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6
The subject of maternal mortality and morbidity is naturally one
of supreme interest to all Authorities administering Maternity and
Child Welfare schemes. To the implications associated with the
known mortality amongst mothers, attention is necessarily directed,
and tends to dwarf, the even more important subject of ill-health
amongst women after confinement. Of the extent of ill-health amongst
mothers we have no actual statistical data. That it is extensive the
hospital records of gynaecological out-patient departments give ample
proof. A contribution towards a reduction in this ill-health may be
found to result from the working of the new Midwives' Act and the
London County Council's scheme for domiciliary midwifery, and
the linking up with the Borough Council's Maternity Service. The
provision by the London County Council of a municipal midwifery
service (available, at a maximum fee of £2, for any woman who
applies for it) naturally raises the question as to whether any alteration
should be made in the class of cases admitted to the Maternity Home.
When the Home was opened, the general overcrowding and unsatisfactory
home conditions made the admission of cases likely to follow
even a normal course, very desirable. Since then overcrowding has
been lessened and the London County Council domiciliary midwifery
service has come into being. In view of this, the point arises whether
the time has not arrived when the restriction upon the admission to
the Home of abnormal cases should not be lifted. From the point of
view of the potential patient it seems a hardship that the presence
of some abnormality debars her from enjoying the excellent care
received by patients in the Deptford Council's Maternity Home, with
its highly trained staff. In this connection it is of interest to note
that, of the seven maternity homes provided by Metropolitan Borough
Councils, three make provision for the admission of abnormal cases.
It would appear that in the case of two of those boroughs providing
these extra facilities (both having a resident medical officer) the
total cost per patient per week is materially less than in the case of
Deptford, where the cost for the year ending 31st March, 1937, was
over £6 per patient per week.
To Dr. Donnelly and to Dr. Hill I desire to express my sincere
appreciation of their valuable work in their respective spheres—
Tuberculosis and Maternity and Child Welfare; and to the Staff
generally my thanks for their loyal co-operation.
Your obedient Servant,
F. Leonard Keith, Medical Officer of Health.