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Of the cases attended by midwives, 226 or 43.9 per cent. were attended by a
midwife in private practice.
The majority of mothers then, prefer to be confined in their own homes, although
in many cases the home conditions are not all that could be desired. This preference
does not appear to be due to any lack of institutional facilities, but simply to a dislike
to leaving home and family. During the actual labour the children are usually
cared for by neighbours, but are quite frequently turned out on the stairs.
That these home confinements do not cause a high sepsis rate is shown by the
statistics given above, but there is no doubt that in many cases the conditions are
unsatisfactory from other points of view.
It will be noted that the majority of cases are attended during confinement by
a midwife, who usually leaves on the tenth day. The few cases attended by a doctor,
in addition to the midwife, represent complicated cases for which help has been sent.
A large proportion (31.7 per cent.) of the number confined at home were attended
by a doctor or student with an untrained nurse. The attendance of a trained midwife
to perform nursing duties is desirable at every confinement, and the British Medical
Association has embodied in a national scheme recently submitted to the Ministry of
Health a proposal that a doctor should be in attendance during the ante-natal period,
the complicated labour, and the post-natal period, and that normal labour should be
supervised by the midwife. It is also realised that a high degree of skill and special
knowledge must be possessed by doctors undertaking this work.
Quite a considerable number of cases (14.9 per cent.) were attended by hospital
students. These were all from St. Bartholomew's Hospital, even though Shoreditch
lies outside the official boundary of the St. Bartholomew's district. The numbers
attended by students appear to be increasing, possibly owing to the fact that claims
for payment are often not pressed by the hospitals. Although the attention given
appears to be good on the whole, yet the objection mentioned previously remains,
and in the case of the hospital student, in particular, it is to be feared that the handywoman
is more prominent than she should be. The demand for increased facilities
for teaching midwifery is of course reflected in this extension of student work, and
while experience for students is very necessary, it would seem desirable that they
should be accompanied to their cases by a trained midwife. If the hospitals were
to insist on this, it should not be difficult for suitable arrangements to be made.