A Field for Trained Midwives

Kai Tiaki : the journal of the nurses of New Zealand, Volume III, Issue 1, 1 January 1910, Page 35

A Field for Trained Midwives

A. Bagley

(By

The trained midwife, like the trained nurse, always provided that with her training is combined the necessary individual character — if once employed is (if obtainable) always employed. There is no doubt that good midwifery nursing, with its thousand opportunities for prevention of illnesses of both mothers and infants by rational and cleanly treatment, feeding, etc., is going to play a most important part m the betterment of our race ; for it begins at the very beginning, and is surely worth for those who undertake it, their best of heart and brain and bodily effort, and that continuously. It is so easy, after one has qualified, to " rest on the oars," and think the work is learnt ; no need to study. That is the greatest mistake. It is astonishing how easily one can slip back. The midwifery nurse needs to take up her books occasionally ; keep eyes and ears open for better methods which are always coming along (she will discover some for heiself if she is keen). Most of all, let her avoid getting lax on the salient points taught m her school ; a most important one being the continual and thorough attention to her bag and appliances, as much as if it were under her matron's daily inspection. As things are, regarding the conditions under which trained midwives work, it would seem that their services are only obtainable by the well-off people who can pay an adequate fee for their constant services ; or by the poor, at least those whose incomes warrant their admission to the State Maternity Hospitals, or to out-door attendance by St. Helens nurses. There remains uncared for the middle-class, who wish to be nursed m their own homes (they form by far the largest class of people m New Zealand), and at present provide an almost, undisputed field for the untrained midwife. The old type of midwife is fast dying out. Though m many instances undesirable, we must give her her just tribute. Many of these women have done excellent work according to their lights, often exhibiting the real nurse's spirit m much unselfish work, done under often very trying conditions. One can frequently find among them some whose self-

taught devices for meeting emergencies show thought and ability, and who have used every means within their reach for improving themselves m their w r ork. But they are passing, and m this transition stage, if the trained midwives do not step m, and so adapt themselves as to bring their services within the reach of these by far the largest — the middle class — it will mean that this work will quickly pass out of their hands, and as the Midwives' Act forbids unqualified persons to conduct confinements, these people will only have skilled attention for that occasion (a doctor will be engaged), but the so necessary nursing attention during the puerperium will be denied them, as it will devolve upon whatever domestic assistance can be procured at the time ; but the patient will not be nursed, nor will the baby be given the best chance for a good start m the race of life. How then are things to be adjusted so that women m middle-class circumstances can have the benefit of the necessary skilled attention during labour and the puerperium, at fees within their means ? The suggestions humbly offered are the result of more than a year's close observation of the conditions, domestic and otherwise, existing m town and country pretty well all over our Dominion, and of the present methods. Reading " Una," the Victorian Nurses' Journal, a few weeks ago, we find that the same question of how to place trained nursing, both general and midwifery, -within the reach of this above-mentioned class of people is agitating the thoughtful members of our nursing profession there also. They, like ourselves, see that now is the time for trained nurses to secure this field for themselves, or they will most certainly lose it. (We • must not forget m quoting '■' Una," that they are considering nursing both general and midwifery ; that there midwifery is a post graduate course for the trained nurse, there being no Midwives' Act m Victoria). We have proved that the visiting trained nurse is a success already, and so, we feel sure, will the visiting midwife be ; she is even more necessary.

The luxuries of life always have to be paid for, and no one can expect to have the constant attentions of the trained midwifery nurse at half or a third of her fee, any more than one can have twenty doctor's visits at the price of five or ten. (We know that many do have that last, however, nor is our own profession altogether mercenary. But we must live !). A maternity case, so long as it be a normal one, can be quite well attended on visiting lines if there is fair domestic help m the house. This has been proved by the very successful district work of the St. Helens nurses. Perhaps the midwife, working privately, whether a doctor were engaged or not, stays somewhat longer with her patient the first day, than is the custom for district work. Her daily visits should enable her to maintain a sufficiently aseptic condition for the patient and child, and she could leave instructions as to diet and visitors. Such skilled daily attentions from a trained midwife would surely be much more beneficial than the constant muddling of the untrained woman, who will as soon swab a ruptured perineum with a marine sponge or a piece of flannel, as she will "try the pains" during labour; and seldom being provided with even a clean nail brush, let alone the other necessities of a midwife's outfit, the wonder is that so many cases escape septic infection Primiparae should not, of course if possible, be attended on these lines, requiring as they do, so much more constant attention, and the labour being generally a prolonged one. A midwife working m this way would find it a good plan to get to know some decent woman who would for a wage of, say 15s. a week or more, be willing to work with her from case to case, to do the household work ; a nurse with a good practice of this sort could perhaps keep two or three of them going, and some women would prefer this work to general service. The patient could afford then to keep help until she was really strong enough to take up her household duties again. Patients of this class usually engage a midwife (?) or nurse (?) for a fortnight or ten days ; who is expected to do everything for husband, children, house, and last of all — too often — for patient and infant. At the end of that time, and just when she so much needs to keep off her feet, the mother must take up the household burden again, with the added care of the new baby. If she had been attended by a trained midwife on visit-

ing lines, the same fee, or a very little more than she paid her untrained nurse would secure her skilled attention as much as was really necessary, and enable her to retain help m the house until she was stronger. vShe would be much more likely to breastfeed her baby, too. That is the case for the patient. Now for the midwife — She could have at least three cases on hand at the same time, very likely taking emergency confinements or visits at the same time. If she charged 255. to 30s. a week, she would earn more than the usual fee ; she would have no night work, except for labours. Nurses whose family ties make it desirable for them to keep a home together would find this way of working more convenient than private nursing. Many of the untrained registered midwives work something like this and do very well ; why should not our trained midwives and with much more satisfaction to the patients, if not to themselves ? These suggestions could doubtless be much improved upon. Every place would create its own opportunities, and difficulties also, perhaps, at first, but they would not be unsurmountable to a tactful nurse, and many would find this work more varied and interesting than ordinary private nursing, with one patient all the time. Our trained midwives should spread themselves out more into country places ; they are so much required. Those who have started m country towns are doing well notably at Timaru, Masterton, and Waihi. In almost every other place, both North and South, there is an opening for a good midwifery nurse ; for although there are a good few registered women, most of them are elderly, and nearly all have family ties and homes, that prevent them working constantly. At any rate, they are passing, and their places should be filled by trained midwives the first of whom will be the pioneers of, almost, we might say, a new profession, for as we would have it, it wii<L rise up a new profession, and for how much good will depend upon those who are first m the field.