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a large number of women who will have normal confinements in
whose cases the examination by the Clinic Medical Officer would be
supplementary to that provided by the midwife who will conduct
the confinement. Again, there is the reed of post-natal examination
which should be carried out in all cases. The clinic would be
available in this case for all mothers who are attended in their
confinements by midwives. It has been suggested that all these
services can be provided by the general medical practitioners.
Many women, however, are not covered by the panel and without
actually requiring relief as provided by the Public Assistance
Committee, are in receipt of incomes so low that the sum charged
per attendance would seem large, particularly for a service of the
value of which they were not absolutely convinced. The alternative
is the provision of a service free to certain applicants, provided by
the general medical practitioner, who would be paid by the Local
Authority. This is a line of development which is in the experimental
stage in some areas and is considered by some as the
probable solution.
Page 26 in "The State of Public Health, 1930" reads :—
"It is possible that eventually the ante-natal clinic, as we
know it to-day, especially in the larger towns, may to some extent
disappear, thus leaving the ante-natal supervision of maternity
patients to be carried out by private practitioners with the assistance
°f a relatively small number of consultative ante-natal clinics
staffed by specialists. Whatever the ultimate destiny, however,
it is elear that there will remain a need for ante-natal clinics,
particularly in industrial and urban areas, for some time to come;
the tull development of pre-natal supervision will depend very
greatly upon the efficiency of these clinics."
lo obtain the maximum benefit from the ante-natal services
run on its present lines, it is necessary to have clearly in mind the
purposes of the service and its limitations. It is first necessary to
Classify the case as regards normality. This will determine the
Category of the attendant required for the confinement. For normal
cases booked by midwives the ante-natal clinic can provide the
necessary medical care. Abnormal cases should at once be referred
to the medical attendant who is to conduct the confinement. In
this district the abnormal confinement will take place either at home
with a medical practitioner in attendance, at Oldchurch Hospital,
or at once of the london Hospitals to which the patient is admitted
under the care of the Consultant Gynaecologist. Abnormal cases
then.when diagnosed,are taken off the books of the ante-natal
clinic.Normal cases should attend at specified times and it should
be the duty of each attendant midwife to see that each of her
patient dose obatin the necessary medical examination at the
required times. The home supervision of all cases then, will be