The Development of Maternity Services in Bristol

Transcription

1 Brisl Medico-Chirurgicl Journl. Vol. 88 Development Mternity Services in Brisl By C. C. Hncock, M.A., D.P.A., F.H.A. sometime Chief Executive Officer Southmed Group Hospitls hisry development mternity services in Brisl Are since 1948 would not be complete without sry service before Hving been closely ssocited with development mternity services with Brisl Locl helth Authority, under Brisl's first full-time Medicl Officer Helth, Dr. D. S. Dvies, n lter Dr. R. A. Askins, followed by Pressor R. H. Prry nd lter Pressor R. C. Winden, I hve, refore, seen rerrirkble progress in helth services, which col- 'ectively resulted in outstnding reduc in mternl nd infnt mortlity, nd improvement in helth mors nd bbies, which without our Unique system midwifery, I venture sy, would not hve been possible. We hve now rrived t present system Nl Helth Service, including Hospitl Authorities, University Medicl Schools, Executive Councils nd Locl Helth Authorities, but by 1974 different pttern is likely emerge, which it is hoped will unify ^e vrious brnches, with consequent improvement in public service. It my be helpful present hisry briefly Vou in two secs:? Superintendent Helth Visir nd Deputy specr Midwives under Dr. J. C. Heven. re 20 Helth Visirs who lmost lwys entirely con- fined Mternity nd Child Welfre work nd re 72 midwives; 18 in mternity homes nd 54 in privte prctice. Mny midwives without trining qulifics. re only four municipl nte-ntl clinics with 368 mors ttending. Milk grnts up tl?2,000 per nnum mde, detils which hd be submitted His Mjesty's specr. re lso 20 voluntry schools for mors, in running which lte Mrs. Wered, wife Judge Wered, nd Miss Wered ok leding prt. re homes for unmrried mors?grove House t Redlnd; Brisl Mternity Hospitl t Southwell Street; Mrlborough House t Kingsdown; nd Slv Army Hostel. re mternity institus for norml nd bnorml cses, including Brunswick House with 19 beds for mrried women only. Brisl Generl Hospitl hd 12 beds, Brisl Royl firmry 10 beds, which lter incresed 30, nd Poor Lw Estville stitu hd 18 beds. Southmed Hospitl s we now know it ws not n in existence. (1) period under Locl Helth Authorities 'rom Mternity Act th July, 1948; nd '2) period following implement Nl Helth Service Act on 4th July, 1948, when, in this region, under ble Chirmnship ^r- H. G. Tnner, I ws given lmost free hnd develop those services which cme within my view in Brisl Are, centred on Southmed Hospitl, which ^s redy for expnsion, lrgely due foresight Brisl Locl Helth Authority, guided by Dr. R. Prry. Fi'st Period When I left St. Peter's Hospitl in 1921 (hving keen re when Southmed Hospitl ws plnned) nd j?ined stff Brisl Helth Deprtment, development mternity services under permissive powers Mternity nd Child Welfre Act ws beginning tke shpe. Aprt from my per- sonl recollec, I m indebted Annul Reports?f Brisl Medicl Officers Helth for verifict'on vrious steps tken. A Miss Richrds, who ws ppointed in 1914, ws *An Address Midwives Brisl Are It is unnecessry quote lrge series sttistics showing reduc in mternl nd infnt mortlity present rtes but it is worth noting tht in 1919 births notified in Brisl 6,940, mostly home confinements, birth rte being per thousnd popul nd infnt deth rte per thousnd births. It is sid tht sttistics cn prove nything, nd recently I red in Sir Alec Dougls Home's memoirs sry two sttisticins tlking ger, who decided tht s y lredy hd four children ech, y would not risk hving ny more mselves s every fifth child born in world ws Chinese! Between 1921 nd 1928 re ws grdul devel- opment Locl Helth Authority mternity ser- vices, lte Pressor Ryner nd Mr. R. Stthm contributing in n dvisory cpcity re, emphsising tht 'norml tended become bnorml' 1923 it ws reported tht no midwives now subsidised by Locl Authority nd tht midwives' fees pid wholly, or in prt in six cses only during yer midwives sought medicl help in only 168 cses nd prctice by unqulified 51

