MIDWIFERY TRAINING.

Otago Witness, Issue 3911, 26 February 1929, Page 68

MIDWIFERY TRAINING.

AN OBSTETRIC HOSPITAL. i PROPOSED ADJUNCT TO DUNEDIN HOSPITAL. WELLINGTON, February 22. A meeting of New Zealand graduates in medicine, held in conjunction with the Medical Conference, passed a resolution urging on the Government the immediate necessity of establishing an up-to-date obstetric hospital adjacent to Dunedin Hospital for the more efficient midwiferytraining of the future doctors of the Dominion.

The proposal involved in the foregoing resolution has already received consideration at the hands of the medical faculty of the University, and by it has been brought under the notice of the department. That the representations . made have impressed the department’s representative with the need for the establishment of such an institution is shown by the following extract from the report for 1928 of Dr H. Jellett, consulting obstetrician to the Department of Health:— The training of medical students and the limitations forced by circumstances on the Medical School at Dunedin have been under the consideration of the department and of the medical faculty of the school for some years. I am glad to say that practical steps are now being taken to overcome the difficulties of giving a sufficient training. In November last, in accordance with your instructions, I accepted the invitation of the medical faculty of the School of Medicine, Otago University, to meet them to discuss the present position of medical training in that school, and. the best methods of improving it. I found that the faculty thoroughly recognise the inadequacy- of the present methods—an inadequacy which is in no way due to want of effort on the part nf the teachers, but rather to want of adequate clinical material and of the necessary funds. I think I may say that they also recognise that when the new regulations for the training of midwives have begun to bear fruit the midwife will be better equipped in the art and practice of midwifery than will the medical practitioner. This is a very serious state of affairs, because the midwife’s training is only designed to make her capable of conducting a normal labour and lying-in, and for all abnormal cases she must look to the medical practitioner. If . the education of the latter is insufficient, then he is unable to deal with emergencies, and to help him out of them he will, amongst other mistakes, be led to fall back on radical surgical procedures because of his ignorance of the milder obstetrical procedures which would have better served his purpose. The effect of this on the rate of maternal mortality is obvious. I think it may be taken as a fact that, in at least.Bo per cent, of confinements, the attendance of a medical practitioner is not essential, and that in the remaining 20 per cent, it is either desirable or essential. On the other hand, it is also a fact that it is not always possible to distinguish beforehand into which group a patient will fall. Therefore it is advisable—or, at all events, customary—that wherever possible a medical practitioner is present in all cases, lest a need for his services should arise. If his education is insufficient to enable him to satisfy this need, then the principal reason for his presence is lost, and, in fact, it would probably be better that he should not be present. The removal of the difficulties under which the medical faculty at Dunedin works in obstetrical matters is consequently very closely bound up with the whole problem of the lowering of the rate of maternal mortality in this country. The Plunket Society has received support and encouragement both from the Government and from the general public. Scholarships have been founded, and hospitals and other institutions have been provided to help it to carry out its most worthy and necessary work. It helps and advises the mother during pregnancy; it cares for the infafit during its first year of life. It deserves and receives the greatest credit for so doing. On the other hand, the obstetrical department of the Medical School at Dunedin, which trains those who will later be responsible for the care of the mother when she most needs it, and without whose skill there would often be no infant for the Plunket Society to tend, is left in the same financial position that it occupied many years ago. This department plays one of the most important parts in medical education, and yet it has no professor at its head, no suitable hospital at which to educate its students, and insufficient funds adequately to remunerate its teachers. I suggest that the general 'public are in ignorance of the needs of the University in this respect, and I think it is probable that they are also in ignorance of the very close connection that exists between the fulfilment of these needs and the reduction of maternal mortality. It is impossible to lower the latter without improved medical education. It is. impossible to provide that education with the resources at present available in the national Aledical School of the country. It is impossible materially to improve these resources without considerable financial assistance from without. Presumably, the provision of such asisstance is primarly a matter for the Government; and in the present financial position of the country it may be a difficult matter. There must, however, be many i wealthy individuals or corporations who are both willing and able to assist in such

matters if the necessity for assistance was brought home to them. Up to the present, I fancy this has not been done. It does not become a university to hang out the reversed flag of financial distress. It is more suitable that would-be benefactors should go to her and learn her needs. Here is one of them. Mainly by private benefactions the faculty of medicine has available annually for the payment of its staff the sum of £l6OO. From similar sources the faculty of surgery has a similar sum. The corresponding sum available for the faculty of obstetrics is £530, which it is proposed to reduce by £75 at the end of this yoar; and yet midwifery is one of the most urgently important subjects of the medical curriculum.

During the past 20 years benefactions to the extent of £16,000 have been received by the departments of medicine and surgery. During the same period the department of obstetrics has received nothing, but a little more than 20 years ago it received a benefaction of £425 13s 6d as a special donation towards the foundation of the Batchelor Hospital. I suggest, sir, that this department can help to remedy this state of affairs in an indirect but none the less effective manner, and that manner is by making a public demonstration of the needs of the obstetrical department of the Medical School at Dunedin a part of its propaganda for the reduction of maternal mortality. The department can give the pre l sent situation the necessary publicity, and. if this is done, I think the needs of the University would receive the same relief that the needs of the Plunket Society have received in the past.