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INCIDENCE OF CONGENITAL MALFORMATION
In accordance with the requirements of the Chief Medical Officer of the Department of Health and
Social Security information is supplied to the Registrar General concerning congenital defects apparent at
birth. Notifications are received in the Health Department, recorded and scrutinised. Further information
may be sought from hospitals so that the defect can be more narrowly defined and accurately placed in classification
form.
A summary of notifications received and an analysis of malformations notified are shown in Tables
6 and 7.
MIDWIFERY SERVICE
(Table 8)
There are 19 full-time midwives on the establishment. 11 full-time and 2 part-time midwives were
employed at the end of the year. The vacancies are not being filled for the time being due to the diminished
number of home confinements.
The attachment of midwives to general practitioners' surgeries continued and the scheme is working
satisfactorily. Those Midwives not attached held their own ante-natal sessions, observing close liaison with
General Practitioners, Obstetricians and hospital services. Ante-natal care included classes in preparation for
child birth, and the classes were shared with Health Visitors.
Sterilised maternity packs were provided for all mothers having home confinements, and a modified
outfit was provided for early discharges from hospital.
The maternity medical services co-operation card was used between midwives, general practitioners,
and hospital services, ensuring that each member of the team was aware of attention given to the patients
by other members.
"Domino" Scheme
Under this scheme which commenced in conjunction with the Central Middlesex Hospital in September
1971, patients are delivered by the domiciliary midwives in a hospital suite. The selection of patients is
carried out by a Consultant Obstetrician who shares the ante-natal care with the midwives. Following delivery
the domiciliary midwife gives nursing care for approximately 48 hours in the hospital and then continues to
do so at home.
General Practitioner Unit
In October 1971 a small unit was made available in Central Middlesex Hospital to general practitioners
who wished to care for and deliver their own patients within the safetv of the hospital premises. The domiciliary
midwives participate in this scheme and share ante-natal care with the General Practitioner and continue to
look after the mother following delivery first in hospital and then at home.
Early Discharges
618 patients were discharged from hospital before the 10th day compared with 610 in 1970. The
majority were planned early discharges, others were accepted on account of emotional or domestic difficulties
and a number took their own discharge. Two part-time midwives were employed solely for the nursing of these
cases, assisted by full-time midwives acting as maternity nurses where necessary.
Refresher Courses
The Supervisor of Midwives and two midwives attended these courses in 1971 to comply with Section
G1 of the Central Midwives Board Rules.
Pupil Midwives
A total of 13 pupil midwives were accepted for Part 2 district training from St. Mary's and Central
Middlesex Hospitals. A community care programme of lectures and visits was organised to give a composite
picture to the pupils of the work of Local Authority as it affects community care generally and maternity
services in particular.