTON, This Day. OTOE REPORT OF THE COMMITTEE SET UP BY THE GOVERNMENT LAST YEAR TO INQUIRE INTO MATERNITY SERVICES HAS BEEN RELEASED. The committee consisted of Dr. D. G. McMillan, M.P. (chairman); Dr. Slyvia Chapman, medical superintend ant of (he St. Helen's Hospital, Wellington: Mrs Janet Fraser, wife of the Minister of Health, the Hon. P. Fraser; Mrs Amy M. Hutchinson. Mrs N. G. Kent-Johnston, Dr. T. F. Corkill, and Dr. T. L. Paget, Director of Maternal Welfare. The order of I’eforence covered all existing public and private maternity ’ facilities, including ante-natal and post-natal care, district nursing services, the use of anaesthetics and the training of midwives and maternity nurses. The committee finds that the preference in New Zealand is for attendance by both doctor and midwife, or doctor and maternity nurse, % e ■ 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. The former system, the committee states, is advocated by the majority of doctors in New Zealand and by the majority of women, although at pres- * ent, mainly owing to financial circum stances, a considerable proportion of .women are attended on the midwife system, especially in the St. Helen’s hospital and the annexes to public hospitals. -'I While of opinion that the midwife system can give a safe and efficient p, service, a majority of the committee recommends that, as a cardinal principle, the combined system of doctor-and-nurse attendance be adopted in all present and extended public maternity services.

Commission’s Proposals,

In order to bring this system within the reach of all, it is proposed:— (1) That house surgeons be appointed to act in conjunction with the senior staff in all the main maternity hospitals and in the larger maternity annexes. (2) That hospital boards make provision for the doctor attendance of indigent in smaller hos- •' pitals. P I t (3) That provision for such attendance be incorporated in any f national health insurance system i that may be developed. ||;f| On this subject, -s reservation is H jnade by Drs. Chapman and Paget, i, 'who state their opinions that the application of full doctor-and-nurse attendance is impossible of attainment | “in many parts of New Zealand, especii ally isolated districts, p | It was shown by the inquiry that | there was an overwhelming tendency .in New Zealand towards the hospitalisation of all maternity cases, both ‘ normal and abnormal, the present perf/ centage so treated being 81.75. The committee holds that the advantages bf hospitalisation in New Zealand have been clearly proved, and recom- £ jnends that it be the main basis for any national maternity service. *■

r- Needs of Dominion. I; /'The maternity hospital system of the Dominion, in the committee’s opinion, may form the basis of a complete and uniform system suited to the needs of cities, larger towns and Country districts. The proposed system is described as follows: — % V Country Districts. (1) In all country districts, matcr- | nity hospital facilities should be proCvided as close to the homes of the mothers' as is reasonably possible, by the establishment of public maternity hospitals, or financial assistance to efficient private hospitals, the hospital | board to be responsible for the care of indigent cases The most satisfactory method of financial assistance would be by hospital benefits under a health system, which would enl* able the ideal of doctor attendance in country hospitals to be attained. The alternative, in the meantime, would be a uniform and acceptable system of subsidy by hospital boards. i Larger Towns. ' (2) In all the larger towns and small i. cities, the policy should be to develop maternity hospitals of a larger and more modern type, in buildings erect?ed for the purpose by the hospital y, boards, and designed on modern principles, with a minimum of ten beds. Each such hospital should be in the charge of a doctor, with special ex|fperience in obstetrics, who would be responsible for the treatment of hos-*-:pital board cases and the training of maternity nurses. In Chief Cities. (3) Auckland, Wellington and Christchurch should each be provided with a main obstetric centre within a convenient distance of the general hospital, on the lines of the Queen Mary Hospital, Dunedin. Its activities should include a full maternity service to mothers in poorer circumstances, the treatment of abnormal cases and the training of midwives and medical students. In view of its special relationship with the medical school, the Queen Mary Hospital should remain under the Otago- Hospital Board, but the other three, as training schools for midwives, should be St. Helen’s Hospitals, under the Department of Health. Dr. McMillan, however, considers that the respective hospital boards should conduct all four institutions. Abnormal Cases. It is considered that until all abrtormal cases can bo dealt with in the proposed hospitals, each metropolitan general hospital should have on i‘s, staff an experienced obstetrician, who' would be responsible for the treatment of all emergencies and abnorumalities admitted to the general hospital.

Intermediate Hospitals,

Regarding “intermediate" maternity hospital service in cities and towns, the committee recommends that the development of such institutions as those conducted by the Salvation Army be encouraged. As an alternative. it suggests, although not unanimously. that an independent ‘'community" wing be attached to the public maternity hospital, staffed by trained nurses and not used for teaching. In country districts, if no suitable private hospital is available, the public maternity hospital should be open to local doctors for the treatment of their private patients