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]
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.] Mr. J. T. Dodd. [Continued. if it were an illness; she requires careful feeding, and more than in ordinary cases. Before an illness you do not usually have to take precautions, but in this case a couple of months beforehand she ought to have proper care and skilled attention, and for a month or so after she ought to have care and skilled attention. So that a confinement is much worse than an illness, becavise you want attention before and after the confinement. 6992. No doubt she reqiiires a great deal of attention.—But it is not only the woman who requires attention, but the child also. When a person has an ordinary illness, there is an end of it after it is over. 6993. Sometimes they die ?—Yes; but in many cases they live, and the child is enfeebled and weak, and will be so all its days, just because a few shillings are not spent on proper attention to the mother; so that it is more serious in her case. 6994. No doubt there may be an element which makes it far more serious, because of the new life that is affected?—Yes, and the grandchildren, and so on, and this omission of skilled attendance increases pauperism. A great deal of pauperism comes from enfeebled constitutions. 6995. But your own evidence goes to show that this Act, as you say, deals with the evils of the present system, and you are prepared to say that, as the result of the operation of the Act, there has been an enormoiis diminution in infantile moi-tality in Oxford— There has been a great diminution of infant mortality in Oxford, certainly. 6996. Will jow give the figures upon that point, because they woiild be very useful to have ?—Yes, I refer to it in section 49 on page 18 of my precis. 6997. Will you read the whole of that, because it will be a veiy good thing to have it on the notes ?— I say : I can show this reduction best from the tables and reports of our able medical officer of health, Dr. Ormerod, but will here give a brief account of it. In his report for 1902, he stated that the health of a considerable proportion of the parishes of Oxford was satisfactory, but. he added, ' there are two ' parishes, however, St. Clement's and St. Ebbe's, the ' vital statistics of which compare very uirfavourably ' with the rest of Oxford'; and remarked ' that the ' fact that out of every 1,000 children bom alive in ' these districts, 198 in St. Clement's, and 193 in ' St. Ebbe's, die before they reach the age of one year, 'is a state of affairs that requires attention.' The infant mortality for 1902 in the whole of Oxford was 128 • 8 per 1,000 births. The rate for Oxford for the year 1908 was 94 ■ 4, that of St. Ebbe's had fallen to 159, and St. Clement's to 97, see pp. 2, 27, of his report for 1908. This was the third year in succession that the rate was binder 100 per 1,000 births. The average of the 28 years, 1875 to 1902 inclusive, was 137 • 2, while the figures for the following years were 94-7, 112-7, 118-4, 97-5, and last year 94-4. I believe this reduction is chiefly due (1) to the work done by the ladies' health committee of the Oxford Sanitary Aid Association, (2) to the plan of supplying ' unsatisfactory babies ' with modified milk from the Oxford Dairy Company, and the personal care and attention to the babies given by the Com- pany's milk chemist, and (3) to the city council, through the exertions of the medical officer of health and of Miss Martin, the inspector of midwives and official health visitor of the city council. Perhaps some small share of the gratifying results maybe due to the Oxford board of guardians, which relaxed its deterrent system as to medical relief to infants, and also, in a very few cases, paid for the modified milk. 6998. I presume it was the Midwives Act that directed attention to the subject ?—I do not think so. 6999. The dates you mention ai-e really siiggestive of that. The Midwives Act was passed in the year 1902, wliich is the year you start from ?—I thmk I can deal with that. No, it was not the Midwives Act, I am sxire. It was Dr. Ormerod, our very able medical officer of health, who called attention to it. 7000. You attribute part of the result to Miss Martin, the inspector of midwives ?—She has done good, hxit I put her work in the third category. The medical officer says there is little doubt that the explanation is to be found in the work done by the Oxford ladies' health committee. This work began in 1905, and, growing ever since, now deals with the infants in aU parts of the city. But he is too modest to say he has had miich to do with it, though he started the endeavour against infant mortahty. He gives the credit to the ladies' health committee. They have paid very great personal attention, and money has been spent on it. 7001. They have given advice to mothers previous to confinement and afterwards ?—Yes, that is so; and, where necessary, modified milk has been supplied. 7002. You have that system of modified milk, have you ?—Yes, and it has done a great deal of good. I think the personal influence too of the lady visitors has done a great deal of good. The personal influence of the certified midwife would be a very useful thing to have. 7003. It would work on parallel hnes with these associations, would it not ?—I do not know. I cannot say much about associations. 7004. I mean such as the ladies' health committee ; midwives would woz-k ia harmony with them ?—No doubt. 7005. The objects of these health committees would be served by the assistance of the qualified midwife ?— Certainly they would all work together, no doubt, for good. 7006. Do I understand you to advocate the actual payment of the midwife by the local authority ?—Yes, where the mother cannot pay. 7007. But that is not what I mean. Do you wish to see salaried midwives ?—Yes. 7008. Employed by whom ?—By the local aiithority. 7009. How would you proceed ?—It would be done by the boards of guardians. As the law stands now, the certified midwife would be appointed, just as the poor law medical officer is appointed, by the boards of guardians. 7010. But have they the power to do it ?—Yes. 7011. To appoint a certified midwife ?—Certainly, with the consent of the Local Government Board (4 & 5 Wilham IV. cap. 76, sect. 46). Whether they have it without that consent, I do not know. I could not answer that off-hand. What I would venture to suggest is that the giiardians should pay her a small salary, and then pay her according to the services rendered. 7012. On a certain scale?—Just as they do with the doctor in confinement casqs, where a fee is paid; and each woman should apply, when necessary, for the services of the appointed midwife. It woiild be very convenient if the officer to whom she applied was a woman, or if one of the relieving officers was a woman. 7013. But what criterion would the destitution authority apply in order to determine the point as to whether she was a person who should be in receipt of this assistance or not ?—The board of guardians would decide it. 7014. Upon the lines on which relief to the poor classes is now given, or sick relief to the poor?— Just the same as sick relief to the poor, but I should be vei-y careful to avoid calling them paupers. 7015. You think there would be no difficulty in defining the recipients of such relief ?—No more difficulty than we have now in doing it. 7016. You do not think it would have any regret- table effects upon the class so favoured ?—I think it would be a very good thing for them. 7017. You do not think it would sap their self- reliance ?—I think it would do them good, and so far from demoralising them, it would have just the reverse effect. It is very demorahsing to us of the comfortable classes that these poor women should be lacking what is really necessary, and I think it is very bad for the State. 7018. (Mrs. Hohhouse.) You say in your precis that the special object of the Midwives Act is to secure that every confinement should be attended by a skilled person, viz., either a doctor or a midwife. Do you wish to imply by that that it would be advantageous to ensure the attendance of either a doctor or a midwife](https://iiif.wellcomecollection.org/image/b21361113_0309.jp2/full/800%2C/0/default.jpg)
