H.—3la.

SUMMARY.

PART I.—REPORT ON LOCAL CONDITIONS. In Part 1 of the report the Committee has given a detailed review of the conditions existing and the facilities available in all the Hospital Board districts throughout the Dominion. Recommendations arising out of the needs of each particular locality have been made. PART 2.—GENERAL SURVEY AND RECOMMENDATIONS. Methods op Attendance. Turning to the general considerations based on this complete survey, the Committee has first discussed the relative position of the doctor, the midwife, and the maternity nurse in the maternity service. The Committee found that the preference in New Zealand is for attendance by both doctor and midwife, or doctor and maternity nurse, in all cases, normal or abnormal, rather than for attendance by midwives in normal cases with the doctor acting in a supervisory capacity and available in abnormal cases. The former system is advocated by the majority of doctors in New Zealand for reasons which have been fully explained, and is favoured by the majority of women, although, at present, mainly owing to financial - circumstances, a portion of women are attended on the midwife system, especially in the St. Helens Hospitals and the annexes to public hospitals. Full consideration was given to this matter because it is recognized that in some countries with very efficient maternity services the midwife system operates. It is the opinion of the Committee, however, that, while the midwife system can give a safe and efficient service, the system of doctor and nurse attendance can give a still more efficient and a more satisfying service. The extension of this principle is therefore advised, and certain recommendations have been made whereby such a combined service might be brought within the reach of all by the appointment of house surgeons to act in conjunction with the senior staff in all the main public maternity hospitals and in the larger maternity annexes, by Hospital Boards making provision for the doctor-attendance of indigent cases in smaller and by the incorporation of provisions for doctor-attendance in any national health insurance system which may be developed. The Committee fully recognizes the importance of thoroughly competent medical attention, and is in complete sympathy with all steps which will lead to the most efficient practical training of medical students in this work and to the encouragement of the special practice of midwifery by those to whom it appeals. While in isolated districts all general practitioners must of necessity engage in obstetric practice, the Committee is in accord with the tendency in larger communities for the midwifery to be undertaken by those who, through partial or full specialization in this branch of medicine, are best fitted to give the service. See reservations by Doctors Sylvia G. de L. Chapman and T. L. Paget.. Hospitalization or Domiciliary Attendance. The Committee next examined a second important matter of policy regarding which there are differences of opinion—the extent to which hospitalization should be encouraged. It was found that the tendency in New Zealand was overwhelmingly in the direction of hospitalization of all maternity cases, both normal and abnormal; at the present time 81-75 per cent, of all cases are conducted in hospitals. The Committee is satisfied from the evidence presented that the advantages of hospitalization, as far as New Zealand conditions are concerned, have been clearly proved, and has no hesitation in recommending that any national maternity service shall be based, in the main, on hospital attendance. District Nursing Services. As a natural corollary to this increase in institutional treatment there has been a . corresponding decrease in domiciliary attendance which has affected both the public district nursing services and private maternity nursing practice. Although provision must still be made for a certain amount of this type of attendance, both in the cities in association with the St. Helens Hospitals and in the country through the agency of district nurses, the Committee is satisfied that the existing facilities of this nature , are sufficient and that there is no object to be gained in attempting to extend such services in the face of the present trend of practice.

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