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65
to working class or lower middle class mothers, and they were attended
as follows:—
Confinements at Home : —
246 attended by a doctor and an unknown nurse.
83 attended by a doctor, and with a nurse from a Nursing
Association.
115 attended by certified midwives.
71 attended by Queen Charlotte's Hospital Midwife.
Confinements in Hospitals, &c.: —
39 confined in Queen Charlotte's Hospital.
70 confintd in other hospitals, homes, &c.
23 confined in Poor Law Instutions.
There has been from time to time considerable difficulty in some of
our poorer districts in obtaining attendance during confinements.
Medical attendance for poor class midwifery is not easy to obtain, and
the practising midwives do not always supply the deficiency. During
1918 medical aid was culled in by midwives in six urgent cases, and the
doctor's fees were paid by the Borough Council. The Board are anxious
to secure an efficient midwifery service throughout the country. They
are also of opinion that the status of the midwife should be raised, and
that competent trained women devoting themselves to this service should
be adequately remunerated. Hitherto, midwifery has not been attempted
by the Nursing Associations ; their rule that none of their nurses should
attend a case without a doctor has restricted their efforts to maternity
nursing alone. They have also been deterred by the cost, and fear of a
loss on the working of the midwives. If the two Nursing Associations
would undertake midwifery, and provide properly trained and efficient
midwives, they would fulfil a much felt want and relieve the position as
regards confinement to no small extent. I have communicated with both
Associations, and they are w illing to undertake the work provided the
Borough Council would help them in case of loss on the innovation, and
this the Council could do by undertaking to idemnify the Nursing
Associations against such loss.
If each Association appointed one midwife at a salary of £140 per
annum, it is highly improbable that in her first year she would earn more
than £40, leaving £100 for the Council to make good on each salary,
and I therefore recommend that, subject to the following conditions:—
1. That the midwives are competent and approved by us.
2. That their services are available for all women who need
them.
3. That the ordinary fee of the district is charged, and that
it is only reduced or remitted when the circumstances
of the case justify this action.
4. That the Council may, if they desire, be represented upon
the Committee of Management of the Nursing
Associations.
5. That it be understood that their staff are to be subject to
instructions from the Council.
the Council should guarantee the Nursing Associations against a
loss on the working of their midwives, and I estimate the cost to the