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General and
staffing
DOMICILIARY MIDWIFERY SERVICE
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 (92), midwives employed by district nursing
associations (46, including supervisory staff) and district midwives employed by
hospitals. At the end of 1956, 13 hospitals had 44 district midwives.
The rate of payment to hospitals providing midwifery services on behalf of the
Council was increased on 1st April, 1956 from £10 10s. Od. to £13 4s. Od. for each
confinement. Payments to the district nursing associations were made in the form of
block grant (93 per cent.) for both midwifery and home nursing.
Service
organisation
The service which is centrally administered is supervised by tour non-medical
supervisors. The Council's and the district nursing associations' midwives work in
close association with health visitors who, in the main, are responsible for the teaching
of hygiene in pregnancy and mothercraft.
All the Council's midwives and those of the district nursing associations carry out
ante-natal examinations of mothers at the clinics and, in addition, at least three home
visits are made. A number of midwives attend the surgeries of general practitioners
and, where this arrangement has not been made, co-operation between general
practitioner and midwife is secured by personal contact supplemented by the interchange
of written information.
Many meetings have been held in the County to consider the proposals of the
Minister of Health in his circular (9/56) on ante-natal care in relation to toxaemia,
at which the divisional medical officers represented the Medical Officer of Health.
Opportunity was thus given for discussion of problems relating to toxaemia and, as a
result, co-ordination between hospital, general practitioners and local health authority
services has been improved.
All mothers having a home confinement are weighed regularly ; each is seen by the
clinic doctor at 30 weeks, in addition to initial and 36th week examinations, and routine
blood tests are carried out by the blood transfusion service or at hospital laboratories,
including initial and 30th week haemoglobin estimates. Rhesus negative mothers
without anti-bodies at the 34th week may be confined at home and in these cases
routine cord blood tests are carried out in most parts of the County.
The midwives' record card has been redesigned so as to avoid the necessity of
duplicate records being made by the midwife and her relief. The card is now printed
in two sections, one of which can be left at the patient's house during the puerperium.
Midwives are responsible for securing the mother's attendance for post-natal examination
and follow-up visits are made to the mother who fails to keep her appointment.
Attendances for post-natal examination are, however, still too low.
Analgesia
All midwives now carry inhalers for the administration of ' Trilene The service
for providing ' Minnitt' apparatus by ambulance is also maintained so that the form of
inhalation analgesia given to the mother can be based on clinical judgment of the case.
During 1956, inhalation analgesia was administered to 84 per cent. of mothers
delivered at home, an increase of 3 per cent. as compared with 1955.
Premature
babies
509 babies weighing 5½ lb. or less were born to 475 mothers during 1956. There were
65 sets of twins which included 78 premature babies.
389 babies weighed over 4½ lb. and 120 weighed between 2 lb. and 4½ lb.
354 premature babies were nursed at home. There were 11 neo-natal deaths in this
group and 343 were discharged well.
Still-births
Of 10,247 babies born there were 90 still-births (52 fresh and 38 macerated) during
the year, a rate of 8.8 per thousand births.
Among the ascertained causes were :
Prematurity 36
Congenital defects 16
Post Maturity 1
Breech presentation 3
Prolapse cord 3
Impacted shoulders 3
Bilateral adrenal haemorrhage 1
65
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