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proposed to undertake a survey to try to follow up all illegitimate children born in
London during a specified period in 1953. The co-operation of voluntary associations
dealing with the unmarried mothers and their children has been promised and it is
proposed that the survey shall be carried out within the scope of the normal work
of the health visitors who will make visits at specified intervals until the children reach
school age. Changes in the child's environment will be noted and the effect observed
of such changes on physical and mental development, behaviour and habits. Incidence
of illness and accidents will be included. The survey will extend to boarded-out children
and to those placed in residential, voluntary and private nurseries. The fact of adoption
will be noted when it occurs. From the survey there should emerge a picture of the
number of mothers who do manage to maintain a stable relationship with the child.
DOMICILIARY MIDWIFERY SERVICE
the council's domiciliary midwifery service had its origin in the Mid wives Act
of 1936, which laid on the Council the duty of providing an adequate service of midwives
for attendance on women in their own homes in London. To provide this service
the Council employed salaried midwives and entered into agreements with voluntary
hospitals and district nursing associations already employing midwives, and the service
commenced in 1938. Midwives attended patients either as midwives on their own
responsibility or as maternity nurses under the direction of a doctor and were encouraged
to make the fullest use of the maternity and child welfare services then provided by the
Metropolitan Borough Councils. The hospitals and voluntary associations received
payment from the Council for each confinement undertaken. Every woman attended
by a midwife in her own home was charged a fee which was reduced if necessary,
but medical aid, if summoned by the midwife, was provided free to the patient.
The service underwent no fundamental change as a result of the coming into force
of the National Health Service Act, 1946, except that it became a free service. The
main result of the Act was to effect closer integration of the domiciliary midwifery
service with the maternity and child welfare services and the other health services for
which the Council became responsible under the Act, and also with the maternity
medical services provided under Part IV of the Act. The service is still administered
centrally and the whole county is kept under close and constant supervision, the service
being adapted to the changing character and requirements of the area.
Every effort has been made to integrate the domiciliary midwifery service with the
maternity medical services provided by general practitioner obstetricians and general
practitioners under Part IV of the National Health Service Act, and with the maternity
services already provided by the local authorities and by hospital authorities. Early
consultation was established with the London Local Medical Committee to ensure
co-operation between doctors providing maternity medical services and the midwives
engaged in domiciliary practice. This co-operation and understanding has been
gradually increased by continued emphasis to the midwives of the need for good
liaison with the family doctor and the introduction of forms for exchange of information
between doctor and midwife.
Doctors who agree to give maternity medical services to a patient send this information
to the midwife and let her know the services they propose to undertake so that the
midwife may know whether she is to act as a midwife or a maternity nurse. The
midwife reports her findings to the booked doctor on the 1st and 36th week ante-natal
examinations. The doctor returns her report form after each examination with his
findings, if different from her own, and adds any instructions he may wish to make
on the care of the patient. Midwives are encouraged to try to conduct these examinations
with the general practitioner but in practice this is very difficult to arrange. Attached
to the form is the analgesia certificate which the booked doctor fills in and sends to the
midwife. The midwife sends the doctor a notice of the delivery of a booked patient