MATERNITY SERVICE

Rotorua Morning Post, Volume 1, Issue 12, 5 September 1931, Page 6

MATERNITY SERVICE

DOMINION SYSTEM " DR. DORIS GORDON MAKES COMPARISON WITH | VICTORIA WHAT IS NEEDED. Writing in the New Zealand Medical Journal on the development of the New Zealand maternity service, Dr Doris G. Gordon makes a comparison with that of an Austral'ian organisation, which, independent of the Go vernment, has performed remarljable work. The Australlan Bush-nursing Association couducted its flrst 2500 maternity cases without one fatality. It is not a State enterprise, is non-politica], and is not subject to State inspection. The association has three types of service stations. Firstly, the settlers in sparsely-popuiated areas have heen encouraged to finance a fir&t-aid station, where a nurse resides. lThis nurse is allowed to conduct norma] cases in a patient's home., Secondly, in rural towns, . hospitals of four to eight beds have been erected tc accommodate surgical, medical and maternity cases. The latter include abnormal cases sent up from an adjacent flrs.t-aid station. These hospitals have established an Empire record as regards low maternal mortality. Thirdly, at larger towns in strategic situations, the association _ has base hospitals. These are equippe-.i | with ambulances, X-ray plants, etc., irj whereby they can collect and deal with all the more serious cases from the aid posts and smaller hospitals in the vicinity. The association is a self-helping one, finance being provided by the people of the district, supplemented, if necessary, by the funds of the administrating board in Melbourne, which has established a trust for this purpose. This board reserves the right of saying where hospitals. shouhl be built, of what type, and supervises the working efficiency of its institations. .

The principle underlying the successful obsletrical work of the association is a "maximum" of co-opera-tion between patient, doctor and nurse." It considers the ideal arrangement is that providing for a doctor and a nurse to be present at every conflnement. Dr. Gordon queries th?.t if the maternal death rate for the provincial areas of Victoria can be so reduced, why cannot that of New Zealand? New Zealand statistics show that the rate in our main cities has been lower than the Dominion one, the latter being kept up by the ratio of fatalities in the rural areas. If this could be reduced the rate would come down to approximately 3 or 3.5 deaths of mothers per 1000 births. A Superior Qrganlsatlon. If, says.Dr. Gordon, we concede that the conditions of backblock life in Victoria and New Zealand must be equally hard on settlers' wives, we . are faced with the conclusion that the difference in the maternal safety for the two groups of women must lie in ihe superior organisation of the association compared with the similar services operating in New Zealand. The association has one super bo.ard oontrolling all its work, continues Dr. (lordon. Tliere is no over-lapping, no vvaste, no area is left without an adequate obstetrical service. In New Zealand, on the contrary, the obstetrie needs of every district are the concern of the^ hospital boards administering the particular area. This does not include centres large enough to have St. Ilelen's Hospitals. Many of our hospital boards have erected maternity wings, or annexes, which are doing excellont work for the women in .their immediate neighbourhood. Other boards have not seen their way clear to make any provision for obstetrie cases. Many of the maternity wards are magniflcent structures, built at a cost, perhaps, that is not justifled by the annual nuinber of conflnements taking place therein. The weakness of the New Zealand system compared with the Victorian, says Dr. Gordon, is that as each of our hospital boards administers its area according to a strict geographical boundary, and only takes cases from its own district, a costly maternity hospital in one district may bo standing half empty, while women from 20 miles away are debarred from entrance "because they belong to another board's area." Visualise two hospital areas, A and B. A, with .50 per cent. local funds and 50 per cent. Government money supplied in days of affluence, has built an elaborate maternity annexe. B has no provision for obstetrical cases at all. A woman of the working class, from the district B, desires adynission to the annexe of A, but under "present rules is excluded by the policy of boundaries, albeit the maternity ward A may be running only half full.

Extending the Service. How long will public opinion sanction the extravagance of A's annexe not returning its maximum of safe maternity in proportion to public money sunk in its construction, whilo the working mothers in B are compelled to seek the services of the "gamp," or, at least, the one-patieut licensed home? Surely, continues Dr. Gordon, In these days of natlonal eoonomy authorlties should consider whether a little more centrai controi could not be beneficiaiiy exercised, so that existing maternity hospitels in provincial ar>eas might serve as wideiy as their accommodation permits. During recent years we in New Zealand have cherished the ideal that shortly small maternity hospitals would be fitted in all rural areas te serve the needs of the country mothers. This ideal must not be abandoned, albeit economic conditions may cause us to modify our architectural ambi tions and our administrative tactics.

Anyone watching the lllustrations of the BU3h--nursing Association realised that the archftocture of the buildings was in no v/ay responsible for the high standard of work attained • therein, and after profiigate spending in late years, in our endeavour to reduce ftfew Zealand maternal mortaiity, authoritles vi/ouid do weii to remember that exceilent results can, after all, be obtained In humble buildings. After quoting an instance of building an ante-natal block to a maternity hospital under what she terms our "cumhersome and rcduplicative system," Dr. Gordon emphasises the fact that £2800 — £300 over the estimate . — was spent for an ante-natal block in 1 provincial area. » The average number of patients confined in this hospital was - three per week, .continues Dr. Gordon, and- on>s wonders how much worse off they wouid be if their ante-natal examinations had been conducted In a 20-foot-square corrugated-iron buliding lined with beaver-boarding and partitloned off into two modest little compartments. Under our local governing systems/ civic ambition may tempt a town to covet an expensive maternity hospital

when a large and efflcient annexe exists 20 miles off along a main highway. Humbier Buildings Suffi.cient. With a little adjustment of local parochialism the Government .couhl decree that all the existing wellbuilt maternity wings be used as base hospitals, and all' bordering distriots within a radius of, say, 40 miles, could be served by humhler wooden cottage hospitals. The principle of the nurse stationed at an outpost, and flnanced partly by the Settlers and partly by a centrai funcl, is already operating in certain New Zealand disiricts. In our case the centrai fund is the local hospital board. In concluding .th.is sectiori of ,hers paper Dr. Gordon . suggested that, whether the obstetrie needs of small country towns are to be served by private hospitals, suhsidised for a iimited number of ; cases, or whether they are to be served hy hospital board cottage hospitals, the principle of making residents of the .aro'a "help themselves" rntist be more rigidly enI'orced than lijlherto. We havo iearnt to oup cost-ln the last ,12 months that people only value what they pay.ffor, and a State service that can be too' easily obtained soon degenerates , into "spoon feading" and nationai suicide. A ' . :