State Examination of Midwives

Kai Tiaki : the journal of the nurses of New Zealand, Volume XV, Issue 3, 1 July 1922, Page 104

State Examination of Midwives

The State Examination of Midwifery Nurses was held on May 31st and June Ist. There were 62 candidates of whom 56 passed entirely, and one in the oral examination. Taking oral and practical examination marks with the marks given for the written paper, seven passed with 90 per cent and over, forty-two with 75 per cent, and over. Twenty-four were already registered nurses— the remainder previously untrained women. The remarks of the examiner for the written examination are printed below, and show very clearly where, despite these excellent results, there are defects in teaching, and it is hoped that those responsible for lectures and bedside teaching may digest these remarks and rectify any defect. Text books are for the nurses themselves to study; lectures should be given from the lecturer's own knowledge and observation. The list of passes with the training schools is also appended.

QUESTIONS.

1. What are the four principal causes of maternal mortality in order of importance ? 2. In a midwifery case, where no doctor has been engaged, what symptoms would make you think it imperative to send for a doctor? 3. In what form do you meet venereal disease in midwifery practice, and what symptoms would you look for in (a) mother, and (b) child? 4. Describe the usual motions of a baby's bowels during the first week. Mention any abnormalities which may occur, and give reasons fpr such abnormalities. 5. What do you understand by contracted pelvis? If a patient is in labour what symptoms would lead you to suspect contracted pelvis ? 6. What can you learn by abdominal palpation of a midwifery case? Is vaginal examination ever necessary?

EXAMINER 'S COMMENTS:

The papers put in by the candidates in the Midwifery Examination were, on the whole, well done. Kefer'ence to the figures that I have submitted to you shows tfiat, out of the s^xty-two candidates only five failed to obtain 50 per cent., whilst twentysix obtained 75 per cent, and over, and all but two of the rest 60 per cent, and over. I assessed question 1 at 10, questions 2 and 6 at 15, and the rest at 20 per centeach. The answers to question 1 were not as good as I had expected. In view of the great publicity recently given to the matter, one would have expected every candidate to have named sepsis first as the principal factor in maternal inortality. Yet many did not do so and some even omitted it altogether. It is interesting to quote here the figures recently published by Doctor Jellett : Of 30,761 births in New Zealand the death rate from sepsis is 1 in 459, eclampsia 1 in 831, post partum haemorrhage 1 in 1,061, placenta pravia 1 in 2,796. _ Question 2 was with two or three exceptions, very indifferently answered. Few of the candidates seemed to have read the appendix to their text book, where the question is fully answered under the heading "The Regulation of the Central Midwives' Board," although eclampsia is not specially mentioned there. Most of the candidates neglected the new born babe. Question 3 produced answers which showed that the candidates as a whole have very hazy ideas on venereal diseases. This is not creditable to their teachers. A text book is recommended for midwifery pupils which, except for a description of opthalmia neonatorium, refers very briefly to these diseases. Yet authorities tell us that in the large cities 5 per cent, of pregnant women are syphilitic, and that gonorrhoea is much more common. Doctor Williams in his "Obstetrics" states that in 10,000 consecutive labours- he had 705 foetal deaths, and that 26.5 per cent, were due to syphilis (under this heading he includes from the period of viability to two weeks after birth). This does not,