2 midwives continued. City hd for 6 months per nnum t Brisl pitl, Southwell Street. Public Helth notifics 1 bed Mternity Hos- use Briefly, following re some developments which ok plce during period mened : Puerperl Fever Puerperl Pyrexi Reguls cme in force in 1926, nd I remember Medicl Officer Helth closed Mternity Unit t Royl firmry be- nity puerperl plced ddil Locl Authority, nd on retirement Dr. D. S. Dvies s Medicl Officer Helth in 1928, Dr. R. A. Askins, Chief School Medicl Officer, ws ppointed ceeded dul post nd Dr. Heven retired, being sucby Dr. M. G. Hughes full-time on 1st June, This mrked commencement in Brisl development new er Services. Mternity Centrl nd scle fees for services municipl midwives ws put in oper. Dr. Mrgret Hughes survey (published in 1938 M.O.H. report) stted tht confinements during tht yer t home by docrs greed 823, by midwives 2,090, nd in hospitls 4,049. All this ws under shdow wr preprs nd consequent locl considers, wr breking out in September Helth Committee, Brisl few wns tke dvntge powers constitute Public Helth Hos- uthority / Royl firmry gve se ground for medicl students. Dr. Prry soon hd plns prepred nd scheme ccepted by Council for lrge mternity unit with 100 beds be built 1 Southmed Hospitl, ger with n Out-Ptient Deprtment, Csulty Sec, Mternity, Child Welfre nd School Medicl Clinic, new Nurses' Home nd Midwifery School Buildings. University welcomed step in interests trining docrs Docrs. He secured co-oper ll wellknown Obstetricins in Brisl, including Mr. D. C. Ryner, Pressor H. J. Drew-Smy, Mr. H. L. Shepherd, Miss Mbel Potter, nd Mr. F. J. Hecr. nd midwives. buildings completed nd1 fter hostilities commenced in 1939/40Thus Southmed Hospitl becme min centre for trining undergrdutes in midwifery, post-grdute trining docrs nd 4'so only 'Prt I' school for opened He reported tht socil conscience ws lredy wkened sd mternl nd infnt mortlity rtes nd tht mongst mny societies formed re Nl Society for Preven fnt Mortlity; Nl Society for Women; Schools for Mors Associ; nd Cre Unmrried soon trining midwives nd lso Midwives Tech-1 ers' Course. connec with plnning se buildings* following interesting points rose. Mr. Lurence, rchitect, suggested Plnning Authority tht Mors. Some people thought mortlity rtes due mor bering o mny children nd hd strted birth control clinics, one being estblished t should be from new rod be clled Monk5 Avenue, n under construc, nd this w5 greed. Ministry decided upon chlet type build' ccess Prk Redcliffe Hill. yers up outbrek wr progrmme Helth Centres, linked with new Centrl Helth Clinic in Tower Hill, ws plnned nd prtilly implemented. Joint ppointments ten for two resons; problem infecntibiotics s we now know m not beins ings, pprently s wr thretened n^ site ws ner lrge eroplne fcries, it ws ( desirble for buildings be spred out. vilble, nd lso becuse, full-time nd prt-time medicl ficers for Mternity nd School Medicl work mde. municipl district mternity service ws estblished nd linked trining Brisl longer provide institul mternity beds. As beds n lso min obstetric trining ccession in 1931, Dr. Prry ok every possible step ensure Brisl Helth Authority ok dvntge new legisl sp untrined nd hndy women doing midwifery, estblish Mternity nd Child Welfre Clinics nd employ Nurses nd with mid-thirties notice tht s mternity work ws responsibility Locl Helth Authorities nd firmry's commit' ments for generl work hevy, y could no his During impressive scheme under Midwives Act for n Service ws implemented; Helth Clinic ws opened with specilist ser Midwifery vices, estblishment dy nd night nurseries ws Dr. Askins left Brisl shortly fterwrds hving been ppointed Chief Medicl Officer for Sourn Rhodesi, nd his Deputy, Dr. R. H. Prry, t erly ge 34 ws ppointed Medicl Officer Helth in n 1937 dequte re-orgnis City Helth Services ws furr fcilitted t tht time by boli Poor Lw Authorities. Southmed Hospitl, with its smll Mternity Unit, under Dr. Percy Phillips, ws put On specr under construc. ry. being permissive pitl. full-time following yer Portwy Joint Clinic ws opened, Centrl Helth Clinic opened with specilist services nd Bedminster nd Speedwell Clinics for Centrl Helth Clinic nd City mde contribu for mternity work Brisl Royl firm- one Brisl City ws tht yer 27 mors died in Brisl in connec with childbirth, eight se from puerperl fever, nd 365 bbies died under ge one yer, this being 59.8 per thousnd births. Dr. Askins outlined