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The Midwives and Maternity Homes Act, 1926, amended section (ii) of the
Midwives Act, 1902, so as to make it an offence for any uncertified person to attend
women in child-birth, except under the direction and personl supervision of a
registered medical practitioner, unless the case was one of sudden or urgent necessity.
During the year 7 enquiries were made into such cases, as compared with 8 in 1927.
In 1 case no further action was taken; in 5 a verbal or written caution was administered.
The remaining case was prosecuted and the defendant was bound
over in the sum of £10 and mid 21s. costs.
Uncertified
persons.
The Births and Deaths Registration Act, 1926, requires that the birth of every
still-born child shall be registered by the registrar in a register of still-births, containing
the heads of information prescribed by the first schedule of that Act. During
the year there were 473 still-births reported by midwives in their practice, as compared
with 582 in 1923, 594 in 1924, 510 in 1925, 513 in 1926 and 486 in 1927. Of the
cases reported this year, 256 were male and 215 female, while in 2 cases the sex
was not stated. 279 were reported as macerated. 192 not macerated, and in 6 the
condition was not stated.
Still-births.
During the year 294 cases of puerperal fever were reported, as against 267 in
1927. 55 of these cases proved fatal, as compared with 40 in 1927, a case mortality
of nearly 18.7 per cent. as compared with 15 per cent. in 1927. In addition, the
Registrar-General recorded 33 deaths from puerperal sepsis which were not certified
as fever, as compared with 23 the previous year. The distribution of notified cases
with the mode of delivery was as follows, deaths being shown in brackets :—Medical
practitioners, 110 (19) ; Certified midwives, 58 (10) ; Medical practitioner and
certified midwife, 5 (2); Hospitals and poor law institutions, 91 (17); Medical
students, 11 (1); Cases of miscarriage or abortion where no attendant was engaged
16 (5); Uncertified women, 1 (0); Not ascertained, 2 (1). Total, 294 (55).
Puerperal
fever.
In July, 1926, the Ministry of Health made Regulations requiring the notification
of puerperal pyrexia which is defined by the Regulations to be " any febrile condition
(other than a condition which is required to be notified as puerperal fever under
the Infectious Diseases (Notification) Acts) occurring in a woman within 21 days
after child-birth or miscarriage in which a temperature of 100-4 Fahrenheit (38
centigrade) or more has been sustained during a period of 24 hours or has recurred
during that period."
Puerperal
pyrexia.
The Regulations were amended in 1928 and now require a medical practitioner
to notify any such case on the approved form and transmit the notification to the
medical officer of health of the district in which the patient is actually living at
the time of notification. In addition any notification of a case in a London hospital
must specify the place from which and the date at which the patient was brought
to the hospital and shall be sent to the medical officer of health of the district in
which the said place is situated. 787 notifications of puerperal pyrexia were received
during 1928, as compared with 892 in 1927. 42 of these cases proved fatal and
were distributed as follows, the deaths are shown in brackets:—Medical practitioners,
248 (14); Certified midwives, 155 (11); Medical practitioner and certified
midwife, 9 (2); Hospitals and Poor Law institutions, 319 (9); Cases of miscarriage
or abortion where no attendant was engaged, 32 (4); No information, 3 (2). Total,
787 (42).
22 of the cases, with 7 deaths, were subsequently notified as puerperal fever,
and are therefore shown in both tables.
The Rules of the Central Midwives Board indicate the emergencies for which
a midwife must advise in writing that medical aid be obtained, and for which such
help must be secured. A notice in the approved form is sent to the doctor, and
London County Council. In the year now under review 6,984 such notices were
received, as compared with 6,622 in 1927. The estimated number of confinements
Medioal aid.