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DOMICILIARY MIDWIFERY SERVICE
Number of
births and
home
confinements
Organisation
and staffing
Ante.natal
arrangements
Maternity
nursing
associations
Still.births
details relating to births appear on page 7 from which it will be noted that
the number of live and still.births in London in 1954 was approximately the same as
in 1953, that is, 51,655 as against 51,971. The number of home confinements, which
are set out in the table on page 68, rose slightly from 10,458 to 10,546.
The duty to secure provision of an adequate domiciliary midwifery service under
Section 23 (2) of the National Health Service Act, 1946, is discharged through the
Council's own full.time salaried midwives (98), mid wives employed by district nursing
associations (33, including supervisory staff) and district midwives employed by the
hospitals (60, including supervisory and part.time staff). The service is centrally administered
and is supervised by four non.medical supervisors. The average annual case load
of each midwife is 64.
The fullest co.operation with other local health authority services, statutory and
voluntary bodies, and with general practitioners providing maternity and ante.natal
services is encouraged. A few midwives now attend ante.natal clinics in the surgeries
of general practitioners ; but since, in the main, general practitioners are prepared to
send mothers for intermediate ante.natal care to the Council's centres there is a system
of exchange of reports for the majority of cases between the booked doctor and the
midwife, supplemented by personal contact. Blood tests, including Wasserman, Kahn,
Rhesus and haemoglobin, are carried out for all expectant mothers attending the
Council's centres and chest X.ray is offered through the mass X.ray service.
There was one major change in the domiciliary midwifery service during the year.
At the request of the North West Metropolitan Regional Hospital Board, the district
midwifery work of the Maternity Nursing Association was transferred to the Council
on 1st April, 1954. The Maternity Nursing Mission, as it was then known, opened its
first district midwives' home in King's Cross Road in 1896. The Association was taken
over by the Royal Northern Hospital in 1930, and carried out the latter's district midwifery
work, in association with the City of London Hospital. In 1938 the Maternity
Nursing Association became an all.district second period training school, probably the
largest in the country and certainly one of the best known. During the long years of
its existence, the Maternity Nursing Association gave much valuable service in the field
of domiciliary midwifery. Both the Maternity Nursing Association and the City of
London Hospital came under the jurisdiction of the Northern Group Hospital Management
Committee on 5th July, 1948, and the arrangements for providing domiciliary
midwifery in agreement with the Council continued.
The three district homes used by the Maternity Nursing Association have now been
given up and an alternative home for the midwives has been provided in a former
hostel for day nursery students and in flats converted from surplus health service
accommodation or made available by the Housing Committee. A superintendent has
been appointed to take charge of the home at Scholefield Road. Facilities offered for
Part II training of pupil midwives are being continued. The transfer has resulted in a
simpler and more economical service.
Of the 10,546 mothers who were confined at home 922 were primiparae, 9,624
multiparae and there were 101 still.births. In England and Wales the still.birth rate
was 23.5 per 1,000, but whereas in London the still.birth rate in hospital was 21.5 per
1,000 the still.birth for domiciliary confinements was only 10.3 per 1,000.
The still.birth rate for home confinements in London has remained at about this
level since 1951. It is to be expected that, since confinements likely to be abnormal are
taken into hospital, the still.birth rate would be lower for domiciliary confinements.
The markedly lower figure for domiciliary confinements would, however, suggest
that arrangements made for the ante.natal care of mothers by the clinic doctors and
midwives at maternity and child welfare centres by which women are selected as
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