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accommodate all confinements can be expected for some considerable time. A possible
alternative is the early discharge of mothers (48 hours) for maternity nursing in their
own homes. With the present establishment of midwives, whose case load is already high,
it would be impossible to undertake these increased duties on any large scale. Experimental
schemes have, however, been started together with four hospitals in divisions 1, 2, 7 and 8,
where four midwives with long service with the Council are now engaged in this work, which
relieves them of irregular hours and night duty. However, this work has no wide appeal to
practising midwives.
Mothers are selected during pregnancy for early discharge. The midwife makes a visit
to assess home conditions and where these are suitable gives the mother a co-operation
card which serves as the patient's clinical record. The hospital invites a general practitioner
obstetrician to undertake the intermediate ante-natal care and to supervise the puerperium.
Some of these mothers have been unwilling to forego hospital care during the lying-in
period. Others may resent an arrangement by which they forfeit the home confinement
grant although they must face some expenses which the grant would normally cover.
Many require hospital confinement on social grounds and their accommodation is unsuitable
for nursing the baby in the early neo-natal period.
A preliminary review of the experimental schemes shows that in spite of the most careful
selection by the obstetrician of cases for early discharge more than one-third of the mothers
are found to be unfit to go home on the second day.
It is to be remembered that the Cranbrook Committee recommended 10 days lying-in
period in hospital. The present domiciliary services in London have been developed to
provide a comprehensive maternity service for less than 20 per cent, of the total births
in the county. Any extensive changes with the aim to secure early discharge from hospital
would tend to overwhelm the services and to prove unpopular with midwives. It seems,
therefore, that the problem requires much further consideration and understanding on the
part of hospital services, general practitioners and the Council alike.