View report page

63
—but have little effective ante-natal care. Closer liaison between moral welfare workers
and health visitors may help to improve the position.
Case-work for the unmarried mothers during the ante-natal and the immediate
post-natal period is undertaken by the moral welfare associations. The voluntary
committees and matrons of mother and baby homes also do case-work.
DOMICILIARY MIDWIFERY SERVICE
the council's domiciliary midwifery service had its origin in the Midwives 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 direction of a doctor, and were encouraged
to make the fullest use of the maternity and child welfare services provided by the
Metropolitan Borough Councils. The hospitals and voluntary associations received
payments 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 national 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 changed 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 of the services which they propose to undertake
so that she may know whether to act as a midwife or as a maternity nurse. The midwife
reports her findings to the doctor booked for the case on the 1st and 36th week antenatal
examination. 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. One general
practitioner obstetrician in the county holds a clinic in his own surgery which a Council's
midwife attends and it is possible that this practice may be extended. Attached to the
form is the analgesia certificate which the doctor fills in and sends to the midwife.
The midwife sends the doctor a notice of the delivery of a booked patient within
36 hours of the baby's birth. After discussions with the London Local Medical Committee,
the midwife is now asked to notify, with the patient's consent, the list doctor when
she has to be booked for a home confinement. The introduction of these forms for the
e