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into constant contact with her colleagues, the clinic doctor and the health visitor, in a
way almost impossible prior to 1948. A progressive programme of mother-craft and
health education has thereby been developed on a team basis. Varied exhibits, posters
and demonstrations are provided by health visitors to stimulate the interest of expectant
mothers. Health education for individual mothers as well as group teaching with
modern visual aids are given, in which doctor, midwife and health visitor each take their
share. All midwives have attended courses in relaxation for expectant mothers, including
relaxation by suggestion. Classes are arranged by midwife, health visitor or physiotherapist
according to convenience in any particular centre.
Inhalation
analgesia
Mothers can be taught in the ante-natal clinic to accept without apprehension,
inhalational analgesia which all midwives offer to the mother having her baby at home.
In 1948 only gas and air was available and the Minnitt apparatus was carried by the
ambulance service to the home on the request of the midwife. 63 per cent. of mothers
confined at home had inhalational analgesia in 1949. By 1958 this figure had reached
88 per cent. which is probably near the maximum acceptance rate for the county as a
whole, as there will always be mothers who do not want it or whose delivery is too
rapid for it to be given. In 1954 the Central Midwives Board permitted midwives to
administer Trilene on their own responsibility. The midwives, some of whom had
taken part in the trials, were sent for training. By 1957 all midwives were provided with
approved inhalers. Their use had a striking effect on the ambulance service whose mileage
run by vehicles for this purpose was reduced from 50,000 miles in 1949 to approximately
3,000 miles in 1958. Gas and air, however, is still available and the choice of analgesia
is left to the clinical judgment of the midwife. In 1958, 17 per cent. of mothers confined
at home had gas and air and 71 per cent. had Trilene. The use of analgesia by inhalation
and the introduction of legislation in 1953 to permit midwives to order pethedine have
given to the mother having her baby at home the same possibilities for the relief of pain
which are given to the mother in hospital.
Blood testing,
etc.
Routine medical examinations are made by the clinic doctor unless a booked doctor
is giving ante-natal care himself. Measures are taken for the early recognition of
toxaemia through weight records and blood pressure readings. The full range of blood
tests are given, the Rhesus factor determined and tests for antibodies are carried out in
appropriate cases. In most parts of the County cord blood is taken for Coomb's tests
from all babies born at home of Rhesus-negative mothers.
Maternity
medical
service
The integration of the domiciliary midwifery service with the maternity medical
services provided by general practitioner obstetricians and general practitioners under
Part IV of the National Health Service Act has progressed steadily. Regular consultations
are held with the London Local Medical Committee and there have been full
discussions on new proposals to promote better co-operation in the interests of the
patient. In 1948 a regional obstetric committee was set up in each of the Metropolitan
Regional Hospital Board areas and in 1950 the Medical Officer of Health became the
Chairman of the combined London Obstetric Committee.

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