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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    19 May 1909.] Dr. A. RiVEES-WlLLSON. [Continued. that any other fee would provide adequate remuneration for a case which is admittedly a difficult one. 6565. Yes, or for any other later attendances of some days or weeks in which they might be necessaiy; but if you are going to have a fee paid in all cases it must hardly be fixed at the point which meets the maximum of obligation?—It would hardly meet the greatest amomit of time, because one might have to attend such a case for a period of, say, a month after- wards, and 21. would be a very small fee for such a case. 6566. But such a case would surely be unusual, would it not ?—Not very unusual, taking the more difficult of these oases. 6567. But the attendance at the moment may not be followed by any serious conditions ?—It may not, but the case requires supervision. 6568. But the supervision of a skilled midwife, so long as nothing serious overtakes the woman, would be sufficient, would it not ?—I do not think so, because the doctor would, in my opinion, be held responsible for the subsequent course of the case. 6569. Would not the midwife realise when any serious indication arose ?—I do not think any doctor would be disposed to triist his reputation to her. 6570. The doctor would have to attend, consequently, and see the woman in evei-y case after the application of instruments ?—Yes, I think he would assume the subsequent responsibility. 6571. Woiild not some graduated scale of fees which would take account of circumstances be more acceptable generally than a lump fee to cover all kinds of cases ?— But the fee of 21. was not considered a very large one in the case of pauper patients, and I do not see why people should pay a lesser fee in other cases. 6572. Is that the normal amount in Oxford ?—Yes, in all cases where the doctor attends a case, and it is a case of difficulty to which he is called by a midwife employed by the board of guardians. 6573. You wovild not in any case leave the amount of the fee to be determined by the authority that pays ? You woiild prefer that it should be fixed by an Order from the Local Govei-nment Board, say ?—I think that the minimum should be fixed, anyhow. 6574. Such an Order might also lay down the period of attendance that might be involved on the accept- ance of siich a fee ?—Yes, that would be possible. But time might admit, of course, of an-angements being made for the subsequent conduct of the case ; that is, if a woman later on developed serious puerperal sepsis which requii ed an operation, or the opening of abscesses, or anything of that kind. But such a thing could be provided for by a subsequent an-angement. I presume the poor law and the general hospitals would come in. 6575. This is the only question, I presiime, in con- nection with the Midwives Act that really touches the susceptibilities of the medical profession P—I think it is the main question anyhow. 6576. (Mrs. Hohhouse.) You stated jxist now that you had lost something like two-thirds of your mid- wifery practice ?—Yes. 6577. Do you consider that to be directly owing to the Midwives Act ?—Undoubtedly. 6578. Are the midwives practising in Oxford working on their own acooimt ?—Some of them are. 6579. And some \vadev different schemes?—Some are under the Acland scheme of district nursing. There are fom- working under that scheme. 6580. Does that scheme guarantee the fee to the medical man ?—That scheme has a medical man attached to it. These four midwives can summon the medical man who is part of the scheme. 6581. That is to say, one doctor?—Yes, one doctor. 6582. And is he paid ?—Yes, he is paid. 6583. Is there a fixed charge ?—He is paid a certain fee by the committee who govern those midwives. I do not know what it is. I may say that there was formerly another maternity charity in Oxford, but the managers of this charity amalgamated it with the district nursing scheme. Formerly they had a doctor who was engaged to supeiwise every case vmder the maternity charity, and he received a card the same as in the case of the charity with which I am connected, and he visited each case on receiving notification that the person was in labc>ur. 6584. There are two charities there ?—There are two still. 6585. Both employing certificated midwives ?—Yes, both employing cei'tificated midwives. 6586. And both having their own medical men attached ?—Yes. 6587. Could you state the fee paid by the other charity to the medical man ?—I could not tell you that. 6588. You do not know whether it is a fixed fee, or whether there is a sliding scale ?—It used to be half a guinea in each case, whether any interference was required or not. 6589. Did that include subsequent treatment ?—It includes attendance for one week. 6590. Assuming that the case required further medical assistance, did the charity pay the fiirther fee ?—The case has to be handed over to the poor law medical officer in the event of the people not beiug in a position to pay. 6591. Then I gather that the midwifery work that you have lost does not lie among the very poorest in Oxford ?—Not probably the very poorest, but the class of people in regular employment earning, say, a matter of 30s. a week, such as employees of the University Press, and such institutions as that. 6592. Would they not naturally come under the two charities you mention?—Yes, but it does not provide for all of them. It is entirely dependent on voluntary contributions, and there are only a certain number of cases that could be attended. The cases that would be attended imder the charity must be entii-ely unable to be provided for iu any other way. 6593. In the case of both charities, is that so ?—■ Yes, in both charities. 6594. Do you know the number of cases taken by both charities ?—They are very few by the Acland Charity, because there are only four midwives. 6595. But they could take a good number of cases in the year ?—They tell me that they take not more than about four at a time. 6596. Still that would include a considerable number ?—Yes, but of course, as I said before, we are exceptionally well situated in Oxford with regard to that, except in the outlying districts. 6597. Can you tell me the average number of births in the year in Oxford among all classes ?—No, I cannot tell you that. 6598. Have you yourself been summoned to many cases to assist midwives under the Midwives Act, or has your partner ?—I was called to them, but I have given them to understand that I do not respond. 6599. And the same apphes to your partner ?—Yes, the same applies to my partner. 6600. Then you have no personal knowledge of cases coming under the midwife's care?-—No, not personal knowledge, except of course the cases that come in to the charity. 6601. You have stated, as I imderstand, that a con- siderable araoimt of suffering was involved by the working of the Midwives Act, but jo\i have not personally come in contact with those conditions, have you?—No. I said that, on account of the refusal of the medical men to go, much suffering was probably caused by delay. 6602. You did not mean to imply that the mid- wives were inefficient ?—Not at all. 6603. Are there any doctors in Oxford besides yom*- self who have made it known among their patients that they will not attend on the call of a midwife ?— Yes, several. 6604. What number?—I know of five or six who have done so. 6605. Do you know how many there are who are willing to attend ?—I could not say that. The matter is now under the consideration of the district branch of the British Medical Association, and perhaps until the inquiries they are making are complete, we shall not have the exact figures. But I think there is a very con- siderable proportion of the doctors in general practice who would refuse to attend.