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53
Ensuring that the services of a trained midwife
are available for all confinements.
The Council already pay the whole or part of a midwife's fee
in necessitous cases, but the applications for midwives' fees are less
numerous than they used to be. Formerly this fee was frequently
paid, but recently the number of applications is much less. Probably
this is due to the change which has occurred in the attitude
of the expectant mothers to institutional confinement. Expectant
mothers now take far more advantage of the facilities which have
been provided for normal confinements in maternity hospitals.
Possibly also the change over from the Board of Guardians to the
Public Assistance Committee of the Count} Council may have had
some influence in this respect.
Maternity Beds.
The Council has an agreement with the Acton Hospital
for abnormal cases. The arrangement with the Middlesex County
Council for ordinary confinements is working satisfactorily. Necessitous
cases are dealt with by the Public Assistance Committee.
It is unnecessary at present to enter into the question of institutional
treatment, but as the provision of a maternity home was discussed
by the Committee before the agreement with the .Middlesex County
Council was entered into, it may be advisable to refer to the Final
Report of the Departmental Committee on Maternal Mortality
and Morbidity on this phase of the question. The Committee's
report is definitely against the establishment of small maternity
homes or even of special maternity Hospitals unless such a method
is unavoidable. They believed that new maternity units should,
where practicable, be provided in association with general hospitals
rather than as isolated units. In expressing this opinion, they were
in no way minimising the admirable work which has been done by
many of these special hospitals, but they believed that in addition
to the saving which may be effected in capital cost and in working
expenses, a higher standard of obstetric practice can be obtained
where the resources of a general hospital and the sendees of a
specialist staff, non-obstetric as well as obstetric, can be called upon
at any moment.
There is one condition in which the present scheme could be
improved. We have in the agreement with Acton Hospital, provision
for the admission for confinement during pregnancy where
ante-riatal examination has revealed abnormalities likely to require