London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1912

[Report of the Medical Officer of Health for London County Council]

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Annual Report of the London County Council, 1912.
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, which includes board and lodging
in addition to the practical instruction given by the midwife.
Many midwives are employed in Poor Law Infirmaries, and a large proportion of 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 some 18,000 to 20,000 are delivered in their own homes by midwives working for
maternity hospitals or in connection with one or other of the free maternity charities.
notified by
From information received under the Notification of Births Act the following figures have been
obtained showing the number of births notified by midwives:—
7 midwives reported over 500 cases in the year.
5 „ „ between 400 and 500 cases in the year.
10 „ „ „ 300 and 400 „ „
12 „ „ „ 250 and 300 „ „
23 „ „ „ 200 and 250 „ „
26 „ „ „ 150 and 200 „ „
43 „ „ „ 100 and 150 „ „
71 „ „ „ 50 and 100 „ „
69 „ „ „ 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 to supervise 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.
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 date on which this sub-section of 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 in 20 instances there was evidence that the woman had been engaged
beforehand and had received fees for three or more confinements. Proceedings were instituted and
fines in seventeen cases amounting to £24 16s., with £13 2s. 6d. costs, were imposed. In three cases,
the woman was convicted and bound over for 12 months. In one instance an uncertified woman was
tried on a charge of manslaughter and was sentenced to four months' imprisonment.
Most of the other women reported as having conducted cases were found on enquiry to have acted
in emergency, or had only conducted 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
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 3,603 of these notices were received. The figures for the
previous years were: 1905,1,113; 1906,2,320; 1907, 2,533; 1908,2,755; 1909, 2,894; 1910, 3,026;
1911, 3,477. The rise in the figures is no doubt due to the fact that midwives realise more fully
the importance of complying with this rule of the Board. Notices were received from 335 midwives.
Midwives in infirmaries and hospitals acting under the direction of a qualified medical practitioner
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:—
1 midwife reported advising medical help between 80 and 100 times during the year
3 midwives „ „ „ 60 and 80 „ „
9 „ „ „ „ 40 and 60
32 „ „ „ „ 20 and 40
68 „ „ „ „ 10 and 20
222 „ „ „ „ less than 10 times during the year.

The reasons assigned by the midwife for giving the advice were as follows:—

Purulent discharge4
Abortion or miscarriage48
Varicose veins16
Ante partum haemorrhage107
General unhealthy conditions27