The scope of the Maternity Nurse

Kai Tiaki : the journal of the nurses of New Zealand, Volume I, Issue 2, 1 April 1908, Page 45

The scope of the Maternity Nurse

MISS MARGARET BREAY

Read at the International Conference on Nursing at Paris, June, 1907.

(BY

There is, probably, no subject connected with nursing upon which more diverse views have been held than upon the scope of the maternity nurse. 'The keenest controversy has centred around the length and extent of her training, whether or not it should be included Li the three years' curriculum of general nursing education, and whether maternity nurses for the poor are best drawn from the same rank in life as their patients or from the more educated classes. The real point at issue may be stated in a few words, and is whether the ministrations of any motherly woman who has seen a few maternity cases are sufficient for a lying-in patient, or whether such ? patient requires the attention of a skilled and intelligent nurse, who, in the absence of the doctor is able to be left in responsible charge. I believe that not only the highest and most intelligent professional skill is desirable in a maternity nurse in the interest of the patient, but also that the moral and educative influence of the right type of woman is of the greatest possible importance, and that the best women the nursing profession can produce are needed for this work. Most especially they are needed in the homes of the poor, for in the United Kingdom we have with sorrow to own that while in lying-in hospitals puerperal fever has been stamped out, the mortality from this preventable cause throughout the country is as high as ever, and the main cause is unquestionably the inefficient maternity nurse. To some persons it appears that the fact of motherhood suffices as a qualification for maternity nursing, and it is even not unusual to hear the fact of having Had a large family, and lost the greater portion of it, advanced as an unanswerable proof of competence in the management of infants. While a personal experience of the pain and peril of childbirth may teach sympathy with others undergoing the seme fxperience, I submit it is not a convenient moment for absorbing instruction on the technical side. Further, because a person has had pneumonia or enteric fever, or undergone abdominal section, we do not consider her qualified

thereby to nurse similar cases, and it is equally illogical to suppose because a woman has had a child that by that fact she becomes competent to nurse other women in childbirth. Assuming then, that every woman who desires to be a maternity nurse should 1 have definite training to fit her for this work, what should be the extent of her education ? I am of those who hold that our maternity nurses should be well educated women : who have already leceived tiaining in general nursing, and that their special training should include instruction in the science and art of midwifery. I should like, if I can, to justify these beliefs. The date when it was reasonable to suppose that any kindly woman needed only a little special knowledge to become . a competent maternity nurse passed, if it ever existed, when lister, Pasteur, and other heroes of science revealed the paramount importance of the aseptic principle. No woman who does not grasp the meaning of this principle and conscientiously put it into practice, is sp.fe as a maternity nurse, and it will be conceded that a certain amount of education is needed before a nurse can apply it intelligently to her w T ork. For this reason we may class as out of date those who would have us believe that the ideal maternity nurse foi the poof is the woman who will in the intervals of attending to the patient, cook, mend, and scrub for the rest of the family. It is easier to keep one's hands free from contact with infective matter than to cleanse them when infected, and a woman whose hands are roughened by daily toil, and who is constantly wrestling with dirty corners, is not a suitable or safe person as a maternity nurse. She has her uss, her honourable use, but she should not, be engaged in this branch of work. There is a consensus of opinion amongst those who hr.ve studied educational questions that a general training should always precede a special one. Thus a good general education helps 'a pupil to grasp the principles underlying her work as a nurse, aild in the same

