State Examination of Midwives

Kai Tiaki : the journal of the nurses of New Zealand, Volume XIV, Issue 3, 1 July 1921, Page 113

State Examination of Midwives

The State examination of midwifery nurses trained alt St. Helens Hospitals, Batchelor Memorial Hospital Dunedin, the Essex Home, Christchurch, and other institutions recognised as training-schools, was held on June Ist at the following centres: Auckland, Wellington, Whangarei, Napier, Gisborne, Christchurch, Dunedin, and InvereargilL There were 57 candidates, and 51 passed, 4 failed entirely, and 2 obtained a partial pass. Nurse Elsie S. M. Julius (E.N.), Alexandra Home, Wellington, passed first. Nurse .Julius attended lectures at St. Helens, Wellington. The following nurses obtained 75 per cent, and over : — St. Helens Hospital, Auckland. — Mrs. Eileen H. Crossan, Jessica Stewart, Mrs. Hilda M. Coyle, Ellen Foulkes, Olive B. Roberts, Mabel W. Vos (E.K.). Kawakawa. — Edith Packer. Whangarei. — Mary Hohson, Dorothy Hamilton (R.K), Isobel M. MeLeod (8.N.), Ivy Wilson (R.N.). Townley St. Helens Hospital, Gisborne. — Jocelyn B. Bailey, Anne K. Harris, Mrs. Ada H. Jeffreys. McHardy Home, Napier. — Theresa- Tarleton (Bjsr.). Salvation Army Home, Napier. — Lilian .T. Moyle. St. Helens Hospital, Wellington. — Louisa M. Green (R.N.), Ellen V. Donovan (R.N.), Mrs. Mary C. Walker. Wairau Maternity Hospital, Blenheim.-— Helen Fleming, Janet B. Dunlop (R.N.), Margaret Maxwell. Alexandra Home, Wellington. — Barbara Mackenzie (R.N.), Kathleen E. Owen. St. Helens Hospital, Dunedin.— Tiria V. F. Townshend. Cromwell Hospital and St. Helens, Dunedin. — Strowan F. Robertson. Batchelor Hospital, Dunedin. — Nettie P. Arnold (R.N.), Grace Seymour, Dulas Jones. Cromwell Hospital, Dunedin. — Agnes E. Graham. St. Helens Hospital, InvereargilL — Lena M. Maedonald (R.N.), Elsie Taylor (R.N.). Essex Home, Christclmich. — Alice Keyte (E.N.).

St. Helens Hospital, Christchurch. — Rosina E. Newman, Olive S. M. Pcarce (R.N.). The following w-ere also successful : — McHardy Home, Napier. — Matilda M. Mea* clem. St. Helens Hospital, Wellington. — Louisa Williams, Ellen Beard, Martha Hutchins, Alice E. Mercer, Mary I. Blair. Salvation Army Maternity Home, Wellington. — Marie E. McLachlan. Wairau Maternity Ward, Blenheim. — Annie Jordan (R.N.). Alexandra Home, Wellington. — Lily M. Oil, Ada. Walker. St. Helens Hospital, Christchurch. — Grace Gibbs. St. Helens Hospital, Dunedin. — Oonah E. Murray, Maggie B. Ramsay. Naseby Hospital. — Edith M. Paterson. St. Helens Hospital, InvereargilL — Lillian -J. Rule. N.B. — These names are not given m order of merit. The undermentioned obtained partial pass :'( — St. Helens Hospital, Auckland. — Marion Jones (oral portion). St. Helens, Wellington.— Ruby E. Lindsay (written portion). The questions were: — 1. What changes take place m the breasts and nipples (a) during- the first three months of pregnancy, (b) m the first seven days of the puerperim ? Name the complications that may occur during the latter period. Select one, and say how you would treaft it. 2. Give the indications for the hypodermic administration of (a) morphia, (b) pituitrin, during labour. What is their respective dosage? Under what conditions is their use particularly dangerous to mother or child? 3. Discuss the diagnosis, dangers, and treatment of prolapse of umbilical cord during labour. In what type of presentation is it most likely to occur? 4. Face presentation: Name its two most common varieties. Which is the more favourable? How may it be diagnosed (a) by palpation, (b) by vagi-

