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73 of the 102 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 6, a raised temperature
in 3, phlebitis 2, and inflamed breast 2.
Of the 34 summonses to infants, 16 were on account of some discharge
from the eye, 12 because of feebleness or asphyxia, one because
of deformity, and one, some other abnormal state of condition.
250 out of 658 midwifery cases attended is a percentage rate of 38.0.
The corresponding figures in the years 1942 to 1944 were, 33.1, 32.3 and
32.8.
Local Authority's Midwifery Service : The Midwives Act,
1936, imposed the duty on certain welfare authorities, of providing a
domiciliary midwifery service. In many areas part, if not all, of the work
was undertaken on behalf of the authority by the staff of nursing associations,
or in some cases by the staff of local hospitals. In this district,
the nursing association which covered most of the area, did not provide
a maternity service, so there was no alternative but to the Council's
engaging its own staff for the purpose. Most of these were, in the first
place, recruited from those already engaged in domiciliary midwifery
practice in the area. While this was not imposed in respect of those
appointed in the first instance, a condition of later appointments was that
the applicant should be a state-registered nurse as well as being a qualified
midwife. At the inception of the scheme, the Minister of Health
suggested, that each midwife in a district such as this should be able to
attend 100 cases per annum. This calculation, however, did not sufficiently
allow for the time-off of the midwives, nor for the time required
for attendance at clinics. Experience has shown that the figure of 80
was too high, and 66 is to-day's standard. Over most years the average
number of cases attended by the midwives here, is about 68. In 1943,
probably because of evacuation, the figure fell to 61, while last year,
when there was a sharp fall in home confinements as well as in the total
number of births, the figure was 50.
The sixteen midwives work in four teams of four, this arrangement
proving the most convenient to enable each to obtain the off duty time
to which she is entitled. The general conditions of service of the midwives
are now determined by the Rushcliffe award. It was not found
necessary, materially, to vary the conditions of service to conform to this
decision.
Last year the number of patients attended by the Council's midwives
was 799, being a percentage of 25.4 of the total number of confinements of
local mothers. To 568 they attended as midwives, and to 231 as maternity
nurses.
Of the patients attended by midwives acting as such, 328 were
assessed to pay the full cost, in 49 cases no charge was made, while 191
were assisted. The corresponding figures in regard to patients attended
by midwives as maternity nurses were 183, 18 and 30.
One of the less satisfactory features of domiciliary midwifery at one
time, was the use made of unqualified attendants. To control such