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148
The increase in maternity medical services is reflected in the decline in medical aid
fees paid by the Council from .£15,829 in 1949 to £7,739 in 1958.
A number of general practitioners have always been employed sessionally in the
Council's ante-natal clinics but the peculiar structure of general practice in London makes
it necessary often to place a doctor in a clinic out of his area, thereby defeating the
objective of continuity of care of the mother in pregnancy and labour, which is attained
in other parts of the country.
General practitioners giving maternity medical services are able to use clinic
facilities for tests and for health education, whether the mother has her intermediate
ante-natal care at the centre or not. Since 1948 arrangements have been made for the
interchange of records between the general practitioner and midwife at booking and at
the 36th week of pregnancy. It became clear, however, that these arrangements did not
cover all contingencies and a personal ante-natal record card to be carried by the mother
herself was introduced in 1958. This card, designed to give full details of pregnancy,
is available at each visit to doctor or midwife and serves as an appointment card for the
patient. Through its use the midwife can be given more readily an opportunity to
participate fully in the ante-natal care while working under the guidance of the general
practitioner. In addition 13 midwives regularly attend ante-natal sessions in the surgeries
of general practitioners.
By the end of 1958 all midwives were trained in the use of intra-gastric oxygen for
the resuscitation of new born babies and each midwife now carries the apparatus with
her. This has already proved a valuable measure as the work of resuscitation can be
begun at once before the arrival of the doctor. The attention of midwives has been
directed to the syndrome of neo-natal cold injury and its predisposing causes; low
reading clinical thermometers and room thermometers are provided as part of standard
equipment.
The acceptance rate of post-natal examinations by mothers has not yet reached a
satisfactory level. In 1948 separate sessions were held for post-natal examinations, but
gradually these sessions have been merged with ante-natal work. By 1955 combined
clinics had been established throughout the County, and in home confinements the
responsibility for securing the attendance of the mother and the follow-up of the
defaulter has been laid on the midwife.
Co-operation
with
hospital
services
Co-operation between the domiciliary midwifery and hospital services is most
dramatically represented by the work of the Emergency Obstetric Units. Since 1938,
when University College Hospital established the first unit, eleven other hospitals then
under the control of the Council had also given this assistance, transport being provided
by the ambulance service. When the National Health Service came into operation the
service continued unchanged and in 1955 two other units were added. Only the name
was changed as the use of the term' flying squad ' provoked confusion with calls for the
police. The Emergency Obstetric Unit is called out by midwives in an emergency
without waiting for medical aid. The Units have given aid not only in cases of
haemorrhage or obstetric shock but also for malpresentations, uterine inertia and,
occasionally, for resuscitation of the baby.
The hospital service provides six premature baby units in addition to many beds for
babies in paediatric wards. Midwives are advised to transfer their cases to hospital if
possible, when it seems likely that the baby will be born prematurely. All multiple
births, if diagnosed during pregnancy, are referred to hospital for delivery. About 500
premature births occur annually at home. There is a working rule that babies born at
home weighing less than 4 lbs. should be transferred to a premature baby unit. A nurse
and special cot are brought to the home by the ambulance service or in less urgent cases
the midwife takes the baby in a heated cot by ambulance. In 1948, premature baby sets,
containing everything required to nurse a baby in the home, were available in the
divisions on loan. Experience has shown that with the increasing use of hospital facilities
the demand for these packs is declining rapidly.