STUDY OF MATERNITY HOMES IN M1NNESOTA AND PENNSYLVANIA

U. S. DEPARTMENTOF LABOR JAMES J. DAVIS, SecretatY BUREAU CHILDREN'S GRACE ABBOTT' Chiei IN HOMES OF STUDY MATERNITY AND M1NNESOTA PENNSYLVANIA VASHINGTON GOVERNMENT PRINTINC OFFICE 1926 Provided by the Maternal and Child Health Library, Georgetown University COPIES SINGIJE OT TEIS PUBLICATION }IAY BE OBTAINED TBEE UPON B IPPLICTTION TO TgE CEILDRET.-'S UREAU ADDITION.T.L COPIEA tdAY E' PBOCVRED IEOI' IEE SSPEBINTENDENT OT DOCI'I'ENTS GOYDBNMENT PRINTING OITICE WASEINGION, AT 15 CENTS PEII COPY D. C. Provided by the Maternal and Child Health Library, Georgetown University CONTENTS Poga Letter of transmittal- fntroductory summary- - - lu.qg:g and significance^ofstudy uonorLtons lounct ln fwo DtateS_ _ Medical and physical data_ ___- _______ S o c i a ld a t a - : - - - - - - - - - Conclusions------Maternity homes in Minnesota Licensing and supervision--____ ____ Origin and development_ Capacity and population ________ ___ Grounds and buildings Administration --- _______ Boards S t a f f s -- - - - - Finances--r------ 1 1 3 3 0 , 3 3 A o o o o p;;r;;t,r- -----:-:-:-::-----___ : -: __ 6;ffi',*sli?;d ;;;; __:: __ ' Special provisions in Minnesota for unmarried mothers and their children Responeibility of county child-welfare boards Establishment of paternity Placement in foster homes and adoption Suqe.qyisionofchildren's institutions, of boarding homes,and of . child-plaeing agencies-- --Discharge arnd,continuedsupervision of patients___ rrovrsrongmaoe lor Da,bles_______ General statement--Casesstudied over period of one year Descriptions of individual homes -----Case siories-Maternity homes in Pennsylvania Legal provisions------- - - - - Origin and development _ Capacity and population Grounde and buildings Adminietration- - - - - - - - - - - l8 18 - - - - - - - :" :- - - - - - : - : - :- - : : : : 19 Absence of t'aunender feeg" ------19 Income from board paid for babies _-_____ 19 Records and reporte 19 Admission of patients--20 Source ----------20 Limitations-20 D i e t s- - - - - - - 22 23 24 Infant care-----------24 Q!'servanceoipuUtlc-tre"tthmeasurc"--------------:---:--:--::-----------:: 25 Vital statistics --- - - - -- -- 25 Routine and regulations -- ---- --- j 25 Training for future employment26 Recreation 27 Ratesand feesrncomeirom wort l}-p"[i""trl 27 27 28 29 29 29 30 30 30 33 45 +l , 47 48 49 50 5l 61 51 III Provided by the Maternal and Child Health Library, Georgetown Universify IV CONTE}TTS Page Matemitv homes in Pennsvivania-Continued. Finairces R a t e sa n d f e e s- - - - - - - Income frorn work of patients--Ineome from " surrenderfees" Incorne from board paid for babies -----R e c o r d s n d r e p o r t s- - - - - - - - - - - a Social records Nledical records r\drnission of patients- - i\Ollfee --.. -:-- 52 53 53 53 o6 53 OJ Limital,ions-Diets - P r e n a t a lc a r e - - - - - - - Confinementand postnatal care -----Infant care Observanceqf public-health measures'Vital statistics--- --- - - - * Routine and regulations--- - * - - --Iraining for future emlrioymcntRecreation Discharge and continued supervision of patients--Procedure in Pennsyivania relating to piacing out, adoption, and support of children of illegitimate birth--Provisionsmade for babies------Keeping babies wlth their mothers Placement in foster homes and adoption----trfforts to fix paternity -------Descriptions of individual homes- - -.. Case stories Appendixes A.-Child-welfare standards applicable to mateinitr- homes - - - - - - - .\ledicalstandards-------Social starrdards- -,- - - B.-Certain State lari-sand reguiatiolrsaffectingmaternit]' homes--II innesota Pennsylvania 5+ 54 5l 55 57 58 5|.' 59 oy 59 60 61 61 b2 oJ OJ OJ ot 6{i S{ S; rf \9 s9 9r f'nir ersitr Provided b1'the N{aternaland Child Health Library, Georgetow'n LETTER OF TRANSMITTAL IJNnnp Srarns Dnp.lnrMnNr or Lason, Cutrnnnx's Bunnau, Washington, Murch 10, i926. Srn: There is transmitted herewith a repor.t on a studv of msrternily hom.s in lrlinnest-rta Pennsylvanii. This investisationwas and madc urrderthc directiono{ the author of the r.eport.Dr."Ethel M. lYatters, then associate director of the rriaternity'and irifant-hvsiene division of [he children's Bureau. The medicai data were coilFctetl [y D:. Ju,ne_M.-Hull and the sociai data by Miss A. Madorah Donahue, both of the stafi of the division. The work ryas made possibleby the cooperation of the State board of health and the State board ol control, of idinnesota,and of the State departmentof health and thc Stalc depar.tment welfare,of Pennsvlvarria. The of bureau is indebted to the directors of theseagencies aird their stafis for much assistance. Respectfullysubmitted. Gnace Lnnort, Chr,ef. Hon. Ja.unsJ. D.rvrs. Beuetary oj Labor. Provided by the Maternal and Child Health Library, Georgetown University IN HOMES MINNESOTA OF A STUDY MATIRNITY ANDPENNSYTVANIA INTRODUCTORY SUMMARY PUNPOSE AND SIGNIFICANCE OF STTIDY Maternity homeshave not beenqiven mueh attention in the United 6tatcs. Ithas not been the usuallrocedure here,as it is in England, to licensethem or to give them the status of bmall hospitals. The term "maternity hom-e" has not been definedin most Slates, either in the statutes ielating to the protection of maternitY and infancy or social usage. The chief purposesfor which bv common medical o--r reclamation niany of theseinstitutions were foirnded were the-mo-r'al of "irnfortunate women"-prostitutes and those addicted to drugs or alcohol-and the provision of shelter for indigent women' The homesprovided religibusinstruction as well as obsietrical serviceand care beiore and aft-er confinement, and some of them also placed babiessoon after birth. They have been known most commonly as rescue homes,missionhomes,asylums,or shelters. In their work the permanent h6alth and physical well-being of mothers and babies were factors of foreriost importance. hot senerally considerdd in With regaid to policy the homescould be classified three gro-ups. The speci6l policv of-one Eroup was to protect the mothers from 'anotler, publicitr: of to br-ing ir,boutthei-r moral reclamation; and bt tne ihird, to bring about f,heir reclamation and also to save the lives of theii babies." Ttris difrerence in tho homes' policies is still noticeable. In the past practical training or help in economic and social adiustment ifter ]eaving the home wa,srarely given the mother, and Iittle or no efrort was-made to establish patornal responsibilitv for her baby. Neither through their own efroits nor throulh cooperative relationi with other ageicies did the homes attempl constructive social treatment. Wittrin recent ye&rs, however, there has been a sradual tondency for tho homes to limit their intake chiefly to unmariied mothersand to developtheir medicaland socialservicoto include prenatal,postnatal, and inlant care and the preparationof the mother rnoral, and social adjustment in the community. ior econonorc, A study of the medicaland nursing problemsinvolved in maternityhome woik and of the resulte of the vdrious methods of social care and lesal protoction developedin relation to it is therefore of interest to pfiysicians and nurses-and to social workers in various fields. The of int'brdenendence medical, nursing,and sociel work in any maternity-horno undertaking has given to this study a twofold purlose: (1) I -- + Provided by the Maternal and Child Health Library, Georgetown University 2 -rr_lrcRxrry rroMns rN MrNNEsorA AND pENNsyLvaNra r*ffJ*$i:1i"C'$:,i*"?l-,*'ir,u'*: $Ll'fi',"Ji-Tffi "t n*:llifi il;", and has.also .oo.if;ul|Hl'u*to" supervision rr_."n -{nal-rsisof work of the homes asage ciesin.establishing standards of "oori5rlJdi"g included the srudv-ll in Minnesota in -"i!:i-t'l;?:"Lrt:x.rng their homes to the putiu"t*-oi'iil.ul io"to", but v.eremar< i; Mi; i tl *. ::-"",1 e'r g r a e -ve, u ;1X.,1? ff i*""fi oerdor $i*:"::i,- i..ii J"ri#'fo^", has1eec a *tlf b n brar€. b the. , rn 'Lvlrnncsota originarrist of 22 homesfurnished b.v to be licensed, Dla-te department of werfardw-as bur autho'zed to supervise them rhe as qllffi lsl"rrtli;B""?H",Ji 6:X,ffi :?,'lt*f.,h"Ji*:H,lf#Unix;*t;:-:1"-rT"fl;ii j'lffi o,ot""nil.ff sJ'lvanra had no hTr.:1yj:,_lg;il-;;.h hoJnes ,Jf{ ro r :T : i i{l}i{li il:l #"Xif :i"*lj:'iu, 1 rh s dvb c e o.L.o,. is t.u eaus im*otorw;ii;"";dfi '#Hf fi t[:t"r,:lo*'irt it"T*;ii.:"ifT**l.r.iri?1t'*ffi t,ca1e"*i',i".irrr. home, homes udedi, incl lq"^!fitolo"luau lar,ge inteirded the ;;;ili;yT:.;lli{,-ffi}J3i ?; 1n1.11,,tr #;fi;"mp1 ,fi{ r,:;::**q$#*+;nf,td*"",r,.r,ruif lTili?Tj#rfi q{';101"":,i'Ti;'niiiJ,,??