MATERNAL WELFARE

Nelson Evening Mail, Volume LXIII, 16 July 1929, Page 3

MATERNAL WELFARE

INSPECTION OF HOSPITALS MEDIOAL UECOMMISNDATIONB in i report to this Uiioelof-General ol Health (Dr. '}. If. A. Valin.iiim), the Inspector ol Private Hospitals (Uf.'i. L. Paget) reviews the present position and past year's work in maternity hospitals anil" ante-natal clinics, lie stales ihut the 371 Institutions in this department of public health have, (Hi the whole, been maintained ill a satislactoiy condition. These hospitals consist of seven St. Helen s Hospitals, f/J I tiblic maternity hospitals, fir maternity wards attached'to hospitals, 93 private medical and surgical hospitals, J\h mixed medical, surgical, and maternity hospitals, and lb 7 private maternity hospitals. This shows an increase of six public maternity hospitals during the year. No fewer than 26 licensed bos pilals were voluntarily closed, Some because lhey were superfluous, or which, lor oilier reasons' did not meet with sufficient support, and some because they wore not being conducted satisfactorily. The comparatively low charges for obstetrical nursing and hospital services as compared with those for medical and surgical services, states Dr. Paget, continues tn create a difficulty when the ([iiestion of establishing new private maternity hospitals is being considered. The economic factor makes it impossible, for private enterprises, which must look to a reasonable financial return, to build more than is just necessary for the purposes for which they are intended, and in most instances only necessary conveniences can be afforded, and others that 1 regard as desirable, but not essential, have to be omitted. The same economic condition is a considerable factor in making it difficult to get private maternity hospitals equipped in such a way that sterilisation can be carried out with ordinary facility. While the, standard of asepsis lias undoubtedly been, considerably iim proved, there are still a number of instances in which the licensees prefer to adopt methods of sterilisation which are cumbersome and costly, in fuel, time, and trouble, rather than spend a small sum on u, high-pressure dressing steriliser, even though that can now be obtained for £lO to £l2. Though it is indisputable that sterilisation of dressings can be carried out bv mean:, of boiling, steaming, and baking to dryness, in practice it is found that such' methods are so cumbersome that The amount of sterilised articles necessary for use in emergency are seldom on hand. It will be a very great advance when not only all hospitals but all obstetrical practitioners will consider a. high -pressure dressing steriliser an essential part of their equipment. Sir John Bland Sutton recently said- that, the obstetrician who conducts a. labour without wearing sterilised gloves cannot be held guiltless if the patient develops puerperal sepsis. This may be regarded as a rather extreme statement, as there are rare cases when departure from this rule may be necessary, but it is quoted to show the trend of opinion towards insisting upon full aseptic precautions being taken in all. obstetric cases. .

A NOTABLE RECORD A satisfactory increase in the attendances at ante-natal clinics is reported. An increase ill the numbers of sterilised maternity outfits is also noted. In yieW of the fact that maternal mortality in rural districts (as defined by the Government Statistician) compares in.favourably with that in urban districts, particularly as regards eclampsia, the need of the extension of these clinics is evident. Dr. Paget quotes the following notable record of one of the St. Helens maternity hospitals:—"Under conditions of systematic. . and skilled ante-natal eai ('.complete sterilisation of dressings, and sound aseptic technique, the last 1300 consecutive deliveries in this St. Helens Hospital resulted in only one maternal' death, which was due to embolism and occurred after the patient had returned borne against the advice of the medical officer. One other death v.hich occurred in the hospital was a case of eclampsia which was brought in after delivery elsewhere, and was then in a comatose condition." The first case rejected the advice of the medical officer; the second case had no ante-natal care. The same authority also states that the still birth rate and the deaths of infants in the first fortnight of life have been reduced under these conditions to 38 per 1000 births, as compared with the New Zealand rate of 52 per 1000 births. Dr. Paget says he is convinced that. the problem of reducing maternal mortality can be. best solved by three principal methods: (1) By the "universal acceptance by women of the necessity for skilled and systematic ante-natal care; (2) by the general application of the principals of aseptic surgery in the practice of obstetrics both in and out of hospitals; and (3) by the provision of small, well-equipped maternity hospitals so located as to be available, to patients—particularly When the home conditions are not suitable for patients during confinement; and in cases where the indications point to serious departure from the normal.