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68
CO-OPERATION OF CLINICS WITH MIDWIVES AND
MEDICAL PRACTITIONERS.
The Ministry desire that midwives should be encouraged to bring their
patients to the clinics and to do their ante-natal work there under supervision
until their knowledge of what is required and their skill in detecting abnormalities
are sufficient to enable them to do the routine work in ordinary cases by themselves.
It is quite impossible to encourage the midwives to attend with their
patients at ante-natal clinics; the County Council instruct midwives to take
their patients to the centres, but even if the midwives wished to do so, the centres
cannot really make it worth their while to attend, the doctor's time is too taken
up and the number of clinics are too few. There are no facilities for medical
practitioners to use the centres at the present time, either for the conduct of
examinations or for following up their cases and subsequent supervision, as
suggested by the Ministry; the centre doctors, however, spare no pains in
reporting to doctors and midwives as regards cases sent to the centres for
examination, expert advice or treatment.
Supply of Midwives:—
The Ministry state that the services of a qualified midwife should be available
for every confinement whether she acts as midwife in charge or as a maternity
nurse under the direction of a doctor. The only way in which this can really
be brought about is by the employment of whole-time or part-time municipal
midwives, an arrangement already carried out by some local authorities and
recommended by the Ministry of Health. Many Maternity and Child Welfare
Authorities employ whole-time midwives. In London, Bethnal Green have
appointed a whole-time midwife who is assisted by a part-time deputy. The
Medical Officer of Bethnal Green, in his 1929 Report, states:—
"During the year 120 mothers were attended, 87 by the Borough Midwife
and 33 by a private midwife acting as deputy for the Borough Midwife,
while 1 patient was removed to hospital in labour. Of the 120 mothers
delivered, 7 were primiparae and 113 multiparae. There were 28
expectant mothers on the books at the end of the year.
"The Borough Midwife or her deputy paid 1,490 visits in connection with
her practice and 11 other visits. She also conducts a regular weekly
session for ante-natal care of her patients, and assists in the work of
the Welfare Centre. It is gratifying to record that 36 of the mothers
delivered by the Borough Midwife during the year had been previously
attended by her, 9 of them on two previous occasions, and one on three
occasions.''
Eliminating the "Handywomari':—
The Ministry of Health suggest that Maternity and Child Welfare Authorities
by contributing to the fees of midwives would enable doctors to employ midwives
at confinements in the place of "handywomen." This could be carried out on
approximately the same lines of procedure as the provision of a midwife to
necessitous cases. The question of the provision of sterilised outfits might then
be considered in connection with the work of these midwives, and for issue to
any other midwives whose services are supervised to any extent through the
Maternity and Child Welfare Scheme. Speaking generally I consider that these
outfits should be issued by the London County Council to midwives whose work
is entirely supervised by Officers of the County Council, and the Borough Council
should issue these outfits to those midwives engaged to attend cases under the
Maternity and Child Welfare Scheme of the Borough. A scheme has been put
into operation at Lambeth under which maternity outfits, containing sterilised
dressings, are supplied to midwives for expectant mothers who are unable to
obtain these outfits themselves. The outfits are supplied to Lambeth by Boots