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DOMICILIARY MIDWIFERY
The coming into force of the National Health Service Act, 1946 meant that this service
became free to the patient. The Council's domiciliary scheme has been basically unchanged
since its inception in 1938. Over the years the number of midwives employed by hospital
districts has fallen, their work being taken over almost entirely by midwives employed
directly. The main result of the Act was to allow closer integration of the domiciliary
midwifery service with the maternity and child welfare services and other services for which
the Council became responsible under the Act and also with the maternity medical services
provided under Part IV of the Act.
It thus became Council's policy for all domiciliary midwives to use its ante-natal clinics
for the booking and examination of their patients. (The clinics are also used by an even
greater number of women booked for hospital confinement to obtain their intermediate
ante-natal care.) A doctor, who is either a full-time assistant medical officer, a general
practitioner with special experience or, to an increasing extent, a general practitioner
obstetrician, attends all or alternate sessions with the domiciliary midwife, depending on
the numbers in attendance at each session. Blood specimens are taken from all mothers
attending the Council's ante-natal clinics for haemoglobin estimations, Wasserman and
Kahn tests, determination of Rhesus factor and tests for Rhesus antibodies in appropriate
cases. General practitioners are invited to use these facilities for their own patients.
Midwives also take cord blood in those Rhesus negative cases which are fit for home
confinement.
Special emphasis is laid on the early recognition of toxaemia and weight records are kept
as a routine. During 1960 the preventive measures against toxaemia were further reinforced
by making home helps available free of charge where hospital consultants or general
practitioners certify that rest at home is essential for this reason and that admission to
hospital is thought unnecessary or impracticable.
The administration of analgesia by midwives has shown a marked and rapid rise—
expressed as a percentage of domiciliary confinement, from about three per cent. in 1946
to 34 per cent. in 1948, to over 70 per cent. in 1951 and to over 80 per cent. from 1955
onwards.
There has also been a marked change in the number of domiciliary confinements booked
by general practitioners for maternity medical services. In the early years of the National
Health Service the number of domiciliary confinement in London booked by general
practitioners for maternity medical services was low and by 1956 it was only 26.6 per cent.
of all home deliveries. However, the Council's policy was that a general practitioner
obstetrician and a domiciliary midwife should be booked for every domiciliary confinement
and since 1961 the percentage has been well over 80 per cent. Plans to promote the fullest
co-operation with general practitioner obstetricians were agreed with the London Local
Medical Committee and in 1960 they were offered free facilities at the Council's ante-natal
clinics.
Further consideration was given during 1964 to the introduction of revised off-duty
and night-duty schemes for the Council's directly-employed midwives and experimental
schemes were tried out in several areas. By the end of the year a new off-duty and nightduty
scheme had been adopted for the county, the principal feature of which was that in
normal circumstances, with a full complement of staff, it is only necessary to require a
midwife to be on duty at night on two nights a week. Naturally the midwife is on call for
a much larger area than was previously the case and if she has not her own transport
she may now call on Radio Taxis to take her to and from the patient's home. The midwives
much appreciate the new arrangements and undisturbed nights.
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