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155
With regard to the operation of any income scale for remission
of fees in whole or in part, I have suggested (vide supra) that if your
Authority wish to encourage domiciliary midwifery, it will be
necessary—in framing such scale—to ensure that the woman who
is confined at home is not at a financial disadvantage compared
with the woman who chooses to go into an institution for her confinement.
The full cost of maintenance for 10 days in your Margaret
Lyle Maternity Home Scheme is £3 10s. 0d. On the other hand,
the following would be the cost of a home confinement with provision
of home help:—
Midwife's Fee £2 0s. 0d.
Home Help £3 17s. 0d.
£5 17s. 0d.
Some 25 per cent. of women confined at home have the additional
expense of medical fees in the event of the midwife requiring
to summon medical aid (average £1 7s. Od.). In addition, a home
confinement entails sundry expenses (e.g., medical and nursing
requisites, upkeep of patient, etc:), which are avoided in the case
of an institutional confinement.
Under these circumstances it is not a matter for surprise that
there has been such a marked increase in the proportion of institutional
confinements during recent years. It is for the Council to
decide, as a matter of policy, whether they wish to subsidise institutional
at the expense of domiciliary midwifery, and to frame
their scales of recovery accordingly.
It is suggested that further consideration be given to your
scales of recovery in operation with respect to both domiciliary and
institutional midwifery.
One of the main objects of the Act is to improve the status
of the midwifery profession, and in the accompanying Circular it
is stated that—
"The Minister regards it as of the utmost importance
that the midwives employed in the new service should be
adequately remunerated. The work to be carried out by them
is in his view at least as important as the work carried out by
health visitors, and he feels confident that local authorities
will in respect of the midwives appointed by them adopt scales