Part 15

Lying-in patients are to be compared to surgical (or operation) patients, not to medical patients, and should be perfectly well in health.

Since lying-in is not an illness, and lying-in cases are not sick cases, it would be well, as already said, to get rid of the word ‘hospital’ altogether, and never use the word in juxtaposition with lying-in women, as lying-in women should never be in juxtaposition with any infirmary cases.

As to amount of work, necessary administrative conveniences and the like, a lying-in institution is to be compared to a surgical, not medical hospital, or rather to a hospital for operations.

It has been already shown that great improvements are required in the manner of keeping midwifery statistics, and that many data are wanting for this purpose. It would be altogether wrong to deal with these statistics on the same principles as if they were general hospital statistics. Lying-in is neither a disease nor an accident, and any fatality attending it is not to be counted as so much per cent. of inevitable loss. On the contrary, a death in childbed is almost a subject for an inquest. It is nothing short of a calamity which it is right that we should know all about, to avoid it in future. A form of record is appended (Table XVI.), which appears to afford the means of registering the required information.

I. CONSTRUCTION OF A LYING-IN INSTITUTION.

What then, first, should be the principles of construction for a lying-in institution, in order to combine safety for the lying-in women with opportunity of training for the pupil midwives? And,

1. How many Beds to a Ward?

Not more than four.

Or single-bed wards might be arranged in groups of four.

Also, it must always be borne in mind that four beds mean eight patients. There are two patients to each bed (unless it is meant to kill the infants) to use up the air, which is besides used up by a necessarily far larger number of attendants than in any general hospital. For, during the time the mother is incapable of attending to the infant, the infant is incapable of attending to itself. Also, an exhausted mother, and feeble, almost lifeless infant, cannot ring a bell or make themselves heard. Indeed, an infant which cannot cry is in the greatest danger.

TABLE XVI.—Proposed Registry of Midwifery Cases.

NOTE.—Should any death take place in a woman discharged from the institution within a month from the time of her delivery, a record of this death, its date, and cause, to be entered in the column of Remarks. In the same column should be entered remarks on abnormal configuration, or on abnormal conditions of health which might influence the result of the delivery.

For all this provision must be made. There are scarcely two points in common between a lying-in institution and a general hospital.

2. How many Wards to a Floor?

Only one four-bed ward, or four one-bed wards in a group.

3. How many Floors to a Pavilion (hut or cottage)?

Two, at most. In every alternate pavilion better only one floor, unless the pavilions be so far apart as to cover an extent of ground which would make administration almost impossible, and cost fabulous.

How many Beds to a Pavilion or Hut?

There would therefore be no more than eight beds, and in each alternate pavilion no more than four beds.

How many Pavilions or Huts to a Lying-in Institution?

Not more than four two-floored pavilions, two one-floored pavilions, and two two-floored delivery pavilions; unless, indeed, building space can be given, with all its cost and administrative difficulties.

4. How much space to the Bed?

The minimum of ward cubic space for a lying-in woman, even where the delivery ward is, as it ought always to be, separate, is 2,300 cubic feet in a single-bed ward, and 1,900 cubic feet in a four-bed ward.

As it is a principle that superficial area signifies more than cubic space, the surface of floor for each bed should not be less than 150 square feet per bed in a four-bed ward, and in a single-bed ward not less than 190 square feet, because this is the total available space for all purposes in a single-bed ward. This space has to be occupied, not only by the lying-in woman and her infant, and perhaps a pupil midwife washing and dressing it at the fire, but often by the midwife, an assistant, possibly the medical officer, and pupil midwives. In a four-bed ward there is space common to all the beds.

The Delivery Ward.

Ought to be separate in every lying-in institution; must be separate in an institution of more than four or five beds, though in separate compartments.

Every delivery bed should have a superficial area of not less than 200 square feet, and a cubic space of not less than 2,400 cubic feet.

5. How many Windows to a Bed?