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General practitioners and midwives together supervise the care of expectant mothers. The doctor
supervises the care of the expectant mother, and arranges for a blood specimen, chest X-ray and a certificate
of medical fitness for gas and air analgesia. The midwife examines the mother at her special clinic (Table
48), visits her at home, and ensures that everything is prepared for the confinement. Every mother has a
general practitioner and a midwife booked for her confinement. The liaison between the general practitioners
and the midwives is good. Several doctors attend at the midwives' ante-natal clinics to see the expectant
mothers booked with them.
The Maternity Record Card based on the Enfield Chase one is being used by the general practitioners
and the midwives.
The general practitioners and the midwives also meet together at Pound Lane Clinic from time to
time to discuss points of interest over a cup of tea.
The assistant medical officers take blood specimens from expectant mothers referred by general
practitioners.
Midwives instruct expectant mothers on the use of the apparatus for gas and air analgesia. Mothers
who have gas and air analgesia during labour have substantial relief from pain (Table 49). Midwives work
very closely with general practitioners who were present in approximately one-half of the deliveries (Table
49). 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 49). When labour tends to be long, pethidine or pethilorfan is
given. This assists with relaxation and shortens the labour. Trichloroethylene is also administered with good
results.
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 a blood transfusion
apparatus. The "flying squad" was called out to 12 mothers during the year for the following conditions:
six ante-partum haemorrhage, three retained placenta with haemorrhage, and three post-partum haemorrhage.
The Hammersmith Hospital premature baby unit provides a special ambulance for premature babies
who require treatment in this u nit. The ambulance with two qualified nurses trained in the care of premature
babies carries special equipment, including a fitted cot and apparatus for administering oxygen. The ambulance
is sent for by the doctor who may be present at the confinement who has been called for medical aid
by a midwife. Two babies were admitted to the unit during the year.
The Middlesex County Council also provides similar equipment which is kept at the Willesden
Ambulance Station and is sent out by ambulance and two ambulance drivers when it is required to take
a premature baby into a hospital other than Hammersmith Hospital. The midwife in attendance at the confinement
accompanies the baby to the hospital. Four premature babies were admitted to hospital during the
year under these arrangements.
In addition the midwives have assisted in the obstetric survey which is being carried out by the
North West Metropolitan Regional Board, by completing questionnaires on certain groups of cases.
The number of visits made by midwives to mothers and babies discharged early from hospitals was
900. They also answered calls made to them by general practitioners or the ambulance station to attend
mothers booked under the Emergency Bed Service.
HEALTH VISITING (Tables 50-52)
The health visitor is the most important social worker for the care of expectant 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 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 National Surveys and help in the practical
training of hospital student nurses and student health visitors from Middlesex and Battersea College of
Technology who are in training during the year.
Health visitors work in close co-operation with general practitioners (Table 52), staffs of hospitals,
children's officers, welfare officers, public health inspectors and other social workers.
Some patients who attend Diabetic Clinics require advice to be given in their homes on their treatment,
diet and after-care. Health visitors who attend the Diabetic Clinics at the Central Middlesex Hospital
and Willesden General Hospital give this advice under the supervision of the physician-in-charge. Twentyseven
visits were made during the year to the 16 patients selected by the physician-in-charge for these health
visitors. A number of health visitors and temporary clinic nurses 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. No students were sponsored for Willesden in 1962.
HOME NURSING
The Area Health Office is responsible for the day-to-day administration of the Home Nursing
Service in Willesden.
The nurses are non-resident and the local medical practitioners and hospitals receive, from time to
time, an up-to-date list of their names, addresses and telephone numbers, so that direct contact with the
nurses can be made. In addition, four alternative telephone numbers are set out on the list which can be
used for emergency calls at weekends and bank holidays, when the Area Health Office is closed.