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36
It may be suggested that the Maternity Hospital, which is now in course
of erection and which will be able to cope With twice the number of births
that occur at the present Maternity Hospital, will reduce the number of
births that it is suggested will have to be provided for by whole-time midwives.
But the additional beds at the new Maternity Hospital may be calculated
as providing for some of the cases at present confined in the County Hospitals
and in the hospitals in London and for the increased number of child-bearing
women who will come into the district as a result of the continued building
of houses on the undeveloped land in the Borough. Provision has to be
made for the population of the Borough gradually increasing to 200,000
in the course of the next 10 years from its present estimated level of about
150,000.
In Circular 1569, already quoted, it is suggested that in populous districts
a midwife should usually be capable of attendance on 100 cases in a year,
70 cases as a midwife and 30 as a maternity nurse. Much controversy
has taken place regarding this number and it seems advisable, in view of the
facts (a) that from the 1st January, 1937, all midwifery cases have to be
attended for a period of fourteen days subsequent to the day of birth instead
of a period of 10 days, (b) that one of the principal objects of the Act is to
improve the conditions of service of the midwives, and (c) that every opportunity
should be taken to extend the time devoted to the care of each patient
the number of midwives required should be based on the assumption that
each Would be responsible for an average of 80 cases during the year. The
Council is therefore recommended to engage 9 whole-time midwives to
provide for the Borough an adequate service. This number may be regarded
as reasonable but it will be quite easy to increase the number if it is found
necessary after the scheme has been inaugurated.
Until experience of the actual Working of the scheme is obtained it is
difficult to say Whether further staff Will be required to carry on the service
during the absence of the regular midwives through illness, annual leave,
or attendance at post-graduate courses. As assistance in such cases might
be a matter of urgency, it is suggested that approval should be given to the
engagement by the Medical Officer of Health of temporary assistance to
meet any emergencies.
It is not anticipated that the number of midwives required Will decrease,
but to provide for such a contingency it is advisable to stipulate in the
conditions of appointment that the midwives may be required to undertake
duties under the Maternity and Child Welfare or School Medical Services
of the Council.
Midwives at present in practice in the Borough.
The number of midwives Who, during the present year, gave notice of
intention to practise in the district is 50, of whom 37 reside in the Borough
and 13 in adjoining areas.
A detailed summary of the domiciliary cases attended by midwives
in the Borough is as follows :— No. of Total cases
Midwives residing in the Borough. Midwives. in 1935.
Number w ith larger practices 8 485
(100, 82, 68, 57, 54, 44, 41 and 39 cases).
Number with small practices (10 to 40 cases) 3 53
(23, 18 and 12 cases).
Number with under 10 cases per annum 10 12
(6, 6, 0, 0, 0, 0 and 0 cases—three commenced in 1936).
Number in nursing homes who also attend a small
number of domiciliary cases 6 18
(15,3 and 0 cases—three commenced in 1936).
Number entirely employed in nursing homes 10 —
Midwives residing outside Borough.
(32, 32, 29, 14, 6, 4, 1, 1, 1, 1, 0, 0 and 0 cases) 3 121
50 689