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49
has been necessary. A payment of 12s. 6d. is made for every woman referred by
the Council's medical staff; 1,031 cases were so referred during the year.
There are now 27 weekly sessions held by the Association in Council and other
premises and in addition 5 sessions a week are held by the Council at which family
planning advice is given.
Letting of
premises
The policy of letting rooms in health service premises has been considered.
It is desired to restrict such lettings to bodies akin to the health service. Within this
limitation a scale of charges and conditions of letting have been laid down.
Care of premature babies
Special equipment is provided for use when a premature infant is being nursed
at home. Three sets of equipment are held in each of the nine divisions and are
available on request. A deposit is made for the loan of a set and is refunded in full
on return of the set.
The arrangements outlined in my report for 1948 with respect to special transport
arrangements when these infants have to be removed to hospital have operated
throughout 1950. The specially heated cots carried on the ambulances were used
on 68 occasions for premature infants.
Premature babies bora at home: special report on 416
Every domiciliary midwife is asked to report immediately to the supervisor
if she delivers a baby of 5½ lb. or under whether or not it is premature. For the
purpose of this report all still-births have been excluded.
416 babies of this weight were born alive to 385 mothers. In each case the
supervisor visited the home to make sure that medical aid had been called where
necessary, that all facilities for the proper care of the baby were available, to arrange
for loan of premature baby equipment where necessary and to arrange the midwife's
other work so that she would be able to devote sufficient time to the premature baby.
This supervision often necessitated several visits. In their reports the supervisors
have followed up the case for 28 days or until the child was well established.
Medical aid
By the rules of the Central Midwives Board a midwife must call medical aid
for any abnormality. A low weight by itself is not regarded as abnormal, but if the
infant is feeble, a doctor must be called. In the 385 confinements, 189 were attended
by a doctor, either because he was already in charge or because he was called in by
a midwife.
Hospital
care
It is the duty of the doctor to decide whether or not the baby should remain at
home. 100 of the 416 babies were removed to hospital as soon as possible after birth
either on account of their poor condition or because the home conditions were
unsuitable for the proper care of a premature baby. Babies under 4 lb. and any over
that weight who required oxygen were removed. In all cases they were transported
to hospital by the ambulance service in a specially heated cot. Not a single baby died
during the ambulance journey. Where possible the mother was admitted to hospital
with the baby, but unfortunately several of the premature baby units have no
accommodation for mothers. It is appropriate here to pay tribute to the excellent
judgment shown by midwives and doctors on this point. In only 4 cases where the
child died during the first 4 weeks is it at all possible that earlier removal to hospital,
might have made any difference.
Causes of
prematurity
This is a selected group of cases. As so many primiparae are booked for hospital,
the ratio of them to multiparae was 1 : 4. There were 76 primiparae and 309 multiparae.
69 of all infants were not premature according to estimated gestation period
and were 5 lb. or over in weight. 15 of the multiparous mothers had had a small
baby before. Cases of severe toxaemia and placenta praevia were transferred to
hospital during pregnancy so that, the fact, that, these disorders did not appear as