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supervision given to patients by practising midwives, except those attended by
the midwives of the Post-Certificate School, which numbered 400 in 1933. It is
interesting to note that the individual attendances of expectant mothers at AnteNatal
Clinics in this Borough, attached to Infant Welfare Centres, only numbered
259 during 1933.
The establishment of Ante-Natal Clinics at Infant Welfare Centres in
Camberwell was to a large extent for the purpose of placing the facilities of these
clinics at the disposal of midwives who were unable to do ante-natal work of the
required standard, and for women who had no family doctor.
It was not intended that a midwife should no longer carry out her obligation
of routine examinations, but that she should bring or send her patients to the
Medical Officer at the Clinic for the purpose of confirming whether her conclusions
concerning the patient's health and progress of the pregnancy were correct, as
well as to receive advice in cases where special treatment might be deemed
necessary.
In my opinion, the work of these Ante-Natal Clinics is excellently carried
out, yet an improvement from the point of view of individual attendances is
clearly indicated.
Past endeavours to encourage greater use of the Clinics at the Maternity
and Infant Welfare Centres have unfortunately been disappointing. This lack of
co-operation, particularly on the part of midwives, is probably due to the fear of
losing the monetary consideration of confining a woman should the Clinic Medical
Officer decide, in the interest of the patient's health, to refer her to a doctor or a
hospital for her confinement.
The fact that the L.C.C. is the supervising authority of midwives may also
influence their attitude to the Centre Clinics, or they may have other reasons to
offer why they do not bring or send their patients to these Clinics.
There is a steadily increasing desire by women to-day to enter hospitals
for their confinement, and to take advantage of the fully equipped Ante-Natal
Clinic attached to these institutions with its facilities for diagnosis and treatment of
abnormal physical conditions during pregnancy and to receive the benefit of a
medical examination following confinement.
I would accordingly suggest for consideration that the L.C.C. be approached
to enquire whether they would be willing to place their Hospital Clinics at the
disposal of private medical practitioners and practising midwives in the Borough
for patients who have made arrangements to be confined in their own homes.
It is difficult to indicate the number of such patients who might be referred
to these Clinics, as well as to judge the number of attendances necessary for each
patient, but I should think that at least 300 patients a year, and on the assumption
that each patient would be required to attend at least three times, I am of opinion
that the sum of £100 should be sufficient to provide these services, subject to
agreement.
If this suggested Scheme is approved it is not unlikely that a percentage
of midwives' patients may be recommended by the Hospital Clinic Medical Officer
to enter the Hospital for their confinement. In such cases I would suggest that
a compensation payment of 10s. per case be paid to the midwife. Ido not anticipate
that this should cost more than, say, £10 per annum, and I base this figure
on information obtained of the experience of certain Metropolitan Boroughs where
provision is made for such payments to midwives for the loss of a patient.
The proposals outlined in this report may therefore be summarised as
follows: —
(a) That the L.C.C. be asked to enter into an agreement with this Council
to undertake the medical examination and supervision at their Hospital
Ante-Natal Clinics of patients to be confined in their own homes either
by a private medical practitioner or a practising midwife, such services
to include a post-natal examination of every patient. I suggest that this
service could perhaps be provided at a cost of £100 per annum.
(6) That compensation payments be made by this Council to midwives
for the loss of a patient in the event of an institutional confinement