*w}ai'3rbrtr"iv'i"n"iii;";;; ffi: n-i$,tllt*,ffii";i*:'iliv*{*#1*vi;v ho*u denned is a,s anv ,ffi +ilr';ll.lil*:{"#:fi h:".TilF;r#;fi|",H'*tlf *ii::,;Ji tirc state :l{lttl"T?.ix":-,"}!fl:1,""x:-t|;T*lq:r:-?;;;;it"1.",1i;t"i,, oumDerolmaternityhomes studiedin penfiwlvinra was 24. not found. Fourteenmg"-;,U""* io"'"*iectant nrothers. ien rvere ,i"ffi". of loeal-workers differenipa.tr-oiirruitate; through the assisrance in of theseB \4.ere nra- round bemaIe ityhomes :1, i?y t"illi5;l; \!ere ;:liffitil*"XTi #X,g:f::iy'""j;"ne. rn ro ; z+. Jeri, r.rj,pi ", stving.obstetrical ;1,rti;ffiil 3 of, }l!J.ii,,Tf "Xlu.#ft !r. cerrain terni ma " ryhomes o' rnstrtutrons :L"9 which did not."ur.i ; liJ,lyfl,ifl"in;iJl: health nursing divisioa tn""S-ttJ "r tn""tnyra:ii#ii1 tlpurtnr"nt of healrh it was jnereased.a p.uti-riou#'"tuuy consrcierabl.y "t of theseplacesrvas madeto eliminaretho.e whi[i-;t #i conrormro rhe dlfinition of n;cnrhers,t# n"tn ortil" . rr fennsyrvanraa rist of"finstitutiodsnas furnished by the state crepartnrent rve'are' e. tt of nraternit;'htimesar rrre lil;;i;h;"rilir-excepr ".." ",u."in ".o,.utizerr registrati.n of rhoservhich were 51ate, aided this list ras not "rripf"iJi rre;e^rr ri:i o r as.oies l"ii+!l:t t ,::H *T;#; : to y_H *t i{ for the purpose tfrl. .t"iri" ",jffi "' *"[l9d ":t: ,"r,.uu*#,,oo*'ri"yr._",1"r-io.t;.1;;;;i;;;r^111i;,sr.iiJilllilif,'fi fi Provided by the Maternal and Child Health Library, Georgetown Universitr INTRODUCTONY .SUMI{ARY used the one Trvo schedules, for medicald-ata, other for soci-al'we're and a socialworkervisfor eachinstitution .;;.li.J. A ptty.i"io" and interviewedsuperintendents],p_11.oo., i;;i-;;.h ;.ti["iio" ir'nd nurses, socialworkers' In ;11:"ii";.;d ;;;;;iiins--phvsi,'ians, iii"'iia-i'iia,'ul '"co'd''of the patients -for the h;;;* ;;;;;Iih; were possible) rvhenever o".i"O""f on" .'"u, (tite cale"dat year7.922,o{ care to ascertainthe methocls -uied,.theplans {trai.a"l" or6er of patientsrvhendis_chu.ged, ;,or1ers unJ-n"!G, tle status ;;J;f"; In t ioO of ."p".vision alter discharge._ many ;J;h;;"r.| "ra somecontactwitihthe patients if"it L""it. in" f """"" "g""i "ui""i"to of the types of personi admit" t"iotir"*" opinio" ;;r,l'ih;';;t-"6f" iheit reactionsto the ho-me'. In order to evaluate more ;;d' ;;,1 egrploved bv the homes conferences ;;;;ilLy "l ;il;;"i"i;;i4oa' pubJicand priof t6tui social agencies, 'the ;';,;'h;id'*iit homes and ',"itt ""pr".u;;ti;;; th; g;;;i'o;"g Uofitasof -"*il'.?.-; 'rlte, and them' other individuals actively interestedtn "'l;ffi&h-';'id.ly be held as to the details or ;;T'"iitg" il;-*3r in maternity-home p"il;i:^"";"d *u""g"r"un|-*}i"t ..nonld prevait t rtuodutd. of preria al, confinenrent I ?o1J.n.!; \\.()rk, certorn *ro, nl'uiieverv mother and babv are entttled' anct oI ;;;;;i ;;;; lo rig!!' have "'ii"tt ti* we"dlock^has-a r"- ottt--of ;hl;li .t'..*r-".i"; "ilila .ooi"."n"u. ca]ledby the Chiltlren's Bureau il,;;;*ft"o"tiUlor[U i" thbappendix to thrs report (seep' 87;' -''frvo of ili"i"i'lpti;t"d which veiy n'early t"oiu S.. p. 66), guo" "*" thesestandards' approximaied CONDITIONS Pennsylpi. and iU? t"ri.5-=t,rii"a,"* i""tii""-*oia lsee S-a; bnein up to or measured FOUND IN TWO STATES Thematernityhomesstudiedinthe.twoStateshadsimilarorigins chiefly from religious ""tubtished cases but'-alsoalmost ""e";;i;""hi=dfiI[;y-we*' auci they motives, ",i*itfd-a "ot.o"5',-,lternity caie, ot moral lehabilitagi.l env type of woman;t "Aiog"tnettet'the homesalso were similar prtiZi"p in ,'il'"."'"C;.hi";;aiii"i. of ""a in-.studv.but an analysis the ;;"til1;5 io"in" 6;-st;c tU" poti"i"r "r homes"andof their.m-edical and ;*i;;r;A-di"t"uti"" "f u"a r""-"Ttr-rno*s considerablevariation !n tfe extent #i"l ;";;td up to the accepted standardsof care [;-*;;;;;a ;;hi"h;il for mothers and babies' MEDrcaL AND PHYST.AL DATA prenatal care. -' - Minnesota every homo anil eramtnuti,ons superts;sion.--1.n iH, oo" *u, vrsited new policies were in. pl":T: i;;J;h"; "*;;;;; tile paiients at the time of ailmissioncomplete and ;i;J";A;i;;"; iri;*t ;i;;dii wasserr ;ij.?Jrri."T"rl"a ihyri""r ;.aminationsincrudins essenwhich are recognizedas.thefirst mann tests urroougroul.;ilili, ali although In Perinsyivaqia, ;; i#;;;i,; pelvic measiilcluded "i%il;"il"T"ii,trr"".. i;"-ination which ; ;;;;;; iloni*guo" tht;f than half gavetheTfas*roury"t"fui;-t1;;a rssure,less urements, and u*aminations, onlv 9Jr^1 bloodtest;";il;inJ"outi* sermanD test of placentalblood; in more than i#iril;;;"th;w;d;*ann infections that venereal *as sosuperficial ;;;-i;rr?;h tftu ""u-i"u-t-io"detection' have escaped toight easily -- Provided by the Maternal and Child Health Library, Georgetown University MATERNITY IIOMES IN MINNESO?A AND PEN\SYLVANIA Seven of the Minnesota homes used the State universitr laboratorv for their work. The others either had their owrr laboraiorv or usel that of a cooperating hospital or clinic, Irr Pennsvlvania tir-,,-thirds of the-homesused the laboratory of a Str te, a borough, or a cit r- heaith d e p a r t r n e n t .a n d e i g h t h a d t h e i r o w n l n b o r a t o r r o r i h e u s e ' t , f t h a t oI a Dnvate physlcran. with aftenti()rr \Ae_{iqqtsupervision of patients during pregrra,n(..\-, to individual needs,was "excellent" or ;gbod" t iri the large majority of Minnesota homes, those closely ii touch rvith the" medical school of the lJniversity of Milnestjta having r-ery satisfactory practices. _Bxcellent records on nredical care wire piactically universal in the Minnesota homes, but in the PennJvlvania homes records were riot so well kept, a few homes keeping none. In both States, horvever, the prenatal examinations were^apbarentl1siven al. regular intervals-u-eekly, semimonthh-, or monthjv; and individual instruction was given the mothers in r"eqardto their'physical condition. In 14 of the Pennsylvania homEs and in 5 oT thosc in MinneFota the prenatal examinations were giveri in the horne; in the o t h e r s t h e f a t i e n t s w e r e t a k e n t o r , l i n i i s , a l t h t - ' u g ha f e u ' h o m e s arranged_for examinations in the home *'hen prFgnancr. u-as {ar advanced. There is much to be said both for and against all the medical care being provided in the home. Some persois maintain thal ii is more costly foi the comrnunitv to supply proper equipnrent and servico -also for phr-sical and obstetribal examinationi and for confinement care; others, that itis.much be-tter to_give all the care in the home, whatever the cost. It is claimed that the unmarried mother especially is less,likely. to be a further e{pense to societ;,if _her care is grren -the entirely under the influence of home, pariicularly ih,, lretiside care. According to Dr. Janet Campbell, the pregnant "u-onrrn>hould live in a "physiological rather thin a patliolo"sical atmosphere.,'2 Just what emergenc-ies can he met in the'ordinar:y cleliverv rbom of a maternity home may be a rnatter of difler.ence orrinidn, bub ihe Lf prenatal rare should be sucir as to preclude these eur'ergeneies far as as possible. fn the absence of complete facilities for medieal care in the home the home should