nal touch? What is the appearance of the face of the child immediately after delivery? 5. What, are the imperative indications for circumcision m the newlyborn? What instruments and material's are necessary for the operation? Name two possible complications following it, and state how you would deal with them. 6. Describe the normal lochia at the various stages of the puerperium. How is it affected by (a) saprgemia, (b) septicaemia, (c) subinvolution of the uterus ? EXAMINER'S COMMENTS. An ideal paper should, on the one hand, give scope for those who have displayed outstanding industry m study and observation; and on the other detect those who have acquired an insufficiency of elementary knowledge m their subject. Questions two and four were set with the former purpose m view; the remaining ones with the latter. I think that the quality of the papers submitted reflects great credit on the training-schools' curricula and on the industry of the candidates. In some of the questions the powers of observation and deduction possessed by the nurses was called into play, rather than their mere book knowledge. Those who displayed these qualities received the highest marks, but no one was failed who was able to igive satisfactory answers to numbers one, three and five, the purely nursing questions. Those who obeyed the mandate at the top of the paper, to be brief arid to the point, scored most; but literary style was not expected, and, indeed, one of the best papers was the least meritorious from this point of view. There was no difficulty whatever m selecting the best paper, which gained a full 10 per cent, more than any other. All those that gained 75 per cent, and over were excellently written, some failing at one point, some at another, but all showing the results of good training well assimilated. It may be of interest to give short comments on the questions seriatim. No. 1. — The essential changes m the first three months of pregnancy were well

given. Secondary areola and strige are not normal phenomena of this period, nor is colostrum often present m a primipara. The candidate who described this fluid as creamy was lacking, we are afraid, either m experience or descriptive power. The increase m erectility of the nipple was a minor point mentioned by no one. No less than seven gave themselves an unnecessary amount of trouble by reading the second part of this question, as meaning the whole of the complications of the puerperium, from after-pains to insanity. The intention of the examiner, as was fairly clear from the wording, referred to breast complications only; but, as there may have been some possibility of ambiguity, full marks were given for either interpretation. The favourite trouble selected was ' ' cracked nipples, ' ' and the answers showed a sound knowledge gained from practical experience m the treatment. No. 2. — Many candidates excused their lack of knowledge of morphia and pituitrin by saying the doctor would tell them, the quantity to give. This excuse will not hold water. Where the administration of dangerous drugs is concerned, the patient must be surrounded by every precaution. A chemist dispenses under doctor's instructions; yet if he receives a prescription where the dose of one ingredient is dangerously high or ridiculously low, it is his duty to communicate with the prescriber to see whether a mistake has been made. If errors arise, as they often do m written orders, they are much more liable to occur m verbal ones; and the nurse's knowledge may prevent a slip of the tongue or a misunderstanding from endangering a patient's life. Any reasonable dose — £, 1/6, }, or. 1 — Avas accepted as a correct answer for morphia, and a half or a whole ampoule for pituitrin, For the former, l-60th, i grain, repeated m half an hour, and even 10 grains, were suggested; while some apparently thought that pituitrin was a solid and prescribed it m doses from l-100th of a grain upwards! The main indication for the exhibition of morphia, viz., exhausting useless pains m the first stage with threatened secondary inertia, was well known. A great

