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Uncertified
women,
48
By Section 1 (2) of the Midwives Act 1902 it has been illegal since March, 1910,
for any uncertified woman habitually and for gain to attend women in childbirth
except under the direction of a registered medical practitioner. During the year
enquiries were made into 21 cases in which it was alleged that a delivery had been
conducted by an uncertified woman. In seven of these no further action was taken ;
13 cases were dealt with by a verbal or written caution and in one case legal proceedings
were instituted, but the Council failed to obtain a conviction.
Still-births.
During the year, 720 still-births were reported by midwives in their practice.
The figures for previous years were : 1918, 535 ; 1919, 686 ; 1920, 896 ; 1921, 684.
Of these infants 398 were males, 315 females and in 7 cases the sex was not stated.
Of the 720 still-births, 400 were reported macerated, 310 not macerated and there
was no statement with regard to the remaining ten.
Puerperal
fever.
During the year 311 cases of puerperal fever were reported, of which 91 proved
fatal, a case mortality of 29 per cent. In addition to these cases the Registrar General
records 31 deaths from puerperal sepsis, which were, however, not notified as
peral fever. The distribution of the notified cases was as follows :—
Delivery conducted by Cases. Deaths
(a) Medical practitioners 117 33
(b) Certified midwives 116 29
(c) Medical practitioner and certified midwife 7 2
(d) Hospitals and Poor Law institutions 60 23
(e) Cases of miscarriage or abortion where no attendant was engaged 11 4
Total 311 91
Medical aid.
The rules of the Central Midwives Board provide that in certain emergencies,
which are specifically enumerated, a midwife must advise in writing that medical
help be summoned and must also see that such help is obtained. The form on which
this advice is given is sent to the doctor and a copy must also be sent forward to the
local supervising authority. During the year 6,804 of these notices were received,
as against 7,269 last year ; assuming that approximately 44,000 confinements were
conducted by midwives during the year it appears that medical aid was required
in just under 16 per cent. of the cases, a precisely similar figure to that of 1921.
Ophthalmia
Neonatorum
There is no part of a midwife s activities on which the Council lays greater stress
than a due observance of the rules of the Central Midwives Board dealing with inflammation
of the eyes ; the midwife is bound to call in medical aid for this condition
however slight it may be, and the case is at once followed up by one of the Council's
medical inspectors. The borough medical officer is also informed in order that the
health visitor may continue to keep the infant under observation after the midwife
has ceased her attention. The Voluntary Nursing Associations render most valuable
help in cases receiving domiciliary treatment.
The subject of in-patient hospital treatment for ophthalmia neonatorum came
under notice during the year. In July a conference was convened by the Metropolitan
Asylums Board with a view to considering what steps could be taken to bring about
an extended use of the facilities offered at St. Margaret's Hospital. It was stated that
about 25 per cent. of notified cases were sent into the hospital, whereas many more
could be accommodated. Later in the year the Departmental Committee on the
Causes and Prevention of Blindness referred to the matter in their report, giving
it as their opinion that for various reasons, it would be better to have a few beds
allocated to the treatment of ophthalmia neonatorum in some of the well-known
teaching hospitals rather than concentrate all the cases, as is now done, in one
institution. The whole subject is under consideration by the Council. The Departmental
Committee also referred to the general scheme of control of ophthalmia
neonatorum in force in London at the present time and expressed the view that
these arrangements were satisfactory.