arrangeTor obstetrical examinations at a clinic and for the services of a laboratory and should employ a trainecl nurse. rf.the clinic keeps complete re'cords which are available to the obstet'cian the pregnancy can be properly superrised and safeguarded. A trained maternity nulse from the clinic irr on the staff of t-he home can make the proper connecting link between the patients and these cooperacrnE aEeilcres. For ade{'uaTe care of mothers and babies it is very inrportant that the superintendent of a maternity honre should be a'trained and int€lligent person who will carr.y out the directions of the phr-sician. In some of the homes visited the medical service was foirnd to be highly standardized; but tire maternitv-honre staff failed ro cooDerate with tho physicians, so that the results of the home's work weie not rTbe_term.s.bywhich_thohorleswereratedwere: Excellent,good,fair,andpoor. tromes, br..lanei M. dampbell,senior Medical . trlealtb, Ministrv of lQreat B4-tain]: bv _Materniry Ofrc€r, Maternity snd Cbild Weuare.' LonOon.t-gZi. Provided by the Maternal and Child Health Library, Georgetown Universifr INTRODUCTORY SUMMARY o in shollv satisfactory. Although the superintendents nearly all the in htrrrrt,. both stales were kintrl.yand rvereintercstedi1 their charges, tho.e in Minnesota had had more training and education to fit them mo|e than half of rvhom f,'r 11,"*rvork than thosein Penlts.ylvania, with 3 in the 1l homes studied in Minnesotahad only r-* srtelerilentary an "rrrlnared education. Fir-e\Iinnesota *nd eight Pennsvlvania (of graduates graduatenul'ses theseone o1 werecoilege oerintendents t en"h State was a phr:sician;. In hoiies which rrndcrtookseveral tr oe, of work the phviical care of e-tpcctantand nursing mothers riir* f.,uud to be leis satisfrrctorythari in homes uhich undertook onlv one. The homesin Minuelota did not give so many kinds of ser.;iceas did those in Pennsylra*ia. Sixteen of the Pennsylvania caredfor childrerrother than thoseof the patients,or for dehornos in linouent sirls. or for ased or needy\Yomen' uddition to giving ma" ihcreas only oneof the Minnesotahomescared r"rriitv-h;*e'service, "patients, onlr- one cared.for delinotler than tlose of io. "h"ildr"o quents,and none cared for the oiher types of personsadlitLed to hontes. the Pennsvlvania Di,et.-ih,a food of the expectantmother and the nursing mother to is so iruporr,ant the rvell-Feing 1!e mother and the child that -of the an attelhpt was madeio anal_yze diet of the patientsin the homes. of studybf the efficiency an to it is imp6ssible make a comprehensise dietary without cbreful mea*ulementof the amount of institutfon's food provideil and of the amount eaten b5r individt'als; and "uth ffi.-""";;tit"ii* an analvsis ;lt be tt";\';;"ld .il; ""aei'taken rvasmade 6t tne menusfor a seriesof meals servcd to the patients. ihi, soo. a qualitative picture of the diet in terms of the use of served thatthe amountof eachfood ain"r;"tfoodi. Itwas assumed af ,, m"al was the equivalent of an g,verage-serving.The diets were the groa"a by fin,iing the averageus-e.duringf -u'e.ek eac.htype of ^of loo,t *u["riai aiid compariig this aveiage daiiy food ]ist u'ith a srading sheet u'hich ouiiioed diets of folr different grades. The ianqd"v of the diets was measured by the extent to rvhich they .oniaineh satisfactory amounts of the foods containing "ade-quate and vitamins A, B, C and- D' Many oiot"io," mineral subitances, 5iit," [,ont". reportedthat an a,ltlitionalamount of food was served io the nursing inothers; for the most part this $'as milk in some form. In clasiifyinE the diets of the hombs,therefore,separategrades "diets of pregnancy and iactation. were given for the The follo'*-ingdaily food plans were used in grading the diets: Adequated'iet One pint to I quart milk. One egg. One serving rneat. One servln[ leafy vegetable (asparagus,lettuce, greens,cabbage,string beanst etc.). One serving other vegetable. One serving Potato. One serving iruit (citrous fruit at least four times a week). One serving rvhole-grain cereal. Four or mole slices-bread (with butter at three meals). Provided by the Maternal and Child Health Library, Georgetown Universify }I.{TI,]I].\ITY TIOMES IN MINNESOTA AND PENNSYLVANIA Pr obablE ad,equat d,id, e One cup to 1 pint milk. l)ne or tn'o servingsegg or leafy vegetahle. (rne servinq meat. One servinf other vegetable. Une serrzingpotato. One servine fruit. One servin[ w-hole-grain cereal. Bread or ofher slarihy foods, with hutter. P ossiblg inarleciuat ili,et e One-half cup to 1 eup of milk. ()ne or In'o sen'ings egg or leafv r-egclal,lc. Lrne servtnEmeat_ Onc serrin[ potalo or other regetalrle. Onc sen'ins fruit. Bread or other starchy foods, with srirnr:ilrt-er. Probablu i.nadequatc rlid llilk in coffee to cne-half cnr_-. One or trvo ser','ilgs egg rlr ntc:l,t. O n C r ' ; "1 . . \ ' rs e r v i . i l g si e g o f r h l e o r . f r r r i t . , Une serving potato. Bread or ot-h6r starch-v- foocis, r-ith srnall amount butter or butter substitute. rn both states the diets _for e^xpecirrntmothers feli considerably -qhort of desirable standa'ds. oriir- cne ho*e in h{innesoia rvas c l i r s s e d s r l e f i r rtie i . r '" r c e q i r e t e " f l n t i n o r i e i n p e n n s . y l r r n i a . L f i n n e a s o t r . n o u ' e \ - e rh i d a l a r g e r p r o p o r t i o n o f t h e h o m e s , , p r o b a b l y a d e _ , qunte''_in diet than Penn=ylrariia-2 out of 11 as .orfipnrua i"itn f ou-t of 21 (the rtiet of 3 Pehns.ylvaniahomes rvas not raied). I n most,of the homes of botfi states the diets of the nursing mothers r\ cl'e nct satisfa.tory. In no Penns.vivaniahome and in on'lv 2 Minnesolr.. hoirresl-zr.s the diet classedas definitely adequate. Diets were g r a r i e r iq r . " p r , , b n b l v . i n r d e q r i a t e " o r , , p o s s i b i y i n a d e q u a t e , ' i n m o r e T n a n n n i l t n e n ( ) t n e sn e a C l r L a t e . r S irnpos-ihle to freter.nrine. exactly the ave_rage ., -I,t or^r)lrlk 4aily consurrrp uon ll;u" DY ilre patrents, as lhe amotrnt purehased by the liornes rrnedJrom 2 quarts daily in a home having ollr 4 personsto 57 quarts d_arly ln another where there were more than 300. Furthermore. there rvas no way to estimate how much the staff consumed, ri t otii": i'erl tl.e other children, and coniequently accurate-determi.babies,_or n.llron ct the anrount of milk used bv each preEndnt woman or nurs_ irrg mother rvas out gf the_question." Every su-perintendent ciaimed that drilere'tration from the. ordinary diet wai made for.a patient rvhen the ph.l.sicianordered it. 'fhe con-clusion rvas that these diets would be improved if more spinach, Iettuce, kale, and cheese (especially cotiage chee.";,a" -eg$s, \\eri as mol'e mllk. were used. - Eest ancl .sleep.-In only two homes in Minnesota and three in renlr-sylyanir rvere rest periods provided as part of the resular routtne, but in mosr of the homes in both States-they rver.earr"ansed for -oanv mo_therwho seemed to be in special need of ihem. - ,t'or the most part in the homes ln both states plentv of sleen in the open air, another necessity for expectant motfiem, fras provided Provided by the Maternal and Child Health Library, Georgetown Universitr IN.TRODUCTORY SUMMARY t some of sleepand openwindorvs']ut through regulationsas to hours with insufficient'air t iuJ lo"'"'o*atd horuesin each "ituit ","'" in *"L"--qT:l+td and "Plfi,onot huqi,ene'-Toilet Fut$t'gfacilities theimportance ftfi"l"sotahomes uiitfr" in the sll homes borhStutJrl"i" of prenatal ti"gg"i'-"^1,in J;";.t hvgiene of nersonar "utu-*u. at leasttwice o wgek;iir a ferv^Penrreqlirement that-p&ti;J;-bathe lhe puti ents bathing when svivania homes tn"' Ji'i*"J" ;gtil;ii;"t'' tf,ev pleased''""ioiiiiil-ith'_,Cure as essen^ of the teeth' anottrer item acceptedsix of the tul Mio"utotarnd 't4-6tiil": tial. was'includerii" ;il;;;[ by the home or "if."