In view of all the difficulties by which the problem is surrounded, the uncertain results which have attended some of the most intelligent and sincere efforts in that direction, he would be foolish indeed who ventured to dogmatize upon the reduction of the infantile death-rate, or the best methods to be adopted toward that end. There are, however, certain well-established facts, certain verities, upon which I would insist. It is perfectly obvious, for instance, that every child should be ushered into the world with loving tenderness, and with all the skill and care possible. The slightest blunder of an incompetent, unskilled midwife may involve fatal consequences to mother or child, or such injuries as are irreparable.[[153]] So that the very first principle upon which everybody agrees, theoretically at least, involves the need of important legislative reform providing for the supervision of midwives, and the establishment of a system of training and education without which no midwife should be allowed to practise. That such a law would have the effect of materially lowering the rate of infant mortality, as well as that of mothers, no one who has ever given the matter serious consideration can doubt. From personal observation, and the testimony of gynecologists and obstetricians of large experience, I am satisfied that this reform alone would save many hundreds of lives each year, alike of mothers and infants. It is appalling to think of the large number of ignorant women who are practising as midwives. Many of them have no conception of the importance of their work; they are often dirty and careless, as well as ignorant of the first principles of obstetrical science. Knowing nothing of the need or value of antiseptic precautions, they are responsible for thousands of cases of blood-poisoning every year, and because they are ignorant of the methods of restoring asphyxiated infants they kill thousands of babes in the passage from the wombs of their suffering mothers.[[154]]
In most states there is very little supervision of midwives; in some cases practically none at all. New York, always rather prone to take pride in its record upon such matters, has regulations which are wofully inadequate. All that is necessary to enable a woman to practise as a midwife is: (1) a certificate or diploma from some school of midwifery, native or foreign, or (2) signed statements as to her fitness and character from two physicians. No inquiry whatever is made into the bona fides or character of the school granting the certificate, nor are the physicians held responsible in any way for the women they recommend.[[155]] So long as the applicant meets either of the foregoing slight requirements, the authorities must issue her a permit to practise as a midwife. She becomes a “registered midwife,” and the title creates an altogether unwarranted confidence in the minds of the people. It is not only the poor, illiterate immigrants who are thus deceived, but many very intelligent citizens are under the impression that a “registered midwife” has had some sort of training. Immigrants coming from countries like Germany, where all midwives have to undergo a thorough training, are naturally unsuspicious of the fact that here we have nothing of the kind. It is impossible to present the evil results of the employment of untrained and incompetent midwives statistically, or even to estimate them. Some idea may be gathered from the fact that, while the physicians of the New York Lying-in Hospital, in 1904, attended over four thousand confinements, 2766 of them in the tenement districts among the very poor, with only three deaths,[[156]] one midwife, in a very similar tenement district, showed me a list of sixty-two cases she had attended with five deaths. And she spoke proudly of her “good record”!
A FREE INFANTS’ MILK DEPOT (MUNICIPAL), BRUSSELS
In Germany for some years midwives have had to pass a regular examination. In England, under the Midwife Act of 1902, they are placed under a much stricter supervision than ever before, and are made responsible for the cleanliness and care of mother and child during the lying-in period of ten days. While it is felt that this law is inadequate, it is believed that its enforcement tends to improve conditions materially. For years the New York County Medical Association and other medical societies of standing, supported by Boards of Health and the leaders of the medical profession, have tried to get legislation enacted providing for the establishment of a standard of education and training for midwives. In every state legislation of a uniform character should be enacted providing that no person shall practise as a midwife or accoucheur without having first undergone a thorough training and passed an examination set by the State Board of Regents or some similar authority. They should be held responsible for malpractice, incompetence, or neglect, just as physicians are held responsible. While it is true that such a reform would inflict a certain amount of hardship and suffering upon many women, on the other hand, it would raise midwifery to the dignity of a profession, and provide lucrative avocations for many other women. In any case, it is a most tragic folly to set the hardship involved against the enormous gain to society.
