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In 9 the 8ll cases delivered in their own homes the midwife acted as Maternity
Nurse.
Medical Aid was summoned in 330 cases. In 245 these help was required for the
mother and in the remaining 85 it was summoned on account of the baby.
The domiciliary midwifery arrangements seem perhaps unnecessarily complicated for a
compact area such as West Ham and indeed they are not without difficulties arising from
this cause: but goodwill and good sense on the part of all concerned succeeded in
achieving another year of smooth and harmonious working.
ANALGESIA. The total number of midwives working in West Ham at the end of the
year was:-
Domiciliary Midwives - 15
Hospital Midwives - 35
All the domiciliary midwives and 31 of the 35 hospital midwives were qualified to
administer Gas and Air Analgesia.
Arrangements were made during the year for the storage, maintenance and delivery
of gas and air analgesia equipment by the Ambulance Service under the operational control
of the Chief Officer of the Fire Brigade. These arrangements worked extremely well and
were a great boon to both patients and midwives alike. Our thanks are due to the Fire
Chief for his helpful co-operation in this direction.
SUPERVISION OF MIDWIVES. The Senior Assistant Medical Officer for Maternity and
Child Welfare is the Supervisor of Midwives and there is no non-medical supervisor. It
is recognised that this is not the best possible arrangement. The midwife of today
practises a skilled and exacting art. She is entitled to easy access to, and the personal
guidance of her statutory supervisor. This close contact can hardly be maintained by an
officer who has the cares and responsibilities of a busy section of the Public Health
Department.
The Council's statutory duty covers the supervision of all domiciliary midwives,
including those employed by agencies as well as the municipal midwives. It would also
seem desirable that the pupil midwives who when qualified will work under a local authority
supervisor, should have some practical acquaintance during their training with the methods
and standards of local authority supervision.
With four-fifths of the domiciliary midwifery in agency hands, however, adequate
supervision by modern standards will tend to duplicate the work of the agencies own
supervisory staffs. The problem which confronts the Health Service, therefore, is to
ensure that the supervision of midwives is both wide enough and searching enough to
fulfil the Council's statutory responsibilities without unnecessary duplication or encroachment
on the work of others.
The solution will not be easy and will require understanding and co-operation of
the agencies concerned. A tentative exploration of the ground was started during the
year but had not progressed to the point of definite proposals.
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