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64
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 showed
a steep increase in 1946-7 (the immediate post-war period) and a big decline since 1948.
The table and diagram on page 68 show the number of home confinements attended
during the years 1945-53 by the Council's midwives, hospital district midwives and
district nursing association midwives. The chief factors effecting the decline in the
number of home confinements were (a) the fall in the birth rate (b) the shortage or
unsuitability of housing accommodation and (c) the attraction of hospital confinement
and the increase in the number of maternity beds provided. It is problematical whether
or not the recent increase in maternity benefits, and in particular the introduction of
the special grant of £9 for a home confinement, will have any effect in halting the trend
towards hospital confinement.
Owing to the reduction in the number of home confinements any developments in
the domiciliary midwifery service must be looked for in the quality of the service
provided by the midwives and the measure of co-operation and integration with other
health services and the national medical services provided under the National Health
Service Act rather than in any expansion.
L.C.C.
midwives
541 of the confinements attended by the Council s midwives during 1953 were
primi-gravidae, and 5,149 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 94 compared with 98
at the end of 1952 and 111 at the end of 1951; the average number of confinements
attended by each midwife was approximately 58 compared with 61 in 1952, and 62 in
1951.
Agency
arrangements
At the end of the year 60 midwives for domiciliary confinements (including supervisory
staff) were employed by hospitals and 40 (including supervisory and part-time
staff) by district nursing associations.
Ante-natal
sessions
The Council's policy 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 that she may be able to attend her ante-natal session. Each
midwife undertakes 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 exhibition 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 also undertake such sessions at a few clinics. Specimens of blood are taken
from all mothers attending ante-natally and tested for Wassermann and Kahn reactions
and for Rhesus factors. In eight of the nine divisions routine haemoglobin tests are made,
further specimens are taken for anti-body 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 first and 36th week examination as mentioned 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.