scheme under Southmed becme greement milk nd similr foods provided nd Midwives ppointed. X-rys first rrnged for mternity ptients, Mr. Stthm ws ppointed Southmed Hospitl nd number mternity beds incresed sterilised mternity outfits supplied t cost price, nd in responsibility on n inugurted, infec. Midwives nd Mter- Homes Act 1926 lthough mde whereby mternity cses lso dmitted on behlf Gloucestershire nd Somerset Helth Authorities. An elborte system ssessment ptients' bility py ws nd cuse 1930 Hospitl, Ministry lso greed n ir rid shelter being constructed under Csulty nd Out-Ptients Deprtment. As is now known first lrge dylight rid 1 midwives. 52

3 Brisl 1 ' re ws?f csulties during n ir Hospitl itself imed t Filn nd lrge number Southmed Hospitl. Also ttend midwifery cses (lthough y pid specil fes if y did so), nd lterntive rrngements hd be mde ccordingly. Socil condis lso hd brought rid number bombs strddled but in ech cse lnded between spred out buildings nd not single csulty occurred. wr brought bout rpid produc new ntibiotics, which revoluised rt medicine. wr nd ir rids brought mny problems Mternity services, including opening chnged, cusing problems for home confinements nd consequent incresed demnd for hospitl confinements. min responsibility for midwifery, nd trining midwives, for wht ws clled Brisl Clinicl Are?i.e., Brisl, South Gloucestershire nd for prt evcu- mternity beds t Cedr Hll, ^renchy, nd t Mortimer House, Clifn, where second prt' Midwifery Trining School ws set up. midwives in mternity hospitls nd homes,, nurseries, ger with service during district midwives wr period. epit ; hd been s pttern Nl progressive Helth s might hve ernerged Dr. Prry prepred scheme for cre premture bbies t Southmed Hospitl nd gs nd 'r nlgesi ws introduced for district work. Cre illegitimte children ws reviewed nd in 1945 Knoll t Corner this new venture. for district midwives in trctul ' Second Period 1948 Army 1973 An Generl Bureu ws estblished nd Somerset Helth Authorities. Centrl Midwives Bord lrmed t first with turn events, but eventully moved with times. re is still reluctnce use G.P. Units fullest extent nd chnges will no doubt emerge with opening meet new situ for Brisl So fr s mternity services concerned 9ret chnge ws fct tht every womn (nd child) ws now registered with Generl Prctier, nd Admissions vried between 8,000-10,000 per nnum, with ll problems involved, cncells nd incresing nurrtber sent in for vriety resons, s emergency dmissions. Criteri for hospitl delivery nd dmission Generl Prctier units respectively prepred nd detiled rrngements for plnned erly dischrges greed with Brisl, Gloucestershire hd its environs. new mternity unit on St. Michel's Hill. connec with Bureu I would like py specil tribute lte Dr. H. M. Golding nd Mr. Rlph Btten. free midwifery service. Thus new er between midwives nd Prctiers who soon relised key posi- Emergency Southmed for whole Brisl re. It ws closely ssocited with Group Admissions Deprtment, which hd seprte sec del with mternity dmissions nd pplics for re. se ssocited. for interesting problems t Locl Voluntry Hospitls, when nlised, ^ere lredy overloded nd could not ccept ny expnsion work, but thnks City Frs nd Pressor Prry, Southmed Hospitl with its new Gildings nd mple spce ws redy develop s generl nd mternity hospitl, nd Aldermn J. J. Hiln, first Chirmn Southmed Group Mn9ement Committee, instructed me prepre pln *0r its rpid expnsion nd introduce ll new deprt- ehtitled?pened mternity Emergency Admissions Bureu following is brief descrip mternity services with which I, s Group Administrr, ws necessry some con- Slv t? obstetric world. re mde with dmission some Hos- solved, nd developments which hve tken plce since dvnce medicl knowledge brought bout wht ws termed s 'medicl explosion' nd this lso pplied ments rrngements Home for ptients. following On 4th July, 1948 Nl Helth Service Act ^s implemented. This ws revolu rr thn n Solu in medicl services country nd c'osely nd Thornbury Hospitl (20 beds), Wlker Dunbr pitl, Clifn begn tke mternity cses nd conjunc f, 1952 new wrd under cre Dr. Beryl Pressor A. V. Nele ws opened t Southmed Hospitl for 28 infnts under one yer, nd 12 beds for well mors with bbies New