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17
"Domino" Scheme
Under this scheme which commenced in conjunction with the Central Middlesex Hospital in September
1971, patients are delivered by the domiciliary midwives in a hospital suite. The selection of patients
is carried out by a Consultant Obstetrician who shares the ante-natal care with the midwives. Following
delivery the domiciliary midwife gives nursing care for approximately 48 hours in the hospital and then
continues to do so at home.
The number of confinements conducted by midwives increased from 7 cases in 1971 to 85 cases in
1972, enabling the midwives to maintain their expertise, and maintain continuity of patient care.
General Practitioner Unit
In October 1971 a small unit was made available in Central Middlesex Hospital to general practitioners
who wished to care for and deliver their own patients within the safety of the hospital premises. The
domiciliary midwives participate in this scheme and share ante-natal care with the General Practitioner and
continue to look after the mother following delivery first in hospital and then at home. Ten patients were
delivered in 1972.
Early Discharges
750 patients were discharged from hospital before the 10th day compared with 618 in 1971. The
majority were planned early discharges, others were accepted on account of emotional or domestic difficulties
and a number took their own discharge.
Refresher Courses
One midwife attended these courses in 1972 to comply with Section G1 of the Central Midwives Board
Rules.
Training
A total of 23 pupil midwives from Central Middlesex Hospital and St. Mary's Hospital were accepted
for Part 2 district training and domiciliary experience.
78 Obstetric nurses spent one half day per week with midwives.
6 Community option students spent one week with midwives.
28 Ward sisters from Central Middlesex Hospital spent one half day on an exchange basis to acquaint
them with the domiciliary midwifery service.
Obstetric Students
Nurse students from St. Mary's and Central Middlesex Hospitals continued to spend one day each with
the domiciliary midwives to observe their work in the care of mothers booked for home confinements and
planned early discharge.
Midwifery Servicb
Deliveries attended:—
Doctor not booked, doctor present
Doctor not booked, doctor not present 3
Doctor booked, doctor present 33
Doctor booked, doctor not present 124
"Domino" Scheme 85
Number of home booked cases transferred to hospital before confinement 12
Cases in which analgesia was administered:—
Gas and air 59
Trilene 54
Pethilorfan 72
Number of times Emergency Transfusion Service used 1
Visits paid:—
Ante-natal 2,432
During labour 260
Nursing domiciliary confinements 660
Nursing institutional discharges 3,731
Clinic Sessions Attended:—
Ante-natal 363
General practitioners' clinics 126
Relaxation
Mothercraft 8
Number of cases in which medical aid was called by midwife 30