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APPENDIX A
THE DOMICILIARY MIDWIFERY SERVICE AND THE CRANBROOK
REPORT
Before the Mid wives Act, 1936, came into force the domiciliary services in London
were provided either by independent midwives or by midwives on the staff of hospitals
or voluntary nursing agencies. The 1936 Act laid on the Council the duty to provide an
adequate service of midwives for attendance on women who wished to be confined at
home. The Council at that time took over a number of independent midwives of the
required professional standard and entered into agreements with hospitals and district
nursing associations already undertaking domiciliary midwifery practice by which these
bodies were paid by the Council for each confinement attended. This pattern was not
substantially changed by the passing of the National Health Service Act, 1946.
The Council's domiciliary midwifery service is administered centrally and is supervised
by four non.medical supervisors of midwives. A supervisor of midwives is always on
duty to answer calls for assistance from general practitioners, midwives, hospitals, the
Emergency Bed and ambulance services, police and the general public. It is necessary to
maintain this 24.hour service in London with its considerable floating population and
influx of numbers of pregnant women, some of them unmarried.
The domiciliary midwifery service is at present provided by the following means:
Direct service—The Council employs between 90 and 100 midwives. Most of them live
in flats provided by the Council or made available by the metropolitan borough councils;
some live in their own homes. Midwives work in groups of three, four or five, each midwife
covering a defined area and acting as relief to her colleagues. In addition there is a hostel
in North London, which provides an opportunity for newly qualified midwives to gain
district experience under the guidance of a superintendent midwife, before they take over
an area of their own.
Midwives are not provided by the Council with motor cars but there is an assisted
purchase scheme and since 1960 they also qualify for a grant for driving lessons. Midwives
who use their own cars, motor scooters or bicycles for their professional work receive
allowances.
Agency services—(i) Twelve district nursing associations undertake midwifery and
employ 59 midwives for this purpose. Their midwives can now be called upon to provide
relief for the Council's midwives and each midwife is responsible to the Supervisor of
Midwives for her own supply of drugs, keeping of records, etc. The Council provides a
car to all but two district nursing associations and reimburses the associations for 93 per
cent. of their approved expenditure.
(ii) Hospital districts—In 1938 agreements were made with sixteen hospitals which then
employed district midwives to undertake domiciliary midwifery on an agency basis; these
arrangements were continued when the National Health Service Act, 1946, came into
force. In some areas senior medical staff from the hospital attend the Council's ante.natal
clinics and provide medical aid on the district when required. In others, hospital midwives
call in medical aid from the general practitioner services and also act as midwives to cases
booked by general practitioners for maternity medical services.
During the Second World War the volume of domiciliary midwifery was considerably
reduced; several hospitals gave up their districts and did not resume this work when the
war was over. There has been, too, a pronounced trend towards institutional midwifery,
clearly illustrated by a comparison of figures of place of birth in London in 1938 and
1960:
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