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47
but has no power to provide medical or nursing midwifery services for
the district. Cases where midwives had spent many hours in endeavouring
to obtain the assistance of medical practitioners, thereby causing considerable
distress and perhaps undue suffering to women in confinement,
seemed to call for some action by the City Council, the authority empowered
to provide midwifery and medical services under the Maternity
and Child Welfare Acts.
While the Rules of the Midwives Board provide for the calling of
medical practitioners to assist midwives, payment for such services being
made by the London County Council, it has been happening with increasing
frequency that the practitioners in the neighbourhood are not available
to render assistance. The demands of private or panel practice or
disinclination to practise midwifery may account for the difficulties
experienced by the midwives. The Medical Officer of Health was
accordingly directed to communicate with the British Medical Association
for any suggestions which that body might offer for the solution of the
problem. Failing any result from these consultations it seemed appropriate
to approach the authorities of Westminster Hospital, who
already provide both indoor and outdoor midwifery services for cases
from the Maternity and Child Welfare Centres.
A further matter could be discussed with the Hospital—namely the
provision of expert medical assistance in medical practitioners' cases.
There are no doubt cases of difficulty in a doctor's midwifery practice
where a consultant's opinion and help might be of the utmost value but
where there are no means to pay for a consultant. The doctor attending
must either endeavour to obtain the patient's admission to Hospital or
decide to await developments. There is sometimes delay in sending
patients to Hospital and the risk of serious consequenccs may be greatly
increased. The provision of expert assistance for necessitous women in
confinements in their own homes, whether the case be under the care
of a midwife or medical practitioner, would appear to be an important
contribution to the efforts to reduce maternal mortality. It is hoped
that the scheme which is now being negotiated with Westminster Hospital
will ensure that in Westminster no woman in childbed need suffer for
the lack of skilled medical assistance.
Laboratory Facilities.—Arrangements with Westminster Hospital
for the bacteriological examination of material from suspected cases of
tuberculosis, diphtheria, etc., continue. From 1st April, 1933, a special
arrangement has been made for the examination of milk for tubercle
bacilli while as occasion arises other special examinations of water, milk