H.—3l

48

In forty hospitals the forceps rate is 20 per cent, or over, and of these hospitals twenty-six are found in Group I —i.e., in hospitals with less than 51 confinements annually. This group contains the highest proportion of hospitals whose equipment is poor, and whose powers of obtaining a positive asepsis are therefore limited. It is obvious that, under these conditions, the dangers of the application of the forceps are greater than in the many larger hospitals, which are almost able to dispense with this instrument. I regret to have to draw your attention to the high proportion of public maternity hospitals in Canterbury in which the use of the midwifery forceps is excessive, but it is so marked a feature that it calls for attention. The contrast which exists between the practice of these hospitals and of the hospitals which form the midwifery-training schools is very great. Thus in St. Helens and the Essex Home taken together the percentage is 3-8, while in the other public hospitals of Canterbury it is 14-2. If it was possible to bring to the notice of those concerned the ill effects, both in practice and in example, of unnecessary forceps application it might be of value. The following table shows the present position both in regard to Canterbury and to the only other public hospitals in the Dominion in which the rate exceeds 25 per cent.: — Table " D." —Forceps Application in certain Public Maternity Hospitals. Hospital. Group. Percentage, Forceps Rate. Otaki .. .. .. ~ .. I 33-33 Lincoln .. I 27-7 Amuri .. .. .. .. I 25-0 Cheviot .. . . .. .. I 33-3 Lyttelton .. . . .. .. I 30-45 Inangahua .. .. . . .. I 57-89 Westport .. . . .. . . II 30-7 Cromwell .. .. .. .. II 27-45 Rangiora .. .. .. .. .. 11l 30-0 Average for New Zealand .. .. .. .. .. 9-67 The average rate of forceps-application in public hospitals in the Canterbury Health District is as follows : Group I, 18-48 ; Group 11, 16-12 ; Group 111, 13-59 ; Group IV, 3-4. In Group 111 there are three hospitals of which one has a percentage of 30.0, and another of 0-97. The number of patients confined in each hospital was practically identical. The total foetal mortality in the former hospital was seven, and in the latter three. Finally, an analysis of the statistics of all hospitals in Group IV gives the following result: —

Table "E."

From these figures it is obvious that a sevenfold increase in the forceps rate has not been associated with improvement in either the infant or the maternal mortality. The General Statistics of Maternity Hospitals.—A new form of monthly return for use in all maternity hospitals was introduced at the beginning of 1929, with the result that, for the first time, it is possible to arrive at the true mortality of tliese institutions. These records possess great value, and when they include the statistics of a number of years, I believe they will form one of the most important guides available to the results of maternity-hospital practice. Dr. Paget has had a valuable summary of these returns prepared with which he will himself deal. There is, however, one subject to which I wish briefly to refer —namely, the maternal death-rate. The recorded rate now includes not merely the patients who die in maternity hospitals, but also' all those who died after transference to another institution. It is, therefore, as faithful a record as can be got of the total deaths. The following table shows the relative mortality rates in maternity hospitals and outside them : —

Table "F."—Birth-rate and Maternal Death-rate, 1929.

Class of Hospital. Percentage of j Percentage of x .fc orceps Kate. infant Mortality. Mortality Public .. .. .. 2-2 1-49 0-2 Private .. .. .. 15-81 1-82 0-26

Live Births. Deaths. ! , 1,000 Live Births. Maternity hospitals .. .. .. .. 17,224 66 3-83 Elsewhere .. .. .. .. 9,523 63 6-62 Total .. .. .. .. 26,747 129 4-82