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68
efforts have been made with success to increase the co-operation
between the Borough Council and the Hospitals. Regular quarterly
meetings are held to discuss the operation of the scheme, and
suggestions for improvement are often before the Committee.
The attention of all Maternity and Child Welfare Authorities
is specially drawn to the Recommendations in Section X of the
Report, the most important of which are those designed to
improve the standard of obstetrics:—
1. The establishment, under the direction of the Medical Officer
of Health, of an adequate service of Obstetric Consultants:—
(i) To assist medical practitioners, who undertake domiciliary
midwifery, in cases of doubt or difficulty in the ante-natal
period, at the time of confinement and during the
puerperium.
(ii) To conduct consultative ante-natal and post-natal clinics,
to which patients may be referred, by general practitioners
or from the routine ante-natal and post-natal clinics.
(iii) To exercise clinical supervision over the in-patient treatment
of the maternity patients for whom the Local
Authority assumes responsibility.
(iv) To supervise the treatment of patients suffering from
puerperal sepsis.
(v) To be responsible for the emergency domiciliary service
for cases of grave obstetric abnormality in which removal
to hospital is contra-indicated (e.g., certain cases of shock,
eclampsia, or haemorrhage).
(vi) To assist the Medical Officer of Health in the confidential
investigation of the circumstances associated with each
maternal death occurring in the area.
2. The Local Supervising Authority, in consultation with the local
medical profession, should, in future, be empowered to take
steps to ensure that the best obstetric skill is made available
in all cases in which midwives are required, under the rules of
the Central Midwives Board, to call in a doctor.
3. Emergency Units ("flying squads") should be provided whereby
members of the staffs of maternity departments will be