."1 "f Pennsr,lvaniu no*.*,"Jitngf -:lt^ttained i;;EiFI#;,,"dT j:il.;::'1""i"Ji&1,"#cr"oro,,tdoorexerciseand as lhey ail had recreation*u" gio"f i""l[ *L"irlioo"Jotu"Lot"es, or tu"-penns'ylvauia thuo.o""-itlta o. srounds gurd"o"lu*t *"* var{s' so that this ;;h locateo'i;titi'ti;til were homes ";tv;q;; ^mind provided' J u r " important f eature "f i' il;t""i;;"9*1'Y" j; "qri1te] aird freedom 'i of cf9e,{r1r^-s;uiuhygiene'- lr h3'PPY' [cntal 1"t-;;';"pectani-11il1r's we]th-e from worry are a'mong essential" are under economlc natienis fare. The malorrtyFf maternitlr-home mental -iiitut"'"gtJ;t;^ tL; necessary the antl social huoor.upJ'oifithot the [ome' 'n[i"i;;; il" "pitit trrrnquillity-; "t;ntpttt'*'uoh ttii,aittaoo"tugfi:ll3 lo o*ttoitiog lhat, rt, assistance "o.oSt""" ;;;"inli that it provrdesrn assist,ance ona tn" for oonorl,unibies ";;iltiilgreat importanceure fu"tot" of working out indivrdriaiiirfilttti"pleasant ;f the'Eomes'w-as States ttffi''ilitit"";;-;;;i In both "#'r,:#'1{*{,lllH"_:*"il",:'^f t-tfml:f;qi1i}8?ff with"hrrd-and' Programusually^alrmajolity of or lecreatron. rle fol't?'lii'ditp""ttd no,t.e^{.in to ility 'wls fl*"if .regard fast reqtilntions:und consid'erable and 6rher mattcrs ofdailv iife' trr" rt"me, risitind hourr, ob."oi"ilr"* fraine of to bring about u.ryot9'"'o""tJoi9ti'ffi';n9-t1tul enforced shich'tended rigidly to"tio" and rn' urirr,l rhan recreation were found' however' "o.rto "fstiio'J"rlnflexible nrles. Welt-ptannJJ;ilg;;fu9.;f only about onehomes'and onlr about oou-r-i[ fi fnJ rtii"""sota litn""'t"g"tu1' 91'-o:"utiooul the Pennsilouoiu-no-tp had, sixth of gil]:tings of the ilan thi-Jveni"g 'Th-9 to, provisions that a """i"'#J"*ltn", tn"iiti"itiiiJo'of-u "tufi-membei caredfor during i?:b undor batients the total number lerv mo1,hcr"-unooi*dilil;"t; ;;d ip.";l s #t "*t in N{in'nesota-left yea' io p"oo#I*ftthe of I ?m.oun-t dissatisthe [omes before ""rtui" i" their leaving'such as "'"il1i;;;;ilioai.ut"" ili faction,b,rt ottt""''"t;::""# ;lt; elsewhbie' Pe-; o"^thulu"t that'they had provisionmade {or-i-h"i" cure 'venoreal disease. '"fi:ff#J::#:'ffi-:l'i"ll;* io of hom-es botf,_'3tai*=."-iiuiftti" .""i-t-n,ii" patients!" 9""t^t^t:.li:q ' "ff one-rhirdof the liii*"."t"-fto*"1 ii!; Iorpitut" th'eobstetrical_procedure " for hospitals delivffi bo"n"uti""i1J" givenrvithin-thehome was^ "good" o, ""*J"ii"oi; large ror ypq,p,oJd"dbvthe majoritv p"i"Jvi"uoiu no-"s"and about' --___ Provided by the Maternal and Child Health Library, Georgetown tlniversity 8 }TATEI.INITY HoMES IN MINNESoTA AND PENI(SYLVANIA &ovlce. was "poor"..i.n.o3e. home in Pennsylva_nia in none in Minnesota, and and it was "fair" in tu'o homesirreach State. The duration of bedside care in the homes averaged2 weeks in Minnesota and 14 to 16 days in Pennsylvania. In liomes having a suffi.cient number of assistanlsto give bedsidecarean earh' return"of the patientsfrom the hospitai is no.-t matter of seriouscondern.but in a large hospitalswith small maternitv wards a pationt misht bc sent out too soon and her future health-jcopardized. There ivas considerable difrerencein the procedureof"ttre homesin the two States in the matter of the time which the mothersspent in the homesafter the birth of their babies. rn l\4innesotapracticallv all remained at least three months becauscof the requirement by tlie state board of co'trol that babiesof illegitimate birth in matei.nity homesbe brea-qt fed for at least that length of time; but in Pennsvlvania u"iderariations existecl in the periods of aftercaro of the difierent homes. About one-fifth discharged pntients the any fime after they haclleft the hospital,about.one-thirdendearored have them iemain during the 1o nursing plrjod, a.nq a lirtle less than half definitely trietl to-kecp 'lheJcngth them I'or this period. of .timepaticntsre.rnained some in , nomeswas rnfluenced provisionmade to assistthem after .b1'.the. th,eyleft, such as hospitalization,rest periods,or continued medical life and health oT babies;inagr.emother,s io1r","'no-"ill.]iua, very few exceptions,nursed their babies for at least three'months. ".irI h.qmes only were,departures from this gqneralpractice noted; ll lI" rn thesethe weanlngof babiesbeEanat six weeks. rn Pennsylvania the superin"tendents all stated that breastfeeding j"ggur?B.ed,1t leastfor ashort time, the periodsvarying accordl 1L. t() physr(,rans' rng orders. rn all the Minnesota honresmothers were given some traininE in caring for their babies_; a few this rraining in oniv .llsi;t.'-- h-" ii "Y". -Hennsylvania homeslhe mothersweregivenlareful tiainiis in infant care; rn the other 7 tb,cvreceivedlittle or no instruction. " , $ plarr.for. further. gupervision increases tho service that a home is able_ grre by provrdrng more workers inslead of more house accomuo modations. This is rvell illustrated in the Minnesota policv. uncler which the-county child-u elfare boards assume responsiliilitv"for the mother u'hen she leaves the home and help in her'adiustrndnt in her home county: The difficulties mentioned'in the section on prenatal care (_see 3), resulting from too wide a program of service,iessened p. the adequacv of oostnatal caro also in c-ertain homes-particularly those in-Pennsvlvania. Infant care. Care of infants rvas rated as ,,excellent', in 3 Minnesota and in 4 Pennsylv-ania .hom_es, "good" in 4 l\{innesota and to pennsvlvania homesr."fair" in 3 Minnesota and 3 Pennsylvania homes, and",,poor, in 1 Minnesota and 1 Pennsvlvania home. AII the homes studied in "both states reported that they used. a prophylaclic in the eyes of newborn babiesi but neverth"t"J. in on" h.oTg,ln, ?ennsylvania a-nursery was visited in which four of the elg_nr, DaDteslad acute ophthalmra. ..-Breast feeding nas reiognized in Minnesota as important in the Provided by the Maternal and Child Health Library, Georgetow'nflniversity INTRODUCTORY SUMMARY I General health provisions. In all but one Minnesota home public-health requirements were carefullv observed: not all the Pennivlvania institutions showed the same cdre. The physical equipment"of the Minnesota homes gave them certain advahtases over tiLose Pennsvlvania in providini for in the seneral health of tTreirpatients. Three-fourlhs of th'esehad 6een buill particularlv for materlnitv-honle llse. ,\ll but one were rated as "condition. Onh- three of the Pennsvlvania homes in " e'xcellent " had been built for maternity-home use. Less than half lvere rated as in t'excellentt'condition"and most of the others were rated as in "good" condition. It is generally recognized that large dormitories rvit'h many beds are not so satisfacton as roorns rvith only a ferv patients in each. An acutc infection cau bc contlolled far more readilv in a room of the latter type than in a dc,rmitory, In Minnesota the p r o p o r L i o no f h o m e s h a v i n g s m a l l r o , r m s s i t h i i n g l e b e d s w a s m u c h hisher than in Pennsl-lvan-ia-7 of. the 11 Minnesita homes studied aslompared r.r'ithonlv t of the 24 Pennsylvania ones. Several homes in each State had laige dormitories which rvere crorvded; in some of the Penns;'lvania homes the dormitory beds were so close together that it was hal'd to pass betrreen them. In both States th-e oolicv of about half the homes was to refuse admission to patients with"any communicable disease and to make arr&ngements for their care elsewhere. Severai homes rvhich accepted patients u'ith certain diseasesrefused to admit those rvith Eonorihea br svphilis. In Minnesota all the homes which excluded inolicants willi venereal diseasegave sufficiently tholough examinations io make reasonably sure that s-irchcasesdid not escap"e detection; some homes required iir addition to their orvn oxaminati6n a certificate of freedom from disease siEned by a member of the State board of health. In