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attended 246 cases during the year, two having over 40 cases,
one 31, one 25, five between 10 and 20 cases, eleven under 10 cases,
while six did not attend any.
By the rules of the Central Midwives' Board it is obligatory
on midwives to send a notification to the local supervising authority
in certain circumstances. During the year the following numbers
of notifications were received:—
Sending for medical assistance 292
Still birth 11
Death of Infant 12
Death of Mother —
Laying out the Dead 7
Artificial Feeding 18
Liability to be a Source of Infection 22
Of the 292 summonses to medical practitioners, 37 were on
account of some condition during pregnancy, 87 during labour,
114 in the lying-in period and 54 abnormality of the infant.
Of the 37 summonses to a patient during pregnancy, the most
frequent was on account of ante-partum haemorrhage in 15 instances;
three were because of post-maturity of the infant and seven because
of albuminuria, oedema or toxaemia.
Of the 87 summonses to a patient during labour, the reason
given in 45 instances was delayed labour, and in four uterine inertia.
Abnormal presentation (including persistent occipito-posterior and
breech) accounted for 28, and foetal distress for two. The doctor
was summoned on four occasions on account of miscarriage or
abortion.
75 of the 114 summonses to patients in the puerperium were
on account of rupture of the perineum. Post-partum haemorrhage,
with or without adherence of the placenta, was the reason in ten
cases. A raised temperature was the cause in thirteen instances,
phlebitis in three and some abnormality of the breast in four.
Of the 54 summonses to infants, 26 were on account of some
discharge from the eye, feebleness or asphyxia in 12, developmental
abnormalities in 5, and some other abnormal state or condition in 10.
In the Ministry of Health report on maternal mortality it is
recommended that the local supervising authority should be
empowered to take steps to ensure that the best local obstetric
skill is made available in all cases in which midwives are required
under the rules of the Central Midwives' Board to call in a doctor.
An analysis of the reasons for the summons shows that in many of
the conditions for which the practitioners are summoned it is not
obstetric skill that is required, and yet to attempt to put on the
midwife the responsibility of deciding to which case she can, as by
existing practice, summon the practitioner named by the patient
and those to whom she must summon someone other than this
practitioner, would prove difficult of practice.