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83
Report of the County Medical Officer—General.
The midwives in classes (a) and (b) are entitled to use the description "certified midwife by
examination." Of those giving notice of their intention to practise, the untrained midwives, class (c)
represent 14 per cent.
The 555 midwives who gave notice of intention to practise cannot be taken as the number of midwives
practising at any given time in the County. In some institutions it is the custom for a midwife to
act as an assistant for three months or less after she is qualified, and her place is then filled by another
newly qualified assistant, who in her turn gives notice of intention to practise. At any given time it may
be estimated that some 400 to 450 midwives, or nearly 9 per cent. of those on the roll are in actual practice
in London. The remaining 91 per cent. act for the most part as monthly or general nurses under medical
supervision. Of the practising midwives 56 were working entirely within poor-law institutions or lyingin
hospitals and were under medical supervision; 86 others were attending patients on behalf of
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, to ascertain 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 a 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 supervise the training of pupils for
the Board's examination. The inspectors paid 1,570 visits to midwives or institutions employing
midwives. In 1,121 cases the report was satisfactory, in 75 unsatisfactory, and in 374 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. This occurred in six cases on the following grounds:—
Omitting to advise the seeking of medical assistance for the mother 2
Delay in reporting the facts to medical practitioner summoned to
case 1
Failure to take temperature and pulse 1
Employment of uncertified parson as substitute 1
Lack of care with respect to the cleanliness of mother and
child 1
Charges of malpractice, negligence or misconduct against eight midwives were investigated
during the year, and in the three undermentioned instances prima facie cases were established against
the midwives concerned.
Charge. Result.
Infringements of rules of Central Midwives Board Cautioned by Board
Malpractice, negligence and misconduct Name removed from Roll
Failure to advise the seeking of medical assistance Name removed from Roll.
Inspection.
There are some five midwives who are illiterate, but other members of their family enter up their
registers for them. A copy of the rules of the Board translated into Yiddish by the Jewish Board of
Guardians at the request of the Council was supplied to the Jewish women in East London who have
difficulty in understanding English. There are some 12 or 13 Jewish midwives and two Italian
midwives in practice in London.
The fee a midwife receives for attending a confinement and the subsequent visiting for 10 days,
varies in different localities from 5s. per case upwards, but usually a fee of 7s. 6d. to 10s. 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
18820 l 2
Fees charged
by midwives.