Penns5rlvania, 6n tlre bther hand, the inadequate examination might have pernrittcd applicants rvith veneleal diseaseto enter several homes which liad the policy of excludinE them. In such cases noL onlv "hecome nright other pati-ents infect"ed but the patients with venereal diseasen'orrld fail to reeeive adequate treatment. More than half the Penus.ylvania homes kept patients in isolation until examination if they could noL be exahiried upon arrival. More than one-fourth niade no attempt to protect from infection patients alread.y in the honre. In the Miunesota homes which adniitted patients ivith venereal discasethere was practically universal practic'eof prrblic-health nre&sures, sucb as the provision of individual'Lou els, separate toilets, and separate di-hes antl drinking cups for such patientsibut in Penns v l v a n i a a f e r v s u p e r i r r t e n d e n t s " a p p i r e n t l ; ' i d h o t r e c o g n i z er h e i m d portance of these'measures, and their h,,'mes ditl not piactice them. A policv which provides for adequate examination of all parients It th'e tinie of adnilssion and the treatment of those affiictbd with venereal disease arrd which assures all other patients security aqainst infection would seem to be the most, reasonable and the most riidelv useful policy for maternity homes to adopt. A number of homes in Minnesota but-onlv one in Pennsvlvania look precautions at the time of admissionasainst other coilmuni- States patients suspectedof having an infectious disease, other than cable diseasesas well as venereal-such as takinE throat and nose cable-diseases well as venereal-such as talinE throat and nose as vaccinating against smallpox. In ali- the homes in both cultures and vaccinatinq ,against smallpoxali Provided by the Maternal and Child Health Library, Georgetown University 10 ]I..ITERNITy rloMES rN MTNNESoTAAND pENNSyLy.{:ir.{ venereal, 'were isolated. Mental defectives were received in all the homes except two in Pennsylvania and one in Minnesota, unless the condition of theso natients was such as to make them difficult to manage. Mental ilefectives rvere not seEregated either in the Pennsylvaiia or the Minnesota homes that aiimitted them. Yital statistics. The rnortality of infants during the first three months of life for the 13 Pennsylvani-ahomes for which-the information was available was about twice that which would ha,ve been expected both at the rate prevailinE in the State as a whole and at the rate prevailing in the bntire biith-registration area (32 as compared with 16.6 an-d 15.4, group s{udied in 10 Minneresncclively), u-'hereas mortality of the "one-half the times that which sota homei'wds approximately one and would have been dxpected both at the rate prevailing in the State as a whole and at the iate prevailing in the birth-regislration area (28 as compared with 18.S aid 20.8, rispet'tively). SOCIAL DATA of According to thc generally acceptedstanclards cliild care (see n. 87). childien born AL It.\TI.]R]II'IY II0}[JIS IN }IINIIESOTA AND PENNSYLVANIA Celsalern section." ft seemedthatthe visiting physician who attended delivt'rics arranged for emergency work to be done outside the home. Tlie diet was rated as " possibly inadequate" for both pregnancy and lactatior. The superintendent claimed to furnish food bountifulJy, but Nhere was effort to have the patients eat the most suitable food.' Milk rvas not no si:)ecial rnuch used. {ipon being qestioned the superintendent said, "The girls can have milk if there is airv lc{t ovcr." furnished, nor any special attendance in case of lowlJo dcntal service r',-as Erade infcctions. 'ihe superintendcnt rvas judged to be cooperative with the physician in al,tendance, bu'uthe medical siandards cf the home were not of the highest. 'lhe rnaternity register *'as in bad condition. The record oT the disposition of the baby was ornitted in every casel various dates were also ornitted. Ceriain births ',vhich had been recorded as iesitimate were forrnd to be iliesitimate. Al,out heif the palienls rrere said to be married; but it seernsinrprobible ttrat tnarried women living in the vicinity would leave their homes and come to this place weeks in advance of delivery with hospital facilities available elsewhere in the city. Sorne of these pai,ients had not consulted a physician, and the t,r'oprictor of the home cailed one for the delivery from a small group who used lrCi IlOlile. 'I'l:c ,rl'ncr of this hcspitai scemed to be a kind, r'r.ei1-neaning, but ignorant \,.:)rl3rl. ()nlJ'onc locel social rvorker expressed confidencein her. Il o:rr VI This rr'asthe most iecentll- organi-zedof all the institutions studied in hlinnes()'.!r. Primerilf it ri'as for the care and training of delinquent girls rvho might l,r-. heiped by a celtain amount of freedom iather than by the restraint of a ref(irnretory. The addition of rvork for unmarried mothers had been incidental Lcithe othcr rrorii and had been made becauseof unsatisfactorv conditions lonE eristing in the other two maternity hornesin the city. -\11 met werewomcn of culture and good preparationfor their tire si:rli rrrembers trork. i1n.l iirc.r-s'ere zeelor.rs thc best results. l'he austerity of some of the for ,;.pecial1y the haii in\vhich the patients had their meals,ap peared af|enge.rrlents. of u n : r i l r i i ( t i \ c ; i , r r t ,r l r e r e\ i a s I v e r J g o o d s p i r i l , a n d t l r e g i r l s l o o k c dh a p p y l n d healthl-. Thcie seemedto be more unity in the interests of the gloup than in some homes where the appoinirnents were more elaborate, The medicai work I'as carefuil}' done, and records of all examinations were on fiie at the hospital, 'rvhich cooperated understandingly'with the staff of the home. The home had m:[de a comnlete report to the State board of controi of healtb e complete report to the State board of controi of health prevlous J*ear (dent&l servlces, malor rn $.ork li.ork done in the previons 1*ear (dental senices, major and miior surgical opermrnor surgicai aticns, glasses and braces fitted, and leneleal-disease treatmentgiven) and of the results of intellicence tests. The staff closely foliowed physici ans' directions. the results of intelligence tests. The staff closelv foliowed ohvsici ans' directions. gave-_unusnalii_os1-.ital The r:o-operating. service to tlis home_in keeping tire might reenter the hospital, and if herlaby was l--reastfed it might go with she m her end lle cart,dfor in the pediatric n'ard. hcr and be carcd the rrediatrienard. The diet rating s-as " probably inadequate " for pregnancy and " possibly in'I'here adequate " for lactatron. aciequate for iactation. There \ras reason to believe, however, that the sample \ras reason to believe, however, that the sample best advantage, as thc gardens,cows, chickens, and rabbit, hutch all contributed; and it was for.rndthat some simple but important things such as cottage cheese and skimmed milk had not been considered worth mentioning in the menus, although the5' 5.s.. in rather common use. 