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149
Home visits are made by health visitors or midwives, at the request of maternity
hospitals to patients seeking a maternity bed on social grounds. There has been a
varying practice among obstetricians in seeking the co-operation of the Council. This
lack of uniformity of practice has created a serious problem especially in the north-west
area of the County where there is a large community of immigrant peoples. Despite the
fact that the provision of maternity beds in London is one of the highest in the country—
over 80 per cent.—it has proved very difficult to book maternity beds in that area for
women who require beds on social grounds or on grounds of age and parity if they
apply after the 20th week of pregnancy. Attempts are made at the Council's clinics to
book beds for these women in advance. When it becomes apparent that a booking is
unlikely to be obtained a letter is sent to the family doctor asking him to arrange
admission through the Emergency Bed Service when labour starts. If the general
practitioner does not agree the patient is referred to a general practitioner obstetrician.
If he also is unable to make the arrangements the domiciliary midwife must take this
responsibility. This procedure, which has been adopted of necessity in the last few years,
can only be regarded as an unsatisfactory improvisation. The patient is left in a state
of anxiety and uncertainty and an unnecessary burden is placed on doctors and midwives.
Delay in admission is inevitable, as a bed has to be found and the mother must be
visited by a doctor or midwife before the Emergency Bed Service can act. If maternity
hospitals have no area responsibility—and no provision is made for this in the recommendations
of the Cranbrook Committee—it is difficult to see how the
obstetrician can arrive at a decision that all priority cases have been booked and a ' first
come, first served' policy applied. Arrangements that have been in operation since
1951, for the allocation of a certain number of beds to the Council's clinics each month,
have broken down in the peak season for births. No difficulty has been experienced in
obtaining the admission to hospital of any patient showing early signs of toxaemia
or one who has any other obstetric or medical grounds for admission. This seems
to indicate that the provision of ante-natal beds in London is adequate. Since the meetings
of the professional representatives of the three parts of the national health service on
ante-natal care relating to toxaemia of pregnancy in 1956, health visitors make home
visits on request by maternity hospitals to non-attenders at hospital ante-natal clinics.
Ten teaching hospitals and two hospitals of the regional hospital boards still undertake
district midwifery practice under agreements with the Council. The Royal Free
hospital and the Elizabeth Garrett Anderson hospital discontinued in 1952 and 1956
respectively. The Royal Northern Hospital Maternity Nursing Association's work was
transferred in 1954 to the Council's domiciliary midwifery service. Charing Cross
hospital have sent medical students to district cases with midwives of the Metropolitan
District Nursing Association since 1953. There has, however, been a marked fall in the
number of confinements attended in the home by the hospitals from 4,644 in 1949 to 2,085
in 1958. A decline in domiciliary midwifery has of course been the general picture in the
last ten years but loss of cases on district must present a serious problem to those responsible
for the training of medical students. Although the number of cases dealt with by hospital
district midwives has declined during the decade reviewed, the proportion of such cases
booked with general practitioners for maternity medical services has risen from 2.4
per cent. to 17-7 per cent.—a three fold increase in numbers. A few hospitals, particularly
those with an exclusive area of practice, have accepted in principle that if the hospital
is to act as the agent of the Council in providing midwives and maternity nurses to
meet the needs of the area, they must take calls from doctors giving maternity medical
services. Most hospitals with district practice, however, have not agreed to do so and
coverage of the area has had to be made through midwives of district nursing associations
or the Council's midwives. This procedure necessarily reduces the number of cases
available to hospitals on their districts.
The Council provides facilities for the district training of Part II midwifery pupils Staff