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Health
education and
preparation
A wide and comprehensive health education service is provided at the Council's
clinics, using such methods as films, film-strips, flannelgraphs and posters. Methods of
inhalational analgesia are demonstrated so that mothers become quite familiar with
the type of apparatus they will use whether their confinement will be at home or in
hospital. All the Council's domiciliary midwives will shortly have completed a course
on relaxation and the part it plays in assisting during labour.
Treatment
facilities
No difficulty has been experienced in obtaining the admission to hospital of any patient
showing early signs of toxaemia. This seems to indicate that the provision of ante-natal
beds in London is adequate. There was some evidence, however, that the follow-up of
non-attenders at hospital ante-natal clinics was not always satisfactory and where this
was so it was arranged that a health visitor would make a home visit on request by the
hospital. However, the need for hospital care for patients in high risk categories is not
always satisfactorily met because the patients attend first for ante-natal care at a late
stage in pregnancy
In November 1950 the Council sent a deputation to the Minister of Health to urge
the need for a policy decision on the provision of hospital maternity beds and in January
1951 arranged a conference of the four Metropolitan Regional Hospital Boards and the
Boards of Governors of teaching hospitals in London.
The same year the Minister issued a circular (LHA.1/51) to all local health authorities
and hospital authorities on the subject of selection of maternity patients for admission
to hospital giving advice similar to that in the Memorandum from the Standing
Maternity and Midwifery Advisory Committee. However, as stated in my annual
report for 1952, the varying practice of some hospitals within the same regional hospital
board area in seeking the co-operation of the Council in applying uniform standards
for the admission of women to hospital maternity beds reacts unfavourably on those
hospitals which loyally co-operate in applying such standards. Since 1952, local discussions
with individual hospitals and hospital authorities and the meetings that have taken
place recently following the issue of the Advisory Committee's Memorandum have,
if anything, shown that there is a limit to the agreement that can be reached, and have
emphasised the need for a firm policy directive to all maternity hospitals. No doubt this
is one of the matters which will receive close attention by the Cranbrook Committee.
It is significant that despite the fact that some 80 per cent. of all births in London take
place in hospital, about one-quarter of the mothers delivered at home by the Council's
domiciliary midwives are in those high risk categories considered by the Advisory
Committee to indicate hospital confinement. This point is illustrated by the facts
brought out following scrutiny of cases dealt with in 1956.
Of 9,597 mothers who had their babies at home in 1956, 751 (7.8 per cent.) were
primigravidae and 1,675 (17.5 per cent.) were parity 4 and upwards. Many obstetricians
regard first pregnancy as a priority group for hospital delivery; taking primiparae and
mothers of parity 4 and upwards as high risk category cases, 25.3 per cent. of these
London mothers delivered at home should have been delivered in hospital. Even if
allowance is made for the refusal by some mothers of high parity of a hospital bed, this
high proportion of home deliveries of cases in high risk categories indicates that hospital
maternity beds in London are not being made available to all mothers who need them,
but rather to those who approach the hospital for booking early in pregnancy.
Stage of pregnancy
at first
attendance