'l'he training .of patients for future employment was varied and efficient and shoned utilization of aII avaiiable resources. Coursesin home nursing \yereprovided lry the lted Crossl teacherswere procured from the extension divisioh of the State universities. A 13-year-oid girl (not a maternity case) wasattending pr.rblicschool at the time of the study; and four girls, one a mother whose chiid had died, were taking businesscoursesat the expenseof the horne. Ample provisicn rvas made for outdoor life, both work and recreation. About haif the proceedsfrom certain work done by the girls n'as used to finance recreatioual activities; the other half was kept by those who did the work, menus rrhich lhe siaff furnisl:ed for lhis ratine did not rel)resent the diet to the patlents for an indei'rnite time, allowing them to remaln thioughout patients Ior r.ndelnli€ lrme, atlo$lng tnem Iemaln t,nlougnollt any elllerel}lergencies such as ophthalmia in an infant cr evidences of an5' infection !n the mother. If any condition arose after her return to the home that necessitated bcdside care If anv condition arose after her return to the home that necessitatedbcdside care Provided by the Maternal and Child Health Library, Georgetown University MINNESOTA 43 rr@rr, -*i!nT ii"ii.i: iri?"'been usedtemporgrilv urrErru usuuEr rtavE ugE! useu Ji;h"; -Thislivingroomandthesun I -.This anitabledining room rvasadddg. mitable dining room rvasadded. living room and the sun pario. weie ui*pty were simply but attractively furnished.. Good pictures,-books,magazines,b,nd other simitar furnished, magazines. ther similar touc.hes touchesadded greatlv to the good impression. added greatly sood impression. The home v,ras overcrolvded; it seemed that in their zeal to render service the staff had taken in too large a number of persons. T"T_ 19 rogm., 1."* ifir -opgging y-11 dinip,s. -ir"r-U ta1s9Jra]l being used in tieu of one. The living to,o-,,, a Houn VII This institution \4/as not only a maternity home but also a place of temporary care.for dependent-children under,2 years.oiage.- It rvasof rnbre recent deivelot'nrent than most of the homes studieil, as-it was founried less than 20 years ago. -\t the time of study the-sulerintendent had been fn charge less than iw-o years, and great iinlrrovernent had been made in that trme. r\ll admissions to this hor're were made through a certain social aqencv which nas controllcd bv a rcligious denominalion. A preliminary soeial iivestigation w?s T,ad.eby this ageDcy lo help to,decide r.hether the applicant should be admrtted. .'l he ageneygave alsoa.physical examination so as to exclude any appticantwil h venereal disease. Tlre corrntv child-uelfare board assumed complete responsibility for all mal.ernit.vcasesafter admission to the home. 'l he lrouse rvas s'ell equippedand exceptionaliyn.ell kept. Only a few defects were noticed. (Jne of these was 1,hecroivded coirdition oi the doimitorv where both -waitiag ald nursing mothels slept. Another rvasthe lack of a iiviig room f-or.the girls; it ivas expected that 6ne would be supplied before long] The di!ing.roorn r'vasmosf ai;tractive, and it's'as used temforaril5'as a livirig room. tr'Tldicai care was given to mateinii.,y patients at vari6us cririics, and thi home carefuliy calried out all directions liven at the clinics. Dentat work was arranged . for if the clinic physicians considered it necessarv. Obstetrical examinalions rvere nradc at the clinics,but specific information on lbese rvas not scnt lo t,he home,and it nas not Inown whetherlhev were thoroush. ,\t the cnset of lahor each patient was senl to a hospital for delive"rv. several hospital-s_rvere rised,and a palienl nright be sent to one flrat did not have tne record ol her prenatal care. At ore hospilal it was said lhat pelvimetry u'asdone "if thcre xas lime befurc delivcry.'' patienls returned to'the hom"e so.on after.delivery,and there ras no provision for bcdside care in the home, 'lhe superrnlenclent n'as very particular about the health and conifort of the patients, and if any of them felt ill thev l.ere sent to a clinie. Th.ediei rvasg_ood, being rated-as "jrrolrairly adequate', for both pregnancy and lactat,ion. [r-e girls might have hll they"rvanted lo eat, includirig i-unehes betrn'een meals. The waitresses t'ere instrucied to notice timid ones"at meals to see rvhether they would like seoond helpings. The children rvere well cared for and had t-he servicesof a pediatrist. Excellent isolation facilities were provided in case of infection. Trained assistants carlied out the directions of the phvsicians. The group.of dependent childre! *-as cntirely under supervision of thc social agenc)-_previou,sly mentioned. Every r:hild of iliegitimate birth who was retained in the institution aftel his rnoiirer had left remained under supervision of the county child-l,velfareboard unless the guardianslifi l.as taken ?rom the mother, in l'hich casethe child rvas committed to the ag^ency piacement. for Tire social atmosphere_qf the home ri'as particuiarly good ana tnd superintend'l'he ent rvas sympathetic. The maternity patients n'ere given as much freedom as en! was sympathellc. t maternity patients n'ere given as much freedom as n'erb was practicable, the home's nurses and volunteer workers a,ctins a, was practicable, the home's nurses and volunteer workers acting as chapcrons 'r'raining f o r when n e c e s s a r y . , T r a i n i n g for e m l r l o y m e n t w a s p r a c t i c a l i y I i m i t 6 d lto h o u s e h o l d w h e n necessary. employment was practicaliy limited o household w.ork,selving, w o r K s e w l n g and the care of the babies; few sirls received training in dietwork,, selving,, and the care of the babies: a few girls rece-ived traininE in dietkitch'en work. The home was constanlly occupied.to capacity, receiving giris from ail parts of the State. The reeordswere vell kcut. Hour VIII This home was a well-ordered place housed in an attractive building with large grounds. It had a good, efficient matron and a particularly congeniatsiam. Eveiy department see-med busy-andhappy. _ It was an outgrow{h of missionary l.ork by a locai group of men and women, and it was one of the oldest efforts r_rf tvp-e its in the State. In the early years of the work various types of \.'omen neediig 96E920_261_4 Provided by the Maternal and Child Health Library, Georgetownt nir enir\ 44 ][-\TI.,RNIT1' ]IOMES IN MINNESOTA AND PENNSYL\TANIA eare were accepted,but at the time of the study the only ones cared for were unmarried mothers. The home rvas licensed onlv as a maternitv hosoital. The attending physician, a woman, called twice weekly and irot only gave good prenatal and obstetrical care but also instructed the patients in personal hygiene and the care of their babies. She received qood cooperation from the rest of the s1aff. A small l2l'orstory eqrripmcnl rvas risedat the home for urinalyses,and tirc city lairoratory ancl the State university iaboratories were also available. Each applicant for admission to the home rvas detained in isolation until a ph1-sical examination was rrade, as no patient rvith a constitutional diseaseor an acute infection rvas kept. The facilities for isolation and segregation \vere sood. The diet kitchen, the babies' bathroom, a delivery room with bath, and a twobed ward \\'ereon one side of a corridor. and on fhe other side a.sinsle-bed room. arr examirrationroom which had equipment for spccial cases. and i labor ru,rm. Tlre delivery suiie was espeeiall.v uielf arranged and safeguaided. The diet was rated as " probably inadequate " for pregnancy and as " possibly inadequate " for lactation. Breast feeding $.as supervised and the babies t ere rvell nourished. They were kept in a nursery rrnder the care of a trained nurse, and the mothers rvent there to nurse the babies and sat in lon- rockins chairs lrv the babies'beds. The superintendeni I'as & very businesslike person. The home at first gave the inrp,'es-sion certrin human interests'were that sacrificed business to efficiencv: .,r-as but this irlyrression dissipated by obsen'ation of the girts at work, at meaisj etc. \o girl rvaslrermitted to leave the home nnaccompaniedfor any purpose. Groups of girls \\'ere accoml-,aniedto church, on wallis, and on tittl-e butings. There l'ere no other outside activities. Preparation for future employment was linrited to trainins in householdwork. Rerords \l'ere yery tvell kept. For years the management had followed the policl- -of keeping _mothers and babies together for the moral effect on the mother; for tliis reason the records sho.wed,general15r, that mother and babv left the hr,tne together. Horvevr:r, these_ records sho*ed-a