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61
within 36 hours of the baby's birth. After discussions with the London Medical Committee,
the midwife is now asked to notify, with the patient's consent, the list doctor
when she has been booked for a home confinement. The introduction of these forms
for the exchange of information has greatly facilitated co-operation between midwives
and doctors providing maternity medical services.
The number of domiciliary confinements since the end of the 1939-45 war shows a
steep increase in 1946 and 1947, the immediate post-war period, and a gradual decline
since 1948. The following table and diagram show the number of home confinements
attended during the years 1945-52 by the Council's midwives, hospital district midwives
and association midwives. The chief factors affecting the decline in the number of home
confinements have been :
(a) the fall in the birth-rate ;
(b) shortage or unsuitability of housing accommodation ; and
(c) the attraction of hospital confinement and the increase in the number of
maternity beds provided.
Owing to the reduction in the number of home confinements any developments
in the domiciliary midwifery service must be looked for not in any expansion but in
the quality of the service provided by the midwives and the measure of co-operation
and integration with other health services and with the maternity medical services
provided under the National Health Service Act.
L.C.C.
midwives
Five hundred and seventy-three of the confinements attended by Council midwives
during 1952 were primigravidae and 5,474 multi-gravidae. The figures do not include
women booked by the Council's midwives who were subsequently taken to hospital before
confinement. The number of midwives employed at the end of the year was 98 compared
with 111 at the end of 1951 and 121 at the end of 1950. The average number of confinements
attended by each midwife was approximately 61 compared with 62 in 1951 and
57 in 1950.
Agency
organisation:
At the end of the year, 71 (including supervisory staff) midwives for domiciliary
confinements were employed by hospitals and 42 (including supervisory and part-time
staff) by district nursing associations.
Ante-natal
sessions
The Council s poliery is that midwives shall use ante-natal clinics for the booking and
examination of their patients. A doctor, who is either a full-time assistant medical officer
or a general practitioner with special experience, attends all or alternate sessions depending
on the numbers in attendance at the clinic. Emphasis is placed on the importance of
ante-natal care and the midwife is expected to hand over a delivery to her relief midwife
in order to attend her ante-natal session. Each midwife does one clinic session weekly.
A health visitor is also present at most midwives' clinics in order to give talks to mothers
on mothercraft and health education generally. In some divisions, these talks are given
as a series of demonstration talks arranged by the health visitor on separate afternoons.
In other divisions, talks are given during the sessions to small groups of mothers or to
individuals. Many of the newer centres are equipped with demonstration kitchens and
cases for exhibits of layettes, etc. Most of them have libraries of books and journals
which can be lent to expectant mothers. Classes are held for relaxation exercises by
physiotherapists in some divisions but midwives take such sessions at a few clinics.
Specimen blood is taken from all mothers attending ante-natally and tested for
Wassermann and Kahn reaction and for Rhesus factor. In eight of the nine divisions,
routine haemoglobin tests are made. Further specimens are taken for antibody tests in
Rhesus negative cases at the 34th week and midwives also take cord blood in those
Rhesus negative cases which are fit for home confinement.
General practitioners who have arranged to give maternity medical service to their
patients are encouraged to send them to the centres for intermediate ante-natal examination
by a booked midwife. Reports are exchanged between the midwife and the doctor
on the 1st and 36th week examinations (see above). If, as occasionally happens, the general
practitioner wishes to take full responsibility for the whole ante-natal care of a patient,
he may send her to the centre for a blood specimen to be taken. It is known that general