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74
Annual Report of the London County Council, 1914.
Inspection.
charitable, poor-law or other institutions, and were paid either a salary or a fee for each case allotted
to them. The remainder practised independently.
All practising midwives, except those working in hospitals under medical supervision, are subject
to inspection by the Council's officers, for the purpose of ascertaining whether they are complying with
the rules of the Central Midwives Board as to cleanliness, the possession of antiseptics and appliances, the
keeping of registers and case books and the sending of the required notices to the Local Supervising
Authority. The work of inspection was carried out by Miss E. Macrory, M.B., Ch.B., L.M., D.P.H.,
and Miss M. A. Pilliet, M.B., Ch.B.
In addition to the ordinary routine inspection, special visits are paid to the midwife when any
case of a septic nature or of persistent high temperature occurs in her practice, and in all cases of inflammation
of an infant's eyes. The inspectors also advise midwives on any points of difficulty which
may arise in the course of their duties, and in some instances instruct the midwives as to methods of
work. On occasion a midwife is accompanied by the inspector either to a confinement or on a subsequent
visit to a patient to ascertain whether her methods of work are efficient. This is done where there is
any reason to believe that the midwife's work is not up to standard, and also in cases where a midwife
has applied to the Central Midwives Board for approval to her supervising the training of pupils for
the Board's examination. The inspectors paid 1,214 visits to midwives or institutions employing
midwives. In 886 cases the report was satisfactory, in 36 unsatisfactory or presenting some unusual
feature, and in 292 the midwife was not seen. Most of the unsatisfactory reports related to cases in
which some slight breach of the rules had occurred, and the midwife's attention was called to the matter
by the inspector, who was subsequently able to report favourably. In cases of a more serious nature,
or where the midwife had a bad record previously, the matter was reported to the Midwives Act Committee
of the Council, and a letter of caution was sent to the midwife.
Charges of malpractice, negligence or misconduct made against five midwives were investigated
during the year, and in three instances prima facie cases of negligence and misconduct were established
against the midwives concerned. The Board considered that the charges in one case were not proved,
and the Council was requested to furnish further reports with regard to the other two midwives.
Fees charged
by midwives.
The fee a midwife receives lor attending a confinement and for the subsequent 10 days visiting
varies in different localities from 7s. 6d. per case upwards, but usually a fee of 10s. to 15s. is expected.
The charities employing midwives pay 5s. or 6s. a case, and provide the midwife with registers, forms,
antiseptics, etc. It is apparent from the number of cases taken by midwives and the small fees paid
that very few can rely solely on their practice as a means of livelihood. Many of them are married women
who do not trouble to obtain a large practice; a few keep lying-in homes; others, especially those with
a fairly large practice, are approved by the Central Midwives Board to give practical instruction to
pupils preparing for the Board's examination. The pupil resides with the midwife and goes with her
to cases. The fees for pupils are usually about £1 1s. per week, and this includes board and
lodging in addition to the practical instruction given by the midwife.
Maternity
charities.
Many midwives are employed in Poor Law Infirmaries, and a large proportion or the 3,000
confinements in infirmaries are conducted by midwives, and many of the infirmaries are approved
as training schools for pupil midwives. Over 5,000 cases are taken annually into the maternity
hospitals, and 18,000 to 20,000 women are delivered in their own homes by midwives working either
for maternity Hospitals or in connection with one or other of the free maternity charities.
Births
notified by
midwives.
From information received under the Notification of Births Act the following figures have been
obtained showing the number of births notified by midwives:—
8 midwives reported over 500 cases in the year.
4 „ „ between 400 and 500 cases in the year.
13 „ „ „ 300 and400
14 „ „ „ 250 and 300 „ „
22 „ „ „ 200 and 250 „ „
15 „ „ „ 150 and 200 „ „
47 „ „ „ 100 and 150 „ „
81 „ „ „ 50 and 100 „ „
135 „ „ „ "20 and 50 „ ,,
Most of the midwives who had 300 cases and upwards have qualified assistants, and many are
approved by the Central Midwives Board for supervising the work of pupils. From information received
under the Notification of Births Act, it is computed that some 30,000, or 25 per cent. of the total births
in London are attended by midwives, excluding the cases attended by midwives in infirmaries.
Uncertified
women.
By Section 1 (2) of the Act it has been illegal since March, 1910, for any woman, unless she be
certified under the Act, habitually and for gain to attend women in childbirth except under the direction
of a registered medical practitioner. Since the Act became operative enquiries have been made into
all cases in which it has come to the knowledge of the Council that a delivery had been conducted by
an uncertified woman, and during the year proceedings were instituted in four cases, and fines amounting
to £3 5s., with £3 l1s. 6d. costs, were imposed. Most of the other women reported as having conducted
cases were found on enquiry to have acted in emergency, or had conducted only one case and, consequently
could not be described as practising habitually; these women were informed of the provisions
of the Act. and in some cases cautioned by letter.
Medical
help.
The rules of the Central Midwives Board provide that in certain circumstances a midwife must
decline to attend alone and must advise in writing that the case requires medical help. The
form on which this written advice is given is sent to a medical practitioner, and a copy is forwarded to the
local supervising authority. During the year 3,534 of these notices were received from 363 midwives.
The figures for the previous years were: 1905,1,113; 1906,2,320; 1907, 2,533; 1908,2,755; 1909,