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Domiciliary Midwifery Service - Section 23, National Health Service Act, 1946
For the first time since the operation of the Midwives Act, 1936, the Borough
became the local supervising authority for all midwives practising in its area. This
entailed the statutory supervision of some 190 midwives, 15 of whom were directly
employed by the Council in the domiciliary service.
Domiciliary Confinements
231 confinements took place within the Borough between January and March and 367
from April until December. 60 other patients were transferred to hospital in labour,
due to complications, and 13 calls were made to the emergency obstetric unit. In
addition to the nursing of delivered patients, 1,329 ante-natal visits were made at
welfare centres, 22 ante-natal clinics were held weekly, 13 conducted by Domiciliary
Midwives and 9 for patients booked for Hospital confinement.
Home Assessments
Owing to the limited number of maternity beds available to the area, not everyone
who would like a hospital confinement could be accommodated. Medical classifications
were prescribed as essential for admission to hospital. Those who did not qualify
were visited at home with a view to booking for domiciliary confinement if the conditions
were suitable. 623 of these visits were made during the nine months period;
at least 50% of the homes proved to be unsuitable.
The Early Discharge Scheme
This scheme helped to relieve the pressure on hospital accommodation. Separate
figures were not available for the first three months; but during the ensuing nine
months, 550 home assessment visits were made, as a result of which 367 mothers were
accepted home after 48 hours for nursing by the Council's midwives. Two part-time
midwives (later increased to three) were employed especially for this work. The
immigrant population within the borough presented a special problem to the maternity
service as their living conditions were so often unsuitable for either domiciliary
confinement or an early discharge from hospital.
Maternal Deaths
6 maternal deaths were investigated of women who had lived within the borough.
All occurred in hospital.
Stillbirths
5 domiciliary stillbirths occurred between April and December, three of which
were attended by a Council midwife, two of these were macerated; no obvious cause
could be found for the third.
Accommodation
The Council took over accommodation for midwives in the hostel and in various
housing properties, and the former charges to the midwives continued. A proposal to
adapt a cottage to take a midwife was subsequently agreed.
Health Visiting - Section 24, National Health Service Act, 1946
The Council for the Training of Health Visitors in a pamphlet published in 1964
defined a health visitor and her duties thus - 'A health visitor is a member of the
public health nursing team, concerned in teaching the principles of healthy living and
in counselling all members of the family. As a member of the staff of a local health
authority she may work from a central office or clinic, or from her own home. She has
contact with family and clinic doctors, midwives, home nurses, home helps and other
staff concerned with the provision of welfare services, and members of many voluntary
organisations. Much of the work of the health visitor is undertaken in the homes,
where she can talk with individuals in their own environment. Families which include
a handicapped member of any age may receive advice and help, as may patients recently
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