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31
good as those of Class V.) Further, although actual numbers
were fortunately small, babies of mothers who had no ante natal
care had a mortality rate some 5 times that of the overall national
figure.
Other facts brought to light by the survey were that during
pregnancy ⅓d of all women had no blood test for anaemia and
1/6 th did not have their blood pressure taken at each visit to the
doctor.
Maternity services are provided in three ways, viz, the hospital,
the local authority and the general practitioner, a situation
which often leads to frustration and even desperation when the
expectant mother is referred in turn from one to the other instead
of being allowed to deal with one agency only. Perhaps this
situation is responsible for the fact that, in the survey previously
mentioned, more than half the mothers did not attend for ante
natal care before the 16th week. This information will doubtless
give added impetus to those who would make out a case
for a unified service while maintaining that such a consolidation
will encourage a more ready response for these services from
the prospective mother.
It has long been recognised that priority for skilled obstetric
attention should be afforded the prima para, the young and the
rather older mother, and those mothers having their fourth or
subsequent child. This, to all intents and purposes, means a
hospital bed.
At present, when there are more women of child bearing
age than ever before and the birth rate is rising quite perceptibly,
the pressure on hospital beds for maternity cases is mounting.
Unfortunately, staff to attend these cases has not increased pro
rata; hospitals, therefore, are driven to institute a system of early
discharge which inevitably throws an added volume of work
on domiciliary midwives whose numbers are insufficient to cope
satisfactorily with such extra cases. Traditionally, the mother
of the young wife has been close at hand to assist, but with
the mobility of population resulting from the numerous housing
projects, one often finds the younger generation far removed
from this type of assistance.
Domiciliary midwifery is a local authority responsibility
and. as hospital facilities are unlikely to expand sufficiently
quickly, an increase in births and a growing number of early
discharges could create substantial difficulties locally.
Fifty years ago infant mortality in Greenwich was at the
rate of 108 per 1.000 live births, the actual number of children