many mentioned its use m eclampsia. This method of treatment, introduced by so famous an obstetrician as V-eit, and still warmly advocated by Stroganoff and many German authorities, cannot be ignored. One candidate considered that veratrone had replaced it. These answers showed a good knowledge of different methods of treatment, though as a matter of fact the use of the latter drugalso has been abandoned by many m favour of venesection. Full marks were given only where the main indication was given. Every probationer must have, at some time or other, seen morphia used far steadying the pains and producing sleep m exhaustion. One or two were acquainted with its use m the initial dose for "twilight sleep." The last clause of this question read, "mother or child;" and the real danger of morphia, known to few, is that if it is administered within three or four hours of birth the child may be born asphyxiated, or with marked and dangerous oligopnoea; The use of pituitrin and its dangers m the presence of any cause of obstruction to labour, was well known and requires no further comment. No. 3. — Some candidates gave themselves additional trouble by failing to distinguish between presentation of the cord with unruptured membranes and prolapse, which can take place only after rupture. The latter alone was the subject of this question. Many omitted to mention pulsation, which, if present, is, of course, an important diagnostic sign where so small a loop has prolapsed as to leave the matter m doubt. No. 4. — Only one or two candidates gave correctly the commonest positions of face presentation, viz., 8.M.P., and L.M.A. A little reasoning would have shown that as most face presentations are produced from vertex ones at the onset of labour, the most frequent vertex presentation, L.0.A., would produce, by extension of the head, "R.M.P. as the most frequent face position. Tn the same way. R.O.P. would produce L.M.A. Brow presentations are an entity m themselves, and not varieties of face ones.

The anterior position is, of course, the more favourable. The unfortunate misprint of " palpitation" for " palpation" considerably puzzled a large number. Many accepted it as a synonym of auscultation; and one ingenious student suggested that as palpitation of the foetal heart, indicating distress, was a sign of malprcsentation, a face variety could be inferred if the breech was m the funclus! The diagnosis of this presentation- by palpation alone is admittedly difficult, the chief trouble being m the location of the back, which is indistinctly felt except m the neighbourhood of the breech. The points by which the abdominal and thoracic curvature, present m these cases, may be distinguished from a spinal convexity are: (1) presence of the small parts on the same side, and (2) no increase m convexity when the breech is pressed towards the pelvis. Having definitely determined on which side the back lies, a marked cephalic prominence, high up on the same side, can be produced only by a face presentation invasion. In an ordinary vertex, on the other hand, the cephalic prominence, produced by the sinciput, is on the opposite side. A correct answer to the vaginal findings carried with it half the marks for the whole question, and the majority scored well here. One distinguishing point between the mouth and anus rarely given m. text-books is that the examining finger may be bitten or sucked. One candidate suggested the insertion of the finger into the mouth m the quest for teeth! ;\t 0> 5.— -Every midwife, soon after she commences practice, will almost inevitably have to prepare for, and carry out the after-treatment of, the operation of circumcision. The question was designed to test the students' knowledge of the. ordinary aseptic methods. Only one or two mentioned sterile towels. On the whole the question was well answered. Minute knowledge as to instruments was hardly expected; but it came somewhat as a surprise to be told that midwifery forceps and bone-cutting scissors were part of the armamentarium. The common complications of haemorrhage and sepsis were selected as a rule.

The treatment of the former by pressure pending the doctor's arrival was not known as well as it might have been. SIWI expedients as washing the part alternately with hot and cold water would not have much effect m saving a child suffering from a brisk reactionary or secondary hgemorrhaige. No. 6. — This was a straightforward nursing question. The daily experience of the probationers should have enabled them to answer it fully and satisfactorily. Very few described correctly the yellow-ish-white, almost creamy appearance, of the "lochia alba." Tt cannot be sufficiently impressed on nurses that septic infection from the uterus is not always accompanied by foul lochia. In the most virulent forms this symptom is absent. Any midwife unacquainted with this fact

may have a feeling of false security which is an absolute danger to her patient. The presence of septicaemia or threatened septicaemia, calls for early recognition and vigorous treatment; and a midwife who waits for putrid lochia as a cardinal symptom delays both. It was gratifying to find such a satisfactory knowledge of this point m the papers. To conclude, as we all know, a year is a very short time m which to instil even the elements of sound midwifery practice into the minds of previously-untrained pupils of all grades of ability, and the high average of knowledge shown m these papers is a striking tribute to the painstaking and intensive training which the candidates have received.