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Maternity Beds.—All Local Authorities should make
arrangements for the institutional treatment of complicated
midwifery cases and for women whose homes are unfit for a
confinement to take place therein. Provision for the isolation
of infective cases is also necessary. Maternity homes
may be established by the larger Authorities, such as the
County and County Borough Councils, but the smaller Local
Authorities are seldom justified in establishing separate
homes and they should either combine with other Authorities
to provide a joint institution or arrange to send patients to
an institution elsewhere. Consulting obstetricians may be
required in connection with maternity homes or to assist the
general practitioner or the midwife.
Domestic midwifery and maternity nursing.—Steps should
be taken by the Local Supervising Authorities under the Midwives
Acts to promote a high standard of practice by midwives
and to assist midwives to maintain their efficiency by
attendance at post-certificate courses of instruction or otherwise.
Maternity nursing by trained midwives should be
encouraged whether a dootor is engaged or not, and the
employment of unqualified " maternity nurses ° should be
controlled as far as practicable. It may be desirable to
employ specially skilled nurses for the home nursing of
complicated cases.
Investigations.—It is desirable that there should be an
investigation in every area by a competent and experienced
Medical Officer of all maternal deaths, and of all cases of
puerperal fever and all still-births and neo-natal deaths,
with a view to ascertaining and preventing the causes likely
to lead to maternal or infant mortality.
Educational measures.—The Local Authority should take
such means as may be practicable to create an informed and
enlightened public opinion in regard to this question of
maternal mortality, as no arrangements for prevention or
treatment can be fully effective unless the intelligent support
of those most directly concerned can be obtained.
The Minister suggested that the Medical Officer of Health
should be instructed to report upon the steps necessary to
provide an efficient maternity service in the area of the
Authority, and intimated that he would be prepared to consider
any proposals of the Local Authority for this purpose
which may be submitted for his approval under the Maternity
and Child Welfare Act, 1918.
In accordance with your instructions I submitted a report
showing that with the exception of the supervision of Midwives
and Maternity Homes (this work coming under the
jurisdiction of the London County Council) the Scheme for
Hammersmith included all the activities mentioned in the