View report page

86
Most of the midwives attending 300 or more cases in the year, have qualified assistants who work
with them, and many of them are approved by the Central Midwives Board to supervise the practical
work of pupils. The midwives of 15 institutions reported attending some 9,000 cases in patients' homes
during the year. It is estimated that some 30,000 births are attended annually by midwives in
London.
Uncertified women.—During 1903-4, the Council's inspectors, in the course of their daily rounds,
noted any cases of women having name-plates signifying that they were acting as midwives. Inquiries
were made from various sources and the names of over 500 women in London who were practising midwifery
were obtained. In April, 1904, a leaflet was issued by the Council calling attention to the provisions
of the Midwives Act and giving information as to the course to be adopted to secure enrolment under the
Act. This notice was sent to the women whose names had been obtained. From April 1904, until
March 1905, an abstract of this leaflet was inserted from time to time in the daily papers and in such
weekly papers as it was thought were most likely to be read by women practising midwifery. In this
way an effort was made to inform every woman practising midwifery of the provisions of the Midwives
Act, and to give every opportunity to her to secure enrolment. After March 1905, when it was impossible
for any woman to become enrolled as a certified midwife except by examination, it was found that a
small number of women had not availed themselves of the opportunity of securing the right to practice
as " midwives, "some from inability to pay the fee for enrolment, some who did not think their practice
large enough to trouble about, and some through delaying too long. A list was prepared containing
the names of any such persons and this list was amplified from time to time as fresh women were heard
of. At the beginning of 1908, 119 names were on the list, and during the year, 20 additional names
were added. The Council's inspectors have kept these uncertified women under observation and have
reported from time to time details of their practice. In five cases infringements of the Act were found
to have been committed by the women assuming the title of midwife. Cautionary letters were sent in
all cases and four of the women ceased to use the title. In the remaining case, legal proceedings were
instituted and a fine of £2 with £1 3s. costs was imposed by the magistrate. In the majority of cases,
information as to uncertified women reaches the Council in the first instance from certified midwives
who complain of the competition of women not subject to the rules of the Central Midwives Board.
Of the 139 uncertified women reported to be practising as midwives, many were found to be
monthly nurses who delivered a patient before the arrival of the medical practitioner engaged for the
case, and others were found to be neighbours acting in an emergency. After deducting the number of
these women, there remain only 40 uncertified persons who are known to practise more or less
regularly. The number of cases attended by these women ranges from 1 or 2 in the year to 150 per
annum in one particular instance. A total of 900 cases per annum is a fair estimate of the number of
deliveries conducted by them. This number of cases would obviously not create a need for additional
midwives when Section 1 (2) of the Act which practically terminates the employment of uncertified
women comes into operation : indeed their work would be gladly undertaken by certified women who
frequently complain that they now have not sufficient employment.
Medical help notices.—The rules of the Central Midwives Board provide that in certain contingencies,
which are set out in detail in the rules, the midwife must advise that medical assistance is
required and when ever this advice is given, notice of it must be given to the local supervising authority
within 24 hours. During the year, 1908, 2,755 such notices were received. The figures for the previous
years were 1905, 1,113 ; 1906, 2,320 ; 1907, 2,533. The gradual increase in the figures during the last
three years is no doubt in part due to a fuller understanding of the rules requiring such notices to be
given and also to the fact that midwives are recognising better the necessity for calling medical
assistance in cases where there is the slightest sign of danger to their patients.
Notices of calling in medical assistance were sent in by 308 midwives. It thus appears that of
518 midwives who gave notice of intention to practice, 210 sent in no notices of advising that medical
help was required. Some of these 210 midwives are working under medical supervision in hospitals
and poor law institutions and are exempt from this rule, the majority, however, are those midwives
who attend case3 only very rarely.
1 midwife sent in 98 notices
1 „ „ 85 „
2 midwives sent in between 70-80 „
2 „ „ 50-70 „
5 „ „ 40-50 „
8 „ „ 30-40 „
15 „ „ 20-30 „
43 „ ,, 10-20 „
231 „ „ less than 10 „
The midwives who called in medical aid more than 20 times during the year were midwives with
extensive practices.
The reasons assigned by the midwives for advising medical assistance were as follows:—