This is not a paper to discuss the suitability of women for midwifery. All through the ages it has been done by women, until early in the nineteenth century in England and its colonies, it gradually became customary for men-doctors to attend such cases; apart from this, the work of midwifery has never been in the hands of men, except when abnormal cases have required the assistance of a doctor with knowledge of anatomy and skilled in instrumental delivery. Even before the passing of the Midwives Act in 1902, statistics proved that three-quarters of all confinements in this country were attended by women.
Continental countries have been alive to the need for training the women who did this work. For instance, in the great General Hospital in Vienna with its 3,000 beds, 550 beds were kept apart for maternity wards, and of these, 200 were reserved for the State training of midwives—a course of one year's duration being obligatory, with daily lectures on every detail in midwifery from the Professor of Obstetrics. The present writer attended these lectures daily for six months in 1885, and was made to feel the importance in teaching of "hammering" at essentials and of questioning, so that the lecturer might discover whether he were talking above the head of the least clever of the audience.
England's population increased so steadily and rapidly during the nineteenth century, that it seemed to trouble no one that countless lives of mothers and babies were lost during the perils of child-birth; it remained the only civilised country of Europe where a woman could practise as a midwife without any training at all.
For nearly twenty years before the passing of the Midwives Act in 1902, a small band of devoted women laboured in season and out of season urging on Parliament the need of a bill requiring a minimum of three months' theoretical and practical training and an examination before trusting a woman with the lives of mother and child.
This historical fact alone is a sufficiently cogent reason for the now ever-increasing demand on the part of women for the parliamentary vote.
The Central Midwives Board (C.M.B.), a body of eight members (experts elected by various bodies, such as the Royal Colleges of Physicians and Surgeons, the British Nurses' Association, the Midwives' Institute, etc.), now exercises supervision over the midwives of the whole of England and Wales, though local supervising authorities also take cognisance of midwives' work and investigate cases of malpractice and the like. The address of the Central Midwives' Board is Caxton House, Westminster.
The training for the examination of the Central Midwives' Board is based on the method pursued in medical education in English-speaking countries, viz., there is not one uniform course, but each of the training schools attached to hospitals follows out its own plan of training, each hospital having been approved by the Central Midwives' Board as giving an adequate training for its examination. There are now seven maternity hospitals in London, where women students may train in midwifery. Of these, only one—the Clapham Maternity Hospital (with its training school founded by Mrs Meredith in 1885)—is, and always has been, entirely officered by women. Here the course advised is six months, viz., three months in the hospital (Monthly Nursing), and three months in the hospital and district doing Midwifery proper. During this time over 200 cases may be seen, and nearly 100 cases attended personally. The cost of this training is £35 to £40, which includes board and residence for twenty-six weeks. Students previously trained elsewhere may take one months' extra training at a cost of ten guineas. Private doctors and midwives may also take pupils if recognised as teachers by the Board.
Midwifery training is now required not only by those who are going to act as midwives, but also by most missionaries, all fully trained nurses (for matrons' posts or colonial posts) and by health visitors and inspectors before obtaining appointments.
But it should be borne in mind, especially in considering the present condition and future prospects of Midwifery as a profession, that even now a large though ever-decreasing proportion of registered midwives are still ignorant women who have never passed the Central Midwives' Board or any other examination, and have had no teaching from any one more experienced or better informed than themselves. For when the Midwives' Act came into force in 1903, it was necessary to move slowly, and so a clause was inserted, permitting women who had been in bonâ-fide practice for more than one year before 1902 to continue their work under inspection and supervision (with many attempts at teaching them by means of simple lectures and demonstrations). This plan, or some similar one, was necessary, not only in the interests of the midwives themselves, a set of decent and kindly, if ignorant women, who would have been ruined by too sudden a change, but also because a large number of mothers in England would have been left with no one to help them in their time of need unless they were prepared to run the risk of breaking the law. This, until recently, respectable English women disliked to do.
It is important to remember this fact, when considering the present and future prospects of the midwife. The untrained woman used to charge 5s. or 7s. 6d. for her services, and the fact that her name had been enrolled on the Government Register, that she was subject to the supervision of an inspector, without having spent anything on her change of status beyond the 10s. registration fee, did not suggest the need of any particular change in her scale of charges. Thus 7s. 6d. per case, unfortunately still remains the very common fee for midwifery, though this now involves, under the rules of the Midwives' Board, not only the long hours of watchful care at the birth, but ten days of daily visits to supervise both mother and baby, with careful records of pulse and temperature, etc., kept in a register. Naturally, the general public who employ midwives—viz., the poorer classes—do not differentiate between the trained certificated midwife and the untrained bonâ-fide midwife whose name is on the register, and thus the scale of charges remains very low and the profession, as one for educated women, is thereby greatly injured.