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. except in the case of loss of blood, there is time there for arrangements to be made either for the attendance of the disti-ict medical officer imder the poor law, or some other medical man. I feel that most of the cases are those occurring during emergencies of labour, for instance. 6648. That is refen-ed to in Rule B. 19 (3) ?—Yes. 6649. Is there any provision in Oxford by way of provident societies or medical clubs for a woman to insure, so to speak, against the cost of her maternity ? Could she by joining a doctors' club or a provident society do so ?—She can pay her fee by instalments in advance. 6650. Is that done ?—Tes, that is done to a certain very limited extent. 6651. What sort of payments would be made?— They would pay, I believe, in first cases one guinea, and in other cases 15s., but they must also pay their monthly subscriptions to the provident dispensary. They miist be members of the provident dispensary, and then they have the privilege of paying the mid- wifery fee. 6652. For the additional benefit ?—Tes. 6653. Has that been long in operation in Oxford ?— Yes, ever since I have been in Oxford. 6654. And notwithstanding the existence of these maternity charities, which of course compete with the provident system?—Yes, but we are, as I have said before, exceptionally situated in Oxford in that respect. 6655. Would that fee of one guinea or 15s. be regarded as a retaining fee to be paid in any case ?— Yes. 6656. Supposmg the medical man did not attend, woidd he still keep that fee ?—But he would attend; if he were not actually present at the birth he would sitbsequently supervise the case during the puerperal period. 6657. So that it is really in the nature of a retaining fee ?—Yes, it is in the nature of a retaining fee. 6658. Do you regard that fee as a satisfactory one for the services which it implies?—Yes, among the poorer or working classes I regard it as satisfactory. 6659. You spoke of the maternity charity being concerned with old Oxford; is the population moving out of old Oxford into the suiTOunding and outlying districts ?—Yes. 6660. Is there a tendency to a reduction of popu- lation in old Oxford and an increase outside?—Yes, for instance, the whole of the suburb of Summertown, where there is a considerable working population, is outside the operation of all these charitable institiitions. 6661. {Mr. Peclder.) Is Summertown in the city?— Yes. 6662. Not outside the city ?—No, it is in the city now. It was included some years ago. 6663. lour suggestion of lists of medical men would cover the difiiculty as to medical men who would not go to cases on the stimmons of midwives or others ?— Yes. 6664. Are there such men in Oxford ? — Yes, several. 6665. Are they generally known not to be available for such cases ?—They get to be known, I suppose, but still time would possibly be wasted in sending to them. 6666. And your list would obviate that ?—Yes. 6667. (Mr. Fremantle.) Do you think there are many instances in which women under the Central Midwives Board standard are employed as monthly nurses under medical men ?—-Yes. 6668. Under the standard of the Central Midwives Board certificate ?—Yes. 6669. Does it happen that occasionally these women may during an emergency be actually in sole charge of the patient at the time of the birth ?—Undoubtedly. 6670. Does that seem to you therefore a cex-tain danger to the patient?—The danger there probably does not amount to very much. Of com-se it is gene- rally in cases of precipitate birth that they may be left in sole charge. 6671. But those cases of precipitate labour may be very serious, may they not ?—They may be. 6672. And if the woman is not up to the Central Midwives Board standard there is a danger to the case, or there may be ?—Well, it is just possible. 6673. Therefore I suppose, from that point of view, a doctor, if other things were equal and there were no difficulty about payment, as for instance in his highest class practice, woiild ultimately be satisfied with nothing less than a monthly niu-se with the full training of that standard ?—He would require a trained monthly nurse certainly. 6674. That is to say, a woman with at least the minimum requu-ed by the Central Midwives Board ?— Yes, with the amount of training required. The doctor woidd certainly require her to be trained. The Central Midwives Board insist on six months, do they not ? 6675. I think three months is the minimum ?—Then it would take another three months to get these cases. It would take six months, I beheve. 6676. Then coming dovm from cases where it might be desirable (money being no object) to have a woman of that standard, do you think that medical men would agree that in the future it would be advisable that monthly nxirses should also in particular cases have the same standard of training ?—I think so. Of com-se eveiy medical man knows he works with the gi-eatest sense of security if he has trained help in any case, whether it is a midwifery case, or whether it is an ordinary medical or surgical case. 6677. How much hardship and difficulty would it introduce if the Midwives Act were extended so as to include monthly nurses in its scope ?—I do not think that would entail very much hardship, provided there were a sufficient supply of nurses. I do not think it would entail hardship at all, because one's experience, I may say, is this, that the women who are doing monthly nursing are vastly superior to those who have been registered as ah-eady in work as midwives, that is, the bond fide women. 6678. You mean to say if they have not received a a proper training ?—Yes. Many have received a training, but not a training perhaps that would enable them to pass the examination of the Central Midwives Board. Many of the institutions formerly trained midwives and they also trained monthly nui-ses. 6679. That is two separate things ? — Yes, two separate things. The midwife was trained for the examination held by the Obstetrical Society, and the monthly nurse was sent out with a certificate of her competency from the institution that trained her, as the result of an examination held by the matron or some of the medical stafl'. These women are generally very efficient in their work, though they have not the certi- ficate of the Central Midwives Board. 6680. If therefore there were any suggestion that either a medical man or a registered midwife should, apart from emergency, be present at every confinement, you do not think that would be a real hardship in Oxford ?—Not at all. 6681. (Chairman.) From your experience as a general practitioner, is there any suggestion you have to make for the amendment of the Act, or have you any suggestions to make in regard to the administration of the Central Midwives Board, so far as it touches the interests of medical practitioners ? — No, I do not think so. 6682. You have nothing to say as to the examina- tions that the midwives have to undergo ?—Not at all. 6683. You think they are reasonable in qi;ality and properly conducted, do you ?—Yes. Those midwives that I have come across (and a good many have the certificate) seem to me to be very well trained and qtiite up to the work. 6684. It has been suggested here that special pro- vision should be made that a general practitioner should be always one of the examiners. Would there be any advantage in that ?—There might possibly be an advantage in that, because, of course, it is obvious that a general practitioner is better acquainted with the conditions under which midwifery is conducted than would be the case if he practised among people who would not be likely to employ a midwife. I certainly think that. The witness withdrew.