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Screening for Phenylketonuria
A highly specialised screening programme for every baby in the Borough was
adopted as a result of the Department of Health recommendation E/C 109/1/68.
The Scriver test (plasma chromatography) is being used for the early detection of
phenylketonuria and other allied disorders. The midwives were specially instructed
in the taking of blood by heel stab at the pathological department of Lewisham
Hospital. The test is taken whenever possible on the ninth day of life, the domiciliary
midwives being responsible for the babies born at home and those discharged early,
while the hospital midwives undertake the test on all babies staying in hospital the
full ten days. As the scheme had not been adopted by the hospitals in the Bromley
area, Lewisham babies born outside the Borough are followed up after discharge
by the domiciliary midwives. The screening commenced in October and to the end
of December 670 blood specimens had been taken by the domiciliary midwives.
Some positive results have been received but on second examination the results have
been normal in all but one case and that baby is still undergoing investigations.
Pupil Midwife Training
The Greenwich District Hospital commenced a Part II Training School in July,
and the first pupil midwife to undertake District training commenced in September.
Pupil midwives are now trained from Lewisham Hospital and Greenwich District
Hospital. The declining number of domiciliary confinements has affected the training
programme and the emphasis is now upon the social services available to the community.
As many deliveries as possible are made available to the pupil midwives,
but the Central Midwives Board has now agreed to accept any number of deliveries,
however small for each pupil, instead of a minimum of six complete cases. There
were 49 pupil midwives who completed training during the year and a further 13 are
in training at the present time.
Liaison Scheme with Domiciliary Midwives working within Lewisham Hospital
Planning has been going on throughout the year to establish a scheme to incorporate
the domiciliary midwives into the early discharge programme, the idea being to
give a greater continuity of care to patients who are only in hospital for a very short
time. Many difficulties have been experienced, particularly with accommodation
within the unit, but most of these have been overcome and the scheme is to
commence early in the new year.
Staff Training
Resuscitation of the New Born is an important part of the midwives' duty—only a
very few babies require special treatment. To assist the midwife to establish respirations
in a baby needing help neonatal resuscitation tubes and laryngoscopes have
been made available to the midwives. Proficiency in the use of this equipment is
maintained by practise on a model which is available at the Special Care Baby Unit
at Lewisham Hospital.
Statutory Refresher Courses
During the year three midwives attended refresher courses as required by the Central
Midwives Board.
Maternal Deaths
Under the procedure laid down by the Department of Health for the confidential
enquiry into maternal deaths, five maternal deaths were investigated.
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