Maternity hospital

“ It should not be forgotten, however, that young and aspiring doctors have to acquire some practice with the obstetric forceps, and that it is precisely in homes and hospitals that this practice can be obtained. Instead of its being the excessive busyness of the doctor that leads to the hasty and unnecessary use of instruments, therefore, it is now the circumstance that the woman may find herself in a maternity-home or hospital. ”

“ A woman still young, though mother of seven living children, is carried into the maternity ward of the Woman's Hospital. At the hands of the ignorant mid-wife she has suffered maltreatment whose details cannot be put into print, followed by a journey in a springless cart over miles of rutted country road. She is laid upon the operating table with the blessed aid of anaesthetics at hand; there is still time to save the baby. ”

“ This branch of work is of absolute importance to the internes, and of the greatest value to the nurses.
Not less interesting or successful is the maternity work of these hospitals. A great deal of the chronic trouble from which working women suffer so severely comes from want of proper care while they are exercising the functions of childbearing. The poor applicant to the maternity department is seen by the woman physician, who gives her advice as to previous care of herself, and she has in the hospital that thorough rest and care which are indispensable to full restoration to health. ”

“ It is Parliament’s plan to have the new maternity service as available for the entire population as is public education for school children. The city of Bradford exhibits the ideal of a complete municipal system now in successful operation: an infants’ department occupying a new three-story building, with a consultation to which [325] 600 mothers come weekly; a maternity department with the ante-natal clinic; a maternity hospital, announced as “the first of its kind” in the world; a staff of municipal midwives for service in the homes ”

“ To a certain extent transport difficulties can be eliminated by making more use of public hospitals nearest to the patient's residence, or of private maternity hospitals subsidized by the Hospital Board of the district. ”

“ In connexion with this Maternity Hospital, the Salvation Army has a Training School for midwives and nurses, all of whom must pass the Central Midwives Board examination before they are allowed to practise. Some of the students, after qualifying, continue to work for the Army in its Hospital Department, and others in the Slum Department, while some go abroad in the service of other Societies. The scale of fees for this four months' course in midwifery varies according to circumstances. ”

“ This is being attempted, not by establishing another medical and nursing agency, but by establishing a centre through which the maternity work of every hospital, private physician, midwife and nursing agency in the community may be co-ordinated and developed to its fullest extent; a centre at which there will be a complete record of every pregnancy in that district; a centre from which the whole community may be educated to realize the need of and to demand adequate medical supervision and nursing care for every woman and her baby before and after birth. ”

“ Considering the need for cleanliness in a very broad and practical sense, the nurse will realize that the test of her ability to protect her maternity patients from infection is not what she is able to do in a hospital where there is every facility for clean work. It is not the ability to maintain asepsis in a tiled operating room that counts, where she is aided by sterilizers, basins, and solutions of various kinds and colors, a wealth of ingenious appliances and a corps of co-workers. ”

“ For the birth itself, the mother should be in experienced hands, preferably those of a highly trained and certified midwife or maternity nurse such as Queen Charlotte’s or the London Hospital supplies, one who is experienced in all that has to be done in normal, healthy circumstances, and who can detect at once any necessity for specialized help. ”

“ Those who have arranged to be cared for by a midwife. 4. Those who have made no arrangements of any kind. The nurse’s relation to a patient registered with a hospital 413for delivery depends upon the scope of the work of that particular institution. Some hospitals will register patients early in pregnancy, and assume the entire medical and nursing care and supervision from that time until after the baby is born. The Maternity Centre nurse, obviously, has no responsibility for these patients. ”

“ In one hospital, at least, the directors find the greatest assistance from a committee of ladies who look after the maternity patients, both before they enter and after they leave the hospital. They endeavor to procure work for the mother, and watch over her welfare and that of the child. But they make it their invariable rule to give aid only on condition that the mother makes every effort to fulfill her maternal duties; for they believe there is a regenerating power in motherhood, and that care for her child is the surest safeguard against a mother’s committing a second fault. ”

“ Once more the devoted ladies of the Woman’s Auxiliary nobly responded to the growing demands of pressing hospital needs, which included provision for laundry work under their own supervision, better accommodation for their admirable little band of pupil nurses, and the inauguration of a much-needed maternity for ladies desiring private hospital accommodation. ”

“ Continental countries have been alive to the need for training the women who did this work. For instance, in the great General Hospital in Vienna with its 3,000 beds, 550 beds were kept apart for maternity wards, and of these, 200 were reserved for the State training of midwives—a course of one year's duration being obligatory, with daily lectures on every detail in midwifery from the Professor of Obstetrics. ”

“ To many women of good position the maternity is a great blessing, if they have not comfortable homes and friends to care for them. The expense in the hospital is much less than the price for which good medical attendance and nursing can be secured at home. ”

“ It was opened in 1901 as a hospital for women, with a dispensary and out-patient department, admitting cases of accident and general illness as well as maternity patients. After nine years, it was decided to draft the general cases from the district to the Edinburgh Hospital for Women and Children, and The Hospice devoted all its beds to maternity cases. ”

“ All of the municipally subsidised institutions have had their accommodations increased since the war. There are the Municipal Maternity Hospitals, where care is free, or there is the Mutualite Maternelle, the self-supporting maternity club through which one may make arrangements for accouchement. There are free meals for mothers at the Cantines Maternelles, which are spread over Paris. Are there other children in the family, so that their care is a burden to the mother? She must not tire herself with the housework. ”

