RELIEF OF PAIN

Southland Times, Issue 23557, 11 July 1938, Page 8

RELIEF OF PAIN

Use Of Measures In New Zealand

FULL EXAMINATION BY COMMITTEE (United Press Association) WELLINGTON, July 10. The report of the Committee of Inquiry into Maternity Services discusses the gradual extension of the use of measures of pain-relief in labour and while suggesting that the greatest development of such measures could be obtained under the direction of a doctor it considers that the administration of sedatives by midwives could safely be made more general. In New Zealand, perhaps more generally than in most countries, the demand for the more extensive use of the measures of pain-relief which are known to be available is being made by some women's organizations and by individual women. The committee, sympathizing with the effort to extend to all patients in labour the fullest degree of pain-relief consistent with safety, examined this question very thoroughly, states the report. The committee has reason to believe that there are few countries where the use of some measures of pain-relief is more general than New Zealand, but found {hat there were very considerable differences of practice among doctors and hospitals both in methods and tbe extent to which these agencies were used.

The investigation was mostly concerned with the practice in the public maternity hospitals, and it was found that, speaking generally, the amount of pain-relief hitherto given in such institutions has certainly been less than in the average case where a doctor is present; this has been an inevitable limitation of tne midwife system. The committee is satisfied that any conservatism in the introduction of these measures has not been caused by any lack of sympathy with suffering, but mainly to genuine doubts about their safety from the point of view of both mother and child, and also to a feeling that where such measures were extensively used the necessity for artificial assistance in labour was increased, with certain possible risks. The committee is, however, convinced that there are now various methods by which under suitable conditions a satisfactory degree of pain-relief can be very generally used with complete safety. The majority of the committee is of the opinion that pain-relief can only be developed to the most satisfactory degree if the doctor, in addition to directing the details of the use of sedatives during the earlier stages of labour, is also present to give, or to supervise the giving of, the anaesthetic in the final stages. This has already been referred to as one of the reasons for advocating the principle of doctor-attendance in all cases.

Nevertheless the committee is of the opinion that, pending this development, the practice now adopted in a number of public maternity hospitals operating under the midwife system where sedatives are given under the direction of, though not necessarily in the presence of, a responsible medical officer could quite safely be made more general, thus very considerably supplementing the limited amount of anaesthetic which the midwife is able to administer. There is general agreement that these measures are much more satisfactorily controlled in the hospitals. Drs Chapman and Paget support this report with the reservation that '.hey consider attendance by the doctor at the delivery for a greater period than is at present usual would have the effect of burdening the service with r.n unnecessary cost.

TRAINING OF NURSES AND STUDENTS

REFRESHER COURSES FREE OF COST RECOMMENDED

(United Press Association) WELLINGTON, July 10. The Committee of Inquiry into Maternity Services devotes a portion of its report to the Government to the training of midwives, maternity nurses and medical students in midwifery. The early history of obstetrical training for nurses in New Zealand is referred to in another section of the report, and we are here concerned with the position obtaining since the year 1925, when the Nurses and Midwives Regulation Act was passed, it states. The Act provides for the training and registration of two types of obstetrical nurses—maternity nurses whose training fits them to attend confinements under the supervision of a medical practitioner, and midwives whose more detailed training enables them to conduct normal cases on their own responsibility. After detailed consideration of the present position of the training and control of midwives and maternity nurses the committee advances the following recommendations:— (1) That in the interests of efficient training the present “closed” system be adhered to in training schools for midwives, and that in these schools the appointment of tutor midwives be given consideration. (2) That short compulsory refresher courses be held for practising midwives and maternity nurses. Such courses should be free of cost. (3) That no measures be taßen which might have the effect of reducing the efficiency of midwives’ training. (4) That an adequate system of superannuation for midwives and maternity nurses be introduced. (5) That legislation be enacted conferring on .the Nurses and Midwives Registration Board powers for imposing adequate discipline on the midwives and maternity nurses under its jurisdiction. After a comprehensive study of the needs and conditions of obstetric training in New Zealand, the committee advances the following recommendations:— (1) That in view of the paramount importance of sound and practical training of medical students in obstetric practice, the Government, hospital boards, and charitable institutions having the care of parturient women be urged to do all in their power to assist the university in increasing the case material available for instruction of students. (2) That the appointment of resident house surgeons to the St. Helens and bigger public maternity hospitals be considered. (3) That post-graduate vacation courses in midwifery be inaugurated at the Otago Medical School on lines similar to those followed in the English and Scottish universities.