View report page

148
at home. If, as it appears, one of the objects of the new Act is to
encourage domiciliary midwifery, the responsible Authority should
take steps to ensure that institutional midwifery is not being
subsidised at the expense of domiciliary in framing their necessity
scale and scale of remissions for payment of midwives' fees. In my
opinion the future demand for the services of domiciliary midwives
will depend, not so much on the efficiency and status of the personnel
of the new service, as on the housing conditions and family
circumstances of expectant mothers in the area, and on the relative
cost of home and institutional confinements.
(c) It is difficult to forecast with any degree of certainty the
probable proportion of domiciliary confinements likely to be
attended by independent midwives in private practice, but I
estimate that in this area the proportion is not likely to exceed
5 per cent.
(d) 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. With regard to the number of women attended by
doctors alone (item 3 (c)) it is possible that the extra expense
entailed in engaging a maternity nurse instead of a handywoman
may influence a certain proportion of these women to have their
confinements in hospital.
Taking all these circumstances into consideration, I suggest
that the provisional figure of 720 domiciliary confinements per year
be accepted as the basis on which to formulate your proposals.
In Circular 1569 it is stated that:—
"The Minister is advised that for the purposes of their
calculations local authorities might assume that in populous
districts each midwife should usually be capable of attendance
on 70 cases as a midwife and 30 cases as a maternity nurse
during the year."
For the reasons stated above there appears to be no purpose in
differentiating between the number of cases attended as a " midwife"
and as a "maternity nurse" in estimating the annual
number of cases one midwife is capable of attending.
The Joint Council of Midwifery consider that 80 cases per
annum are as many as one midwife may reasonably be expected
to attend; and this opinion is reiterated by the Midwives' Institute
in their recent Memorandum to Local Supervising Authorities.