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The decrease In the number of domiciliary confinements which is proportionately
greater than the decrease in the number of births has given some concern to those bodies
interested in the training of midwives. The unsuitability of their home, and the increased
expense incurred by domiciliary confinement under the present circumstances unfortunately
act as a deterrent to some mothers who might otherwise prefer to have their baby at home.
While the safety, comfort and happiness of the mother and her baby must remain of primary
concern, the training of midwives is also of vital importance, and the experience and the
standards achieved during their training will in turn reflect on the care they are able to
give the mothers.
ANALGESIA. The total number of midwives working in West Ham at the end of the
year wasj-
Domiciliary Midwives 15
Hospital Midwives 47
All the domiciliary and 41 of the hospital midwives were qualified to administer
gas and air analgesia.
The 4 municipal domiciliary midwives all received a course of instruction in the
administration of pethidine, during the month of October - November. This pain relieving
drug has recently been made available for administration by midwives who have been specially
trained in its use. The course of training was arranged at Forest Gate Hospital through the
courtesy and kind co-operation of the Consultant Obstetrician Mr.H.R.England.
SUPERVISION OF MIDWIVES. The Senior Assistant Medical Officer for Maternity and Child
Welfare remains the Supervisor of Midwives and there is no non-medical supervisor.
Though all concerned have been most helpful, the continuing arrangements by which a
decreasing number of mothers delivered in their own homes are cared for by three separate
agencies as well as by the municipal midwives, cannot be regarded as entirely satisfactory.
This splitting up of the service leads to lack of co-ordination, both in the organisation
of the domiciliary servlie and in the statutory supervision, and to certain administrative
complications which result in the spending of unnecessary time and effort. With these factors
in mind, as well as the needs of the training schools to maintain the number of pupil midwives,
the responsible officers have sought for a way of achieving balanced and well co-ordinated
maternity services. Though it Is regretted that no agreed recommendations were in sight by
the end of the year, yet it is felt that the time has not been altogether lost. Conditions
are still changing and valuable experience Is being gained in the administration of the
maternity services under the National Health Service Act. It may be all to the good if some
degree of stability can be attained before final recommendations are made for the future of
these services.
VITAL STATISTICS. The stillbirth rate of 22 stillbirths per 1,000 total births, is
the same as for the previous year. The infant mortality rate of 25.2 deaths of infants
under 1 year per 1,000 live births and the maternal mortality rate of 0.6 per 1,000 live
and stillbirths were lower than last year.
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