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39
(ii) If the patient cannot be moved, the doctor, or in his absence, the midwife
may telephone for the emergency obstetric unit consisting of a hospital team of
obstetrician and nurse who can give emergency treatment, e.g., blood transfusion,
in the home. During the year 62 calls were made on the emergency
obstetric units by the Council's midwives. Doctors can also call in an obstetric
consultant for specialised advice in the home.
(iii) The Council's midwives attend hospitals to take the course of training
and examination in the administration of analgesia.
(iv) Hospital pupil midwives spend three months of their Part II midwifery
training with domiciliary midwives who have been approved by the Central
Midwives Board as district midwifery teachers. The pupils reside with their
teachers and are instructed in the full duties of the domiciliary midwife before
and during labour and the lying-in period. The same training is also provided
by certain district nursing associations and the pupil midwives reside for three
months at the district homes of the associations. During the year 128 pupils
were so trained with the Council's and district nursing associations' midwives.
(v) Domiciliary midwives are issued with drugs and dressings from the
hospital dispensaries.
Before 5th July, 1948, payments were made to district nursing associations and
hospitals at the following rates for each domiciliary confinement:—
District nursing associations £5 12s. l0d.
Hospitals £5 2s. 8d.
Payments for relief of the Council's midwives were made in addition at the rate of
£1 1s. for twenty-four hours, and 12s. 6d. for twelve hours or less. From 5th July,
1948, the payments to district nursing associations were merged in the deficiency
grants made to them for midwifery and home nursing and the rate of payment to
the hospital has been increased to £7 13s. 4d. a confinement.
Payments to
District
Nursing
Associations
and Hospitals
Fees paid by patients (£4 for first confinement; £3 for subsequent confinement
or maternity nursing) ceased at 4th July, 1948, as required by the National Health
Service Act.
Fees from
patients
Midvrives Acts, 1902 to 1936
A large increase in the number of notifications of intention to practise took place
in 1948, as a result of the revision of Rules E of the Central Midwives Board. The
revised rules contained two new requirements, viz., (i) that midwives must notify their
intention to practise as midwives when employed in institutions, and (ii) that midwives
practising as maternity nurses must notify their intention to act as such, thus
for the first time, so far as the latter are concerned, coming under supervision by
the periodical inspection of their statutory records and their appliances. The number
of notifications, compared with the previous year, was:—
1947 1948
As midwives 928 1,213
As maternity nurses Nil 289
The supervisors of midwives visit all cases of puerperal pyrexia and all children
with skin lesions and inflamed eyes. On twenty-five occasions midwives were suspended
from practice for varying periods to prevent the spread of infection.
Notifications
of intention
to practise
There were three maternal deaths among women booked for home confinement,
two after removal to hospital following delivery and one at home. Of the two cases
removed to hospital, one died six days after delivery from haemolytic shock after
blood transfusion, and one 37 days after normal delivery of twins from pulmonary
embolism and low grade puerperal infection. The third patient died at home from
post-partum haemorrhage 24 hours after delivery.
Maternal
deaths
Two courses of six post-certificate lectures each, and five courses of four antenatal
and post-natal demonstrations, were arranged in conjunction with the Middlesex
Lectures, etc.,
for midwives