Report of the Departmental Committee appointed by the Lord President of the Council to consider the working of the Midwives Act, 1902.

  • Great Britain. Midwives Act Committee.
Date:
[1909]
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Licence: In copyright

Credit: Report of the Departmental Committee appointed by the Lord President of the Council to consider the working of the Midwives Act, 1902. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    12 May 1909.] Dr. S. Bakwise. [Continued. into a difiBculty tlie licence would not be renewed. They need not be so strict in tbose localities where we have not got midwives. 6456. (Chairman.) Tou mean they need not be so strict as to conditions of safety ?—No, it is not that. It is not so strict for this reason, that a woman will be struck off the roll if she is not up to the standard of the Central Midwives Board, and she will automatically go off the roll unless we report annually that she is up to the proper standard. 6457. (Dr. Champneys.) To take an illustration which I put to another witness. Supposing you take the case of petroleum oil, which has a certain flashing point, and anything above that is danger : we now only keep just below that danger point, and how can you raise it in any way without danger ? That is what I cannot see ?—My answer to that is this, that the whole system of examinations is wrong. 6458. That is a very big question ?—And it is more wrong on the question of midwives than in anything else. 6459. [Chairman.) But you cannot ascertain the minimum of safety ?—Tou can obtain it by talking to people who know all about the women. It is not so much the examination itself as having the opportunity of seeing what is their opinion of her character and experience. 6460. {Br. Champneys.) How can you talk to every- body about every candidate ?—If you were going to put The witness these women on the same grade it might be different, but I want a second grade for them. 6461. {Chairman.) Tou want a temporary certificate ? —Tes. 6462. {Dr. Champneys.) Would you be able to ask for such an examination on special occasionsDo you wish to ask the Central Midwives Board in special circumstances to send down an examiner to examine perhaps with the local examiner, who is perhaps one of our examiners, and get the Central Midwives Board not to frighten the women by having them taken out of their ordinaiy surroundings ? Was that in your miad ? —If there was any chance of getting this done, we should certainly be able to collect for examination, say, eight women for certain localities where we want them, and these women would have to go through the proper training and comply with aU the Rules in force at the present time. 6463. But they would be examined locally ?—Tes, and not put on the roll, but they would be given an annual licence. 6464. But if they pass, would they not be put on the roU ?—But the women do not pass the examination; they caimot learn the terminology. 6465. But perhaps they would if they were examined locally ?—Tes ; they might, but I doubt it. 6466. But, however, I see the point; it is the annual licence ?—Tes, I have given the matter a lot of thought, aud I believe that is the only way of getting over the difficulty. withdrew. Mr. Walter Schroder called and examined. 6467. {Chairman.). In what area do you exercise the office of coroner ?—^I am deputy coroner for Central London. 6468. That covers a very wide area, does it not ?— Tes. 6469. Tom- evidence, of coui-se, is confined to one or two points ?—Tes. 6470. Tou think that a great deal of damage is suffered by children, and that possibly their deaths ensue, owing to the midwife failing to obtain medical assistance in time ?—That is so. 6471. Tou think that she is not so acutely alive as she ought to be to the conditions which throw upon her the obligation to call in the medical man ?—Tes. 6472. But how would you remedy that ?—I think she fails to recognise, or if recognising, to appreciate, the necessity of calling in medical aid in cases of delicate children and prematurely bom childi-en. 6473. But how are you to impart to the midwife, who is not a woman of sufficient capacity, or has not the flair necessary to ascertain it for herself, that the circumstances require this action ?—I think a quahfied midwife is capable of recognising it. 6474. Do you tliink then that she fails owing to want of power or to ignorance ?—Because she is too casual. 6475. Tou mean she does not recognise the importance of the issue involved ?—That is so. 6476. How are you to give her the qualities of mind and temper which will enable her to realise that ?— From her training she should know. 6477. Tou think that the importance of it is not urged enough upon her from outside, and that the Rules of the Central Midwives Board might make it more impressive ?—I think it should be laid down that, in every case of a prematui-ely born child, or where there is a suggestion that the child is not breathing properly, the midwife should move to obtain medical advice. 6478. Tou mean to say the case might be met by strengthening the Rules of the Central Midwives Board ?—Tes. 6479. Tou think that would be sufficient?—Tes, probably so. I think the midwives treat the matter really as of slight importance, and fail to appreciate the value of life. 6480. Tou put the matter forward from the point of view of the expense to the county involved in holding inquests which are the result of this neglect ?—Tes, that is one point; but it also opens up a very wide question as to whether some of these deaths attributed to natural causes might not be due to other causes. It is a well- known fact that a child prematurely bom and weakly may live or may not live, and if you do not keep up a fixed system to aid the child, then death will easily ensue. What has striick me particularly, holding inquests in these cases, is, that on many occasions, the father or the mothei-, or the neighbour, recognises that the child is delicate and probably will not live, but the midwife takes no action to obtain assistance. 6481. Then you would like the Rule to be so strengthened that in any case of i^rematm-e birth the doctor should be sent for ?—Tes. 6482. Because dangerous feebleness does not necessarily involve that obligation ?—No; certainly where the child is very enfeebled he should be called in. 6483. But that is so already according to the Rules ? —Tes, but there are cases where the child is a bad colour and not breathing properly. In many of my cases the child has simply been moaning. 6484. {Dr. Champneys.) Under the Rules of the Cen- tral Midwives Board, a midwife is bound to ask for medical aid when the child exhibits dangerous feebleness. That seems to cover all the conditions to which you refer, but apparently you do not think it sufficient ?—That shoidd cover it, I think, but some midmves do not send. 6485. All one has got to do is to report such a breach of the Rules of the Central Midwives Board to the local supervising authority, so that the woman may be had up before the Board and dealt with ?—Tes. 6486. (Chairman.) Have you as coroner taken such a step ?—I give notice of eveiy case to the inspectors of midwives to the London County Council, and they generally attend the inquest. 6487. (Dr. Champneys.) What is one to do ? How are the Central Midwives Board to do more than say these Rules are to be obeyed, and have women up befoi-e them in case of breaches of the Rules ?—It is a very serious matter as to the loss of life, to commence with, and it is a very serious matter from the point of view of expense to the county, and I think there should be some method adopted of seeing that the midwives do recognise that these cases of children prematm-ely born and delicate should be at once seen by a medical
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