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107
other and the boroughs. Other considerations were the wide variation in density of
population, social and economic conditions.
At first, the Council's midwives had no definite limit to the area in which they
could book patients. Experience forced the Council to define practising areas for the
midwives to prevent the waste of effort involved in midwives "crossing each others'
doorsteps " to reach their patients and to save long journeys by patients and midwives,
e.g., for ante-natal care. When a patient specially desired to book a particular
midwife outside her area this was however arranged.
A further definition of areas may have to be made under the National Health
Service Act by the adjustment of the areas of district nursing associations and hospital
districts with each other and with those of the Council's midwives.
All domiciliary and district midwives are inspected by the Council as local
supervising authority under the Midwives' Acts to ensure that the rules of the Central
Midwives' Board are observed. Originally this was done by medical supervisors,
but in January, 1939, two positions of non-medical supervisor were substituted for
two of the medical supervisors. The number of non-medical supervisors was
subsequentlv increased.
Supervision
The development of the domiciliary midwifery service was affected, and at times
hindered, by a series of outside influences due mainly to the War. The following
records for the first three years of the service are of interest as showing the effect of
the war in its early stages :—
Average weekly number of confinements taken by all the Council's midwives during the periods quoted:—
January—June, 1938 60
July—December, 1938 71
January—2nd September, 1939 88
§3rd September—31st December, 1939 133
1st January—7th September, 1940† 166
November-—December, 1940 43
January—June, 1941 61
November—December, 1941 86
§ Outbreak of war.
† The first bombing began on 7th September, 1940, and heavy bombardment continued until the
middle of 1941.
As the weight of bombing lessened and the population drifted back to London
domiciliary midwifery settled down again, and the number of confinements and of
midwives gradually increased. In mid-1944 the attacks with V.l and V.2 missiles
were commenced, and there was a fall in confinements. This was followed by the
return to London that heralded the end of the war with Germany. Peace
brought a new fluctuation in an upward direction, as the birth-rate soared to its
post-war peak. By the end of 1947 it had become more steady, but owing to the
twin problems of housing shortage for the general population and of hospital bed
shortage for maternity cases the domiciliary midwifery service was still unable tc
find stability. On 5th July, 1948, it took its place as part of the free National
Health Service and it is still too early to assess what effect this may have had
on its development.
II—Home Confinements
With the foregoing generalisations in mind, it is interesting to look at the
following figures. Figure I shows the number of confinements attended annually
from 1938 to 1947 by all domiciliary midwives and, by way of comparison, the total
number of institutional and domiciliary confinements during the same years.
Figure II shows the relative number of confinements attended annually from 1938
to 1948 by the Council's midwives, district nursing association midwives and hospital
district midwives.
It really is amazing when one remembers the facilities available for sending
expectant mothers out of London that so many domiciliary confinements occurred
there—many of them in small houses—during the bombardment. It is a great
tribute to the fortitude of the mothers and the gallantry of the midwives.
Development