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to be confined can be adequately heated. Room thermometers and low reading rectal
thermometers are part of their normal equipment.
The decision that a premature baby born on the district should be removed to hospital
must be made by the doctor, or if in an emergency no doctor is available, by the midwife
herself. Midwives are advised to transfer a premature baby to hospital if the birth weight
is less than 4½ lbs., or the baby's colour is poor or cyanotic attacks occur. The birth of a
premature baby is notified to a supervisor of midwives as soon as possible. A few small
premature babies, however, will always remain at home, either on medical advice or to
meet the wishes of the mother.
The hospital provision for the care of premature babies in London is adequate. A number
of maternity hospitals have small units for premature babies born in their own maternity
departments and only occasionally admit babies from elsewhere, but five large units will
always admit babies born on the district—University College, Hammersmith, Mothers'
and Lewisham hospitals and the British Hospital for Mothers and Babies. Admission is
arranged directly with these hospitals. The London Ambulance Service collects the hospital
team—a nurse proficient in premature baby care and sometimes a doctor—together with
an electrically heated baby carrier which can be connected to the vehicle's batteries.
During 1960 there were 524 premature babies born at home; 21 babies died in the first
24 hours after birth, five of them at home and the remaining sixteen in hospital, and 490
babies (93.5 per cent.) were alive 28 days after birth.
Particulars of domiciliary premature live births are set out in table (vii). The difference
between the total (524) shown in this table and the number (517) quoted on page 65
represents the cases attended by doctors and midwives independent of the Council's
domiciliary midwifery service.

Maternal deaths
Four maternal deaths occurred amongst the 11,366 births in the domiciliary midwifery
service in London in 1960, i.e., 0.4 per 1,000.
Two women died as result of intercurrent disease:
(i) inoperable abdominal carcinoma;
(ii) malignant mediastinal tumour with cerebral secondaries.
Two women, both para 5's, refused hospital admission, although both had attended
hospital and had been advised to accept a hospital booking. In each case the midwife
transferred the patient to hospital early in labour:
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