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Government Statistical Service, London Rees H G St M 1961 A domiciliary obstetric practice 1948-58. Journal of the Royal College of General Practitioners 4: 47-71 Rosenblatt R A, Deinken J, Shoemack P 1985 Is obstetrics safe in small hospitals? Evidence from New Zealand's Regionalised Perinatal System. Lancet ii: 429-31 Royal College of Midwives 1987 Towards a healthy nation. RCM, London Rutter P 1964 Domiciliary midwifery- is it justifiable. Lancet ii: 1228-30 Sax S 1983 Report of the Commission of Inquiry into South Australian Hospitals.

Garforth and Garcia noted that the midwife may have different priorities to those of the women during the admission procedure, confirming the findings of Kirkham (1983). A woman entering hospital at the end of her pregnancy is unlikely to feel at home in the building and is unlikely to know the midwife who is Midwifery care in the first stage of labour · 29 admitting her. So she needs to orientate herself within the unit and to establish relationships with those caring for her. She may be feeling extremely vulnerable, particularly if this is her first baby.

The need for women to build up a relationship of trust with the staff they meet was recognised by The Maternity Services Advisory Committee in 1982. This report referred to the need for continuity of care in the antenatal period. Since then there has been a growing acceptance that, 'ideally', women should have the same midwife to attend them in labour as in the antenatal period. This has been achieved for a limited number of women, by small teams of midwives working in such schemes as the 'Know Your Midwife Scheme' (Flint & Poulgeneris 1987), and this must be the ultimate goal for all women.

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