Mternity Unit with out-ptient sessions ws opened t comprehensive pln for provision district helth centres surrounding Centrl Helth Clinic ws preyed. As regrds Premture Bby Unit, Dr. Beryl nd 'rhesus' tests commenced Wth Blood Trnsfusion Centre. Clevedon (1951) cme in use for sme purpose. Corner plyed leding prt in 1946 residences cquired Southmed peditric deprtments t Southmed, Mortimer House, Wendover Mternity Hospitl t Downend, Berkeley nd Almondsbury Hospitls. pressure for institul confinements continued nd St. Brend's Hospitl, Clifn, ws cquired for Generl Prctier Mternity Unit, first in n industril wn. Brisl differ- Service on 'Prt II' School for Midwifery trining. Orwise ll or mternity units in re, from Berkeley Clevedon, cme under jurisdic my Hospitl Authority, including comprehensive mternity nd , lthough it ws cler tht Nl Helth Service would come in being, Locl Authority, guided by Pressor R. H. Prry, did not hold up progress. deed, I ws credibly informed tht lte Mr. Aneurin Bevn sid tht if ll Locl Authorities Somerset, devolved trnsferred former Convlescent Home on Downs, nd continued func under ble supervision Miss Norh Den Mtron nd included rendered yeomn From * North Group, including co-oper with University in trining medicl undergrdutes in obstetrics. Brisl Mternity Hospitl in Southwell Street ws lter co-oper Squd Flying Squd, Obstetric Flying which midwives held. re ws complictht mny Generl Prctiers did not wish An Obstetric 53 bsed t Southmed Hos-

4 pit I, ws estblished for re in 1952, detils being circulted ll docrs nd midwives in Brisl, Somerset nd Gloucestershire. Normlly Flying Squd would be clled by Generl Prctier but in n emergency midwife ws uthorised do so. dvntges Blood Trnsfusion Service being situted t Southmed ws here gin emphsised. Premture Bbies cre premture bbies in Brisl re is sry in itself nd commenced with dpt lbour wrd in "A" Block t Southmed Hospitl. On request Pressor Prry, I well remember visiting Southmed with Dr. Corner, discuss with lte Dr. Phillips implement this project. Southmed Hospitl Mngement Committee im- proved nd developed service with full cooper Locl Helth Authorities re (Brisl in prticulr), nd Generl Prctiers. It is n outstnding exmple kind co-oper which cn occur in Nl Helth Service nd which proved so beneficil ll concerned. Lter, smll unit ws lso estblished t Brisl Mternity Hospitl sw birth Good quds t Southmed, first survive in this country for 125 yers. We hve herd ir progress from time time. As usul with pioneer efforts we lst cquire new modern unit, but before I retired, fter strong represents, new comprehensive Specil Cre Bby Unit ws under wy nd is now in use. Premture Bby Unit Scheme ws extended cover re from Berkeley Wesn, nd bby flying squd tem inugurted, designed provide immedite resuscit for premture infnts born t home, nd give specil cre those more robust infnts who fit remin t home. Locl Helth Authority lso provided domiciliry nursing service for purpose. Associted with cre premture bbies, Humn Milk Bureu ws estblished t Southmed in This scheme ws snced by South West- ern Regionl Hospitl Bord, nd covered whole region. A smll Working Prty worked out ll problems involved with equipment, stffing, collec, sterilis nd psteurising, distribu, nd dy dy dministr, including pyment domiciliry donors. scheme soon becme known nd requests for supplies received, even from outside region. Blood Trnsfusion Service Government Regionl Blood Trnsfusion Service hs mde specil contribu mternity nd bby service nd t Southmed in prticulr. Estblished t Southmed Hospitl with co-oper Pressor Prry t beginning wr (under direc Sir Lionel (n Col.) Whitby), it ws first be inugurted in Europe nd out it developed Nl Blood Trnsfusion Service nd S.W. Regionl Unit now in first clss new buildings under direc Dr. G. H. Tovey. cidentlly Whitby ws one Dr. Prry's students when he ws Csulty Officer t Middlesex Hospitl. Nturlly when he ws sked estblish Army Blood Trns- fusion Service he thought Brisl nd discussed project with Dr. Prry. It ws greed tht in return for Dr. Prry tking his cse Brisl Helth Com- mittee he would provide free service civilin popul South West. Dr. Prry nd lte Pr. Hey Groves mde first ppel for