The Maternity Hospital

Kai Tiaki : the journal of the nurses of New Zealand, Volume XIV, Issue 3, 1 July 1921, Page 121

The Maternity Hospital

In the "British Medical Journal" of February 12th is a very interesting' article by J. W. Ballantyne, M.D., F.8.C.P., Ed., physician-in-charge of the ante-natal department of the Edinburgh Royal Maternity Hospital, on "The Maternity Hospital with its Ante-natal and Neo-natal Departments," from which we take a few extracts : — "A neo-natal ward and clinic, an ante-natal clinic, and a pre -maternity ward are all needed m order to complete a modern maternity hospital m its rounded fullness. 7 ' .... 'The maternity hospital occupies a separate place among hospitals, for whilst it is designed for the relief of the sick, it is for the reception of many to whom the words ' absolutely healthy 7 may be fitly applied. It is a hostel rather than a hospital/ 7 .... "The recognition of the preventability of ma ternal deaths m connection with parturition has become wonderfully clear m recent years, and systematised efforts are now being made m many places and by ante-natal clinics and pre-m&ter-nity wards, really to prevent .such fatalities." "On account of a less degree of familiarity with the causes of the diseases of the new-born infant, it is not realised how possible their prevention also is; indeed, it is scarcely recognised how terribly tafral these maladies are, although the separate publication of the neo-natal deathrate 'does not long leave this depressing conclusion m doubt. Their severity 'and their preventability are the incentive and the justification for the neo-natal department of the maternity hospitals of the future. 77 .... THE ANTE-NATAL DEPARTMENT. "The development of an ante-natal department began m different ways m different places. In the Edinburgh Hospital, which the writer believes to have led the van m this forward movement, the beginning was the founding of a bed for the diseases of pregnancy m 1901. . . . Pregnant patients at all stages of pregnancy began to be welcomed at the hospital, and urged to return for supervision; nurses with special knowledge of pregnancy and its maladies began to go amongst the expectant mothers and persuade them to come to the hospital for advice regarding the inconveniences as well us the danger-signals of pregnancy."

From this beginning, gradually, _an ante-natal department of far-reaching utility has been developed, and, as the writer says : — "The ante-natal department of a maternity hospital is like the air service of an army. Only a very incompetent commander would dare to attack without scouting, without a reconnaisance, and without his aviators, who carry out both ante-natal supervision from the early months, give a bird's-eye view of the whole field of operations, and prepare the obstetrician for the attack he has to make upon the foe, that 1 auld enemy ' death and disease, at the time of the confinement. . . . "It may be safely predicted that when the maternity hospital has its ante-natal department m thorough working order — that is to say, when patients begin to come at early dates m their expectancy, and when .all that can be discovered about them is learnt with accuracy at each visit — then will follow an immense gain to the practice of the institution m certainty of diagnosis m early prevision of danger and consequent rational choice of treatment, and m lessening of miaternal, of foetal, and of infantile mortality and morbidity. Only of one disadvantage has the -writer heard — the ante-natal department may spoil the operative work of the place! THE NEO-NATAL DEPARTMENT. The writer emphasises the need of such a special department for the care of the new-born babe for a month after birth, or, m case of premature birth, for a month after the time when it should have been born. The greatest infantile mortality is during the first month of life. What is needed is realisation that (many of the neonatal deaths are preventable. It is recommended m this article that the neo-natal, like the ante-natal, department should be a part of the maternity hospital, preferably an annexe, rather than that separate hospitals for infants should be established. ' ( The clinical part of the neo-natal department should consist of a ward (or wards) not far removed but distinct from 'the ordinary puerperal patients' ward. The neo-natal ward will be furnished with electrical incubators and all othor life-preserving means; will be under

the management of physicians and sisters skilled m the treatment and nursing of new-born infants, and especially of premature and weakly ones, and will be most carefully guarded against infection. In some respects — for instance, m its temperature — its hygiene will be peculiar to itself, for it is really intended to serve as the real nursery, almost as the hothouse of 'the hospital. It must never be forgotten that a prematurely-born infant is really a foetus struggling 'against the rigours of an environment for which he is not yet prepared; he is truly 'the tender exotic plant requiring the moist warmth of the conservatory until such time as his acclimatization is complete. There will be means for frequent weighing of the infants and apparatus for preparing milk according to chemical formulas carefully adapted to each child's requirements. In a word, there will be concentrated into this part of the maternity hospital all the devices of science and all the care of the obstetrical and nursing staff for that campaign

of neo-n-atal life-saving which has here. its special 'terrain "A special place -and differentiated handling will be :affordeid for the syphilitic babies and for those suffering from ophthalmia neonatorum. " The article concludes with some remarks on the responsibilities which m a maternity hospital with such a neo-natal ward would devolve on the institution and on those who have to do with the training of the medical students and midwives. The possibility of a much wider sphere of usefulness m our maternity hospitals m the future is an ideal to which to look forward. With the present facilities the care of new-born babies, premature or sickly, can only be undertaken m a modified degree, though even at present babies needing care are retained after the mothers are ready to leave hospital, and sick babies are frequently taken m again for treatment.