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Midwife "C" is stationed at Isleworth and Midwives "D" and "H" at Cranford and
the southern portion of Heston. The greatest demand for the services of municipal midwives
occurs in the Isleworth area and a midwife should be transferred to that area from the western
section of the Borough. Many expressions of appreciation of the services of the municipal midwives
have been received. On several occasions both the midwife booked for the case and her
relief were not available when required and the services of the second relief had to be obtained.
This unavoidable delay is reduced to a minimum by the use of the telephones supplied to midwives.
In September, 1937, the Council adopted a scheme whereby a woman engaging a midwife
could, by payment of a premium of five shillings, insure against having to pay the fees of the
doctor who might be called in a case of emergency by the midwife. Where advantage is not
taken of the above insurance scheme the doctor's fee is charged, wholly or in part, to the patient
according to her financial circumstances. Where, according to the Council's scale, no charge is
made for the services of a municipal midwife no application is made to the patient for the
recovery of the doctor's fee and the patient is not considered to be able to afford to pay the
insurance premium. A form explaining the insurance scheme is issued to midwives for distribution
to their patients.
In considering the above scheme the patients who booked a midwife must be divided into
three groups namely (1) cases paying the insurance premium (2) cases considered unable to
afford the insurance premium and (3) cases able to insure but not electing to do so.
Table I opposite illustrates the working of the scheme during 1938. From this table the
following points should be noted:—
(a) Less than 20 per cent. of the cases took advantage of the insurance scheme. It is
possible that as the insurance scheme becomes more widely known and understood a
larger percentage of cases will insure.
(b) Provided all the sums reclaimed from patients are recovered the cost per claim to
the Council will be less in the uninsured than in the insured.
(c) In actual practice the whole of the sums reclaimed are not recovered and therefore the
cost per claim to the Council may be greater in the case of the uninsured.
(d) If medical aid had been summoned as frequently among the non-insured as in the
insured, the total number of medical aid summons would have been 283 as against 146
and the total amount of fees, calculated on the average per claim, would have been
£310 18s. Od. as against £160 9s. 0d.
(e) No account has been taken of the cost of clerical and other work in the Health and
Borough Treasurer's Departments in connection with the apportionment and collection
of the sums to be reclaimed from noninsured cases.
(f) The summoning of medical aid occurred more frequently in the insured than in the
uninsured. Any question of a varying standard of midwifery in the three groups can
be discounted. The probable causes are (1) the insured group may contain a larger
proportion of primipara or of women with a bad obstetric history who might anticipate
a need for medical aid and (2) the insured woman, knowing that she incurs no
further financial liability, may more readily press the midwife to seek medical aid and
the midwife for the same reason may be more inclined to seek medical aid or to concur
in the patient's request for such aid.
Of the 102 insured cases 73 attended the ante-natal clinic and a study of the
clinic records fails to reveal an undue percentage of primipara (26%) or of patients
with conditions or obstetrical histories warranting an assumption that medical aid
would be required. The reasons given by the midwives for seeking medical aid in
the three groups of patients are shown in Table II overleaf. The available evidence
suggests that the second of the causes given above accounts largely for the greater
incidence of medical aid summons in the insured group.
The scheme has not been in force for a sufficient length of time to assess its value. The
increased demand for medical aid among the insured does not appear to be warranted wholly on
clinical grounds and if a larger proportion of expectant mothers take advantage1 of the scheme
there would be a risk of increased cost to the Council.
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