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*Excludes eight cases in which parity was not stated.
The Cranbrook Report
The Maternity Services Committee was appointed under the chairmanship of the Earl
of Cranbrook in 1956 to review the organisation of the maternity services in England and
Wales, to consider what should be their content and to make recommendations. Their
Report was published in 1959.
In recommending that the tripartite structure of the maternity services should be retained
the Cranbrook Committee stated that the real problem crystallised into one of co.operation
and co.ordination between individuals providing the maternity services.
In the early years of the National Health Service the number of domiciliary confinements
in London booked by general practitioners for maternity medical services was low.
In 1956 it was only 26.6 per cent. of all home deliveries. However, the Council's policy
is summarised in a recommendation (360) of the Report—" A general practitioner obstetrician
and a midwife should be booked for every domiciliary confinement and there
should be close co.operation between them." In 1960, 60 per cent. of home confinements
were booked by doctors, and it is expected that this figure will be increased during 1961.
The Council has introduced forms by which doctors booking cases for maternity medical
services inform the midwife of their intentions in regard to ante.natal care and attendance
at the confinement, and may ask for blood tests. In 1958 the Council introduced a patient's
personal record card which the mother carries herself, the card provides not only a means of
interchange of information between doctor and midwife but also, if need arises, a clinical
record readily available to the hospital.
At its best, however, co.operation should extend to joint ante.natal care by doctor and
midwife. To this end the Council arranged in the last few years, as an interim measure
pending the publication and implementation of the Cranbrook Report, for 18 midwives
to attend ante.natal clinics in doctors' surgeries. There were limitations to further expansion
of the scheme, there being five times as many general practitioner obstetricians as
domiciliary midwives in London, and the distribution of a doctor's practice, spreading out
like spokes of a wheel involving a number of midwives areas, made it difficult and sometimes
impossible to meet all demands. Holidays, sickness, attendance at refresher courses,
and normal off.duty time, reduce the amount of time the midwife is available, and further
improvements in conditions of service, e.g. one weekend off duty per month, have to be
considered; in the past many midwives had to be content with mid.week off.duty periods
only. Finally the Cranbrook Report itself made it clear that a fresh start would be necessary.
Free facilities will be offered general practitioner obstetricians at Council clinics and the
number of places where midwives attend will be reduced thereby. This will shortly be the
subject of discussion with the Local Medical Committee. All this will mean a gradual
change from the existing pattern and will have the merit of extending these facilities to all
general practitioner obstetricians. In division 6, doctors from four practices form a rota
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