MATERNAL MORTALITY.

New Zealand Herald, Volume LX, Issue 18571, 1 December 1923, Page 13

MATERNAL MORTALITY.

MwX * : . IfjfkTTER TRACNING NEEDED. IpTTER TRAINING NEEDED. J SING CLINICAL MATERIAL. > &-■/.- . No. IV. . " ■ 'i While a great deal may be hoped in improving the present high rate of maternal mortality from the provision of better maternity hospitals, it is equally importi • ant that these institutions should possess li'.- efficien'; staffs. Doctors seem to bo agreed •J-;;'".' jthat the stanlard of maternity nursing Hi tan be greatly improved and that the |>; practical teaching of midwifery in the £- universities requires more attention. ? -«; Discussing this latter subject, an Auckland doctor said that while the theoreti- |.':" cal teaching of midwifery at Otago MediR:; j-al School was excellent, students should *: receive greater practical training than "•they did at present. The case of New ! Zealand was peculiar in that, whereas k: ! there were four city centres, all ilie mediC* - cal students were congregated in the V- smallest of the four ana had to look to - that city for clinical material. "I do not advocate separate medical schools in the other centres:," he said, but Ido think ' more use could be made of the clinical > material offering in them, to the great gain of the individual student and of midwifery practice in New Zealand generailv." .... '*' Obstetric* is a ■ subject to which far i »oo little, attention is given in the universities. It is often appallingly badly taught," said another Auckland spe«i Slist. The fame doctor thought the im- . portance of midwifery warranted the 'establishment of a large maternity hospital where the practical teaching of ftudents could be carried on efficiently, where they could have access to abnormal rases, and where post-graduate courses end the training of specialists would eventually become possible. Low Status of Subject. The status of midwifery in medicine Was altogether too low at present, _ continued the doctor, both in the individual "■ end the national interest. It wa s desirfeblo that its estimation should be greatly raised if the practice of midwifery was to take tho place its importance m the scheme of life warranted. Such improved status was, however, almost entirely a - matter for the public. So fcng as they were content to consider childbirth an operation of naturealthough in all else nature had been abandoned—just so long would its problems receive little study, fend midwifery would continue to be practised more or less inexpertly. After all, the economic motive had sway in the medi- ;'. cal profession as in the rest of. the world. And if the people were content to leave fheir wives in the hands of a midwife, or grumbled if they were asked more than £4 4s from a doctor for his services over 1C days, then they were not entitled to expect the service of expert knowledge and close study., What, in fact, they cot was j ' a high death rate among mothers, although the doctor did not allow that the blame fell heaviest on the medical practitioner, Sut on the general conflitions of midwifery practice in New Zealand. As a parting shot, this •doctor pointed out that people would cheerfully pav 25 guineas for "a simple matter like the removal" of an appendix, which might cost a surgeon only a few minutes of his time. On the other hand, they grudgingly counted the cost of bringing a child into the world and of safeguarding the mother from the attendant Midwifery at University. That there is need for raising the estimation in which the subject of midwifery is held among medical studants is implied in a recommendation of the special committee of the Board of Health: "That the importance of a sound training in midwifery at the Otago Medical School should be recognised by tho creation of a professorship instead of the present lectureship, thus enhancing the status of this subject in the medical curriculum." The recommendation was made two years ago, but no chair of midwifery has vet been established at Otago University. As showing the attitude of doctors, the report of the special committee of the New Zealnad branch of the British Medical Association "*iay be quoted: *" The practical teaching of midwifery in New Zealand, as regards both nurses and students, requires to be placed on a more satisfactory basis. Further, the provision of post-graduato courses for medical practitioners and nurses is also very badly Required." * vi . The central figure in the -whole.problem, ; however, is the midwife. The doctor must necessarily leave much to her, and she is often present when no doc' ;r is called in. In private houses she is. often required to attend not only to the mother, .but to all the household duties, while her patient is confined. From the careful training of the midwife, therefore, much may be Jiopfid in reducing the present toll of mothers in childbirth. Training Maternity Nurses. The passing of the Act in 1904 requiring the registration of-midwives has done much to put their practice on a higher plane. The number of registered midwives . ™ March 31. 1822, was 2064. Of these, 1382 were trained and certificated, the remainder having satisfied the registrar that nt the date of the passing of the Act they -}:ad been for at least three years in bonafide practice as midwives, end tore a cood character.' The proportion of the Trained and certificated to the whole naturally becomes greater each year. Although.good results have accrued from ' 'reparation, tho utmost cannot be hoped tm°til a definitely higher standard of training is required. " Aseptic operation will = j,ot be possible until nurses aim to reproduce at childbirth the strict conditions of ' n'surpical operation," is the dictum of an Auckland specialist. That was the idea], he said but it was not practicable so to treat each case. . . Removal to a properly equipped hospital should be the rule for at least all first confinements. ' In all cases nurses should apply aseptic principles and the " patent lack of knowledge of these often displayed should be rectified during their famine, or by post-graduate courses af St. Helens or public hospitals where there were maternity wards. Substantially similar recommendations are made in a report to the New Zealand branch of the British Medical Association. '•Imperfect and Slipshod." Writing on the same subject, the Director of Hospitals, Dr. D. 61. Wylie, says: "During the years I was in practice, one thing in particular impressed .regarding the average trained maternity nurse, »nd that was her imperfect regard for what can best be described as a clean surgical' conscience. ' So much ■ was this the case at one time that I would far Booner have had the" assistance at an obsteric case of a trained surgical nurse, who had never seen a woman confined, to that of the average ordinary trained maternity nurse. The cause of this lay in an initial error of training, as it was held in some quarters that because the average .maternity nurse after training would have to work in suvroundings in which it would be impossible for her to carry out a strict surgical technique, it was therefore unnecessary during her training to perform her work in the rigid way in which a trained surgical nurse, would be accustomed to do it. In other words she became accustomed to imperfect and slipshod methods." A considerable portion of the recommendations of the Board of Health are concerned with ''the supreme importance (for midwives) of a thorough knowledge of asepsis" and with suggestions for giving the necessary training. The board is also in accord with the British Medical Association as to the need for the practical teaching of midwifery being placed on a moro satisfactory basis as well as the provision of post-graduate courses at St. Helens or other approved institutions. It has already been said that maternity , mortality is a national problem and the State's contribution to its solution' will bo considered in the following article.