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The Emergency Obstetric Unit
This was called on eight occasions, twice by General Practitioners requiring
assistance with patients who were bleeding having had incomplete abortions. On
six occasions the midwife called the unit for assistance with complicated deliveries.
Ante-natal Care
The principal of shared ante-natal care with General Practitioner Obstetricians and
the hospital involves the domiciliary midwives. Many of the patients who are
booked for 10-day stay in hospital or planned early discharge, receive ante-natal
care at clinics where both the General Practitioner Obstetrician and the Midwife
see patients. Attendance at ante-natal clinics amounted to 4,604 and an additional
6,038 ante-natal visits were paid by midwives to patients in their own homes. Many
of these visits were paid to patients who failed to keep hospital appointments.
The opening of the Jenner Health Centre in October provided an opportunity to
increase the attachment of midwives to General Practitioner Obstetricians. Four
doctors are working at the centre and two midwives are working with them. This
change has necessitated the reorganisation of the working arrangements for the area;
the geographical area has now been abandoned. Each of the eight midwives in the
area works with a number of doctors; the amount of midwifery involvement in a
practice decides the number of doctors a midwife can reasonably serve. Ante-natal
care by the midwife is undertaken at the health centre. One of the advantages of
"attachment" is the better communications between doctor and midwife and the
fewer people who need to be involved in consultations when problems arise.
The Planned Early Discharge Scheme
The scheme continues to maintain its popularity, although there was a slight
decrease in numbers (1,355 discharges in 1970—1,295 in 1971). The disturbing
factor is the number of patients who discharge themselves from hospital haphazardly.
There is no upper limit set to the number of patients who may be booked
for planned early discharge.

During the year 1,240 assessments of home circumstances were made in conjunction
with the scheme. 124 homes were considered quite unsuitable. Patients from
some of these unsuitable homes may have subsequently taken their own discharge
against medical advice. It would appear that patients who left before the tenth day
irregularly, did not settle or were unhappy in hospital. This is an interesting fact
when considering the pressures for 100% hospital confinement.
Pupil Midwife Training
We have continued training programmes with Lewisham Hospital and the Greenwich
District Hospital. Forty pupil midwives completed training during the year and a
further nine pupil midwives are in training at the present time. Discussions took
place during this year to investigate the possibility of undertaking a single period of
midwifery training. The idea was acceptable and a training programme was
subsequently submitted to the Central Midwives Board and agreed. The new course
will be commencing in May 1972 with an intake of ten students.
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