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It is interesting that no less than 24 had not received ante.natal care of any description,
though all but five of these had resided in the area for over six weeks, and that 27 presented
themselves to general practitioner or clinic within less than six weeks of the expected date
of confinement. There is evidence that an increasing number of women fail to present
themselves in good time because they think that they stand a better chance to enter a hospital
near their home via the Emergency Bed Service. This division is extremely fortunate to
be able to receive considerable help with maternity beds from hospitals in the East End
of London, but their relative remoteness from this district acts as a deterrent. This is borne
out by the fact that ten patients who were booked for these hospitals defaulted in the antenatal
period and had to be placed via the Emergency Bed Service.
Conversely, there is evidence that a small minority of general practitioners are using
the Emergency Bed Service for cases for whom beds might have been obtained by other
means; six of the ten general practitioner cases who had received ante.natal care for over
ten weeks attended a firm of two general practitioners and three of the remaining four
were referred by another general practitioner.
Out of the forty.eight cases who were known to our clinics—almost half of the whole
series—thirty only presented themselves within six weeks of the expected date of confinement
and in twelve unforeseen emergencies arose. Clinics invariably attempt to find
hospital beds for cases requiring them on social grounds before referring them to a general
practitioner obstetrician with the request to invoke the emergency bed procedure when
labour starts.
The findings, that out of 100 consecutive cases 23 had moved into the area less than six
weeks before the expected date of confinement, that another 27 though resident for a
longer period did not seek advice earlier and that 25 were single women, are interesting
sidelights on the special social problems which are encountered. It seems essential for the
hospital authorities not only to review the maternity bed situation in the area but also to
ensure that hospitals adjust their admission policy to cover late and urgent maternity bed
requirements.
The Royal Free hospital maternity beds—The number of referrals for placement via the
Emergency Bed Service would have been even larger but for an arrangement made between
Dr. F. J. Fowler, o.b.e., t.d., Senior Administrative Medical Officer, North West Metropolitan
regional hospital board, and Miss Jocelyn A. Moore, f.r.c.s., f.r.c.o.g., Director
of the Department of Obstetrics and Gynaecology, Royal Free hospital, by which a number
of maternity beds at that hospital were offered to this division for cases requiring hospital
confinement on social grounds. Ten beds can now be allotted directly by our welfare
centres to cases in urgent social need and all of them are allocated relatively late in
pregnancy, two during the seventh and eight during the eighth month, in order to make
some provision in the area for later bookers whom it is practically impossible to place
otherwise, however great the need. I wish to place on record my appreciation to Dr. Fowler
and particularly to Miss Moore and her colleagues at the Royal Free hospital for their
generous and far.sighted assistance. It is encouraging that this has led to much closer local
co.operation.
Appointment systems at ante.natal sessions—Appointment systems were introduced
experimentally at ante.natal sessions in two centres, as recommended in the report of the
Maternity Services Committee. For sessions staffed by a medical officer and two midwives
two patients were booked at intervals of 15 minutes. It was found that waiting times were
reduced and sessions became more orderly. The chief difficulty encountered was from
patients arriving considerably before their appointment. Only firmness in keeping examinations
to the times booked will overcome this initial difficulty. In view of the satisfactory
results of these experiments it was decided to try out an appointments system at all antenatal
sessions in the division.
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