H.—3l.

Maternity Services in General Medical and Surgical Hospitals. Such a sparsely populated country as New Zealand necessitates the use of general medical and surgical hospitals under the Hospital Boards for a very considerable number of the graver emergencies of pregnancy, as well as for the treatment of puerperal sepsis following childbirth, and for abortions. Private medical and surgical hospitals are also used for these cases requiring surgical intervention, such as Csesarean Section. The use of the general wards of these hospitals in those places which have not a maternity annexe attached to them is the most unsatisfactory feature of the service. Wellington Public Hospital has for some time had attached to its staff obstetrical specialists, and has a labour ward, but the maternity patients, having been confined under aseptic conditions in this ward, are then transferred to the general wards, where it is difficult to ensure that they are not nursed by nurses who also attend septic surgical cases. This is unsatisfactory. Auckland General Hospital has now established a small and complete unit, consisting of a labour ward and a lying-in ward, sufficient to deal with the abnormalities admitted generally for emergency treatment. This unit has a complete staff of midwives and maternity nurses and is under the charge of a visiting specialist. Christchurch, while having specialists attached to their staff, has no separate obstetrical unit which would be required to give the best results. Neither Invercargill or New Plymouth have either obstetrical specialists in charge or a special ward, though both require organized units capable of dealing with obstetrical emergencies which are at present admitted to the general ward. It is trusted that the position in Christchurch will be rectified by the provision of a new St. Helens Hospital, which will be large enough and have the staff to cope with all obstetrical emergencies. Table IV shows the number and nature of cases admitted to these hospitals, and the very high death rate of 7-47 per cent, given in Table V shows the very dangerous nature of the cases admitted, and the necessity for making the very best possible provisions for their treatment in these hospitals until all these cases are provided for. Even under present conditions better results might be obtained if there were better anticipation of the emergencies that arise, and they were referred earlier for treatment.

Table IV. —Maternity Cases admitted to General Hospitals.

37

1936. 1937. 1938. 1939. Cases. I Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. For ante-natal treatment only 24 . . 21 .. 62 1 41 Admitted before delivery— For ante-natal treatment and delivery 29 13 10 1 25 2 For emergency cases without compli- 20 .. 27 .. 52 1 60 cations For obstructed labour .. .. 109 3 117 7 131 4 153 5 Failed forceps .. .. .... .. .. .. 7 1 5 1 For accidental haemorrhage 27 4 28 2 25 .. 31 3 For placenta prsevia .. 23 2 23 1 41 4 45 5 For eclampsia .. .. 29 3 25 2 19 20 2 For puerperal toxaemia without 41 4- 57 4 59 3 64 6 eclampsia For other conditions .. 37 3 65 14 76 5 65 11 Totals .. .. .. 315 19 365 30 510 20 468 35 Method of deliveryNatural .. .. .. 133 7 146 11 173 10 197 8 Instrumental .. .. 16 .. 23 .. 24 .. 43 6 Cesarean Section — Primary .. .. ..127 4 151 10 181 6 190 11 Secondary to failed forceps ..1 .. 3 2 3 1 2 Induction of labour .. 17 1 34 3 35 .. 25 3 Other operations .. .. .. 4 .. 5 1 2 .. 7 3 Undelivered .. .. ..7 7 3 3 2 2 4 4 Totals .. .. .. 510 20 365 30 315 19 468 35 Admitted after delivery— For eclampsia and toxaemia 7 1 9 6 12 2 13 3 For post-partum haemorrhage, shock, 6 .. 7 7 14 3 25 3 and embolism For puerperal pyrexia and sepsis 72 9 112 9 141 9 148 7 For other conditions associated with 112 5 133 7 169 5 195 3 parturition Totals .. .. .. 197 15 261 29 336 19 381 16