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unsuitable rooms normally utilised for other purposes. In the East
End of London the fee is as low as l(5s. for multiparae, and the great
majority of patients pay no more than 30s.
The main causes of the low remuneration of midwives are :—
(a) The economic position of those persons in the community
who principally employ midwives.
(b) The part-time practice carried on by large numbers of
midwives as an aid to another source of income.
(c\ The excessive number of midwives qualified, arising
froln the shortness of the present period of training and the low
educational standard required from entrants.
Reforms and extensions of training designed to raise the status
and efficiency of the service of midwives to its proper level will,
however, inevitably involve the candidate in additional expense
which cannot be met by the present type of entrant. If such
extensions were introduced before other reforms had made the
profession attractive to a better class of candidate, the probable
result would be a shortage of midwives within a few years.
Advantages of an Organised Service.
The committee considered three different methods of remedying
the situation ; (1) restricting the numbers of midwives in practice ;
(2) increasing the remuneration of midwives otherwise than by their
whole-time employment by the State or local authority ; and (3) by
the establishment of a salaried midwives' service under the control of
the local supervising authority. The report discusses these three
proposals in detail, and concludes in favour of the third.
Summary of Recommendations.
The committee summarises its recommendations as follows :—
1. That this committee concurs with the views expressed
in the reports that, although adequate hospital accommodation
for ante-natal cases and abnormal confinements is essential,
normal confinements can be satisfactorily, safely, and preferably
conducted in the patient's own home, except where this is
unsuitable.
2. That the nursing of every maternity case should be
conducted by a qualified midwife, and unqualified persons
should not be permitted to nurse maternity cases for gain.
It should be the duty of the local authority to provide that
midwives are available to act as maternity nurses in the case of