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23
The employment of handywomen, that is persons
untrained in midwifery, in 7 per cent, of all cases is
to be regretted, especially so when there are so many
experienced midwives who find it difficult to obtain
adequate engagements. Many of these cases after the
actual delivery by the doctor are left to the care of the
unskilled person, who is not regulated by any inspection
or rules such as are laid down for midwives. It seems
an extraordinary state of affairs that anyone can set themselves
up as a maternity nurse and yet have no training
either in asepsis, or in the care of midwifery cases.
Two cases came to my notice during 1931 where the
actual delivery of the baby was performed by a so-called
maternity nurse, the doctor arriving late on the scene.
A remedy lies largely in the hands of the general practitioner
in not agreeing to attend any case unless a
skilled midwife has he-en engaged. The real remedy lies
in statutory prohibition of the term " maternity nurse "
without having had hospital experience in the care of
maternity cases.
One other interesting fact in the statistics is shown
in the difference in the percentage of midwives at the
birth between the primipara and the multipara. It is a
mistake to consider the primipara the more difficult
labour than the multipara. In cases where the ante-natal
supervision of the primipara has been adequate it is
frequently the very reverse. It is thus difficult to
explain why 24 per cent, of primipara who engage a
midwife alone should increase to 57 per cent, in the
multipara, and the doctor and midwife figure fall from
'0 per cent, to 35 per cent. It may be finance; having
discovered that the cost of both midwife and doctor is
more than the parents can afford, they do not wish to
repeat the experience, or it may be, having obtained
a faith in the midwife at the first confinement, the
mother is prepared to place the whole trust in the midlife
on the next occasion. It is probably due to the
greater anxiety of the young mother as would be indicated
by the hospital confinement figures—50 per cent,
in tlie primipara falling to 24 per cent, in the multipara.
One disturbing fact brought out of these investigations
is that no less than 17 mothers were confined in
°ne-room premises, 11 being primipara. None of these