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Domiciliary Midwifery.
The trend of obstetric opinion has tended of late to favour domiciliary midwifery in normal
cases, and the council have paid considerable attention to this important subject during the year,
with the result that the facilities for confinement at home are now complete, irrespective of the
patient's financial means.
For patients in comfortable circumstances, the borough is fortunate in its doctors and midwives;
skilful obstetric care has been given by Kensington practitioners to patients referred to them from the
clinics and the Kensington morbidity rate is low. A panel of private midwives has been formed in
North Kensington, who work in co-operation with the borough ante-natal centres, a small subsidy
being paid on each case they send to an ante-natal clinic. In addition, the council have decided to
pay a sum in compensation to any Kensington midwife whose patient may be referred to hospital by
the ante-natal medical officer, so that the fear of a loss of fee will not prevent a midwife from sending
her patient for advice. On two occasions during the year it has happened that a midwife's case has
needed an anaesthetic for the rectification of a malpresentation during pregnancy for which it was
impracticable to obtain the services of a private doctor. In these cases the necessary treatment has
been carried out at Queen Charlotte's Hospital, the patient subsequently returning home for a normal
confinement and the midwife retaining her case. This linking together of the midwife with the most
suitable hospital for each individual case through the medium of the ante-natal clinic, thus forming
a complete and co-ordinated midwifery service in the borough, is one of the reasons for the success of
the council's ante-natal scheme.
Kensington is especially fortunate in that its northern area is served by the maternity district
of Queen Charlotte's Hospital, whose midwives attend a large number of women in their own homes
and are always ready to attend necessitous cases for a nominal fee or free of charge. The high
standard of work of this hospital is of considerable value in keeping down the morbidity rate in the
borough.
In South Kensington, where the facilities for domiciliary midwifery were insufficient for patients
in poor financial circumstances, the council have appointed a whole-time midwife and grant a remission
of her fees in necessitous cases. The services of the municipal midwife are also available as a
maternity nurse to any Kensington woman who has engaged a doctor for her confinement but cannot
afford a nurse's fee in addition ; this should entirely eliminate the employment of the dangerous
untrained handywoman and enable any woman, however poor, to have the services of a trained
midwife at her confinement.
Post-Natal Examination.
Arrangements are now being made by the council's women health officers for every woman who
does not receive a post-natal examination from her own doctor or midwife to attend the borough
post-natal clinic for this purpose. This routine examination after confinement will ensure that
treatment is arranged for any condition which may cause difficulty or danger in a subsequent
pregnancy and it is hoped that invalidism will thereby be reduced.

* This officer also acts as infant life protection visitor.
The visiting in connection with tuberculosis and factories and workshops is dealt with in the
sections of this report dealing with those subjects, and a complete record of the work performed
by each woman health officer during the year appears in Table V of Appendix II.