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147
In view of the impending prohibition of unqualified persons
envisaged in the Act (Section 6) medical practitioners will no longer
be able to employ the services of unqualified "handywomen" at
confinements. It will therefore be necessary to include a proportion
of domiciliary confinements attended by doctors alone (i.e., item
3 (c)).
Nor can we disregard altogether the number of women confined
in institutions, as the maternity hospital of the future will no doubt
make increasing use of the services of domiciliary midwives for
help and co-operation during the periods of supervision both before
and after confinement. It is considered that a hospital case will
require about one-fifth of the attendance given by a domiciliary
midwife to a case dealt with at home.
In endeavouring to form any reliable estimate of the probable
annual number of future domiciliary confinements there are certain
variable factors which give rise to a very wide margin of possible
error, e.g.—
(a) The birth-rate in Leyton has decreased from 24.6 per 1,000
of the population in 1920 to 11.78 per 1,000 in 1934. In 1935,
however, the rate increased slightly to 12.26 per 1,000, and it
would be rash to attempt any prognostication of the future trend
of the birth-rate in the area.
(b) In Leyton, as elsewhere throughout the country, there has
occurred during recent years a marked and progressive increase in
the proportion of mothers who have their confinements in institutions.
For instance, in the relatively short period of five years
the proportion of institutional confinements has increased from
30.13 per cent. in 1931, to 47.95 per cent. in 1935. In the official
Memorandum (200/M.C.W.) accompanying the new Act the Minister
suggests that, in arriving at their estimates, local authorities should
consider whether the establishment of the new service of midwives
may not residt in a diminution in the number of cases confined in
hospital. Maternity beds in hospitals were intended primarily for
cases requiring admission on medical grounds (e.g., emergencies
and cases requiring special medical observation and treatment) or
on account of the lack of adequate accommodation and facilities
at home. Nowadays, however, a large proportion of women go
into hospital for confinement merely because it is more convenient
—and, in this area, less expensive—to be confined in hospital than