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this report. Your Committee have had discussions with Queen Charlotte's Hospital and the Willesden
District Nursing Association as to the collection of these fees. These bodies have expressed the
opinion that the collection of these fees either in whole or in part should rest with them. We have been
unable to come to agreement on this point as we are of opinion that the Council should assess and
collect the fees for the whole of Willesden on the same basis so that as far as possible all residents
receive the same measure of consideration. The machinery already exists in the Health Department
for this purpose and after prolonged consideration of this subject we remain of the opinion that this
is a matter with which the Council alone should deal.
The Extent of the Problem.

It will be observed from the foregoing table that the number of births in institutions is increasing,
the number of births dealt with by district midwives is more or less stationary, while the number of
births attended by doctors is diminishing.
9.—The Act requires the Council to secure that there shall be available in the area for attendance
on women in their own homes either as midwives or as maternity nurses, an adequate number of
whole-time salaried midwives. From the foregoing table it may reasonably be assumed that the
Council require to secure the provision of whole-time salaried midwives for 600 cases of district
midwifery per annum, being the approximate number of cases now annually notified by district
midwives in the above table, and midwives as maternity nurses for a proportion of the approximate
number of 600 cases notified by doctors. It is estimated that 400 of these 600 doctors' cases would
utilise the maternity nurses provided under the Act and that the remaining 200 doctors' cases would
probably make their own private arrangements for maternity nursing. It is estimated then that
the Council have to make provision for 600 cases of midwifery and 400 cases of maternity nursing.
Midwifery.
10.—The Council have to secure the provision of midwives for 600 cases of midwifery per annum
by the employment of whole-time salaried midwives either directly or through voluntary associations.
In estimating the total number of midwives necessary for this work it has to be borne in mind that
ante-natal attendances on a case, attendance at labour and nursing for the prescribed period of 14 days
afterwards will on an average occupy 28 hours of a midwife's time. It has also to be remembered
that from time to time a midwife will be off duty on account of sickness or infection and will be required
to attend refresher courses under the Act. (The Central Midwives Board in a Circular Letter dated
10th December, 1936, propose that this refresher period shall be for one month in every seven years.)
Taking all these factors into consideration, the number of cases that a midwife will be able to attend
per annum is 65-70 and on the basis of the figures in the previous table the Council would require to
secure the employment of nine whole-time salaried midwives for the estimated 600 cases.

Note.—It will be observed that the annual totals do not correspond with the figures for births
notified by district midwives in the preceding table but the totals for the five years in the respective
tables are 2,650 and 2,703. The figures in the above table are obtained from midwives at the end
of the year by circular letter while the figures in the first table are obtained by the addition of the births
notified under the Notification of Births Acts, 1907 and 1915.