volunteers on rdio. British Red Cross co-operted nd I ws uthorised entertin luncheon orgnisers ech yer on behlf Dr. Tovey. All ptients, public or privte, receive benefit this service free chrge. re is no need for me detil you gret sving lives bbies nd mors which hs been chieved nd now we hve trnsfusion bbies, even before y re born! re ws discovery specil blood groups nd introduc crd which should be crried t lest by every prospective mor, showing her blood group. X-ry nd Lborry Services development X-ry dignostic services is fscinting sry, very specil rrngements mde by Dr. G. R. Airth for x-rying mors, bbies nd trnsfusion bbies before birth in co-oper with Pressor Gordon Lennon. extrordinry developments in lborry service hve been invluble in ll spects cre mternity ptients nd bbies nd much clinicl reserch hs been, nd is still, undertken in Southmed lborries under direc Dr. F. J' W. Lewis nd Dr. Normn Brown. Before Dr. Peter Dunn went Cnd I ws instrumentl in providing him, lbeit unficilly, with certin reserch fcilities t Southmed nd I m plesed see he hs now re- turned stff here. Educl Activities Southmed becme centre for trining medicl students in obstetrics nd peditrics, trining midwives, refresher courses, Midwives' Techers Certificte, refresher courses under C.M.B. rules, trining Consultnts in Obstetrics, refresher courses for Generl Prctiers nd trining generl nurses in obstetrics. re ws continuous review trining rrngements for midwives in co-oper with " concerned, djustments mde from time time' specil visits being mde by Secretry, Mr. FenneY Centrl Midwives Bord, prticulrly s Southmed ws n exmins centre. I enjoyed visit5' exminers, nd entertined luncheon mny well-known personlities in obstetric world, includ' ing Sir John Peel, Pressor McClren nd Erl Crnbrook fmous Crnbrook Report. It ws notble occsion when C.M.B. ficil^ pproved lying-in period being reduced from 14 t<" 10 dys!!! A block system trining ws in being ^ when I retired C.M.B. ws sked pprove te11 months course combined midwifery trining. Worn?1' llowed hve ir husbnds present, t les' 54

5 UP first stge lbour, subject suitble condis. Thus Southmed Group becme centre for midwifery for re, only or but importnt unit being t Brisl Mternity Hospitl. confinements in Group incresed from bout 4,500 in ^949 over 8,000 in 1970 when re no Mternl deths. Pressor Winden's excellent report for 1969, birth rte ws 15.6 per 1,000 popul nd "legitimte births 686. infnt mortlity rte ws 16.2 per 1,000 lowest recorded, nd second 'owest 12 lrge wns. Generl Prctier short-sty unit ws recorded s being success, birth control dvice continued be given nd re ws co-oper with hospitls for cervicl smer tests. Dr. Srh Wlker stted tht births registered in Brisl 6,462, full co-oper being mintined With regrd plnned erly dischrges nd home confinements 646. It ws Sir Winsn Churchill who sid "To understnd present nd pln for future you must study pst". It is 53 yers since I becme wre?f mternity problems t St. Peter's Hospitl. Perhps one most striking chnges me is?utlook wrds, nd cre, unmrried mors. I ws ctully present t smll Committee in 1918/9, including mgistrte, when legl represent ws mde tht n unmrried mor with two or more illegitimte bbies ws morl mentl defective, ws so certified nd sent Stplen (now Mnor Prk) Hospitl. problems fmily plnning, contrcep nd bors now splsh hedlines. re will no doubt be rdicl chnges in 1974 in regrd dministr Helth Services nd responsibilities Locl Helth Authorities? one cn only hope tht se chnges will be for better. I hve been ssocited with three such mjor chnges in pst. se chnges will not ffect pressionl role midwife, who, I believe, will continue ply most importnt prt in mternity services. re my be hrd core in mternity cre which cnnot be tckled, s in finl nlysis, problem is n economic nd finncil one. sme kind problem rises in rel such projects s hert trnsplnts, nd perhps lesser extent with kidney trnsplnts nd rtificil kidney mchines. During my twenty yers s Administrr Southmed Group, I received medicl nd nursing visirs from ll prts world, including 23 docrs from behind Iron Curtin, who ll spoke with envy our mternity hospitls, midwifery service nd our unique free Blood Trnsfusion Service.