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91
marked change on those of the previous year, only 1,400 out of the
2,943 confinements occurring in the patients' own homes. Applying
this ratio to the 3,300 births anticipated in 1937 gave a figure of
domiciliary confinements of only 1,500. For this reason it was
decided in the first place to appoint only fifteen midwives out of the
eighteen agreed upon.
It was agreed that those appointed in the first place should,
as far as possible, be selected from those already in practice in the
district. While it was felt that it was desirable that the Council's
midwives should be State Registered Nurses as well as possessing
the certificate of the Central Midwives' Board it was decided that
the double qualification should not be insisted upon in the case of
those appointed at the inception of the scheme, but that this
condition would operate in the case of those appointed subsequently.
Out of the midwives practising in the area, fifteen were appointed
and the scheme was put into operation on July 19th.
To smooth the change entailed by the midwives previously
engaged in private practice, whose practice was not necessarily
limited to this district, coming on the Council's staff it was
agreed that all cases already booked by the midwives should
continue to be undertaken by them even though the patient was
not resident in the district, the charge to be made being that originally
agreed as between the midwife and the patient.
It was agreed that a sterile maternity outfit be provided for
use at all confinements at the cost of the Council.
The conditions of service of the midwives was given on page 79
of the report for 1936. In addition it was decided that midwives
should be entitled to off-duty time in addition to the annual holiday
of the equivalent of one day (from 8 a.m. to 11 p.m.) in each seven
days, and to one week-end (from Friday noon to Monday 2 p.m.) in
cach three weeks, such off-duty time to be taken on such days as
may be approved by the superintendent midwife. A policy of
insurance has been taken out against liability in respect of third
party claims under the domiciliary midwifery service. In addition
to the standard charge for the services of a midwife, where a midwife
acting as maternity nurse assists a medical practitioner in a circumcision
case and does the subsequent dressings, a charge of 10s. 6d. is
made.
The actual inception of the scheme was effected without too
much difficulty, the chief of the difficulties being those arising out
of off-duty time which is, at least, not on the ungenerous side,
and the attendance of midwives at the ante-natal clinics. Up to
this the ante-natal clinics had been staffed by two health visitors.
They are, however, essentially the province of the midwife, and
arrangements were made for each clinic to be staffed by one health
visitor and by one midwife, the hope being that ultimately they
will be taken over entirely by the midwives. In this district,
however, there are ten sessions held weekly and one fortnightly,