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68
On analysis, it was found that some midwives referred the
majority of their cases to the clinics whilst others refer few and some
only exceptionally. As all midwives in the district are dealing
with the same class of patient, the differences in the proportions
referred can he attributed only to the attitude of the individual
midwives.
Too many women attend once only and often that attendance
rather late. The Departmental Committee on Maternal Mortality
and Morbidity recommends a general physical examination at the
16th week and the midwives' subsequent supervision to be supplemented
by a doctor's examination at the 32nd and 36th weeks,
particular attention being paid to presentation or any disproportion
of the foetus to pelvis. Too large a number of midwives
appear to be satisfied with a report of no abnormality occurring
at the time of the single attendance.
Co-operation between the midwives referring the cases and the
Clinic is obtained by the Medical Officer sending a detailed report
of the clinical findings to the patient's attendant.
A clinic is held every fortnight in a central position of the
district by the Council's consultant. Arrangements are made for
the examination of the patients of general medical practitioners
at these clinics without previous attendance at the Ante-natal
clinics. The medical attendant has sometimes availed himself
of the opportunity to accompany his patient.
(b) Educational and Social. Apart from the attendance at
the Ante-natal clinics, many pregnant women are visited in their
homes by tbc Health Visitor. During the year 754 such visits
were made.
The premises at which the ante-natal clinics are held are
spaced so that there are few parts of the district from which the
inhabitants are more than half a mile from the centres. There is
therefore, for those persons who cannot afford the cost of the antenatal
supervision by their own doctors, no excuse on the grounds of
inaccessibility for failure to obtain the requisite supervision.
Many women cannot afford the cost of a doctor and a midwife
at confinement. For such cases the medical supervision by the
clinic, supplementing the midwife's attendance, is sufficient for
normal eases.
The difficulty arises in those cases of complications of pregnancy
or anticipated complications of labour, for which the
attendance of a doctor is necessary. The doctor who is to attend
the complicated case of lalour should undertake complete control