H.—3l.

PART YI.—PRIVATE HOSPITALS AND MATERNAL WELFARE.

I have the honour to submit my annual report for the year 1938, including a history of the development of maternity services in New Zealand, a survey of the existing maternity services, European maternal welfare, Maori maternal welfare, and private medical and surgical hospitals. SECTION I.—HISTORY. Brief History of the Development of Maternity Services in New Zealand from 1882 to 1938. The earliest official references to the provision of public maternity services are those appearing in the annual reports of the Inspector of Hospitals, George Wallington Grabham, MD., to the Hon. the Colonial Secretary. In his first report of 1882, he states :— " Dunedin Hospital. —A small wooden annexe on the north side contains the lying-in department, which consists of two wards, a small kitchen, and a room for the midwife." Again, in 1883, we read with reference to the same hospital: — " There are to-day 130 beds occupied—B2 by males and 48 by females. Twelve of the latter are inmates of the lying-in wards, where I also saw four infants." In 1886 he reports, with reference to this ward : — " I may again point out that the ' lying-in ward' is not well placed for this use. I strongly object to the existence of a lying-in ward as a portion of a general hospital. If needed at all, which I doubt, it should be erected elsewhere in the city." Ten years later, in 1896, Dr. D. MacGregor, M.A., M.8., Inspector of Hospitals, in his report on Hospitals and Charitable Institutions of the Colony, states : — " The practice of granting midwifery certificates based on mere theoretical instruction ought to be discontinued." Prom 1896 to 1901 official records make no reference to any public maternity services. In the latter year a definite step was taken towards organizing nursing services by the passing of the Nurses Registration Act, 1901, and in 1904 this was followed by the Midwives Act. In moving the second reading of this Act the Right Hon. R. J. Seddon said:— " I claim that the reproduction and preservation of life is one of the first duties of mankind, and if I am able to prove that this Bill goes in the direction of the preservation of life I feel sure that I shall have the support of honourable members. As I have said, reproduction is essential for the continuance of the human race. The risks attached thereto we all realize, and if we can minimize these risks and, as is provided in this Bill, ensure that those who are called in at that interesting and anxious time to which I have alluded are efficient, then I say we have so far done our duty. Have we in the colonies up to the present time devoted our attention to this matter, and have we made provision for that skill which is essential to the preservation of life at such an anxious time as that of maternity ? Sir, the deaths at maternity are alarming, and I say without hesitation that if these proposals are given effect to the number of deaths will be decreased. " I may say that up to the present time we have made no provision for the training of midwives. The midwife is generally a woman of advanced years, and in the country districts and on the diggings if you ask them the question how they became qualified, how they obtained their requisite knowledge, they would say, 'Oh ! I picked it up.' Philanthropists and religious bodies do not provide, nor do they in the slightest attempt to provide, for that which is provided for in the Bill ... I may be told that we have a large number of nurses at present training in our hospitals, but we must keep in mind, in connection with this phase of the question, the nurses trained in our hospitals know very little indeed in respect to the matter which is being dealt with specifically in this Bill." One clause in this Bill provided for the establishment of State maternity hospitals where pupil nurses could be instructed in all duties required for the welfare of the expectant mother and her infant. Dr. MacGregor writes in his report of 1906 : — " With the passing of the Midwives Registration Act, 1904, the day of the dirty, ignorant, careless woman who has brought death or ill health to many mothers and infants will soon end. After 1907 every woman who undertakes the responsibilities of a midwife will have to show that she is competent to do so. This will necessarily limit the number of women who can be found in a district to attend a case of labour at a low charge. To meet this difficulty St. Helens Hospitals have been established in each of the four centres where the wives of working-men can obtain, at a fixed charge, care and attendance during childbirth. The success already met with in these hospitals testified to the need for them. There has hitherto been no hospital in New Zealand devoted to maternity work where nurses could be trained, and St. Helens Hospitals provide careful training for maternity nurses." Lavinia Dock, in her " History of Nursing Study," writes :• —- " Of all the great work which this man (Mr. Seddon), so gifted with the genius of statesmanship, accomplished for his adopted country perhaps none will have such lasting effect and do so much for the coming race of New Zealand as this of founding the four State maternity hospitals. They are a more enduring monument of his memory than any statue or tombstone can be."

10— H. 31.

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