Granted an intelligent woman is willing to give six months' work and study and £35 to £40 for her training, what chance has she of earning a decent living? If she could command 15s. or 17s. 6d. per case afterwards, she could make a decent living, given fairly hard work and the acceptance of real responsibility. If she had 100 cases a year, she would earn £75 at 15s. per case, and so on. This rise in the fees payable to midwives has just been made possible by the National Insurance Act of 1911, the framers of which appear to have recognised the necessary result of the Midwives' Act of 1902. As the bonâ-fide midwife, who has received no training, gradually dies out, it becomes necessary to provide the means of paying trained midwives, whom the people are obliged to employ in place of the old ones, but who would soon be non-existent were the means of paying them not also provided by the State.
A 30s. maternity benefit is now given for every confinement of an insured person or the wife of an insured person. As the patient may have free choice of doctor or midwife, it seems possible, now that it has been established that the benefit shall go direct to the mother or her nominee, that hereafter the greater part of it may be paid over to the person who can supply that most necessary item of the treatment, i.e., good and intelligent midwifery with nursing care of mother and child. Therefore, it is the right moment for the careful, well-trained popular midwife definitely to raise her fees to all "insured" patients, being still willing to help the poor at a low fee as before. It should be remembered that in about one-tenth of all her cases, medical help will be required, but this case could probably be guarded against by an insurance fund, if properly organised.
We frankly admit that as things now stand—apart from the possibility of the maternity benefit being made to help her—midwifery is financially but a poor profession. But to an enthusiastic lover of her kind, who has other means or prospects for her future than the proceeds of her profession, there is much that is attractive in this most useful calling.
Now let us turn to a consideration of the poor mother. Dr Matthews Duncan in 1870 put the puerperal mortality at 1 in 100 for in-patients and 1 in 120 for patients in their own homes—shocking figures for a physiological event! Miss Wilson, a member of the Central Midwives Board, stated in 1907 that the average mortality of English women, from puerperal fever, a preventable disease, is 47 in 10,000 or 1 in 213, but that in three of the best lying-in hospitals this figure has been reduced to less than 1 in 3,000. To quote Miss Alice Gregory in her article on this subject in The Nineteenth Century for January 1908: "We feel there is something hopelessly wrong somewhere. It becomes indeed a burning question: By what means have the Maternity Hospitals so marvellously reduced their death rate?"
The answer is not now far to seek in the opinion of the writer, who has worked continuously at Midwifery since 1st May 1884. It is probably wholly contained in the three following points:—
(1) All that makes for scrupulous asepsis in every detail for the surroundings of the mother.
(2) The absence of "Meddlesome Midwifery."
(3) Pre-maternity treatment, a factor which the writer considers to be of great importance, and of which she would like to have much more experience.
By this is meant the building up of the future mother's health by improved hygiene and careful, wise dieting and exercising and bathing during the last three months of pregnancy, which enables many a stumbling-block to be removed out of the way. Hence, the utility of pre-maternity wards wisely used. This is, one knows, a "counsel of perfection"; but every expectant mother should and could be taught how to treat herself wisely at this time.
These three points are all in favour of the well-trained midwife.