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Report of the County Medical Officer—General
79
The fee a midwife receives for attending a confinement and for the subsequent 10 days' visiting
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
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 either
for maternity hospitals or in connection with one or other of the free maternity charities.
From information received under the Notification of Births Act the following figures have been
obtained showing the number of births notified by midwives:—
Fees charged
by midwives.
Maternity
charities.
Births
notified by
midwives.
14 midwives reported over 500 cases in the year.
5 „ „ between 400 and 500 cases in the year
8 „ „ „ 300 and 400 „ „
14 „ „ „ 250 and 300
15 „ „ „ 200 and 250 „ „
27 „ „ „ 150 and 200 „ „
41 „ „ „ 100 and 150 „ „
71 „ „ 50 and 100 „ „
92 „ „ „ 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 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 24 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 twenty-one cases amounting to £27 17s., with £15 3s. 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 letter.
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 3,076 of these notices were received from 370 midwives.
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; 1912,3,603. 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:—
2 midwives reported advising medical help between 60 and 80 times during the year.
20 „ „ „ „ 40 and 60
28 „ „ „ „ 20 and 40 „
59 „ „ „ „ 10 and 20 „
261 „ „ „ „ less than 10 times during the year.
Uncertified
women.
Medical
help.
The reasons assigned by the midwife for giving the advice were as follows:—
Pregnancy—
Purulent discharge 5
Abortion or miscarriage 30
Fit 4
Varicose veins 13
Ante partum hæmorrhage 106
General unhealthy conditions 31
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