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PERSONAL HEALTH SERVICES
DOMICILIARY MIDWIFERY SERVICE
This service which operates under section 23 of the National Health Service Act, 1946
and under the rules of the Central Midwives Board is an excellent example of close
liaison between the four main parts of the National Health Service Act, i.e., Ministry
of Health, Hospital, General Medical, and Local Health authority services.
Domiciliary Antenatal and Post-natal Care
There are 14 antenatal sessions held weekly at clinics. All expectant mothers who
book midwives are also booked with a general practitioner for maternity medical
services. The number of mothers attending the antenatal clinics remained steady
throughout the year. The midwives paid 6,982 antenatal home visits, and 1,498
babies were born at home and visited afterwards for at least 10 days.
Liaison between Domiciliary Midwives and General Practitioners
Since 1962, any general practitioner obstetrician who undertakes the care of a
number of maternity cases, is offered the use of a Council's antenatal clinic to see
these patients, and at the same time the appropriate midwife is in attendance. Twentyfive
doctors availed themselves of these facilities.
Liaison between Domiciliary Midwifery and Hospital Services
The three local Hospital Management Committees convened Maternity Liaison
Committees where representatives of hospital staff, general practitioners and local
health authorities met regularly to discuss various problems and to try to improve
wherever possible the services available to the mothers.
Domiciliary midwives paid 1,134 visits to expectant mothers to assess whether on
social grounds a confinement in hospital was necessary or, where a hospital confinement
was arranged, whether a planned early discharge home was possible.
951 mothers were discharged from hospital less than 10 days after delivery and
nursed by the domiciliary midwifery service. Of this number just over 200 originally
were booked for home confinement and sent to hospital for some complication arising
in pregnancy or labour. 439 were planned early discharges and the remainder were
discharged early, either due to shortage of beds or because the baby died. Planned
early discharge from hospital is undoubtedly popular and has come to stay. It is
regrettable that in large wards it has an unsettling effect on patients whose medical or
home conditions preclude such an arrangement, and an increasing number of these
patients tend to discharge themselves. They, of course, receive the same after care
but present an increasing problem to the domiciliary midwives.
Night rota and off duty rota arrangements
The night rota and off duty rota continued to work smoothly. Only very close
co-operation with the Control Centre makes these rotas possible. This centre,
which is shared with the London Borough of Greenwich, has functioned since the
middle of March, 1965. It is staffed by specially recruited men who are accustomed
to dealing with the general public and with emergencies—i.e., retired police officers.
All calls from patients, after office hours, at weekends and on Bank Holidays, are
referred by the Control Centre staff to the appropriate midwife. (See also Home
Nursing and Mental Health). A supervisor of midwives is on call at all times.
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