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The high rate of infant mortality in the borough has been a matter of much concern to the council
for some years ; they have on various occasions reviewed the maternity and child welfare service
with the object of finding and introducing measures for securing an improvement. Towards the end
of the year they decided, after consulting the advisory committee to the infant welfare centres, to
appoint two whole-time medical officers to conduct the infant welfare sessions in place of the 14
part-time medical officers now engaged on this work. It is hoped that these two doctors will be
able to secure a better co-ordination of the maternity and child welfare service with the other medical
and social agencies in and near the borough, and bring about that reduction in the infant death
rate and that improvement in the health and well-being of the children in the borough which have
so long been desired. It is expected that the new whole-time medical officers will take up their
duties in the coming autumn.
Maternal Mortality.
In 1934, there were only three deaths of Kensington women directly associated with childbirth,
representing a death rate of 1.3 per 1,000 births. The rate for England and Wales was 4.4. The
Kensington death rate is a low one and is a record for the borough, but it could have been lower
still as in all three cases death was due to puerperal sepsis. One was a case of abortion ; the other two
deaths followed full-term deliveries. One of these was a case of very difficult labour but this might
have been prevented by more careful ante-natal supervision and better obstetric technique.
Very great attention has been paid during the year to the organisation of the ante-natal service
in the borough. The council's ante-natal medical officer is present in her office daily from 9 to
10 a.m. to see expectant mothers from any part of Kensington who need urgent advice. She attends
all the ante-natal clinics at the infant welfare centres and the number of ante-natal sessions has
been augmented since her appointment. There is now a weekly ante-natal clinic at four of the infant
welfare centres ; at the other four a session is held twice a month, but with the rapidly increasing
attendances, it seems probable that there will shortly be a weekly session at every centre. In addition
to the ante-natal clinics at the infant welfare centres, a weekly evening session is held from 7 to
9 p.m. at the Baby Clinic, No. 92, Tavistock Road, for the benefit of those expectant mothers whose
employment prevents them from attending a welfare centre during the day.
It is recognised that ante-natal work is not an entity in itself, but is valuable according to the
degree of co-operation between (he medical officer in charge of the clinic and the doctor or midwife
in charge of the confinement. Every effort, therefore, is being expended to improve the co-ordination
between the ante-natal service of the borough and the midwives, doctors and hospitals responsible
for the delivery of the patient. A very great improvement in this respect has been obtained since
the appointment of the whole-time medical officer who visits the borough maternity home and
the maternity ward at St. Mary Abbots Hospital weekly, and who has received most helpful
co-operation from both institutions. The obstetric surgeons at Queen Charlotte's Hospital and
St. Mary's Hospital have also been ready to assist with hospital treatment whenever required. Most
of the Kensington midwives are now co-operating in the ante-natal scheme and send all their patients
for medical supervision.
In 1934, there were 2,195 births in Kensington and the total number of Kensington women
who received ante-natal advice at the borough centres and at the clinics at Queen Charlotte's Hospital
and St. Mary Abbots Hospital was approximately 1,848. This represents 85 per cent. of the total
births and is a satisfactory figure in view of the fact that a large number of the remaining births
occur in better-class families where the mother receives ante-natal care from her own doctor or
from a specialist.
The expectant mothers are attending the borough ante-natal clinics regularly and follow-up
home visits by health visitors are rarely required. Patients are seen once a month until six months
pregnant and then at fortnightly intervals until the last month of pregnancy, when they attend
each week.
Obstetric Work in the Ante-Natal Clinics.
The value of the ante-natal clinic does not depend solely upon the obstetric work performed,
for its function is to educate the mother in hygiene, to remove her fear of the confinement and to
advise her as to any necessary preparations ; however, on inspection of the Kensington case records
for 1934, evidence of much useful obstetric work can be found and in several cases it is obvious that
the woman's life would have been endangered had she not attended the clinic. A selection of these
ante-natal cases is reported to show that the work in the borough is conducted on sound obstetric
lines.
A.—Constitutional disease complicating pregnancy.
(1) A case of chronic nephritis with marked changes in the heart and arteries in a woman of 38.
This patient had not realised that her symptoms were of serious import and had come to the clinic
to book for the maternity home. She was sent at once to a maternity hospital where it was decided