St. Helens Maternity Hospitals in New Zealand

Kai Tiaki : the journal of the nurses of New Zealand, Volume XV, Issue 1, 1 January 1926, Page 9

St. Helens Maternity Hospitals in New Zealand

Paper by Miss Inglis, R.N., R.M., read at the International Conference at Helsingfors.

The question: "Should nurses be encouraged to take Midwifery training?" is a burning one, to my mind, and 1 very much regret that I am unable to take part m the discussion m person. May I be permitted instead to say a few words on Midwifery training m New Zealand? My connection with St. Helens hospitals dates from 1906. St. Helens Hospitals are the State Maternity Hospitals m New Zealand and are supported by the State for the benefit of the wives of working men and for the training of midwives. Unmarried women are not admitted as patients except m cases of emergency. It is now twenty years since the first of these hospitals was opened. Mrs. Grace Neill, who was at that time Assist-ant-Inspector of Hospitals, was instrumental m bringing the need of such hospitals under the notice of the Government. The then Prime Minister, the Rt. Hon. R. J. Seddon, recognised the advantage to the country of institutions of this description and m three weeks the first hospital was opened m Wellington. The building that was used was far from being suitable but much good work was done there. Now there is a well-built modern maternity hospital m this city, Auckland has a still newer building and the other cities live m hopes. Adapted houses can never be entirely satisfactory, and five of the St. Helens Hospitals are lodged m these, however. The work itself, wherever it may be carried out, is performed with the strictest attention to the care of the patient, the well-being of the child and the training of pupils. We claim that the instruction to mothers, which- has been carried on for so many years, and the better training of maternity nurses, has had much to do with the low infantile death rate m New Zealand. As a rule intending patients engage a bed about the seventh month. They are charged £1 a week, if admitted for ante-

natal treatment, and 30s. a week from the date of confinement. The charges have never been altered and now that the cost of living has increased so enormously "the retention of the old rate is a very generous concession by the Government to the working classes. Destitute cases — of whom there are not very many — are recommended, through the Hospital and Charitable Aid Board of the district, which body makes the necessary payments to St, Helens for the treatment received. During the war and for a year after, wives of soldiers received free treatment. At the time of booking patients are given full directions about the care of themselves during the remainder of pregnancy, with warning of dangerous symptoms, and urine is tested regularly. It) is very seldom that a booked patient develops eclampsia. If one does, the invariable reason is that she has not obeyed instructions. The medical officer has always interviewed patients who show any abnormal symptoms. Ante-natal clinics have been held regularly for some years and at the present time all prospective patients are required to attend them. There is no resident doctor, the medical officer, who is appointed by the Government, visits regularly, and at any time when called upon. There are very few cases of abnormality m these new countries though the number has increased considerably since the advent of large numbers of immigrants from overseas. The number of patients m a ward varies according to the hospital, as a general rule wards contain from four to six beds. Single wards are reserved for special cases, e.g., eclampsia, placenta previa. In the hospitals that have been specially built, and m some of the others, there are balconies and verandahs on to which the wards open so that m suitable weather the beds are wheeled outside, to the great benefit and enjoyment of the

patients. The babies are also put out on the balconies whenever the weather permits. Patients remain m hospital for fourteen days, longer when considered necessary for the sake of either mother or baby. Before discharge, instruction is given to the mother on the proper care of herself and her infant, and on the necessity of reporting if all is not well. On her husband is also impressed the need for care of his wife, m some cases a very necessary precaution. District cases are undertaken, the patient being attended at confinement either by midwife and pupil, or by a pupil with a doctor m charge. In that case the patient days the doctor's fee. As as rule the pupil conducts the delivery under the doctor's direction and visits as usual. A district midwife is attached to the hospital. Her duty is to visit the district cases to see that proper provision is made for the coming confinement and to attend confinement with a pupil. At one time she used to visit regularly the patients and babies who had been discharged. The Plunket nurse now visits those who have returned home. An important part of the work of St. Helens Hospitals has always been to take m ex-babies who are needing further care as regards feeding. This is also a valuable side of the training of midwives, as babies are taken m from two or three weeks old up to six or eight months. All babies are kept m a large nursery, being taken to their mothers only for feeding. We consider that the mothers will obtain greater rest if the babies are not kept at the bedside. The period of training for pupils is, at present, one year, but for general trained nurses six months. It is hoped that m the not very distant future this period will be extended. The nominal fee of one guinea is charged and pupils receive free board and lodgings and laundry. They provide their own uniform and books of study. A complete course of lectures is

given by the medical officer and by the matron each term, as well as regular coaching classes so that each pupil receives over 40 lectures during her training. Examinations are held m June and December each year and the terms begin directly afterwards. No pupils are trained as "monthly nurses" only, all qualify as midwives on passing the examination. New Zealand, at present, -bears the stigma of having one of the highest death rates m the world for confinement cases. Statistics may possibly be compiled differenlty m different countries, but those taken from St. Helens Hospitals are found to be more favourable. In 1920 the maternal death rate m these hospitals w r as 4.78 per thousand from all causes, as compared w r ith 6.48 per thousand for the wdiole of New Zealand. Last year, 1924, m St. Helens Hospitals, out of 1937 cases there were 5 deaths, these included 2 post-partum haemorrhage, 1 puerperal exhaustion, 1 rupture of uterus, 1 toxemia and heart failure — none of these can be included m the term puerperal sepsis. Surely these figures help to show the benefit of properly conducted Maternity Hospitals. There is an increasing demand m New Zealand for the nurse with a double certificate for any hospital position, m fact few hospitals, whether large or small, will, nowadays, appoint a new matron who has not a midwifery certificate as w^ell as her general qualification. Should nurses be encouraged to take Midwifery training? My answer to this question is an unqualified "Yes." There is no branch of nursing, m my opinion, that is not enlarged and made clearer if the nurse possesses a midwifery training. She then understands with a much deeper insight, a woman's needs, her trials, her dangers, her disabilities, whether the case be surgical, medical, mental, or neurasthenic. It is only after gaining knowledge m this branch that one fully understands how essential that knowledge is to one's efficiency m nursing*.