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suitable for home confinement, together with medical aid and the ready availability of
hospital services, if necessary, does ensure a reasonable margin of safety for the baby
born at home.
The following is an analysis of the 101 still.births :
(a) Ante.partum 57 ; Intra.partum 41 ; Unknown 3.
(b) Predisposing causes of the 41 intra.partum deaths were
Complicated vertex deliveries 11 Breech delivery 8
Prematurity 5 Short cords . 5
Congenital defects 5 Unknown 7
(c) Full term 68 ; Premature 33.
(d) 17 of the still.born infants had congenital defects.
The record of neo.natal deaths is incomplete because midwives visit for periods Neo.natal
varying from 14 days to, occasionally, 21 or 28 days after the end of labour. There were deaths
56 neo.natal deaths reported in the first three weeks of life, 52 of these occurring within
the first 7 days.
Thirty.five of the 56 neo.natal deaths were premature infants, the deaths of 24 being
attributable to prematurity alone. The causes of death of the remaining 21 full.term
infants were as follows :
Cerebral haemorrhage .. 4 Gastro.intestinal abnormalities 4
Congenital heart lesions .. 3 Pneumonia .. .. .. 3
Atelectasis 2 Acute peritonitis and salpingitis 1
Unknown . 4
During 1954, 519 babies weighing 5£ lbs. or less were born to 492 mothers in the Premature
care of domiciliary midwives [53 mothers were primiparae, 439 were multiparae of bables
which 46 were having their sixth or subsequent baby, 14 mothers—parity unknown],
36 mothers were delivered as unbooked emergencies and had no ante.natal care,
32 mothers had a previous history of premature babies.
Babies weighing 4 lbs. or less, or those showing signs of immaturity, are transferred
to hospital immediately after birth ; 353 babies were nursed at home and of these 346
were well and thriving when discharged by the midwife at two to four weeks ; 283
babies were fully breast.fed on discharge.
139 calls were made to hospitals during the year for the emergency obstetric unit. Emergency
In the majority of cases the unit arrived within 30 minutes of being called.obstetric unit
Conditions necessitating the use of the service were :
Post.partum haemorrhage—46. Eclampsia—3.
Post.partum haemorrhage with retained placenta—43. Medical aid for the baby—3.
Ante.partum haemorrhage—13. Cervical and vaginal lacerations—2.
Retained placenta—12. Failed forceps—2.
Foetal distress—8. Obstetric shock—1.
Mal.presentation—6.
There was one maternal death, due to collapse following post.partum haemorrhage
and manual removal of placenta. There were eight still.births.
The use of gas and air analgesia by the Council began in 1946. The apparatus is held at Gas and air
selected ambulance stations throughout the county and transported to the patient's analgesia
home on the request of the midwife.
All midwives employed by the Council are qualified to administer gas and air
analgesia. Its administration shown as a percentage of all domiciliary confinements
rose again to 79 per cent, in 1954. A similar increase in the use of gas and air analgesia
has also been effected in confinements attended by hospital district midwives and district
nursing association midwives. Analgesia is always offered by the Council's midwives.
It is not administered when the patient refuses it, when she is considered medically
unfit or when labour is too far advanced when the midwife is called.
Certified midwives, who have notified intention to practise to the local supervising pethidine
authority, are authorised to possess and administer pethidine, so far as is necessary for
the practice of their profession.
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