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62
Comments.—During the year the obstetric emergency service was called mainly
for true obstetric emergencies, i.e., sixty-five cases of retained placenta and/or
post-partum haemorrhage and/or obstetric shock. In five cases of malpresentation
or obstructed labour three calls were made by doctors unable to deal with the case
themselves and two calls by midwives unable to obtain medical aid. In only two
cases was the service called for conditions in the infant.
In all cases to which the service was called the mother made a good recovery.
There were three stillbirths and one infant death.
Pupil
midwives
At the end of 1951, 73 of the Council's domiciliary midwives had been approved
by the Central Midwives' Board as district teachers and during the year 196 pupil
midwives from Part II midwifery training schools received their district training
with Midwife teachers employed by the Council. Some hospitals and district nursing
associations which are Part II training schools also provided district experience for
pupil midwives with their own district midwives.
Analgesia
(a) Gas and Air.—The following table sets out the number of women receiving
gas and air analgesia during the year and the percentage which they represent
of the total confinements attended. There were also some women whom the
midwives attended as maternity nurses under the direction of medical practitioners
who themselves administered anaesthesia or analgesia; for them no figures are
available.
Confinements attended by Total
London County Council midwives 5,338 (75.8%)
Hospital district midwives 2,323 (72.5%)
District nursing association midwives 1,443(68.0%)
The comparable figures for the year 1950 were as follows:—
London County Council midwives 5,027(68%)
Hospital district midwives 2,783 (69%)
District nursing association midwives 1,400 (57%)
There are still some mothers who decline analgesia and some who are not considered
medically suitable to receive it. There are also a number of cases where the
midwife is not summoned early enough.

Developments
in 1951
The Minister of Health asked the Council to co-operate with the hospital
authorities in the policy which he had laid down for the selection of maternity cases
for admission to hospital. Broadly speaking, his object was to introduce a greater
discrimination in selecting patients for hospital confinements and so reduce the
demand for maternity beds. He suggested that priority for hospital beds should be
given for (i) medical or obstetric reasons, including a large proportion of primigravidae
and multiparae with four or more children, and (ii) adverse social conditions,
especially bad housing. Hospitals were asked always to consult the Council on
social conditions and always to consult the Council on the question of need whenever
it is proposed to increase the number of maternity beds. The Council, through the
divisional medical officers, is co-operating to the full. The effectiveness of the Minister's
advice and the extent to which the hospital authorities consult the divisional medical
officers will be assessed after the scheme has been working for a few months.