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MATERNAL AND CHILD HEALTH
DOMICILIARY MIDWIFERY
Valerie J. Buckingham, S.R.N., R.F.N., S.C.M., M.T.D., N.D.N.Cert.
(Assistant Principal Nursing Officer)
During 1969 there was a fall in the birthrate of 1.9 per 1,000 population within the
Borough. There were a smaller number of domiciliary confinements: 574 compared
with 849 in the previous year. The domiciliary confinement rate (the number of
domiciliary births as a percentage of all live births) was 12.7% for the year.
The Early Discharge Scheme remained popular. There were 1,284 early discharges
compared with 1,361 in 1968. Although these figures suggest a fall in the use of the
service, they should be olfset against the decrease of 550 births in the year. The
Early Discharge rate for the year was 28.5%, making the proportion of maternity
patients cared for by the domiciliary midwives 41.2% of the total births.
There were a number of stalf changes during the year; six of our experienced
midwives have left us and two new midwives have been appointed.
In addition to the 547 patients delivered in their own homes a further 124 were
booked for domiciliary confinements but they were subsequently delivered in hospital.
Of this number, 45 patients were admitted to hospital in labour for the following
reasons:—
Premature labour—10 patients
Incoordinate uterine action—10 patients
Ante-partum haemorrhage—9 patients
Foetal distress—7 patients
Delay in the second stage—5 patients
Abnormal presentation—1 patient
Other reasons—3 patients.
Ante-Natal Care forms a major part of the domiciliary midwife's role, co-operating
with the general practitioner obstetrician to provide dual care for many of the Early
Discharge patients, in addition to the service provided for the patients booked for
domiciliary confinement. 7,943 ante-natal attendances were made, a decline on the
previous year when 8,991 were made, but this figure is proportionately high for the
number of domiciliary confinements, thus proving a wider involvement with the
early discharge patients. 8,834 ante-natal home visits were also made during the
year.
Careful ante-natal follow-up resulted in changed bookings for 79 patients for
the following reasons:—
Post maturity—34 patients
Toxaemia and hypertension—16 patients
Ante-partum haemorrhage—6 patients
Rhesus incompatibility—3 patients
Abnormal presentation—2 patients
Anaemia—2 patients
Social reasons—2 patients
Other reasons—14 patients.
The Emergency Obstetric Unit operating from Lewisham Hospital was called out
on 16 occasions.
Premature Babies.—There were 16 premature babies born at home, of this number
5 were transferred to the Special Care Baby Unit at Lewisham Hospital, while 11 were
nursed at home.
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