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(Other cases are admitted to Oldchurch Hospital not on medical
"rounds but on social or economic grounds. These cases would
ordinarily, so long as they appear normal, continue under supervision
at"the ante-natal clinic until a few weeks before the confinement.
The Medical Superintendent of the Hospital is notified
in time to call up each of those cases to his own ante-natal clinic
some time before the confinement )
In these cases, the ante-natal records are transferred from
the clinics to the hospital clinic until the confinement, when, after
particulars of the ante-natal visits and of the confinement have
been entered, they are returned.
(c) Other cases are referred to their own medical attendants
into whose hands they then pass. He can, if he desires, request
that arrangements be made for institutional treatment or for
examination by the Consultant Gynaecologist. Ordinarily, however.
he attends the case. In a report to the Public Health Committee,
it was suggested in these cases where the family income was
below a certain limit, that the Local Authority should bear the
cost of this ante-natal supervision by the medical attendant.
The recommendation was not acccpted on the grounds that the
patient could place herself in the hands of a doctor free of charge
to the patient by first passing into the care of the midwife who
would then call in the doctor on the medical aid notice, the
doctors fees in that case being paid by the County Council.
Apart from the fact that it is laid down that it is the duty
of the Maternity and Child Welfare Authority and not of the
Local Supervising Authority of the midwives to provide the
ante-natal services, an impossible situation would arise if the Clinic
Medical Officer were to refer a definitely abnormal case to the midwife
with the advice that she should refer the case to a doctor,
ihese abnormal cases who are to be confined at home, and also
cases of abnormality of pregnancy, should pass out of the care of the
ante-natal clinic into the hands of the general practitioner immediately;
and in necessitous cases, the doctors' fees should be paid by
the Local Authority as part of the expenditure of their ante-natal
services.
Under this arrangement, almost all abnormal cases pass out
of the hands of the clinic staff to the care of those who will be
conducting the confinement. The Health Visitors will continue
to pay home visits as necessary to satisfy themselves not only that
the patients have passed into the care of the attendants but that
they are continuing under that care. For the case continuing
under the care of the ante-natal clinic, particularly until such time
as it is established that the patient has passed into the hands of an
attendant,it is essential that responsibility is accepted. This
necesssitates the patients being kept under observation. For this