H.—3l

I publish in this report a table showing the results of a systematic research into the existing conditions of the maternity hospitals of New Zealand and the results to the 17,845 patients whose confinements took place therein during the year ended 31st December, 1929. Before discussing the results shown, it is advisable to explain the method of collecting the figures shown in the table and the method of classifying the hospitals which has been adopted. In addition to the personal inspection of all maternity hospitals by Nurse Inspectors, Medical Officers of Health, and myself, every maternity hospital at the beginning of each month sends in a form as suggested by I)r. Jellett giving detailed information of all cases attended in the hospital or transferred to other hospitals during the previous month. These detailed particulars are compiled from the register which with its attached temperature charts it is compulsory for every hospital to keep. On receipt of these reports in the District Health Office they are checked, and, if necessary, further information added to them by the Medical Officer of Health and the Nurse Inspectors ; and the results, when complete, are entered in an annual summary sheet which is drawn up in the form of the table appended hereto. Particular attention is given to the tracing of all cases transferred from maternity hospitals to others for treatment, and the maternal mortality-rate is calculated not only from the deaths of patients in the hospital, but from the deaths of all patients which occur after transfer to any other hospital, whether this transfer takes place before or after delivery. I feel that the maternal mortality figures compiled by this method may be regarded as substantially correct. I have particularly refrained from using the figures showing the morbidity-rates, because I am convinced from personal inspection that they are not sufficiently reliable. It is obvious that, unless these figures are reliable and accurate and are used properly, they are of no use as information on the important subject of the influence of hospital treatment on maternal mortality for which purpose they are required. Another precaution is also necessary in connection with these figures if they are to correctly show the condition inquired into—that is, that the percentage rate should be drawn from sufficiently large numbers. I consider that the figures used in this table and from which deductions are drawn comply with the first essential—namely, accuracy —and are for the most part drawn from a sufficiently large number of cases to warrant their use in helping to decide the relative merits of different classes of hospitals as an influence upon the maternal death-rate of this Dominion. That the influence of hospital treatment and environment upon maternal welfare in New Zealand is of great importance as will be recognized from the fact that out of 27,341 confinements which took place in New Zealand in 1929, 17,845 took place in hospitals and 9,496 elsewhere. Consequently, the result of hospital cases musthave a preponderating influence on the maternal-mortality rate for this country. The number of deaths from puerperal causes occurring in New Zealand for 1929 as returned by the Government Statistician was 129, giving a mortality-rate of 4-82 per 1,000 live births. From these figures it is possible to calculate the true maternal mortality-rate per 1,000 confinements. Of the 129 deaths forty took place in the maternity hospitals where the patients were confined ; twenty-six took place after transfer from maternity hospitals to other hospitals, either before or after delivery. All these sixty-six cases are used in calculating the maternal mortality-rate for the 17,845 cases confined in maternity hospitals or maternity wards of public hospitals. Great care has been taken to trace all transferred cases. The remaining sixty-three deaths from puerperal causes, occurring elsewhere than in the above-mentioned 269 hospitals, are not all attributable to the risks of the remaining 9,496 confinements. They include twenty-two abortions, and four ectopic gestations. Since they have no relationship to the confinements under consideration, these must be deducted from the sixty-three remaining deaths from pureperal causes. This leaves thirty-seven deaths in 9,496 confinements, the maternal-mortality rate being 3-90 per 1,000. With this rate established we are now in a position to compare the results of hospital and non-hospital cases as shown by the maternalmortality rate 3-70 of women attended in maternity hospitals with the 3-90 among those attended elsewhere. The maternal-mortality rates for all hospitals taken together and for hospitals divided into different groups are given in Table 1, and are also useful as a comparison of the influence on different classes of hospitals upon maternal welfare. Though these figures may not show the influence of the different groups of hospitals on maternal welfare with absolute accuracy, I am inclined to give very considerable weight to the conclusion drawn from them, because they confirm the opinion I have formed from five years' experience of inspecting these hospitals. The methods of classifying the hospitals in most cases are made obvious by the form in which the table is drawn up, and this classification has been chosen because I consider it indicates that there is a difference in conditions under which the average hospital in each class is conducted. The seven St. Helens Hospitals are staffed by a stipendiary Medical Officer, a staff of midwives and pupil midwives, and pupil maternity nurses. The majority of the confinements are attended by the midwives and nursing staff only. Much of the ante-natal work is also done by the midwives and nursing staff, but it is supervised and checked by the Medical Superintendent. In public maternity hospitals the arrangements for attending patients differ considerably. In some cases all patients are attended by their own private practitioners ; in others by the Medical Superintendent of the hospital. The private hospitals have the same quality of nursing staff as the public hospitals though not always in the same numbers. There is, as far as I can judge, on the whole little, if any, difference in the quality of the medical attention given in the majority of the public and of the private hospitals.

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