The Future of Midwifery

Kai Tiaki : the journal of the nurses of New Zealand, Volume XIV, Issue 1, 1 January 1921, Page 21

The Future of Midwifery

Midwifery is a branch of work in which trained nurses have been slow to specialise, though most of them realise the desirability of obtaining the certificate of the central Mid wives' Board. It is of such national importance that the certified midwife of the future should also 1 be a registered nurse, that it is worth while to consider why, so far, nurses have not been greatly attracted to the practice of midwifery. First, there is the economic side. It is usually essential to trained nurses that they should earn salaries which will keep them in moderate comfort, and from which they can put by somethinjg for the time which is a spectre in the background to many workers, the time when they can no longer earn an income on which to support themselves. Regarded from this standpoint, the prospect offered by midwifery has been of the poorest. If a nurse starts an independent practice as a midwife, the fees which she has been able to command compare most unfavourably with those obtainable in any branch of nursing, although admittedly nurses have been poorly paid; and in the rare instances where she 'has been in such demand as to obtain a reasonable compe-' tence, the heavy work entailed by attending so large a number of cases is so exhausting that sooner or later it is almost inevitable that she will break down. If, on the other side, she considers the possibility of work in connection with one of the philanthropic associations which supplies midwives to the poor, the salary offered has usually been so minute as to close the possibility of work in that direction. From the professional side also, the work, while deeply interesting, has, in the past, it must be owned, been somewhat monotonous, for in district midwifery, until comparatively recently, a midwife 's work has been limited to attending at the confinement, and visiting the mother and child for ten days afterwards. A BROADER OUTLOOK. It is now realised that the work of the midwife should extend over a much

longer period than the above, and, moreover, that it is of such national value that it should be subsidised out of public funds. Thus, the Midwives' Act of 1918, which came into force at the beginning of last year, authorised local supervisingauthorities both to contribute to the training of midwives arnd to compensate them- for loss of practice by reason of their having come into contact with Infection. Further, it places upon midwives the duty of calling in registered medical practitioners to their assistance in emergencies, and requires the local supervising authority to pay the doctor called in a sufficient fee. The fact that no provision was made to pay the fees of doctors so summoned was, in the past, one of the chief difficulties of midwives. ANTENATAL WORK. The supervision of the health of expectant mothers is now recognised as of great importance. Not only can much useful advice be given to these mothers as to personal hygiene, the management of their health, and the desirability of attending a dental clinic, if necessary, but a history of dangerous and abnormal conditions, such as albuminuria, rickets, varicose veins, and venereal disease, may be elicited, and the patient brought, under the care of a medical practitioner at a treatment centre. Thus, many confinements which would be abnormal, -and dangerous to mother or child, or both, run a normal course, if deviations- from the normal are detected and treated beforehand. This preventive work is interesting and satisfying to anyone who has the welfare of the race, as well as of the individual, at heart. The midwife who attends the confinement is the person who should undertake this ante-natal visiting, and it is highly important that she should also be a trained nurse. The Ministry of Health said in a recent circular : " The visiting of expectant mothers before confinement, and of infants during the first ten days after birth, is at present undertaken in some areas by

Health Visitors. The Ministry of Health are of opinion that this work should be assigned to the midwife (where a midwife has been engaged by the mother) wherever this can be done consistently with the efficient discharge of the important duties involved." THE CAR AND THE TELEPHONE. Another drawback to midwifery work has been the isolation of midwives in rural areas, the long distances they have had to cover, and the day and night work necessitated. Those who have studied in France what wide areas in district nursing can be covered by the use of the mo-tor-car realise what might be done in this country by working from a centre, connected' with outlying villages by telephone. The countryside would be efficiently served, and the workers Avould have the comfort of a well-organised home and the stimulus of congenial society, with the result that many efficient women would be attracted to midwifery work.

[The above article, from the "British Journal of Nursing, " October 16, 1920, is of interest to midwives in New Zealand, though it is true the economic side is not so much in evidence here. Midwives very rarely carry on an independent practice as they do in the Old Country. Such midwives as do a visiting practice are for the most part salaried officers of the Health Department, and their remuneration is very fair. It is remarked that it is of national importance that the certified midwife of the future should also be a registered nurse. Possibly in England, where there are many thousands of nurses, this might be practicable; but in New Zealand the necessity of turning out numbers of women as speedily as possible for midwifery work, the time required for the training for both certificates is prohibitive. Moreover, it is our experience that few of the general trained nurses will carry on midwifery work except in the positions of matrons of hospitals. If we were to wait for the general trained nurse the bulk of maternity eases would have to go without a nurse altogether.]