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co-ordination of the whole of the Council's maternity service
which can be readily secured now that the midwives have become
members of the Council's staff.
The first step towards improvement is facilitated by the fact
that the midwives come into close contact with the medical staff
at the Centres and by their obligation to report all unusual matters
immediately to the medical officer in charge of the midwifery
service. At the completion of attendance on each patient the
case record is submitted to the medical officer who is able to enquire
into any unusual feature. The second is attained by the midwives
practising as far as possible the technique adopted at the Maternity
Hospital. They are required to use gloves and masks when
attending confinements and are kept supplied with sterilised
maternity sets. These sets comprise two masks, a pair of rubber
gloves, towel and powder puff, cord dressing and ligatures. At
the same time in the smaller details of equipment the general
policy has been to follow the lead given by the hospital. The
third point, the improvement of the working conditions of the
midwives, has been readily obtained by the arrangement for
adequate off-duty times and holidays and by midwives who become
exceptionally busy being able to call on colleagues for assistance.
The greatest degree of improvement in the maternity service will
probably be secured by the fourth and last point, although the
actual effect of this may not be readily measured. The inclusion
of the midwives as an integral part of the scheme of maternal
welfare has rendered possible the co-ordination of the whole of the
maternity service. As independent midwives they had become
accustomed to a certain measure of co-operation with the Council's
maternity scheme,but since taking up their municipal work they have
availed themselves of the opportunity of complete co-operation.
Home Helps.—With the appointment of the midwives it was
considered desirable to make them responsible, in place of the health
visitors, for the supervision of home helps. Instead of expectant
mothers having to attend at the health centres to make application
for a home help, their circumstances are now considered by the
midwife in charge of the case who recommends, if necessary,
that a home help be supplied at the cost of the Council. The
midwives come into close contact with the home helps when
attending patients and can exercise a far greater degree of super-