Part 20

On the other hand, when once the patient is in the ward, complete isolation is by far the best, for the sake of all the others.

And there is by no means the same necessity for a passage as in the other parts of the institution where any night there may be three or four ordinary delivery cases to be conveyed through the passages.

A covered ambulance for sick cases is not, however, a nice thing, though often suggested.

3. The first two may be called universal and essential principles of good management in every lying-in institution, large or small, however perfectly constructed.

Here is a third, hardly less essential, wherever there is more than one bed to a ward, viz. to remove a lying-in woman three times during her stay in the institution.

The average course of an ordinary case may be reckoned thus:—

Seven or eight hours in the delivery ward. Five or six days in the lying-in ward. Nine or ten days in the convalescent ward.

The nearer wards to the delivery ward in use should always be made the wards for women immediately after delivery; the farther wards for the same women when removed for their convalescent stage.

In a single-bed ward the woman may remain in her own ward from after her delivery till her discharge; that is, no further removal after her delivery is necessary.

4. Cases of extreme exhaustion after delivery, which are better out of the delivery ward yet cannot be moved many yards, should be carried in their beds to the bye-ward adjoining the delivery ward, till they are somewhat recovered.

These must have a constant watcher by them.

5. In a lying-in institution about three times the quantity of linen and bedding for each patient is necessary of what is used at a general hospital.

The day’s and night’s provision of linen is kept in each ward scullery, and in the scullery of each delivery ward in use.

The linen-store in the store-room, and the bedding-store, need to be very complete and ample.

The bedding, that is, the mattress and blankets, of any one bed in the delivery ward should not be used for more than three or four delivery cases in succession without undergoing some process of purification—and this quite independent of any accident, the mattress of course being protected by Macintosh sheeting.

III. TRAINING SCHOOL FOR MIDWIVES.

The few words which will here be added on the management of a midwifery training school are not at all to be understood as a manual for practical instruction, which it is quite impossible to introduce here, but as simply treating of the management, in so far as this determines some constructive arrangements as imperative, and others as to be avoided.

No charity or institution, I believe, could possibly bear the expense of a single-bed ward, or even of a four-bed ward lying-in establishment, for a pretty constant succession of thirty-two patients, unless there were a training school.

Even with a training school, the first year would be one of great difficulty, since all well managed training schools ‘take in’ pupils as much as possible at only two periods of the year, so as never to have the whole of the pupils fresh hands at once. But the first batch must necessarily be all fresh hands. A raw girl cannot be turned in to sit up with a newly-delivered woman and new-born infant. And a midwife cannot be spared to each girl all to herself, to teach her how to handle an infant. [That is, in each single-bed ward.]

The whole nursing service of a large four-bed or one-bed ward lying-in institution is so complicated, so different from that of a general hospital with its 20 or 32–bed wards, that it is difficult to provide for.

In even guessing at what the nursing accommodation should be for so completely new an experiment as a lying-in institution of 40 beds in single-bed or four-bed pavilions, we must begin by stating the probable requirements, the whole being tentative.

The staff would have to be at least as follows:—

One matron.

One head midwife.

One assistant midwife.

One deputy assistant midwife (for the first year).

To establish a really good training school,

Thirty pupil midwives.