number of separation plans rnade ri'hile in the home, and this franknessof the home is to 6e commended. f he -sriuerintendent would not p,ermit.any of her stafi access to recordsl nor rvo.l from work done bv patients. financed s'holly or in part bv prlblic appeals Twentv-orte horirestt-ere or through eontributions from local community ihests. I{ine of [hese receivecl"state aid alsti, and 12 received city or county funds on a per caoita basis. Two were entir elv commercial enterprises,and one u-as subported through its endowm6nt and by money received from- pav patients' Finan'ces of some of the homes seemed verS' involved' The confusion of the financial and personal records indicated gleat need for standards to protect not on-lv the patients but the communities supportins thesehomes. The eipendiiures varied from approx-to nearly $80,0-00. The agg{gga1eamount of State imrrtely'gi,SOO *Eighteen had accounts aid foi 19i2 was reporled to be $34,900. audited by professional accountants. g of these-l8 being State-aided 'th"t" the books were examined by State auditors' institutions Provided by the Maternal and Child Health Library, Georgetown Universih' I r I PENNSYLVANTA RATES AND FEES 53 f I J I I I I I I nccura,te clata were available on rates and feespaid . tn 6.homes^no b.v prrt-ierrts; horne*harl no fixed rates or fees; 15 receiveduit oi 3 part of the expenses nrorethan half their patientsfor the year (4g5 of "'" ' irf s;tl.r either'from the paticnts or from tn.ii. ""r"tiur. !ees colle-ctetl from patients or their families varied from $100 to t1{0 each for their care; boa_1d_ $3 to $35 a week was chargcd. from In sonrehomesthe patientsdid the houseworkto pay to, th;l; fi;;: pital care. rNcoME FROM WOBK OF PATTENTS L I I J J I I I ' I rhree ,honres lrad rrrri^conref'om the wo'k of patients. rn one hrmepatrcnts.wera_permitted go out to work, usually domcstic to work by the day,, the proceeds bcing divided equallv between the p-u]l.lt.lld llc.lrome. In another home whichlared nor only for maternity patientsbut for other cases the proceeds the nati"ents' all of work wcnt to tlre home: most of the work waslaundry work. and the nrat^emrty patrentswere rarely assigned it. rn a ihird home the to orohts,lromart needlework done by the patientswerousedfor recrepurposes the group of patients. a,tronal lor INCOME FROM ..SULRENDER FEES " The policy of insritutionsacceptingbabiesof illegitimatebirth on payment ol & sum ot money by their motherswas found to be still in use in four of the maternily_homesin penns5,-lvania-Two of these were commercial homes and two were und"er direction of church groups. The babies. were acceptedin all of them at any time after tne end or tne penotl or -h.ospita[ care. The feeswere$b0,$165,and $250,a_nd which could nbt be exactl-y one determined-ubp.".La r* io about $165. At the time of rhe study ihe institution itiu.ging $250 man)'babieson surr"ender, t hosear,eefite8 qas not.accepting and were placedrn lamilieswith wet nurses. The fee was estimatecl tr.over plymentLor an adequatep-eriod-ofwet nursing. lhe institution cnarglng$bueontrnued pohcy of accepting rLs nervborn babies.aoDar_ ently rn a_n e_arnest belief that this is a trury food plan for the'mbfher and for the babv. INCOME FROM BOARD PAID FOR BABIES rn someof the homes. somewhat a irregular. amounl'ofrevenue w&s derivedfrom botrrdpaid for babies. RECORDSAND REPORTS Just as there has bee' no central registration of maternity homes in Pennsylva-nia,so_alsothere has bee"nno standard requl#ment in the matter of records.a As a result of these conditions'the records showed great diversity of form and content. SOCIAL RECORDS Most of the24 homesused a record book, in which entries *'ere made of dates of admission,deliver.y,and dischars"; na-e. l.li.th "arrd date, residence, occupation, religiotr, nationality- ih" lnotlrer: oi orflnserprinrs ofauinfants iDhospit,i. bo raken borx 1%td:t"* "r'*"tftY"Yff'fgtJ?it".f3tit"S#?t Provided by the Maternal and Child Health Library, Georgetownf'nir ersin .r-l }IATERNITY EOMES IN MINNESOTA AND PENNSYLVANIA rlisposition of.the Fuby; certajn facts_ about the putative father; and rhe namesand addresses the mother's parents or of some other of relative or friend. very few placessoughi to ascertainas much information about the pirtative father ai about the mothcr.- Th"*u books varied from weli-arrangedrecords soing definite unJ information to a few lines giving severaliiemsl "oo"i.u rn some of the homes th-esup-erintendent stated that she could not place such confidential materiai at the disposalof th;-Children,s Bu.eau.agentor that the study of the recordswas unneeessary. she as could supply any_statistics needed. In 16 homesrecords.i jndividuals were arailable and were studied.bythe children'sBureauagent. rn the other 8 homes the superintendeirtfurnished inro.-aiion.- rri I of lhese8 there was no his-tory the motherex(.epther name ancl of address and the dates of her admission, delivery,airrt tlis,harge; in anolher t\e onlr record.was &.sor{ ,f log. froni which i"ti"r,1,:ii.t. ('ourdnoI be obtalned:rn a third the superintendent statcd thrr[ the recordbook was lost:and in t\e other 5 the agent w"r p.t*itt.d to examinethe files to asceltainthe tvpe of rn"oids and ttie -.inoa ot keepingthem. In 4 of these5 hom'es thc rcports on ntn #ur* ,rffi<'renlto supply most,of the info'mation desired; but the superintendentspreferred giving it themse.lves having'it procur,ed the to n1y agent directly from rhe hisrories; in the fifth a-staff member hiled out a blank from eachrecord for the year. MEDICAL RECORDS Records were kept of the prenatal, obstetrical, and Duerperal examrnatrons patientsin all but 4 of the24 institutionss^tuaiba of in Pennsylvania. _someof thesehistories were not filed at the homes tlremselvesbut in the cooperatinghospitals where the patients were taken for confinementcare. found giving_ adequatedata on the patient's , . very few.recordswere. li1tg.l,.rg"ial or:nedical, indicaiing lhe caie of.the patiena-ft pi;r; Ior her tuture. -t''iveplaceskept chronologicailyarianged sociaihistories, of which two ohly were'entirely acdeptabre. SJoeraiinstitutions had summary cardi which we.e well kept, though onty minimum rnformation such as a hist6ly face sheeb contains wis fouird thereon. Occasionalinstanceswere n6ted where records*"r" ucclr.ible to patients. .In onf .homethe superintendent on"u.itv was the iecondfloor most oI guy.,whrle patients, unsuperviFed for part of the time, were on 1+u nrst,floor, \Mhere r'ne casehrstorieswere in an unlocked file. This superinte-ndent remarked that she noticed evidences the recof ords "havrng becn tamperedwith bv the sirls.,, only 8 of the 24ho_mes compiledreports. Tour of thesepublishedthe annually,1 biennially,. and-l occasio_nally; isiued a type1 rypgf wrrtten annual report, and I issueda monthly birlletin. ADMISSION OF PATIENTS SOURCE In all the homes studied patients were admitted. on their own or,on that of friends or relatiyesor at tlre t"q"u=t oi p;Uflpplication lic anct_ private agencies. In six homes prospective niothers were received commitmentfrom juvenile,municipal,and countv courts. on children were received on cbmmitmont in io nomer. The court Provided by the Maternal and Child Health Library, Georgetown Universin PENNSYLVANIA cc usually retained jurisdiction in these casessinco the commitments were only temporary. The two commercialhomes advertisedin the physicians. ne\Yspapel's circuiarized and Socia,l investigationsof the patients before admissionor a{ter were niadeb;' a qualifiedstafl wot"ker a standardsocial:lgency only or for "In six homes. 