London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1920
Annual report of the Council, 1920. Vol. III. Public Health
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The fee a midwife receives, for attending a confinement and the subsequent visiting for 10 days,
varies in different localities from 15s. per case upwards, but usually a fee of 20s. to 30s. is expected.
The charities employing midwives pay from 15s. 6d. to 21s. a case, and provide the midwife with registers,
forms, antiseptics, etc.
Certain midwives 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.
From information received under the Notification of Births Act the following figures have been obtained showing the number of births notified by midwives:—
| 5 midwives reported over 500 cases in the year. |
| 9 „ „ between 400 and 500 cases in the year. |
| 17 „ „ „ 300 and 400 „ „ |
| 14 „ „ „ 250 and 300 „ „ |
| 25 „ „ „ 200 and 250 „ „ |
| 35 „ „ „ 150 and 200 „ „ |
| 79 „ „ „ 100 and 150 „ „ |
It is computed that about 59,794, or 495 per cent, of the total births in London were attended
by midwives, excluding the cases attended by midwives in infirmaries. This is an increase of 16,000
on the 1919 figures.
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.
During the year enquiries were made into all cases in which it was brought to the knowledge of the
Council that a delivery had been conducted by an uncertified woman. In one of these cases it was decided
to take no further action; 9 others were dealt with by a verbal or written caution, and proceedings
were taken against two uncertified women who conducted a large number of confinements partly inside
or partly outside the county. Convictions were obtained.
The rules of the Central Midwives Board provide that, in certain emergencies which are specifically
enumerated, a midwife must advise in writing and obtain 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 7,458 of these notices were received, as against 5,347 the previous year.
The figures for the previous years were 1916, 3,540; 1917, 3,159; 1918, 2,738. The rise in the figure
during the past two years is no doubt due to the general increase in the births attended by midwives,
and to the fact that midwives realise more fully the importance of complying with the rule of the Board,
and also to the fact that since January 1st, 1919, the Council became responsible for payment of the fees
of the medical practitioners called in. These notices were received from 508 midwives. Midwives
acting under the direction of a qualified medical practitioner within infirmaries and hospitals are not
required to comply with this rule.
The number of instances of advising medical help in the practice of midwives during the year may be summarised as follows:—
| 2 midwives reported advising medical help between 120 and 140 times during the year. |
| 1 midwife „ „ „ „ „ 100 „ 120 „ „ |
| 1 midwife „ „ „ „ „ 80 „ 100 „ „ |
| 12 midwives „ „ „ „ „ 60 „ 80 „ „ |
| 26 „ ,, ,, „ ,, ,, 40 „ 60 ,, ,, |
| 86 ,, „ „ „ ,, ,, 20 ,, 40 ,, ,, |
| 120 „ „ „ „ „ ,, 10 „ 20 ,, „ |
| 260 „ „ „ „ „ less than 10 times during the year. |
Assuming that 59,794 births were attended during the year by midwives, it is estimated that
medical assistance was required in 12.6 per cent, of the cases; in 8.2 per cent, on behalf of the mother,
and in 4 4 per cent, on account of the child.
Midwives are required by the rules of the Central Midwives Board to notify the local supervising
authority whenever a dead body is laid out by them, and 23 such notices were received during the year.
There is a similar requirement in cases where there is a possibility of the midwife becoming a source of
infection, and 35 such notices were also received. 159 notices of cases in which it was proposed to substitute
artificial feeding for breast feeding were also received and transmitted to the sanitary authorities
concerned, in order that the cases might be followed up by the health visitors.
During the year 316 midwives reported the occurrence of stillbirths in their practice, the number stillbirths
of stillborn children being 896. This represents 1.5 per cent, of the births attended by midwives—
approximately the same percentage as in 1919.
The form for notifying stillbirths provides for information as to (a) sex of child; (6) period of
gestation; (c) whether macerated or not; (d) presentation. The information obtained under (a) showed
that 484 stillborn infants were males, 396 females, and in 16 cases the sex was not stated. Of the total
896 stillborn children 465 were reported macerated, 400 not macerated, and there was no statement
with regard to the remaining 31.
The presentations of these stillborn children were as follows:—
| Vertex | 566 | Face or brow | 9 |
| Complicated vertex | 4 | Funis | 6 |
| Breech | 148 | Placenta prsevia | 1 |
| Complicated breech | 4 | Born before arrival and presentation not known | 112 |
| Footling | 38 | - | |
| Transverse | 8 | 896 |
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