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Although the live births have decreased from 3,661, in 1948 to 2,699 in 1958 (the
lowest being 2,583 in 1956), and medical advice and treatment is now available to all,
free of charge, through the general practitioner service, the attendances of the Child
Welfare centres have not decreased as much as might have been expected. In 1948 the
attendances were 31,107 for children under one year, and 10,419 for children aged one
to five years, while in 1958 they were 25,749 and 10,223 respectively. In 1958 89% of
all children under one year made an average of 10,7 attendances at the Child Welfare
Centres, and 49% of all children aged one to five years made an average attendance of 2,2.
It would seem that these centres still fill a need and give a service, partly
medical, partly social, which mothers do not find equally available and acceptable elsewhere.
The change has been rather in the nature of the problems which they bring and
perhaps In our approach to these problems.
The infant mortality rate has fallen from 30 in 1948 (it was 41 in 1947) to 19.18
in 1958. The management of infant feeding has become both easier and less rigid, and
mothers are more knowledgeable in the techniques of infant care. They are now more
concerned with the behaviour and the emotional disturbances of their young children. The
staff are more alert to the need for "Preventive mental health" in their field work, and
for careful observation of the infant's development from his earliest days. In this way
we can hope to suspect abnormality early and give help in accurate diagnosis and in
training and management. Much more time and attention is now given to "Handicapped Preschool
Children" and to their parents and the "Spastic Unit" "Audiology" and "Development"
Clinics are recent developments in this direction. We have made progress, but there is
still much new knowledge to be studied and applied, and new skills to be learned.
There is now much less need to refer children from the clinics for medical
treatment, or to hospital for specialist advice. When this is required our first
approach is always to the family doctor (unless agreement to do otherwise has been
reached) and over the years, the medical officers have built up much closer relations
with the general practitoners who attend the children in their areas.
There have been many changes in the midwivery service but the number of hospital
deliveries has remained fairly constant. The home deliveries have declined over the years
and in 1958 were 312, only 12% of the total live births. However for the first time since
1948 the number was slightly higher than in the preceding year.
The midwifery service which in 1948 was carried out by three agencies as well as
by the municipal roidwives, is now almost entirely municipal. There have been innovations.
All the midwives now train pupil midwives and all are trained in the administration of
analgesics - both by gas and air and trilene, The problems of transport are still accute.
There is no doubt that there has been a gradual extension of co-operation between
the midwives, who now work at the maternity and child welfare centres, the clinic medical
officers and the general practitioners who do maternity work. The centres provide a
meeting point and also afford the opportunity for the health visitor to join with the
midwife in health education and parent-craft activities.
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