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MATERNAL AND CHILD HEALTH
DOMICILIARY MIDWIFERY
Valerie J. Buckingham, S.R.N., S.C.M., M.T.D.
(Midwifery and District Nursing)
During the year a changing pattern of patient care in the Domiciliary Midwifery
service has become evident with the fall in domiciliary confinements.
The birth rate dropped only 0.3% but there was a swing in favour of Planned
Early Discharge from hospital, particularly during the second half of the year.
Domiciliary confinements were:
January to June — 530 = 20.3 % of total births
July to December— 319 = 10.8% of total births
thus giving an overall domiciliary confinement rate of 16.4% for the year. The
increased popularity of the Planned Early Discharge Scheme is evident; there were
1,361 early discharges = 26.4% of total births as against 1,075 in the previous year.
It is interesting to note that the domiciliary midwives nursed 43% of all patients
delivered within the Borough; at present 20 full-time and 2 part-time midwives are
employed.
In addition to the 849 patients confined in their own homes a further 252 patients
were booked for domiciliary confinement but were subsequently delivered in hospital.
Good comprehensive ante-natal care given by the midwives and general practitioners
resulted in 180 patients being transferred to the care of a consultant obstetrician
for the following reasons:
Post maturity—60 patients
Anti-partum haemorrhage—24 patients
Pre-eclampsia—17 patients
Abnormal presentations—16 patients
Anaemia—7 patients
Rhesus incompatibility—3 patients
Of the 72 patients who were admitted to hospital because of complications occurring
during labour the following are of interest:
Primary uterine inertia—23 patients
Delay in the second stage—17 patients
Foetal distress—10 patients
Abnormal presentation—8 patients
Ante-partum haemorrhage—4 patients
The Emergency Obstetric Unit
This unit, operating from Lewisham Hospital, was called out on 15 occasions.
Premature Babies
25 premature babies were born at home; of this number 6 were transferred to hospital
while 19 were nursed at home.
Dual Care Ante-Natal Scheme
During the year general practitioner obstetricians within the Borough have undertaken
ante-natal care for their patients who are booked for confinement in Lewisham
Hospital. About 30 general practitioner obstetricians are in this scheme and 14 of these
doctors also attend the midwives ante-natal clinics. Thus where possible the patient
attends the clinic where she can be seen by the doctor and the midwife.
Attendances at ante-natal clinics amounted to 8,991 a decline on the previous
year, but the number of ante-natal visits made to the patient's own home (11,176)
remained constant.
Post-natal visits made by the midwives totalled 22,248.
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