London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1962
[Report of the Medical Officer of Health for London County Council]
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Domiciliary confinements increased by 776 over 1961 and institutional deliveries discharged
home before the tenth day showed an increase of 233. The figures of early
discharges include (i) cases sent into hospital during labour from the domiciliary midwifery
service on account of some abnormality and returned for nursing by a domiciliary midwife
(this has long been a normal practice); (ii) cases accepted after 48 hours in accordance with
pre-arranged schemes with certain maternity hospitals (see page 49). It will be seen that
there has been a steady increase, from 4,041 in 1958 to 10,859 in 1962 (i.e. almost double),
in the number of home confinements booked by general practitioners for the provision of
maternity medical services. If hospital district cases are excluded the number has been
almost trebled. Also, in about one-third of the cases where a doctor has been booked he
attends the confinement.
Table (iii)—
| Age | Total confinements | Parity | |||||
|---|---|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 and over | Not known | ||
| Under 20 No. | 538 | 210 | 253 | – | – | ||
| 1.7 | 2.1 | 0.1 | - | - | |||
| 20-29 No. | 7,779 | 673 | 3,258 | 2,308 | 1,029 | 509 | 2 |
| 5.6 | 27.2 | 19.2 | 8.5 | 4.3 | 0.0 | ||
| 30-39 No. | 3,474 | 54 | 745 | 1,020 | 812 | 843 | - |
| 0.5 | 6.2 | 8.5 | 6.8 | 7.0 | - | ||
| 40 and over No. | 197 | 2 | 20 | 32 | 45 | 98 | - |
| 0.0 | 0.2 | 0.3 | 0.4 | 0.8 | - | ||
| Not known No. | 8 | – | 2 | 4 | 1 | – | 1 |
| - | 0.0 | 0.0 | 0.0 | - | 0.0 | ||
| Total No. | 11,996 | 939 | 4,278 | 3,433 | 1,893 | 1,450 | 3 |
| 7.8 | 35.7 | 28.6 | 15.8 | 12.1 | 0.0 | ||
Percentages are of the total confinements.
On grounds of parity, 1,450 (12.1 per cent.) of mothers delivered by domiciliary midwifery
services should have been delivered in hospital, but this was not possible either because
beds were not available at the time the mother came for her ante-natal care or because the
patient herself (69 instances) refused hospital booking.
The peri-natal mortality rate for the domiciliary midwifery service (table(iv)) was 11.2
per thousand total births. The stillbirth rate in the domiciliary midwifery service was 7.0
per thousand total births, compared with 8.1 for England and Wales (1961). However,
an analysis of peri-natal mortalities and stillbirths, according to age and parity, does seem
to show that primiparae under 20 years of age delivered at home are at greater risk of
peri-natal mortality or of a stillbirth than other mothers delivered at home. This conclusion
is based on small numbers but does suggest a review of the priority for hospital admissions
in this respect, so far as the maternity services in London are concerned.
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