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5. That the local supervising authority (Midwives' Acts)
should be the unit of administration for the proposed service.
6. That the cost of the service should so far as practicable
be met by the fees charged by, and payable to, the authority
or the voluntary organisation for the services of the midwife.
The remaining recommendations dealt with:—
(а) The steps which should be taken by the local supervising
authority before initiating a scheme in its area;
(б) the status, salary and appointment of midwives entering
municipal service;
(c) the compensation of midwives not accepted for
service;
(d) the necessity for refresher courses of study by practising
midwives ;
(e) the right of appeal by midwives;
(/) the freedom of choice of midwife by the patient.
The remuneration of individual midwives is entirely
inadequate, and compares most unfavourably even with that
of nurses who, as a class, are admittedly underpaid. The
average salaries of village nurse-midwives, Queen's nursemidwives,
hospital nurses, and health visitors all considerably
exceed the £80 which the Committee has ascertained to represent
the average yearly earnings of a midwife dependent upon
her profession. In certain areas this figure may sink as low
as £50, and out of this meagre sum the midwife is expected to
provide equipment, necessary drugs, and disinfectants, and
even in some cases dressings, for her patients. There is
evidence that the low standard of comfort and cleanliness in
the houses or lodgings occupied by midwives in certain areas
militates against the maintenance of a high standard of professional
work, particularly where ante-natal examinations
have to be undertaken in unsuitable rooms normally utilised
for other purposes. In the East End of London the fee is as
low as 16s. for multipara, and the great majority of patients
pay no more than 30s.