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.
[Two experienced good nurses in addition might be necessary for the
first year.]
One cook.
One housemaid.
One or two other female servants, such as scourers—or more (number
required depending on the flooring used).
Though this staff appears enormous, it is calculated upon the plan of
giving only one night nurse to every four beds,—upon the supposition
that 32 occupied beds will give a constant succession of cases, enough
to provide instruction for almost as many pupil midwives;—upon the
principle that for systematic instruction there must be a fair number of
pupils; as, if every moment of their time is occupied in active duties,
they cannot be well trained;—and also upon the obvious fact that it
would be impossible, from its extravagance, to nurse such a construction
without pupils.
[For the _second_ year, if a portion of the pupils are to be made
thorough midwives, and their time of training two years, possibly the
deputy assistant midwife, and probably both the nurses, might be
dispensed with.
The second-year pupil midwives ought to be quite competent, each to be
in charge of two or three first-year’s pupils and several patients,
taking these patients from the beginning, and teaching pupils to handle
new-born infants, look after ordinary lying-in cases, and the like; and
most excellent practice it is for the young teachers.]
As to scourers, the nature of the floors decided upon will determine
what are wanted.
Also, none of the midwives can be expected to be housemaids, even in
their own rooms. They have too much to do. The pupil midwives would be
expected to clean their own bed rooms, but not to scour, either for the
patients or for themselves.
There must be a common room for pupil midwives. Here they take their
meals in detachments. Head midwife, as a rule, with first detachment;
matron carving. Here they receive lectures and instruction from the
physician accoucheur.
The matron must have two rooms.
The head midwife may have two rooms. She will expect to have her tea in
her own room.
The head midwife, her assistants, and all her staff, should be lodged in
a central position, and there should be ready means of communication
with these quarters, both by bells and speaking tubes, from each
pavilion and delivery ward.
A regular night service in a lying-in institution being impossible, the
head midwife, when she goes her last round at night, say between eleven
and twelve P.M., stations other watchers for any emergency arising
besides those now to be mentioned, who are for the night nursing of
ordinary cases.
For this one pupil would probably be told off for each four wards or
beds, and one extra for the whole floor, who must not be an
inexperienced pupil. Her duty would be to visit each pavilion on her
floor, and to have all in readiness in the delivery ward for cases
coming in at night—a not infrequent occurrence.
The head midwife would also arrange for the special care of any critical
case at once, on the patient being conveyed to her own ward, or to that
adjacent to the delivery ward.
In so large and therefore busy a lying-in institution, it would not be
desirable to call up all the pupil midwives to every case coming in the
night. They would be appointed day by day alternately, and the number
told off for the purpose would be called to any case coming _that_
night.
It is therefore most desirable that the sleeping-rooms or compartments
(each with its own window) of the pupil midwives should be arranged in
at least three reliefs, so that the occupants of one dormitory, or
relief, could be called by a bell from the delivery ward ringing into
that dormitory without needlessly disturbing others.
In so large an institution the head midwife even cannot attend every
night case.
The assistant must be a well qualified midwife, who can take her turn in
attending night cases, calling the head midwife if necessary.
Through all this organization, however, as far as possible, each pupil
is told off to be in charge of a mother and infant from beginning to
end.
And there will always be unfortunately a certain number of cases, each
requiring a nurse constantly by her side day and night.
It is obvious that the same woman cannot do this for a succession of
days and nights.
But the number of severe cases requiring it would unquestionably be much
smaller in a single-bed ward hospital, or in a four-bed ward hut
hospital, because of its superior immunity from puerperal disease;
though, from the single-bed ward condition, every such case will require
a nurse all to itself. And the same nurse cannot be always sitting up
day and night.
_N.B._ Repetitions may possibly here be pardoned. The pupil midwife
appointed as night watcher for the whole floor cannot be depended upon
to attend the bell of any individual watcher. She may be absent at a
delivery.
Yet the life of an infant, _e.g._, in convulsions, depends on minutes—on
the watcher being able to summon immediate help, hot water for a bath,
and the like.
Those appointed to be called in such emergency should therefore be
readily communicated with by bells or otherwise, without disturbing
others, either nurses or patients.
As there are no sleeping-rooms for any midwife or pupil in the ward
pavilions, it is necessary to insist upon this—that there should be
every facility for their being rung up or called up at night.
Every pupil midwife ought to have a little bedroom to herself, or at
least a compartment with half a window, or better a whole window, to
itself. There should be a bathroom and W.C. on each floor in the pupil
nurses’ quarters, and a back staircase.
If a small sickroom could be managed for pupil midwives, it would be
advisable. Where there are so many, one may be attacked with bronchitis
or with scarlatina. She could not, of course, be ‘warded’ with the
lying-in women; and it might be undesirable to leave her in her own
little room, though this is quite sufficient for any slight illness. The
top floor, as securing greater quiet, and a certain degree of isolation,
might be the best for this sickroom.
The whole of the pupil midwives’ quarters should have direct and ready
means of communication with the hospital proper. Each relief should be
independent of the other two, and under the immediate supervision of the
official woman, whose quarters are attached to its own.
It need scarcely be stated that an essential part of a Pupil Midwife’s
training is to attend lying-in women at their own homes, with the
conveniences or rather the inconveniences of those homes. Otherwise the
Pupil will be the less fit for her after-work. The last two months of
every six might well be given to this. But, as above said, these ‘Notes’
about management, for they are nothing more, simply treat of it as
regards construction, and do not refer to the necessary training, either
in-door or outdoor, at all.[23]
_DESCRIPTION OF SKETCH-PLANS OF PROPOSED INSTITUTION._
I know of no single building which requires more ingenuity to plan, and
has hitherto received less, than a lying-in institution, especially with
a training school for midwives attached.
Lieut. Ommanney, R.E., has been kind enough to give his time and mind to
the subject—having previously had considerable experience at the War
Office in planning female hospitals—and to embody the whole of the
working accommodation required for both lying-in institution and school
in the thoughtfully arranged sketch-plans, Nos. III., IV., and V.
The estimated cost of these plans is large; but if we must have lying-in
institutions at all, it is only ‘penny wise and pound foolish’ to
cripple either space or necessary appliances, or the means of regularly
and periodically vacating every ward and every ward-office destined for
the use of lying-in women.
[Illustration:
_PLAN III_