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It is computed that some 44,000, or 54 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.
During the year enquiries have been made into six cases in which it has come to the knowledge
of the Council that a delivery had been conducted by an uncertified woman. In two of these cases it
was decided to take no further action, in two others letters of caution were sent, and in the remaining
two the solicitor was instructed to take legal proceedings if he considered the evidence to be sufficient.
Proceedings were taken in one case only, but the case was dismissed.
The rules of the Central Midwives Board provide that in certain circumstances a midwife must
decline to attend and 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, 5,347 of these notices were received, as against 2,738 the previous year. The figures
for the previous years were: 1916, 3,540; 1917, 3,159; 1918, 2,738. 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,
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 432 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.
5 midwives „ „ „ 60 and 80 „ „
15 „ ,, „ 40 and 60 ,, „
65 ,, „ „ „ 20 and 40 „ „
83 „ „ „ „ 10 and 20 „ „
263 „ „ „ „ less than 10 times during the year.
Assuming that 44,000 births are attended annually by midwives, it is estimated that medical
assistance was required in 12 per cent. of the cases; in 7.4 per cent. on behalf of the mother, and in
4.6 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 22 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 26 such notices were also received.
Legal proceedings were instituted by one of the borough councils against a doctor and a midwife
for failure to notify a case of ophthalmia neonatorum. Both summonses were dismissed, with £6 6s.
costs to the midwife.
During the year, 240 midwives reported the occurrence of stillbirths in their practice, the number
of stillborn children being 686. This represents 0.8 per cent. of the births.
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 399 still-born infants were males, 283 females, and in 4 cases the sex was not stated.
Stillbirths.

The presentations of these stillborn children were as follows:—
Vertex 428 Hand, arm and shoulder 6
Complicated vertex 14 Funis 2
Breech 107 Placenta prævia 1
Complicated breech 3 Born before arrival and presentation not known 84
Footling 30
Transverse 6
Face or brow 5 Total 686
Some additional information was obtained as to still-born infants not macerated, of eight or
more months' gestation, as follows:—
Concerning the child—
One of triplets 1 White asphyxia 2
One of twins 23 Cord round neck 4
Hydrocephalus 1 Anencephalic head 1
Malformed child 4 Spina bifida 2