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Ante-natal Care. —Very satisfactory provision has been made for ante-natal supervision in Wellington. St. Helens Hospital, Alexandra Hospital, and Bethany Hospital all have ante-natal clinics staffed by experienced nurses working under the supervision of the medical officer, or, in the case of private patients, of the private medical attendants. No special charge is made for this attendance. The Plunket Ante-natal Clinic, working in conjunction with the doctors, has given excellent free service, particularly to women who are to be confined in private maternity hospitals or in their own residences. The tendency is, however, apparent in Wellington, as elsewhere, for the doctor to take over the more medical aspects of the supervision to a greater extent. In many cases the doctors prefer to undertake the full responsibility of the antenatal supervision of their private patients ; the almost universal practice is to include this service in a composite confinement fee. Ante-natal care is therefore within the easy reach of all women in the city, and there is no excuse for failure to receive this attention. Actually the service is fully availed of, and the unsupervised case is now quite exceptional. District Nursing. —A district (domiciliary) maternity nursing department has always been a feature of the St. Helens service ; indeed, at one time it formed a considerable part of the St. Helens practice. The experience in Wellington and elsewhere is that this service is steadily diminishing, and in the year ending March, 1936, only twenty-seven cases were confined in the St. Helens district. This, of course, is a direct result of the tendency towards hospitalization. The district service has the merit of low cost and in some respects offers a good field for practical nursing training, but on the other hand it has many disadvantages — conditions in the homes are often very unsatisfactory, it is more difficult to conform to the standards of modern maternity care, and between the visits of the nurse the patient is left with unskilled attention. The district nursing service which remains is, of its type, quite satisfactory ; it has behind it the organization of the St. Helens Hospital, and these outdoor patients have the full ante-natal service available. The Alexandra Hospital which also, at one time, had a fairly large district practice, has now given up the work and is concentrating on indoor service. Private domiciliary nursing, where the nurse lives in the home, is also diminishing. Being a main centre, there is naturally less difficulty in obtaining private maternity nurses for this work than is the case in smaller districts ; indeed, the main difficulty is for the private maternity nurse to maintain a practice in the face of the present trend towards hospital attendance. Provision for Unmarried Mothers.—The provision for unmarried mothers in Wellington is very satisfactory, two homes —the Salvation Army Bethany Hospital and the Alexandra Home —being available in which, in addition to receiving confinement attendance, these girls can be cared for both before and after delivery. These institutions take a considerable number of cases from outside Wellington. The establishment of a married women's service in connection with these institutions has undoubtedly been beneficial in that a high standard of maternity care has been developed in which single women and married women share equally. Wellington Suburban Areas. The population of Wellington and its environs is, in the main, so concentrated that, with the exception of the Hutt Valley district, which will be discussed separately, the position of suburban residents does not present any serious problems. All the main suburbs are within reasonable distance of the city hospitals, public and private, and there are no great difficulties, transport or financial, entailed in full attendance at ante-natal clinics. A few of the small suburbs north of Johnsonville are less favourably placed, but the number of cases in these districts does not warrant local provision. The Hutt Valley District. In the Hutt Valley area (including Petone, Lower Hutt, Upper Hutt, and Eastbourne), with a population of about 40,000, there are no local public maternity hospital facilities, and the Hospital Board district nurse does only a very limited amount of domiciliary midwifery. Patients requiring the St. Helens type of service have to travel to Wellington St. Helens Hospital, a minimum distance of about ten miles. A small number of patients receive financial assistance to the extent of £2 or £3 from the Board to help with privatehospital fees. The Plunket Society has a branch ante-natal clinic which co-operates with the city hospitals, but frequent visits to the city hospitals for ante-natal supervision are often necessary, at a cost which is a definite burden to many. Many patients from these districts also attend the Alexandra Hospital and Bethany Hospital. This usually means that it is not practicable for the family doctor to attend, and a city doctor is engaged for the confinement.

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