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measures were adopted to ensure that the most necessitous cases
received priority. Selection is now based on recommendation for
medical or obstetrical reasons, and on recommendation from a
health visitor or midwife for unsuitable home conditions. This
is expected to result in less overcrowding of the maternity wards,
while placing a greater strain on the district midwives.

MIDWIVES. Under the Midwives Act 1936, agreements
remained in force with Plaistow Maternity Hospital, E.13, and
Queen Mary's Hospital, E.15, to supply midwives for district
work. In addition, the Council's four district midwives served
different areas in the Borough, while the midwife from North
Woolwich and Silvertown District Nurses' Home undertook
domiciliary confinements in the Silvertown area. Domiciliary
midwifery practice in West Ham has proved less difficult than
hospital midwifery service from the point of view of staff supply,
chiefly because Plaistow Maternity Hospital is a large training
school for pupil midwives taking Part II of the C.M.B. Training
and Certificate, and therefore the midwives from that hospital
are greatly assisted by these senior nurses, who are expected to
assume considerable responsibility in their work. Similar considerations
apply in the northern part of the Borough in relation
to the Beachcroft Training Home of the Essex County Nursing
Association.
During 1946, 62 midwives notified their intention to practice,
of whom 29 were in hospital, and 33 worked as district midwives.
At the end of the year, 26 midwives were engaged in domiciliary
work.
Medical aid was summoned by midwives under Section 14 (i)
of the Midwives Act 1918, as follows: —
(1) Domiciliary cases 616
(2) Hospital cases 903
Total 1,519
The administration of analgesics during confinements has
not been carried out in the Borough, although 35 of the above
62 midwives are qualified to administer analgesics. In only 16
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