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Another disadvantage is the absence of close contact of mother, and
baby which is usual in hospital. In the opinion of paediatricians and
psychologists, the importance of this association, for physical and
psychological reasons, cannot be over-emphasised. The Council of the
Royal College of Midwives, in criticising the 1944 report of the Royal
College of Obstetricians and Gynaecologists, states : " In considering the
relationship of domiciliary midwifery to institutional delivery we regret
that greater emphasis has not been given to the undeniable benefits, both
psychological and material, surrounding home delivery in favourable
circumstances. We consider that selected normal primipara can, with
safety, be delivered in a suitable house. The birth of children in the
home strengthens family life and loyalty, and although it is in many
cases not advisable, the advantage should not be overlooked."
In viewing this problem from an economic standpoint, one must consider
the economy in trained woman-power involved. For example, it
has been roughly estimated that 2,000 deliveries in hospital require a
trained staff" of 52 persons—approximately 40 deliveries per nurse-unit.
In the year under review, with adequate transport, in an urbanised
community such as Beddington and Wallington the Nursing Association
achieved 95 births per midwife.
The domiciliary service rendered in Beddington and Wallington by
the District Nursing Association, and continued under the Act as agents
for the County Council, is very much appreciated. Analgesia, the
apparatus being carried in motor cars, is available for all mothers in
confinement desiring this facility. The record in the Surrey County
Council area for the training of midwives in the use and provision of
apparatus, is very satisfactory indeed.
Since the National Health Service Act came into operation on the
5th July, making the services of a doctor available for domiciliary midwifery
free of charge, many expectant mothers have booked their medical
practitioner for the confinement.
It would appear that some misunderstanding exists about the nature
of the medical services available for the expectant mother, who is to be
confined in her own home. In these cases the doctor does not accept
full responsibility for the ante-natal care, the labour and the lying-in
period. This was certainly not the intention of the Act, and the Act did
not intend in any way to diminish the importance of either the ante-natal
clinics or the midwives by the introduction of the maternity medical services.
The general practitioner providing maternity medical services undertakes
:—
(1) To examine the patient at the time of booking.
(2) To examine the patient at about the 36th week.
(3) To make a post-natal examination about six weeks after
confinement.
(4) To provide any medical attention additional to the above
either if he considers it necessary, or in response to a call
from the midwife.
He is not required to undertake the more frequent routine ante-natal
supervision that is essential, nor to attend the labour, unless such attendance
is considered necessary by himself or by the midwife. The doctor
may, of course, provide additional services if he so desires.
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