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To meet this difficulty it was thought wise before submitting any report to endeavour to
ascertain what is in fact happening in the Borough.
With this object particulars have been collected of the ante-natal arrangements obtaining
in 1907 consecutive cases.
From a mass of detailed information the following general conclusions emerge :—
(1) Of these confinements 42 per cent. took place in the home and 58 per cent. in various
public institutions.
The confinements in the home were conducted as follows (percentages are of total
1907 cases) :—
By midwives 13 per cent., medical students 9.5 per cent.; midwives attached to the
nursing associations 7 per cent.; doctors in private practice 5.5 per cent.; midwives attached
to hospitals 4 per cent.; doctors attached to hospitals 1 per cent.; doctors called in in
emergency 1 per cent.; pupil midwife 1 per cent.
The following is the order of frequency with which confinements were conducted
in various institutions (percentages as above):—St. Pancras Hospital 22 per cent.;
University College Hospital 13 per cent.; Middlesex Hospital 4.5 per cent.; Queen
Charlotte's 2.5 per cent.; Royal Free Hospital 2 per cent.; ten others (in all) 14 per cent.
(2) In this enquiry ante-natal care has been considered from two points of view :—(a)
date of commencement—anything later than seventh month being classed as unsatisfactory;
(i>) ante natal care subsequent to the first ante-natal examination.
(a) In 16 per cent. of all cases arrangements for confinements (booking) were not made
until after the seventh month, and in 36 per cent. of all cases the primary ante-natal
examination was not made until after the seventh month.
It will be seen that 20 per cent. of all cases, although booked before the seventh
month, did not for one reason or another receive a primary ante-natal examination until
after the seventh month. Twenty-five cases did not book (1.3 per cent.). In 119 cases or
6 per cent. no ante-natal examination was made.
(b) In 105 cases the ante-natal care subsequent to the primary ante-natal examination
was unsatisfactory.
The number of cases in which the ante-natal supervision reached a reasonable standard
under both headings (a) and (b) was 1149 or 60 per cent.
(3) The foregoing figures suggest the need in St. Pancras of a scheme designed to secure
co-operation between all those responsible for ante-natal care. The Borough is fortunate in
being able to draw upon abundance of good will and medical skill, but without co-ordination
effort in one direction is likely to defeat effort in another.
(4) In the Ministry of Health Memorandum 156/M.C.W. the importance of early and
regular ante-natal supervision receives special mention. Ante-natal supervision should be
undertaken by a doctor having special experience in this branch of medicine and ancillary
thereto; facilities such as milk and meals, sewing classes, maternity dressings, and home helps
should be available.
The primary ante-natal examination was made at the Borough Council's ante-natal clinics
in 379 instances, that is, in 21 per cent. of all cases in the series receiving ante-natal supervision.
This proportion suggests that it is neither practicable nor desirable that the Borough
Council should itself try to undertake ante-natal supervision in every case.
(5) With a view to assisting co-ordination (section 3 above) it is suggested that an effort
should be made to induce every institution and every individual booking a confinement to
obtain the consent of the woman to recommendation being sent to the Maternity and Child
Welfare Department of the Council as to the proposed ante-natal supervision and as to any
assistance from the ancillary services of the Council that may be required. The Council's
Health Visitors would then be able to follow up such cases with a view to securing continuity
of ante-natal supervision and to rendering assistance in the various difficulties that may arise.
Any case referred to the Borough Council under such conditions as the Borough Council
may from time to time approve should, it is suggested, be eligible under the Council's antenatal
scheme upon exactly the same terms as women attending the Council's own ante-natal
clinics.