H.—3la.

The Committee has agreed with those responsible for the administration of the main teaching hospitals that it would not be satisfactory to conduct them on the "open" principle. Nevertheless it is felt that all other interests cannot be made subservient to the requirements of the teaching hospital and that some hospital accommodation should be provided where patients of moderate means who so desire it can be attended by their own doctors. It seems entirely illogical that because a patient is living in a city in which the public hospital is a training school for midwives or students she must be denied a valuable privilege which is available in smaller centres. Where such institutions as the Salvation Army hospitals and the Alexandra Hospital are operating they meet this need well, and the development of such services is to be encouraged. The alternative course would appear to be the establishment of an independent community hospital wing in connection with the main public maternity hospitals, staffed by trained nurses and not used for teaching. This suggestion, however, does not receive the unanimous support of the Committee, some of whom hold that the State is not called upon to provide two types of service in its main maternity hospitals. C. PRIVATE HOSPITALS. The same policy is recommended for the development of the private hospitals in the cities as in the towns —a combination of interests to establish hospitals of modern design and large enough to allow of fully efficient staffing. D. ONE-BED HOMES. Throughout the country there still remain a number of unregistered homes in which a midwife is allowed to take one case at a time and which are not subject to inspection as hospitals. The Committee is of the opinion that all such homes should be subject to definite regulations as are the private maternity hospitals. The Committee, though recognizing the useful part which many of these homes have played in the past, considers that they lack many of the advantages of larger hospitals and are not a really satisfactory feature of a modern maternity service. 7. ANTE-NATAL AND POST-NATAL CARE. Ante-natal Care. Prior to 1925 no system for providing ante-natal care existed in New Zealand. Advice on general lines was given to patients by the Matrons of public maternity hospitals, and a few medical practitioners recognized the need for proper supervision of pregnant women, but in the absence of organized facilities many women went through their entire pregnancy without supervision of any kind. In 1925 the Department of Health appointed an officer to organize ante-natal clinics in connection with the St. Helens Hospitals, under the supervision of the Inspector of Maternity Hospitals. The task was by no means an easy one. In most of the hospitals no room could be set aside for the purpose and examination of patients often had to take place under most trying and inconvenient conditions. In addition to this, a certain amount of opposition was encountered on the part of both medical and nursing staffs on the grounds of interference with hospital routine and the extra work entailed. Patients, also, not understanding the purpose of ante-natal supervision, resented being asked to come to hospital for examination, and some years of education were necessary before they began to realize the benefits of ante-natal care. The good results obtained in reduction of the number of abnormalities of pregnancy and labour have long since silenced such opposition, and a fully equipped ante-natal clinic is now regarded as an essential in any well-conducted maternity hospital. This has had repercussions on general medical practice, and there are now very few doctors who do not regard regular ante-natal attendance as a necessary part of their service to pregnant women. The following are the principal benefits of ante-natal care : — (1) Supervision of the patient's general health, and early detection of any pathological condition such as tuberculosis, heart-disease, nephritis, dental caries, &c., which may be adversely aflected by the pregnancy. (2) Recognition and correction of malpresentations. (3) Detection at an early stage of the symptons of toxaemia of pregnancy, with resulting prevention of the more serious manifestations such as convulsions and haemorrhage. (4) Instruction of the patient regarding diet, exercise, and general hygiene. (5) The opportunity for midwives and doctors to gain the patient s confidence, and so banish the unnecessary fears and apprehensions associated with pregnancy and labour in the minds of many women.

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