however, he adds, tell the whole story of the ravages of the disease, for nearly as many more children died soon afterwards, or showed signs of hereditary syphilis later in life. Furthermore, syphilis was the cause of death iri 40 per cent, of all the dead-born premature infants. Sir Malcolm Morris has stated that the subjects of congenital syphilis and gonorrhoea opthahnia crowd the special schools that have to be provided for the education of blind and deaf children, and that of 11,000 children in the London County Schools for the blind more than half owe their blindness to these, diseases. These facts show how important it is ; that our midwives should be able and quick to diagnose venereal diseases, so that treatment, may be begun at an early stage. But it is also important for her own sake that the midwife may take proper precautions to avoid becoming infected. Attendance at the public hospitals to see venereal cases and more especially at the venereal clinics, ought to be part of the training of our midwives. For those who have not access to literature on the subject I append a few notes.* Question 4 was fairly well answered by most candidates. It is a pity that some candidates insist on giving answers that are not called for. Some went into the question of treatment — one of them recommended one dram of citrate of soda before each feed (the usual dose is 1 grain to 1 ounce of milk) ; another recommended 10 drops of brandy frequently repeated (the maximum dose for a. child six months old is supposed to be 10 drops, so it would be somewhat excessive for a baby a few days old). Question 5 produced many disappointing answers, so few candidates referred to the possible appearance of outward deformity in the mother. Question 6 seems an easy one, but was not well answered by many. Only a few referred to distended bladder or to foetal movements (as a sign of a live fcetus). The second part of the question is a debatable one, but the best answer was:— * Printed oil page 107.

(1) In ante partum haemorrhage; (2) In protracted second stage of labour when the presenting part does not descend. The following candidates were successful in passing the State Midwifery Examination held on May 31st and June Ist : — ■ PASSED FIRST. St. Helens Hospital, Wellington. — Maud Newth, R.N. PASSED WITH 90% OR OVER. St. Heles Hospital, Wellington. — Martha Burgess, R.N. Alexandra Home, Wellington. — Blanche Clark, R.N. Waikari Hospital. — Jessie Randall, R.N. Batchelor Hospital, Dunedin. — Annie S. Lundon, R.N. Wairau Miaternity Hospital. — Grace M. Gunn, R.N. St. Helens Hospital, Dunedin. — 'Margaret Brown. PASSED WITH 75% OR OVER. St. Helens Hospital, Auckland. — Dorothy Barkes, May Sine Nelson, Annie G. Pohlen. Whangarei Hospital. — Florence M. Baseand, R.N., Kathleen M. Parnham, R.N., Ezit M. Walker, Ellen Housten, R.!N. Kawakawa Hospital. — Hilda M. Packer. St. Helens Hospital, Wanganui. — Mary C. Lowe, R.N., Amy Wilson, R.N. McHardy Home, Napier. — Marjorie Lumley, Elsie J. Seller, R.N. Town-Icy St. Helens Hospital, Gisborne. — Helen O 'Gorman, R.N. St. Helens Hospital, Wellington. — Mary D. Anderson, Annie Anderson, Margaret Tobin, Mary Mcßeth, R.N., Agnes Davy, R.N., Mabel L. Souter, Elizabeth Symington, Gertrude K Cheek, R.N. Alexandra Home, Wellington. — Helen Burnett, R.N., Edith G. Forster, Violet E, Olsen. Salvation Army Home, Wellington. — Amelia M. Thodsen. Wairau Maternity Hospital, Blenheim. — Wallace Pinkerton, R.N., Ida M. Luoni, Nancy Park, R.N. St. Helens Hospital, Christchurch. — Violet Bargrove, R.N., Clara Porter, Ruby T. Cameron, R.N. Essex Home, Christehurch. — Grace A. Dodge, Minnie Ogden, R.N,

St. Helens Hospital, Dune din. — Betsey M. MeIntosh, Clara W. Pollock, Catherine Hunter, Mary G. Roberts. Batchelor Hospital, Dunedin. — Elizabeth McMullin, R.N., Margaret Jardine. St. Helens Hospital, Invcrcargill. — Gertrude Greaves, R.N., Ivy M. Spittle, R.N\, Essie S. Templeton. ALSO SUCCESSFUL. St. Helens Hospital, Auckland. — Ethel M. Dryland, Emma Hamblyn, R.N., Lilian K Rogers.

Townley St. Helens Hospital, Gisborne.— Edith M. Neal. Alexandra Home, Wellington. — Margaret K. Rogers. St. Helens Hospital, Christehurch.— Lila Fendall, Rose A. O'Shea. PARTIAL PASS. Christina Owen, passed in Oral. N.B. — The above names are not in order of merit.