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98
In one case a midwife was brought before the Committee and cautioned for not advising
medical assistance at once when the placenta and membranes were not complete.
Prima facie cases of negligence were found against 3 midwives and reported to the Central
Midwives Board, and in addition a midwife who had previously been reported to the Board, and
whom the Board had cautioned, was again reported for neglect and for employing an uncertified
substitute.
Nature of offence.
Action taken by Central Midwives Board.
Dirty and negligent Name removed from Eoll.
Neglect of patient Cautioned.
Neglect of patients and failure to visit Cautioned.
Failure to take temperatures and employing uncertified
substitute Cautioned.
Legal proceedings were instituted against one midwife for failing to notify her intention to
practise. This woman had removed from her former address in 1907 and was keeping a lying-in
home, where a number of illegitimate children were born. There was reason to believe that she was
trying to avoid inspection. She was fined £1 and £1 3s. costs.
Seven midwives were reported to be more or less illiterate, but their registers and case books
are entered up by other members of the family and the notices were properly sent in. The Council's
inspectors have given much attention to the more ignorant midwives and instructed them in the
use of the clinical thermometer, and the ordinary antiseptics, and in some cases these women have been
induced to attend the Council's classes for midwives.
There are 14 Jewish midwives who practise among the Jewish population in East London.
Their difficulty in understanding the rules was met by the translation of the rules into Yiddish by
the Jewish Board of Guardians. Two Italian midwives attend women of their own nationality in
Saffron Hill district, and occasionally go to patients in other parts of London.
Fees charged by midwives.—The fee a midwife receives for attending a confinement and the
subsequent nursing varies in different localities from 5s. per case upwards, but usually a fee of 7s. 6d.
(or, in cases of primipara, 10s.) is expected. Fees of 15s. and even £1 1s. have been paid
on rare occasions. The charities employing midwives pay 5s. or 6s. per case, and provide the
necessary drugs, registers, etc. It is apparent from the number of cases attended by midwives and
the fees paid that only a small number can rely solely upon their practice as a means of livelihood.
Many of them are married women, and do not trouble to obtain a large practice. A few keep lying-in
homes and others are registered under the Infant Life Protection Act to take charge of nurse children.
Some of those who have larger practices are approved by the Central Midwives Board, as qualified
to give practical instruction to pupils preparing for the Board's examination, and receive fees from
the pupils for this training.
The lying-in hospitals in London receive into their wards some 5,000 women annually and
provide for attendance on about 19,000 in their own homes. The latter cases are conducted almost
exclusively by midwives. Some of the hospitals pay a fixed salary, others pay the midwife a fee
for each case. The patients themselves are not as a rule required to pay for services rendered by
district midwives attached to hospitals, and in the case of institutions there is either free attendance
or only a nominal fee.
Lists of births.—From information obtained under the Notification of Births Act, and from
other sources in boroughs where the Act was not in operation during the whole year, it has been
possible to get figures showing the number of births attended by particular midwives thus:—
4 midwives had over 500 cases in the year.
4 midwives had between 400 and 500 cases in the year.
9 „ „ „ 300 and 400 „ „
8 „ „ „ 250 and 300 „ „
1 ,, „ „ 200 and 250 „ „
18 „ „ „ 150 and 200 „ „
36 „ „ „ 100 and 150 „ „
53 „ „ „ 50 and 100 „ „
45 „ „ „ 20 and 50 „ „
Most of the midwives who had more than 300 cases in the year have qualified midwives to
assist them, and are approved by the Central Midwives Board to supervise the practical work of
pupils preparing for the Board's examination.
It is estimated that, including the cases conducted for poor law infirmaries and for charitable
institutions by midwives some 30,000 to 35,000 births—that is, between one-quarter and one-third of
the births in London—are attended by midwives annually.
Uncertified women.—In my report for 1908 I mentioned that a list had been compiled of
140 women not certified as midwives who were said to be practising midwifery. Twenty more
names were added during the year, but, on investigation being made, it was found that, as in the previous
year, the majority of cases were those in which a nurse or neighbour acted in emergency before the
arrival of a medical practitioner. Some 900 or less may be taken as a fair estimate of the births
attended by uncertified women who act entirely without a doctor.
One woman was prosecuted for using a title implying that she was a midwife certified under
the Act. She was fined 10s. and £1 3s. costs.