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aid calls to doctors who had undertaken to give maternity medical services. Comparison
of the number of medical aid notices in 1956 and 1960 shows a substantial shift from
statutory medical aid to calls to booked doctors—a trend which may be expected to
continue.

Training of pupil midwives
The Council does not provide a midwifery training school, but facilities for district
experience, with midwives approved by the Central Midwives Board for this purpose, are
available to Part II training schools in the county; 79 of the Council's midwives are approved
teachers and every year some 300 pupils receive training on the district. The majority of
these pupil midwives live in the home of the midwife during the three months' training
period; a maintenance allowance is paid by the hospital authorities which also pay each
midwife a teaching allowance of £30 annually.
Maternity medical services
The London Executive Council is responsible for making arrangements with general
practitioners who undertake maternity medical services. There are some 2,250 general
practitioners in London; only about 590 are general practitioner obstetricians, but all are
entitled to render these services under the National Health Service Act. General practitioner
obstetricians may give maternity medical services to patients not on their list and receive
a higher rate of remuneration.
The London Obstetric Committee is responsible for laying down standards for admission
of doctors to the general practitioner obstetrician list and for the retention of names on
the list. The committee comprises both consultant obstetricians and general practitioners;
since it was set up in 1950 the County Medical Officer of Health has been its chairman.
Originally the committee required general practitioners either to have been responsible
for 30 confinements within a period of three years or to have held a post.graduate resident
obstetric appointment. Since May, 1957 stricter criteria have been applied which require,
save in exceptional circumstances, that general practitioners who qualified since 1951 must
have held a six months' resident obstetric appointment before they can be admitted to the
list.
Health education
Ante.natal care is given in the Council's ante.natal clinics by directly employed midwives,
by midwives employed by some hospitals and with one exception by midwives employed
by the district nursing associations. Thus they work in close association with the clinic
doctor and health visitors who are mainly responsible for health education and mothercraft
teaching. Health education activities in the clinics, particularly through the medium of
group instruction, have been developed and improved in the last decade. Nevertheless,
the most important single factor remains the direct approach by doctors, health visitors
and midwives to the individual mother in her own home and in the clinics. Group talks
and discussions on mothercraft, diet and physiology of labour and relaxation are arranged
for expectant mothers booked for home or hospital confinement, and evening sessions for
fathers are sometimes included. Relaxation classes are generally held by health visitors.
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