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Uninsured Women.
(a) Who arrange for their confinement at a hospital. These women usually receive antenatal
care at or in connection with the hospital.
(b) Who arrange for confinement at home by a midwife. These women may have ante-natal
care at the Municipal Health Centres.
(c) Who arrange for confinement at home by a doctor. These women may have ante-natal
care from the doctor engaged for the confinement.
While the foregoing is a statement of the general position, it should be observed that in Willesden
a considerable proportion of women either insured or uninsured who engage a midwife attend the
Health Centres for ante-natal care. This proportion is increasing, since the Willesden Council became
the local supervising authority under the Midwives Acts.
Memo. 156/M.C.W. states that "it is desirable to associate doctors and midwives practising
in the area much more directly with the clinic and its staff."
As stated above, midwives may send patients to the centre. Midwives always receive reports
from the doctors at the Centres as to the condition of their patients. If their patients fail to attend
the Centres the midwives are informed, so that they may follow up the case as they may consider
desirable.
In respect of doctors, they seldom refer their cases, whether insured or uninsured, to the antenatal
centres of the Local Authority. But the ante-natal services provided at the Centres are available
for the patients of doctors should such patients attend.
Paragraph 5 of Memo. 156/M.C.W. states: "and in towns there are many women
who cannot be persuaded to attend the Centres." I doubt if this applies to Willesden. For such
women, however, it is suggested in the Memo. that arrangements might be made by the Willesden
Council with private medical practitioners for the ante-natal examination at home of those uninsured
women who are reluctant to visit the Centre. Such uninsured persons might be the prospective
patients of a midwife or doctor at confinement. In any case, it is suggested that the private practitioner
with whom these ante-natal arrangements are made should be the doctor likely to be called
in at the confinement. It is also suggested in the circular that the doctor should be provided with
the services of a nurse or health visitor for the following up of the case and the subsequent supervision.
Paragraph 7 of the Memo. 156/M.C.W. is somewhat involved. It states that ante-natal
supervision is to be adequately performed. It states that the Medical Officer of an ante-natal centre
requires special experience in midwifery and ante-natal work. It states that it may be advantageous
to employ part-time private practitioners with such special experience. But it also states that any
doctor, whether qualified by the regulations or not, should be able to see his patient at the Centre
if the patient or doctor (the paragraph does not make clear which) so desires.
Any pregnant woman in Willesden may have ante-natal care at the Council's Health Centres.
This includes examination by a Consultant Obstetrician and following up at the home by a qualified
nurse, who is also a midwife. The Ante-natal Clinics are available for patients of midwives if they
care to send them. They are also available for the patients of doctors and the Council's Obstetrician
will consult with the doctor, and advise as to the course to be taken in any ante-natal case that the
doctor cares to send to the Centres. In the case of those women who book for confinement in the
Willesden Maternity Hospital ante-natal care is obtained from the Consultant Obstetrician, who
subsequently is responsible for the confinement.
It would probably be desirable that a statement should be issued to doctors and midwives
practising in Willesden, stating what facilities are provided, so that they may utilise them as they
may consider necessary.
(2) Better Practice and Treatment by Doctors and Midwives.
This really depends on a higher standard of education and training of both doctors and midwives.
In respect of doctors, the Local Authority at present does not provide facilities for the training
of doctors. In respect of midwives I am of opinion that with the establishment of the Maternity
Hospital steps should be taken at an early date to provide suitable training for pupil midwives.
The hospital presents admirable facilities for such training. It should also be noted that if the
hospital were a training school the untrained probationer would be replaced by a trained nurse who
was a pupil midwife in training, and thus considerable advantage would accrue to the patients.
A difficulty that may arise is in connection with midwifery in the district, each pupil midwife
having to conduct 5 cases in the district, in addition to 15 in the hospital.
Paragraph 3, on p. 5 of Memo. 156/M.C.W., refers to the distribution of midwives and the
employment of municipal midwives. In Willesden there are 26 private practising midwives, and
according to the records received each conducts on the average about 25 confinements per annum.
Allowing that payment is received at the rate of 2 guineas per case, it will be observed that the private
practising midwife makes on the average but poor living.
Paragraph 4, on p. 5, suggests the importance of having a midwife to act as a maternity
nurse where the doctor is engaged for the confinement. This practice has been adopted by the