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78
British Medical Association and of the local branches of the Midwives'
Institute, recommended that the provision of the midwifery
services required under the Midwives Act, 1936, be undertaken by
the Council for the whole district.
In considering the proposals for the provision of these services
the Committee had before them the following information:—
"In 1935, 1,377 of the 2,523 confinements took place in the
patients' own homes. Of these, 822 were attended by local midwives
acting as midwives or as maternity nurses and 555 by other
attendants. The present indications are that there will be over
2,900 births in the district in 1936 and, assuming a similar growth,
not less than 3,300 in 1937. If the same proportion of domiciliary
to institutional confinements holds in 1937 as obtained in 1935,
in 1937 there will be some 1,800 confinements occurring in the
patients' homes, of which, applying the same ratio, 1,080 will be
attended by midwives acting as midwives or as maternity nurses
and 720 by other attendants. In Circular 1568 it is stated that the
Minister has advised that local authorities, for the purposes of their
calculations, 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. The differentiation between the
activities of a woman as a midwife or as a maternity nurse is unnecsary,
as it may be accepted that the time occupied by a midwife
as maternity nurse will not be less than the time taken when she
attends as a midwife. This figure of 100 patients has been criticised
as being much too high, 80 being generally accepted as the outside
figure. On the basis of 100 patients per midwife for the 1,800 confinements
18 midwives are required; on the basis of 80, the requirements
are 23. Some allowance, however, must be made for work
carried on by independent midwives and also, on the 1937 figures,
for the 720 cases which, on the standard of 1935, will not be employing
local midwives, either as midwives or as maternity nurses. For
this reason, although accepting 100 patients per midwife as not
being the ideal to be aimed at, it would seem advisable to work on
this basis for the total number of births occurring in the homes of
the patients. If it should prove that a higher proportion of mothers
having their confinements at home avail themselves of the services
of the local midwives, then additional staff will be required.
Similarly, provision will have to be made for the continued growth
of the district with the corresponding increase in the number of
confinements occurring in the home. Up to the present, 37
midwives living in the district have given notice of their intention
to practise. The work of 13 of these is limited almost entirely to
nursing homes. In addition, notice has been received from 16
midwives, not resident in this area, of their intention to practise
here. There is, therefore, a sufficiency of midwives living and
practising in this district from whom the necessary staff can be
engaged."