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Municipal Centre, the Bird-in-Bush and Cobourg Centres.
Ante-natal examinations are also conducted at the Cambridge
House Centre when required. The Municipal Centre is, however,
less circumscribed in its activities as compared with the
other clinics, inasmuch as patients may be sent there for
examination and advice from any address in the Borough.
The Municipal Scheme of Maternity accommodation also provides
for the ante-natal supervision of the mother, and in addition
to the pre-natal clinic at St. Giles' Hospital for Municipal and
General Ward patients, professional supervision of the expectant
mother is also undertaken at General Hospitals, Maternity
Hospitals and other institutions. Institutional confinements
represent approximately 30 per cent, of the total births occurring
annually in the Borough, private medical practitioners attend
approximately 33 per cent, and midwives the remainder. A certain
amount of professional supervision is given by private medical
practitioners and midwives to patients booked for confinement in
their own homes, but the only reliable information available as to
the measure of pre-natal supervision is that provided by the
institutional confinements.
The importance of ante-natal supervision for every pregnant
woman cannot be overstated, and with the active co-operation of
doctors, midwives, hospitals and the officers of the Local Authority
there is every reason to expect that much of the ill-health of
•expectant mothers and the difficulties and risks attending childbirth
will be prevented. Co-operative action is the keynote of the
terms of the Memorandum, but I feel that in the present state of
uncertainty concerning the duties and responsibilities of local
authorities in matters relating to the health services any action
designed to comply with the requirements of the Minister of
Health should be deferred pending the receipt of the administrative
scheme of the arrangements proposed to be made by the
London County Council for discharging the functions transferred
under Part I of the Local Government Act, 1929.
I am of this opinion for the reason that the position of the
midwife is such as to influence very considerably the whole question
of the application of the principles of ante-natal care.
A comprehensive scheme of ante-natal supervision should
embody as a first principle the direct supervision by the Officers
of the Local Authority of all practising midwives in the area. At
present such supervision is undertaken by the L.C.C., and until
these duties are delegated any attempt to secure co-ordination of
effort is, in my opinion, not likely to meet with much success.
In conclusion, I append tables relating to the situation,
sessions and personnel of the Ante-Natal Clinics in the Borough
and particulars showing the number of births and the Maternal
Mortality rate in each year since 1920.