way a knowledge of general nursing should precede training in obstetric nursing. In this connection it is interesting to note that in the education of students, the General Medical Council in the United Kingdom has decreed that medical students must have held the positions of surgical dresser and clinical clerk before taking their midwifery cases. The training of obstetric nurses should follow on the same lines. Should every nurse have obstetric training? I strongly hold that she should, and that she should never be content to consider her nursing education as complete until she has obtained it. With regard to specialities in addition to general training, we can only make a selection, and specialise in one or two directions, but the three great branches of our work, medical, surgical, and obstetric nursing, should surely be included in the educational curriculum of every nurse, as they are in that of every medical student. In the United Kingdom w T e are behindhand in this respect, and I believe that in the United States of America and in Canada this triple training is already the rule. Here I would like to urge the importance of putting this triple standard of training before nurses as the ideal. If a hospital has no obstetric wards, however much we theoretically consider obstetric training desirable, it is not always possible to arrange for it, though much may be done by establishing post graduate courses in connection with outdoor maternities. But it is always possible to hold up an ideal and to encourage its attainment. Thus if hospital committees gave ■ preference in selecting Matrons and Sister? to those who could produce evidence of obstetric training, a stimulus would quickly be given to the acquisition of this knowledge, and if leave of absence were readily granted to nurses in general hospitals for this purpose the benefit both to nur^e and hospital would be mutual. I b? ve suggested that all ward sisters should have obstetric ta ining, and 1 would especially urge its importance in the case of the Sister of a gynaecological ward. To give an illustration. A nurse who had passed through her three years' course with distinction was promoted to the position of Sister of the gynaecological ward in a large hospital. As not unfrequently happens, a premature confinement came on unexpectedly, the child showed no sign of life, and the Sister directed the nurse to place it in a basin, and put it on

one side for the inspection of the resident medical officer. The cold basin afforded the needed stimulus, and the child began to cry. A nurse trained in obstetric work, even if she had had no general training, would have known it does not follow that because a child is born apparently lifeless it is not living, and would have practised methods of resuscitation. And if a knowledge of obstetric nursing is desirable in the institution worker, to an even greater extent it is necessary for private and district nurses, the reason being that patients require nursing as a whol..', not in sections. Thus a case of scarlet or enteric fever, or, indeed, any serious disease, may in a pregnant woman become complicated with premature labour. It is humiliating to the nurse in attendance to have to own that she knows nothing of this branch of work, and that a maternity nurse should be called in. Yet, if this course is not taken, neither mother or cMld will have the expert care which it is most important they should receive. I should like, therefore, to urge upon those responsible for the training of nurses to endeavour either to provide for experience in obstetric nursing for their pupils, or, failing this, to make leave of absence easy for those who desire to obtain it elsewhere. The founding of scholarships to enable tiained nurses who otherwise would be unable to afford a course of obstetiic training to obtain this experience is also a point to be borne in mind. A word as to the vexed question of whether a maternity nurse should be a midwife. It is sometimes held that as soon as a nurse takes up midwifery she encroaches on the province of the doctor, and is an independent practitioner. I do not think that either of these positions can be maintained. The province of the doctor is to treat disease, and of the midwife to render skilled assistance to a healthy woman passing through a normal process. Directly the case is complicated by abnormality or disease it is the immediate duty of the midwife to summon medical assistance, and to carry out medical orders. She cannot, therefore, be regarded as an independent practitioner. To render efficient assistance to the doctor in his absence a maternity nurse must be able to cope with obstetric emergencies. A nurse who has no knowledge of midwifery is but ill equipped for such work.

Further, from the point of view of the patient, which is in some danger of being overlooked in a controversy on points of training the maternity nurse, who is trained as a midwife, is the safest person. If there is one thing more certain than another, it is this — that whether or no a maternity nurse is trained as a midwife she will have to ad as one, for babies have a knack of arriving at unexpected moments. The nurse, as a rule, is on the spot, the doctor is not. Tberefore, as she will have to tender assistance as a midwife, skilled or unskilled, surely it is desirable that such assistance should be skilled. I have tried to show that a maternity nurse should be a woman of some education in order that she may be safe from a practical standpoint. An equally important reason is that a most useful side of her work is her educative influence. Both in fighting time-honoured prejudices, with regard to mother and child, and in teaching the hygiene of the home, the maternity nurse may be a most valuable

agent in the dissemination of knowledge, and may have an appreciable eftect in raising the standard of the national health, but in order to achieve this her own standards must be high, and she must possess the power of imparting what she knows, a power which is seldom dissociated from educational training. I therefore submit — 1. That it is desirable for maternity nurses to be drawn from the educated classes. 2. That it is desirable that every trained nurse should be trained in maternity work as a midwife, although it is not yet possible that every midwife should be trained as a nurse. Such highly skilled workers are a valuable national asset, and it should be the aim of the State to place them within the reach of every lying-in mother. The value of any subsidy granted with this object would be more than repaid by the insurance to every child of a fair start in life, and consequently the maintenance of a high standard of national health. — From the British journal of Nvrsivg.