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MATERNAL MORTALITY
The Department has continued with the confidential investigation of all maternal
deaths, that is deaths directly due to pregnancy and childbirth, (formerly a function
of the Public Health Department of the London County Council). They include
those attributable to abortion as well as deaths ascribed to other causes associated
with pregnancy.
In each case information on ante-natal care is obtained from the local health
authority clinic, general practitioner, general practitioner obstetrician, and from
maternity home or hospital (both in-patients and out-patients) and brought together.
Besides facts about the patient's physical condition, other information centrally
gathered concerns the follow-up of missed appointments, the need, and availability
of a hospital bed or domestic help and, where the domiciliary midwife was in attendance,
a description of the labour and puerperium. If a post-mortem has been
carried out a copy of the report is obtained. The appropriate consultant obstetrician
adds his own report describing the labour and puerperium. He also comments upon
any difficulty or delay in obtaining medical aid or hospital admission; the availability
and any use of the "flying squad", and the presence of an anaesthetist.
The completed history of each case is passed to the Regional Assessor selected
by the Ministry of Health. The Regional Assessor forwards his assessment to the
Ministry, indicating whether he considers there was any failure in the administrative
arrangements, clinical management or of co-operation from the patient or her
relative.
The investigations are conducted solely for scientific purposes to assist in the
prevention of further maternal deaths. The information about individual deaths is
strictly confidential, but the Ministry of Health publishes a triennial analysis.
During the year 4 maternal deaths occurred and were reported upon.
DAY NURSERIES AND CHILD MINDERS
Private Day Nurseries
There are seven private nurseries registered with the Council under the Nurseries
& Child-Minders Regulation Act, 1948. The Act regulates premises which are not
wholly or mainly private dwellings in which children under the upper limit of compulsory
school age are received to be looked after for the day or part of the day, in
order to secure the safety and well being of the children.
So far as possible formal application is discouraged until the Council's officers
have had an opportunity to visit the premises to discuss the project with the applicant
and to report upon the suitability of the premises for use as a day nursery. On receipt
of the completed application form the Borough Surveyor and the Town Planning
Officer are asked to deal with fire escape provisions and land development requirements
respectively. The Health Committee approves the application before the
premises can be registered as a day nursery.
Places are available for 174 children in these private day nurseries.
Child Minders
There are two types of child-minders, i.e. voluntary and statutory. The voluntary
scheme applies to daily minding of one or two children under the age of five and not
attending school. The statutory scheme is applied to those minding three or more
children who register under the Nurseries and Child-Minders Regulation Act, 1948.
Under both schemes registrations are considered on their merits after the applicants
are visited and interviewed at their homes. In the case of statutory child-minders the
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