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66
Of the cases attended by midwives (43.9 per cent.) were attended by those in
private practice. The ordinary fee appears to be a level one of 21s., with an increase
to 30s. or 35s. for a first baby.
Special facilities provided by the Borough Council for the care of mothers
include :—
1. Agreement with the City of London Hospital for hospital consultation and
admission when necessary.
2. Arrangements under the Puerperal Pyrexia and Fever Regulations for the
visiting of cases by Consultants.
3. Ante-natal clinics (2) to which post-natal cases may also be sent.
4. Provision of milk or dinners for expectant and nursing mothers.
5. Provision of sterilized maternity dressings free where required.
A scheme for the provision of home helps is at present under consideration.

It will thus be seen that the number receiving no ante-natal attention is
considerable, although it is probably lower than the average throughout the country.
A great deal of educative work still remains to be done in order to impress women,
and in some cases even their doctors, as to the importance of this care.
In spite of the fact that many more mothers are now being examined ante-natally.
there are really few of these in which the examination is sufficiently complete. Many
do not report till the later months, and where the case is in sole charge of a midwife,
they are often not encouraged to come till advanced abdominal signs are present.
It is of the greatest importance that every pregnant woman should have a general
physical examination by a doctor as early as possible. In this way unsuspected
disorders such as tuberculosis, heart disease, and many others can be detected,
and suitable precautions taken before the strain of pregnancy makes symptoms
manifest. This is a work which cannot be undertaken by a midwife, however skilled,
and it should be continued with periodic observation and local examination in the
later months. There would probably be a certain amount of objection on the part
of some midwives to a scheme by which they referred all their cases to an Ante-natal
Centre, but there is no doubt that many would welcome it, and it should be possible
to arrange times when they could be present with their patients. The following
gives an impression of the amount of ante-natal work done by the various bodies
working in Shoreditch.