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record of pregnancy, labour and puerperium is then sent by the midwife to County Hall
for scrutiny by a supervisor of midwives.
Top priority is given by the home help service to domiciliary midwifery cases, but, in
spite of this, the demand for home helps is no more than 15 per cent. of domiciliary confinements.
Most families meet their own obligations either by the father taking time off
or with the help of relatives or neighbours.
The Emergency Obstetric Unit
When an emergency arises in domiciliary practice, doctors or midwives call the London
Ambulance Service which immediately alerts the nearest Emergency Obstetric Unit and
dispatches an ambulance to collect them and their equipment which is always maintained
in readiness. If the midwife attends the patient alone she must send a relative of the patient
to summon assistance. In the excitement and anxiety of the moment the use of the term
' flying squad ' has sometimes led to an unfortunate confusion with the police. Nowadays
the midwife gives the relative a simple card, on which is printed the telephone number of
the ambulance service with the instruction to ask for the ' E.O.U.'
The first Emergency Obstetric Unit in London was established by University College
hospital in 1938. A year later 11 other hospitals, 10 of which were administered at that
time by the Council, set up similar units. When the National Health Service came into
force the four Metropolitan Regional Hospital Boards and the Boards of Governors of
University College and Hammersmith hospitals agreed to continue the service. There are
now 15 units operating in the county. In 1960 the average time taken to reach a case was
twenty.two minutes; this includes the ambulance journey from station to hospital as well
as the trip from the hospital to the patient's home.

There were 249 calls to Emergency Obstetric Units in 1960. The most frequent reason
was post.partum haemorrhage with or without retained placenta. It has long been a routine
practice in the Council's service to give ergometrine by intramuscular injection at the
end of the third stage of labour. Since 1959, as a preventive measure against P.P.H., midwives
have also been permitted to give ergometrine during the second stage of labour with the
birth of the head or anterior shoulder. All midwives who had not learned this technique
in their training have now attended courses of instruction at Hammersmith or University
College hospital. Ergometrine is not given during the second stage as a routine by all
midwives. The decision in many cases rests with the doctor or may be influenced by the
practice of local maternity hospitals.
Care of the baby
Medical aid is sought by midwives for babies showing signs of illness, sucking or feeding
difficulties, birth injuries and for assistance in the resuscitation of the new.born baby.
All of them carry intragastric oxygen outfits and have been instructed in their use at two
London hospitals. For the past two years University College hospital has maintained a
resuscitation team, comprising a consultant anaesthetist and nursing staff, which is
constantly on call to local doctors. Midwives have been instructed in the factors predisposing
to neo-natal cold injury and ensure in advance that rooms in which women are
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