It is probable that such trained midwives would command a much higher rate of remuneration for their services than many of the incompetent women who now act in that capacity, and that many poor mothers would be unable to afford to employ them. Even now there are thousands of women who cannot afford attendance of any kind at their lying-in, and doctors tell of children, little girls ten years old,[[157]] for instance, caring for their mothers through the pain and peril of parturition and for the newly born children. The remedy for such a condition lies, not in the employment of incompetent midwives licensed to destroy life because they are willing to do it “cheaply,” but in the extension of free medical service, maternity hospitals, and properly trained midwives as part of our district nursing services. This subject of the extension of our public medical service is a most important one. There is a tendency in some quarters to decry everything of this nature, and to magnify unduly the extent to which such services are abused. That they are sometimes abused, if by that term is understood their use by those who could afford to pay for such services, is undoubtedly true, though it would be easy to overestimate the extent of such abuses. On the other hand, it is certain that in many of our cities we have scarcely begun to make provision for the needs of the suffering poor. It is astonishing to find a manufacturing city of more than sixty thousand inhabitants, with a tenement-house problem as distressing as that of New York City, and with the most appalling poverty, having no city physician upon whom the suffering poor can call by right. I do not know if there are many other cities in the United States so utterly indifferent to the claims of the sick poor as Yonkers, the “city of beautiful homes and great industries” upon the Hudson, but I do know that there are many cities in which there is a sad and shameful failure to provide proper medical care and attention for the needy.
III
In order that the child may be surrounded at its birth with all possible care and skill, it must be born somewhere else than upon the floor of a factory. Notwithstanding all that may be said in its favor, it is little likely that the Jevonian proposal to forbid the employment of any mother within a period of three years from the date of the birth of her youngest child will be adopted for many years to come, if ever at all. Among the foremost opponents of such a proposal would be many of the advocates and defenders of “women’s rights,” begging the whole question of children’s rights, and ignoring the question whether it can ever be “right” for mothers to leave their babies and enter the factory, displacing men, or, what is finally the same thing, lowering their wages. It would be difficult, however, to imagine any such opposition to the proposal that the employment of women should be forbidden within a period of six weeks or two months prior to and following childbirth. Decency and humanity alike suggest that such a law should be embodied in the factory legislation of every industrial state, as is the case in most countries at the present time.
With our cosmopolitan population it is certain that the enforcement of such a law would be no easy matter.[[158]] Little difficulty would seem to be necessarily involved in the enforcement of the period of rest after confinement; all that would be necessary would be to insist upon a copy of the birth certificate of the youngest child, accompanied by the sworn statement of the mother. If the whole onus of responsibility were placed upon the employer, and penalties were imposed in a few cases, there is no reason to suppose that the law in this respect would be less effective than other laws relating to employment. That it would not be perfectly successful is no more an argument against its enactment than the partial failure of child-labor laws, for example, is an argument for their repeal. But the period of exemption prior to childbirth is a much more delicate and difficult matter. It has not, I believe, been found possible in European countries to enforce the law in this direction with as much success as in the other, but the results have been sufficiently successful, nevertheless, to warrant continued effort. In actual practice such a law would have a tendency, doubtless, to discourage the employment of married women in factories, since employers as a rule would not care to take the trouble, or to assume the risks, thus involved in their employment.
But, as already noted, if working mothers are to be forced into prolonged periods of idleness, in the interests of their offspring and the future of society, some means must be provided whereby they may be maintained and secured against want. The philanthropic experiments noted in an earlier chapter owed all their success to such provisions. While it would perhaps be too Utopian to advocate as a measure for immediate adoption state pensions for childhood and youth as well as old age, as Mr. C. Hanford Henderson does in his wonderfully suggestive and stimulating book, Education and the Larger Life, it is not, it seems to me, too much to demand that the state shall (1) allow no mother to imperil her own life and that of her offspring by working too close to the period of parturition, nor (2) allow any mother to suffer want because she is prevented from, or of her own free will and intelligence avoids, such work. If the right of the child to be well born, to be ushered into the world with loving care and all the skill possible, is to be anything but a mere cant phrase, the safeguards thus briefly sketched cannot, it seems to me, be lightly denied. Recently I visited the stables of a friend interested in the breeding of horses. I saw that he had taken great care and pains to secure a well-trained veterinary surgeon, that the brood mares were patiently and lovingly cared for and tended, both before and after foaling. No humane and intelligent breeder of animals would deny them the protection and care here suggested for human beings. Until the state is willing to care for its children, at least as well as enlightened individuals care for their horses, or their dogs, it is mockery to speak of it as being “civilized”!