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Wellington, 22nd May, 1923. Memorandum for the Chairman and members of Board of Health. PRIVATE MATERNITY HOSPITALS. The committee set up by the Board to inquire and report respecting private maternity hospitals beg to submit their report: — As suggested by the Board, the committee have conferred with the Nurse Inspectors located in Auckland, Wellington, Christchurch, and Dunedin, two meetings having been held in conference with these officers, who were given every opportunity of presenting their views. The committee find that owing to the relative scarcity of trained registered midwives, especially in many of the country districts, the Nurse Inspectors have had to accept minimum requirements in many licensed maternity homes. To have insisted on stringent requirements would have tended to exclude such women, and to force patients into homes under the charge of unregistered women. The committee consider, however, that the time has now arrived when this difficulty is not so acute, and that the regulations should be administered with more and more stringency. As the result of their deliberations the committee beg to submit for the Board's consideration the following recommendations and remarks : — 1. The committee suggest that the Government be recommended to give effect at the earliest opportunity to recommendation No. 6 of the Committee on Maternity Mortality, which reads as follows : " That the Hospitals and Charitable Institutions Act be amended to prevent the admission of one or more cases of confinement into any house for treatment in consideration of payment made unless such house be licensed for the purpose." Evidence was placed before the committee showing that tho number of these " one-bed homes " is considerable, and the committee are of the opinion that the time has arrived for such homes to be placed under definite control. In this connection the committee desire to draw attention to the fact that under the Infant Life Protection Act (Infants Act) foster-homes which accommodate one child, are required to be registered. It would appear to be anomalous that while all foster-homes have to be registered, maternity homes taking one case at a time are not subject to registration. 2. The committee found that recently the Medical Board established under the Medical Practitioners Act, 1914, passed the following resolution : " That, with a view to the reduction of maternal mortality, this Board recommends medical practitioners to use every endeavour to ensure that their midwifery cases shall be attended by registered midwives wherever practicable." The committee wish to express their endorsement of this resolution of the Medical Board, and trust the members of tho medical profession will as far as possible adopt it. 3. The committee wish to draw attention to another recommendation in the Report of the Committee of Maternal Mortality, which reads as follows : " The committee considers that efficiently equipped private midwifery wards for paying patients should be established as soon as possible in connection with public midwifery institutions, or in other suitable places." The committee are of opinion that the importance of this suggestion warrants this recommendation being especially stressed, but would add the words " or public hospitals " after the word " institutions." A deterrent to the establishment of properly equipped maternity hospitals by private enterprise is the considerable capital outlay involved. 4. The committee find that at the present time the Department requires in the case of licensed maternity hospitals a proportion of one trained midwife to six patients. The committee would recommend the adoption of a proportion of one to four, an extra nurse to be engaged for every additional four patients or fraction thereof. It is to be pointed out that every patient, so soon as baby is born, becomes two persons. It is recommended that provision to this effect bo embodied in the regulations. By the use of bells or other facilities arrangements should be made whereby patients could obtain the services of a nurse when necessary, day or night. 5. The committee recommend that all maternity hospitals licensed for the accommodation of. two or more patients should be required to have adequate domestic help, additional entirely to the nursing staff. 6. The committee are of opinion that in some cases it is desirable for the Government or local Hospital Board to subsidize or otherwise assist in the establishment and maintenance of satisfactory private maternity hospitals in outlying centres. The committee understand that this is already being done by some Hospital Boards. In somo cases the Boards make a payment in .consideration of a certain number of beds being always available for the use of their patients if required. This achieves the double purpose of assisting the private hospital and serving tho public at the same time. 7. The committee are of opinion that in the case of all maternity hospitals the following conditions should be complied with in order to qualify for a license : — («.) Sufficient air-space, ventilation, and comfort in patients' room. (6.) If applying for more than four beds, satisfactory provision to be made for a nursery and a labour-room. (c.) If members of the licensee's family are to be resident on the premises, separate bathrooms and privy accommodation, should be provided for patients and. family. (d.) Provision for sink-room, or sufficient and suitable equivalent. (e.) The building to .be designed or altered so as to avoid the carriage of bed-pans or soiled clothing from patients' rooms through the kitchen or living-room. (/.) Suitable staff quarters.