“ As far as the larger centres are concerned, no woman, however poor her circumstances, need lack complete ante-natal supervision, for which no charge is made, and proper confinement care, at most moderate cost, in the St. Helens Hospitals or the various maternity annexes of the public hospitals; where the mother is actually indigent, free provision is available through the Hospital Boards or St. ”

“ Even when all the above requirements are or can be fulfilled, there remain a large number of cases of pregnant women, and especially of unmarried women, who cannot be satisfactorily confined at home, either because of their social or sanitary circumstances, or because abnormal or complicated childbirth is expected. For such cases hospital provision is needed. ”

“ Patients who, the doctors think, give promise of having complicated labors and who prefer to remain at home are advised to engage a doctor, and to arrange with the Henry Street Settlement for nursing care at the time of delivery and during the puerperium, as the Maternity Centre nurses do not perform this service. ”

“ A complete maternity service which includes prenatal work, service at time of confinement, post-partum care and subsequent supervision of mother and baby is essential if adequate results are to be accomplished. Anything less than this complete service does not give full protection to the life of the mother and the baby. The Philadelphia Visiting Nurse Society has found that the inclusion of service at time of confinement has given a tremendous stimulation to both their prenatal and postnatal service. ”

“ Additional visits should be made if the patient is still in bed and there is no intelligent adult to give care, or if the baby’s condition is not satisfactory.
A SUGGESTION FROM MONTREAL Ingenuity, resourcefulness, and quick wit on the part of an intelligent nurse can almost always apply hospital ideals to circumstances which would at first seem hopeless. It is the nurse’s knowledge of obstetrical nursing and principles, rather than her equipment, that counts in saving lives. ”

“ Childbirth in Unmarried Mothers.—When a married woman is about to become a mother, she makes early preparation of all that will be required during childbirth and the lying-in period. A large proportion of unmarried mothers, on the other hand, spend their last penny before the termination of pregnancy, and are altogether destitute when the time of their delivery arrives. A sense of shame prevents many pregnant women from entering a lying-in hospital, although to do this would provide them with free medical aid. ”

“ In the branches where a delivery service has been added, the prenatal service has increased fourfold. Both doctors and patients are enthusiastic and see far more reason for instruction and supervision from a nurse who is going to see the case through than from one who drops out at the crucial moment. It certainly has strengthened our whole maternity service, both as to results accomplished and in our relationship to the doctor and to the community. ”

“ Supervisory postnatal visits are paid to patients, not under the care of the visiting nurse service, who have been under Maternity Centre Association care during pregnancy, as well as to those who have not had this care but are referred to the Centre, by hospitals, upon their discharge. ”

“ The next responsibility of the nurse is to advise the patient in arranging for care at the time of delivery, this advice being based upon the patient’s physical condition, the circumstances of her home life and the available facilities for care. Although hospital care may be the ideal for all patients, from an obstetrical standpoint, the mother cannot always be removed from her home with safety to the family circle. ”

“ Happily, the present-day obstetrician, who assumes the care of an expectant mother, does so with confidence and optimism because of the available knowledge upon which he may draw for her benefit. Progress in the various branches of medicine and nursing is steadily pointing the way toward greater and more effective safeguards for the maternity patient and her baby. ”

“ Their need is care, which includes cleanliness in order to prevent infection; suitable food; fresh air and exercise; regular and sufficient rest and sleep; an equable body temperature; early treatment of complications and correction of physical defects. In short, each patient needs to be watched; needs clean care and to practice the approved principles of personal hygiene from the beginning of pregnancy. This without regard to race, color, creed, occupation, status, or location. It means all maternity patients and their babies the country over. ”

“ Those institutions which are connected with a foundling hospital are exceptions in this respect, for some of the women enter the foundling hospital as wet nurses. In the interest of the child it is, above all, necessary that the mother should be well cared for after delivery, for it is during the first three or four weeks after birth that the child is most of all dependent upon the maternal breast. ”

“ The methods and procedures of the delivery-room can be just as good in the case of the very poor woman as in the case of the magnate's wife. In no way and for no reason fear the hospital. It is the cleanest, safest, and by far the cheapest way. The weekly amount paid includes the board of the patient, the routine care, and all appliances and supplies of every sort that will be used. Under no circumstances should a midwife be engaged. Any reputable physician or any intellectual minister will advise that. Let your choice be either the hospital or the home ”

“ I have before observed, that in the Hôtel-Dieu at Paris, there are no men-practitioners suffered, for I do not include the surgeon-major, who is absolutely no more than an officer for the form-sake. Consequently there are no instruments ever employed in the delivery of the women admitted to that hospital. It is true they are extremely well taken care of; all necessaries are found them by that noble charity; but yet it cannot be thought, that the same abundance of ease and conveniences can be afforded, as by those persons, generally speaking, who employ men-midwives. ”

“ If abnormalities develop during pregnancy, the nurse arranges for immediate medical care, either at the patient’s home or in a hospital. If the clinic doctor feels that the patient should have hospital care, but she will not or cannot go to a hospital, she is persuaded to engage a doctor, and a nurse from the Centre helps, as a visiting nurse, to take care of the patient in her own home. ”