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18
MIDWIFERY SERVICE
At the beginning of the year the Middlesex County Council employed four midwives in Willesden
During the year one midwife left who was replaced and two more midwives were appointed, making a total
of six midwives at the end of the year.
Three or four pupil midwives work in Willesden (under the supervision of midwives who are
approved midwife teachers) for three months as part of their second period training for the Central Midwives'
Board Examination.
There is generally a shortage of midwives, and during the year midwives who work in the Wembley
part of the Area helped in Willesden.
General practitioners and midwives supervise the care of expectant mothers. When a mother chooses
both a general practitioner and a midwife for her confinement, the doctor supervises the care of the
expectant mother, and arranges for a blood specimen and a routine chest X-ray to be taken. The midwife
examines the mother at her special clinic (Table 54), visits her at home, and ensures that everything is prepared
for the confinement. Mothers are encouraged to have both a general practitioner and a midwife for
their confinements.
A mother who chooses a midwife alone for her confinement attends the local health clinic, where the
assistant medical officer makes the initial medical examination, takes a blood specimen, and arranges for a
chest X-ray. She then attends the midwive's clinic regularly throughout her pregnancy and is instructed on
the use of the apparatus for gas and air analgesia.
The assistant medical officer examines the mother again at the 36th week of pregnancy and gives a
certificate of medical fitness for gas and air analgesia. Mothers who had gas and air analgesia during labour
had substantial relief from pain (Table 55). Midwives work very closely with general practitioners who were
present at some of the deliveries (Table 56). When a midwife attends a case on her own and requires help, she
must call in a doctor according to the rules of the Central Midwives Board (Table 57).
For serious emergencies the midwife or doctor calls the Central Middlesex Hospital for the obstetric
"flying squad," consisting of an ambulance, a doctor, a nurse, two ambulance men and blood transfusion
apparatus. The "flying squad" was called out 5 times during the year to five mothers for retained placenta
with post-partum haemorrhage.
The Hammersmith Hospital premature baby unit provides a special ambulance for transporting premature
babies who require treatment in their unit. The ambulance is accompanied by two qualified nurses
with special training in the care of premature babies, and it carries special equipment including a fitted cot
and apparatus for administering oxygen. The ambulance is sent for at the request of a doctor who has been
called for medical aid by the midwife. Three babies were admitted to the unit during the year.
In order to study how deaths in the first week of life and stillbirths are caused, the National Birthday
Trust Fund sponsored a survey of perinatal mortality. A comprehensive questionnaire has been completed
of every confinement in England and Wales and Scotland during the week of 3rd to 9th March, 1958, inclusive,
and every stillbirth and death of infant in the first four weeks of life during March, April, and May, 1958.
The District midwives completed the questionnaire for the domiciliary confinements.
HEALTH VISITING
The Health Visitor is the most important social worker for the care of expectant and nursing mothers
and young children. Under the National Health Service Act, 1946, her work has been extended to the whole
family for their health education and for the prevention, care and after-care of illness.
Health Visitors attend with the assistant medical officers at maternity and child welfare clinics and at
schools for medical inspections and routine hygiene inspections. During the year they gave 62 school talks
to senior girls on Mothercraft; these talks were much appreciated by the girls, who showed interest and asked
many intelligent questions. Health Visitors make enquiries for the special National Surveys and help in the
practical training of hospital student nurses, student Health visitors from Middlesex and Battersea Polytechnic,
and home nurse candidates who are in training during the year (Table 58).
Health Visitors work in close co-operation with general practitioners (Table 59), staffs of hospitals,
children's officers, welfare officers, public health inspectors, and other social workers.
Some patients who attend diabetic clinics require advice on their treatment, diet and after-care to
be given in their homes. Health Visitors attend the diabetic clinics at the Central Middlesex and Willesden
General Hospitals, and are responsible to the physicians-in-charge for giving this advice.
During the year, 25 patients, carefully selected by the physicians-in-charge, were supervised by health
visitors, who gave them useful assistance and advice and they demonstrated how the social side is important
in the treatment of diabetic patients.
There is still a shortage of health visitors for the Willesden part of the area (Table 60). Temporary
clinic nurses, therefore, have been employed to help at the clinic sessions and visit schools for medical inspections
and routine hygiene inspections.
The Middlesex County Council introduced a sponsored scheme for student health visitors in September,
1955. Students receive theoretical training at the Chiswick Polytechnic and their practical training in one of
the areas. They must remain with the County Council as health visitors for two years after they qualify.
Four students who were sponsored for Willesden qualified, and were appointed as health visitors in Willesden.
In addition there were two students in Willesden in 1958.