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56
The following note by Dr. Marjory Yule with regard to the work done at the
Ante-Natal Clinic at 14, Salisbury Street, contains a number of points of real
interest and evidence of the value of the work done at the Clinic :—
The total number of attendances at the Clinic during the year amounted to
820; 50 sessions were held, giving an average attendance of 16 cases per clinic.
These cases are referred to the Clinic from various sources :—
1. By Health Visitors.
2. By local midwives.
3. By nurses who run a Maternity Home in the district.
4. By Rescue Workers at a home for unmarried mothers.
5. By the Marylebone Home.
6. By Queen Charlotte's Hospital.
Two of the local midwives attend at the Clinic every week and help in the
work there. They are encouraged to bring their cases along to the Clinic, and to
keep these cases under the supervision of the doctor until the confinement is due.
May I say here how pleased we are to have the midwives with us at the Clinic,
and how much we appreciate their co-operation and help.
Patients who go directly to the Marylebone Home to book up for their confinement,
are referred to the Clinic by the Sister in charge, and they attend the Clinic
then until their confinement is actually due.
The cases referred from Queen Charlotte's Hospital are those who have
delayed too long in booking up at the Hospital for their confinement, and they
are then referred to the Salisbury Street Clinic for ante-natal attendance, and go
to the Marylebone Home for their confinement.
In regard to the actual confinement, when this is in charge of the midwives,
the midwife is asked into the Doctor's room at the first and the final examinations,
and given a full report on the case (verbal and written), and advised on any
particular point of interest in the case. If any difficulty occurs during labour,
e.g., uterine inertia or perineal tears, the midwife calls in a local Doctor to her
assistance.
Normal cases only go to the Marylebone Home for their confinements, as
they do not accept complicated cases there. So the abnormal cases, for example
cases requiring early induction of labour or Caesarian section, are sent to St.
Mary Abbots Hospital.
In every case, a written report is sent to the Nurse, Doctor or Institute dealing
with the confinement, and after the confinement a written report is sent back to
the Clinic with full details of the confinement, so that all the ante-natal findings
are checked up, and a complete report of the case from beginning to end is kept.
The patients are asked to attend the Clinic after their confinement is over, and
they are then thoroughly examined and given any treatment which may be
necessary.
It is unfortunate that there is a tendency amongst midwives and others to use
the Clinic for abnormal cases only. One tries to combat this as much as possible,
and it is here that the Health Visitor is a tremendous help. She is in personal
touch with the people of the district, and can persuade the mothers to attend the
Clinic early. Many abnormalities can be prevented, but treatment is often very
difficult when the abnormality has been in existence for some time.
A criticism has been launched that although the number of Ante-Natal Clinics
throughout the country has increased greatly during the last few years, they have
achieved nothing, since the maternal mortality rate has not decreased. I maintain
that the Salisbury Street Ante-Natal Clinic has definitely justified its existence.
We have unfortunately had one maternal death in connection with the Clinic, but
that is over a period of 3½ years. This case arrived at the clinic, 7½ months
pregnant, and showing definite signs of toxaemia. She was under the care of the
Clinic for a fortnight, and as she was not responding satisfactorily to treatment,
I sent her into hospital, so that she could be under continual medical supervision.
Apparently she had been too long in seeking medical advice, because she did not
improve under treatment, and after her confinement she had complete collapse and
died.