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The midwives give lecture.demonstrations on inhalation analgesia. In the main mothercraft
and relaxation classes are attended by primigravidae, many of whom are booked for
hospital delivery. There are, however, some maternity hospital units which still do not
provide comprehensive mothercraft training either at the hospital or by referring mothers
to the Council's centres. Divisional medical officers have been asked to provide local
maternity hospitals with programmes of mothercraft training held in their centres so that
hospitals can ensure that mothers are enabled to attend classes at the clinics. Out of a total
of 6,012 talks given in the Council's centres in 1960 no less than 3,991 talks (66.4 per cent.)
were given to groups of expectant mothers.
Domiciliary practice
The Council issues a handbook to all domiciliary midwives which sets the standard to
which each must work. The book is issued in a loose leaf binding so that amendments on
new procedures and techniques can be inserted from time to time.
In the clinics midwives make routine examinations of expectant mothers. Every mother
is given a green card on booking, which instructs her how to call her midwife or her reliefs.
The midwife enters each booked patient in her register. Midwives make several home
visits to advise the mother on preparations for the confinement and a maternity outfit is
issued free to the mother at or about the 35th week of pregnancy. Special emphasis is laid
on the early recognition of toxaemia and weight records are kept as a routine. Midwives
are required to summon medical aid if there is a rising blood pressure or if the blood
pressure reaches 130/90 mmHg at any time. During 1960 the preventive measures against
toxaemia were further reinforced by making home helps available free of charge, where
hospital consultants or general practitioners certify that rest at home is essential for this
reason and admission to hospital is considered unnecessary or impracticable.
Iron tablets are given as a routine to all mothers. Blood specimens are taken by the
clinic doctor for haemoglobin estimations, Wassermann and Kahn tests, determination of
rhesus factor and tests for Rh antibodies in appropriate cases. The tests are carried out
at local hospitals or regional blood transfusion centres. The laboratories also carry out
Coombe's tests on cord blood specimens sent in by midwives. Midwives must refer all
cases with a haemoglobin level below 11.8 gm per 100 ml (85 per cent.) to the clinic or
booked doctor and must call medical aid if the haemoglobin level is below 8.9 gm per 100
ml (70 per cent.). General practitioners who render maternity medical services are able to
use the facilities for tests at the Council's centres, whether the mother receives ante.natal
care at the clinic or not.
Midwives hold and administer pethidine but are not permitted, in London, to give
opium.
From 1956 onwards trilene has been employed in the Council's domiciliary midwifery
service and there has been a progressive reduction in the use of the more cumbersome gas
and air apparatus; Talley and Minnitt apparatus can, however, be brought to the house
by the London Ambulance Service at the request of doctor or midwife, if in their clinical
judgment it is required.

In the puerperium visits are made by midwives twice daily for the first four days after
delivery and then once daily until the end of the 10 days lying.in period. A completed
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