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39
It is expected that the majority of women attending a municipal
ante-natal chnic will be women who have booked a midwife
for domiciliary confinement, and no conclusions can be drawn about
the expected mortality of any group of pregnant women without
first considering whether they are a selected group. Routine
supervision at the Leyton municipal clinics is given to women who
are being admitted to one of three hospitals with which Leyton
Borough Council has an arrangement for maternity cases. These
women are booked and supervised at the municipal clinic until
the hospital takes over their supervision at about the 32nd week,
when a report is sent to the hospital from the clinic. Among the
chnic attendances are also women who are anxious to remain at
home and may actually have booked with a midwife, but whose
general health or obstetric history makes hospital confinement
advisable. They form a difficult group as sufficient emphasis
must be put on the possible dangers to induce them to change their
minds without lessening their chances by frightening them. Finally
there are the women who have not made any arrangement at all
for confinement, who may appear at the clinic at about the eighth
month, have almost certainly no accommodation at home and who
expect a hospital bed to be waiting for them. Before the war the
hospital cases comprised about one-quarter of the women who
received ante-natal supervision at the municipal clinics. Since
the war (i.e., for eight years out of the twelve under review) the
proportion has risen to one-third.
Thus the cases under supervision at the municipal clinic are,
on the whole, not an average sample of pregnant women in the
area. They contain an undue proportion of first pregnancies
[thus in 1944, 284 were primiparae and 228 were multipara (Menzies
1945) ]. Of the multipara, those who book a midwife but who
are not considered suitable for domiciliary confinement and others
who are doubtful for home delivery will have attended the clinic,
plus the careless ones whose failure to arrange for confinement
may or may not have included failure to obtain nutritional priorities
during pregnancy. How they compare as obstetric risks with the
Leyton women who have booked directly at hospital and received
all their supervision at the hospital it is impossible to say without
knowing what proportion of the hospital beds are booked on the
"first come first served" principle, and what proportion is left
to be filled from the consulting obstetricians' clinics. The cases
booked by general practitioners for domiciliary confinement or by
private maternity homes ought to come nearest to the midwives'