H.—3la

The nursing stafi consists of the Matron, ten registered midwives, and thirty trainees. Normal cases are attended by the midwife stafi, the medical stafi attending abnormal cases. All cases attending the ante-natal clinic are examined by a doctor, and at the birth, those who have been so examined and certified as fit to receive it, are given what anaesthetic and analgesic relief as is available. Cases which have not been seen by a doctor receive no anaesthetic at all, which definitely precludes the emergency normal case from pain relief. The administration of anaesthetics by a midwife is limited in practice to the use of the Murphy inhaler for chloroform in cases which, as stated above, have been previously certified by a doctor as suitable to receive it, and when required open ether is given by one of the medical staff. Similarly, analgesics—i.e., chloral hydrate, morphia, or nembutal —are given in certain cases by direction of the doctor, but not necessarily in his presence. The extent to which this is the practice seems to vary in different centres, and some complaints were received in Auckland of protracted suffering without relief. The number of in-patients for the year ended 31st March, 1936, was 652. This hospital is a training-school for midwives and maternity nurses. Provision for Abnormal Cases.—St. Helens being fully occupied with booked cases, from 90 to 100 complicated and emergency cases have to be admitted every year to the public hospital in Auckland. There is no labour or special lying-in ward provided, and these cases have to be nursed in the surgical wards where there is frequently no trained maternity staff readily available. The conditions under which the nursing is carried out are most unsatisfactory and constitute a risk to the patients, causing considerable anxiety to the staff. Furthermore, there is no obstetrician appointed as such to the hospital staff. " Intermediate " Facilities.—" Intermediate " facilities are confined to those provided by the Salvation Army in the Bethany Hospital, which, in addition to its work for unmarried mothers, admits a limited number of married women at a fee of £3 3s. per week. This type of service might with advantage be extended in Auckland. Private Hospitals. —The private hospitals in Auckland and suburbs provide ninetyfour beds. According to the evidence tendered and inspections made it would appear that in the majority of private hospitals the facilities provided are satisfactory, but the most popular of the hospitals are overtaxed, the tendency being, as in other parts of New Zealand, for cases to go to hospital rather than be confined in the patients' own homes. The fees charged range from £4 10s. to £8 Bs. per week. According to the opinion of leading obstetricians and also of the Medical Officer of Health there is need in Auckland for the further provision of private-hospital accommodation. There is at present no private maternity hospital equipped for surgical work, and difficulties arise when operations such as Caesarean sections are necessary. The Committee is of opinion that the provision of more private accommodation is to be encouraged. Ante-natal Care. —Ante-natal service is provided at St. Helens and the Salvation Army maternity hospitals, but at St. Helens the ante-natal clinic is situated in a converted house adjacent to the main building and is inconvenient for patients and unsuitable for the purposes of training. The Plunket Society also has a clinic which gives valuable assistance. In Auckland, as elsewhere, it was found that many doctors themselves prefer to supervise the antenatal care of their patients. District Service. —Due partly to the lack of sufficient accommodation at St. Helens, the number of district cases is comparatively high, seventy cases being attended last year. As these are all in the homes lacking the necessary facilities, the conditions are far from ideal, and if there were sufficient provision no doubt most of these cases would enter hospital. Provision for Unmarried Mothers.—The unmarried mothers are provided for by the Salvation Army Home and St. Mary's Home. Salvation Army Home. —Provision is made by the Salvation Army at their Bethany Hospital for unmarried mothers, who are required to stay three months to care for their babies. Normal cases are midwife-attended, an honorary doctor being available in abnormal cases. Pain-relief measures are said to be used for the single girls to the same extent as for married patients. St. Mary's Home. —In this home also a great service is being rendered to the unmarried mother in need of a refuge and care in her confinement. About thirty cases a year are attended, all single girls, who are required to stay six months in the home ; the total fee for the period is £15 155., which is collected from the child's father if possible, but no girl is ever refused admission for financial reasons. No assistance is given this home by the Hospital Board, but it receives a grant of £200 per annum from the Government. Normal cases are attended by a midwife alone, but every girl receives ante-natal care, an honorary doctor giving his services and attending abnormal cases. On the question of pain-relief it was stated by the home authorities that this is definitely on the increase, although complaints were received that normal cases get

11