10 homes there was no attempt to irivestiqate th"e pnt icnt'shistorl',andin thercstan inter"view ttie superintendent a by or Ietter of incruii'r' rvas the onlv effort made in this direction. A few superintentlents thotrght thai any invest,igationwould violate the of the patidnt. Onlv 8"of the 24 homes used the social"ntrfi.lun"e servite e-rchange identify caies. io LTMITATI'NS Race. Eisht homes limited their intake to white women. Trvo were hon'rer; colored'!vomen.and thev rarelv had anr- other palients. for The other 14 acceptedbcth white ind aticnt rva< put ir.t Frr*** !,rcur,errox 13. All lying-in houses shall be licensed and the local healilr officcr shali i!.snect those within his jurisdictiotr a..a saliJy ninxeii trrat triey are propcrl.r'licensedor conducted. Rpcur-,a.rroN14. No mate'rity,hospital shall be granted a licerile uniess sarne is constructed and maintaincd s-ith suih regard forianitation uiua io. rr.ot""6oo of irealth of inmares as shall 'reet *.irh ap[ioval of State b;;;a;f h"fi;;. PENNSYLVANIA . Act No. 19; Stat. 1920,{ecs. tlaws of 1899, 14i04_l4b06l An Act To provide for the iicensing and regulation ol lying_in hospitals sncrron r. Be it enactedetc.,Tharit shall be ]arvfur for the board of hearth of -i".Titutio. an.v locaiity, t. license any person or persons, othei ihan a" r n c o r p o r a l e do r s r l c t lp u r p o s et.o e s t a l r l i s ha n d k e e p a l 1 . i n g _ i n o s p i t a l , aur" , t h s.ard or other private place Tor the ie.c'eption, gq.., utrd tieatmbnt"of *,o-en in 1abor, upon written application filed $'ith the *ia trba.a, aceornparriedbv the endorse_ "sri,.t, ment of sir or more repu_table per.s,,ns, r,itizens tt ,rhere l,rsp i t a l m a . vl , e s i t u a t e d ,w h o . s i r a i i . " r t l i . : i o " i ' n " "fe q p" r"o,ini...,rr.i r e .labi,ir the apfrlicant q,ndt$! the hospital,hospital-ward,or other private pra"",!t utt'n1trl'Le ,,sea forlecit-ir:nate,.mbral.'andcharitarrre'pu.po."i;;."dif,;fi"r"A;;'-i;,q'iiir-'or su.t, it is believed rn.l the P::r^d-.f^lg1\th,a n d p r o p e r l ' rhat thealipli"uiri-t. u propr,rl)ersnlr l s e sa r e s u r t a b l e a r r a n g e d o r s ' r c h p u 1 1 , b ste ,c s a i t l t r o e r r n f lPrerrrf r i t . e rlrr h shall-grant a-licenseior ihe purposd abo'e menlionea lhe irrrri""rrt oi fee of five dotlars. Such ticcnse shall conrinue il f;;;" i;;;p;;i"5;tT,r, "pqt " . subjcct, ho'rv.'er,to he re'oked l,r'th.e boarldort"t"artri g;;ii;;;r,;-;;,,. "rrr, ,,r,on the violation or the rutes and rcgulatio; ;;;i"d";i'tn?' J"ii'i,"aij*,r i,eurti, 96892.-26t 6 Provided by the Maternal and Child Health Library, Georgetown University 92 ]r-{TER\rITy r{o}rEs rN tlrrNNESorA AND pENNSyLVANTA for the go.vernmenlof sald hospitars,, hospitar wards, or _orrrer private praces. rvard, oi Il:.-'q::fl:l:l_91"","1I qylh hosfitat,'hospitat for- 't'u.ilriiaieJia,:er,ept ke-epa_recordin a book that, purpose, eoniaining l?:,.y]*C:t:_t^urposes,shail of,cach the tutt name and address pe.sg+,admitted, thc- datb oi admission,thE date of birth of every child, the daie of its removal, ana trre praceto *t i.r,,u.r, child shall be removed., hospitat, ir;;;it;i ;r;; o."oiri.." p".i""il pru." .g;:.h shall be subject.to the visitation or insp6ction at any tirire tr ifre-nJarai} nearti, granting.the.said license,or any special officerthal may b'e;;;i"ti -pleas,,,upon ior that purpose bv the eourt of common the petidion oi'anl:'r*;"," to. the prevellion of cruelty to childrei of the'proper counry. of every. hospitat, hospitat luard, or other private place ror llrng-ln purposes-to "^|I_q:?.,J19.!_.-o!li".tol which a licensc has been granted according to seition ole ol this act shail, within five days after the L,irth of anv chiid. reuort to lne s&rd board ot health the date and place of sueh birth, the name, s'ex,and color of the child. spc.3. whoever shall,violate the provisions of section one of this act by hospital.ward, or. other prirate L._"Rilgi !9ryjtal, $rthout -ptace for ,yi"g_in'-f,u.po.". ror,nrr€ or reward, license, shall be guilt5.of a rnisdemdandr, andforthe col\'rgtr.on thereof, shalt pe prrnished by a fine not exceeding lI1*91_",o!^"-l\pgn, anct,lor the. second upon convicrion thereof, shal'l :1"_:!"_1.E,gg'l?lu, De,punlsned a-hne not exceedingtwo .offense,_ by hundred dollars and imprisonment of not more than one year, or cither oi both, at the diseretionJ il*-;;;;i:' iJEc. 4. AII a,ctsor parts of acts inconsistent herewith are hereby repealed. Approved the 26th day of April, A. D. 189-. lAdministrative Code, 1923] AqAct ProYidingfor-and reorganizing conductofthe€xecutiyeand administrative the qepartmenl tnereot atrd ceitaiD existing a;d .;".ii"iiiiJi, workof tbB commonw€atrhuv tbo executive. bv !!o eruuuuYe. department the;e;f atrd c€r;;i;;ftfic and certain n€w JhLi"*truadministr;rEUrBdurzrlB, reorganizing, or authorizing the reorganization of ceitain admi'nistrative UEirrtn-enli, oraullonzltsrne-reorgaDrzatton ol certain administrative dgpartmenta, boards, com_ missions, bureaus, urvrlruD. uuL.cs, a!! ageDctes; aen"i."lf'" uu.ed6r divisio's, ofrces,-anj agencies;oennlDg tne pouers and duties of the governor "r__ divisions. offces. and asencies: aidning-ttre -",.,ers and drrii6. ^r +hd governor ^-, posers duties of the -^.,^--^- and -"oirii"iliiiiiJ'ali'^iiiFiL'ji*.0r, 'aamini!ltorive'a"i^ri-Firc'and other oxecutive and administratjve other oxecutive and administrative officeis, officeis, ana'oiitreie'ueial ana'oiitre ie'ueial in".a" and .eommissions: flxingthe salaries rte doverndr, s of lre governor, iieuteinit govetnor, ol lieutenant goverDor, and certnrne\ecutive and certnjn e\ecutive and administrativeoffcers:-providins tbe ippoiotliri'oiirii.iiain aominisiiaiiie'i'm-ccii'rii or arr lor for t-he appointment ol certajn adminislrat,ile officcrs rnd o all of Certatn administrative ofiicers and of deputies and other assis&nts ano emotoveese s t r .cririn i n dpncrrhanrc n l s -h^o,do i s -ndd a^ft-i--:^-^. ^ h e .and employees i e m p l o y e rn c e r t a d e D a r t m e departments, h o a r r n n . n m m i c s i boards, and commissioDs;^-r prescribins tivo departments' !oar.dg' commissions. tiso departments, boards, commissions, and otrceri; abolishi-ng,. and offceri: atrntisf i"n. comhinino .honoino combining, chanqing ihd namt6 ot, rhe h6hr. ^r 't;ails. themanner which the iuriLli;nt;;;d;.'#; in -"' antsandenoplovees oI certaindepartmenrs; "?li ""i.i,-'iiJJX"b"fii"d#.?iri".t: bo;ras, comiaissio"i aad itair-udaitiiliieo". Anr. XX.-PowrRs AND Dorros or rEE Dopenrvnxr o' wpr,renn e*n rrs -cori*,""r""a DnpenrunNrer, AonirNrsrRATrvEl*o Aovrsoar Boenns "*" spcrroN 2001. Powers and clut.ie.s general.-The department of welfare shall. tn bject anv.inconsistentprovisionsin this aet contairred confinrrot^ o.o"^;"o act co"iuiiiea; ;;ti;.;i;Lxercise ,sybjectto any inconsistent [ne powers and perform the duties tawvested ;;ii.i;6.,il the powers and perform the duties bv law r.ested in nnd imnnsed rrnnn tha rtono-+_ bv ir ,iiji," tt" ii;d;i: *=.:""':.3j1$^p:.lfglT the duties by law r-ested{ ment of public welfare and the coinmissioner of rrelrr'. or puDrlc e'etrare anct the commissioner of public welfare. It shail-also exercise such. additional )on lt uv tnts act. upon it , by this act. powers and perform such additionat duties as are imposed irnposed a^fter parturition,.more a^fterparturition, more than one woman, al"'"ot'll-onen rela,t to such persoir than one woman. ."*"'"pi womeo related to such person !:: ^?9911 ?r4n1t19ry.-* ,* 1 (0. :,Maternfty home and hospitar,,shall place i1 ::_11_"li ( ' el9l1":-!9-"re oror e a l m e n t , *.tric.ir,within i p"rioa or *ii-irio"iiru, ""y personr receivesfor care tr6atment, d u r i r ) g p r e g n a n c l 0 r d u r i personrecelveso r careo r treatment,during pregnancl- or durin g o r iimmediatelv p u r s ( , r r e l v e sr tor c a r rr during pregnancv durinqor m m e d i a t e l y or by-blood or mariiage within the .."ona i.nr."i- rti,i;?8frt;f*fAmf,"*#ii;. - x *" (c/) maternitv and Au homes hos- o Provided by the Maternal and Child Health Library, Georgetown University