§ Order for Second Reading read.
§ 11.32 a.m.
§ Mr. Peter Thorneycroft (Monmouth)
I beg to move, "That the Bill be now read a Second time."
I am sorry that the member of the Government responsible for the Department which deals with this matter is not present at this moment. I imagine steps have been taken to encourage his accelerated progress to the House, but meanwhile I have no doubt that some note will be taken of my remarks which can be conveyed to him.
The object of this Bill can be stated quite shortly. It is to see that far more women in the future get some relief from the pains of childbirth than has been the case in the past. We who support this Bill do not belong to one political party. The hon. Member for Epping (Mrs. Manning) who is seconding me is a member of the Socialist Party. The hon. Member for Anglesea (Lady Megan Lloyd George), who unfortunately cannot be here this morning, supports the Bill. Conservatives, Liberals and Socialists all support it. In no sense is this a party issue, for if ever there was a subject which could be raised above party politics it is the relief of pain in childbirth. We who support this Bill believe that if we can get it on to the Statute Book. We shall have done something at any rate towards the reduction of the sum total of human suffering.
Nor are we alone in that opinion. Since this Bill was printed I have had letters from all over the country, and I have no doubt that other hon. Members also have had letters sent to them. I have received letters from doctors and from midwives in support of this Bill. I have had a very great number of letters from mothers supporting it. They beg those of us who have put our names to it to accept no obstruction to it and to do our level best to see that it is made part of the law of this country. Not only have they approached us individually, but collectively through their various organisations. The National Association of Midwives passed a resolution in the same terms. The National Council of Women and that important body the National Federation of Women's Institutes are 693 all solidly behind the proposals contained in this Measure.
With an all-party support from the back benches of this House, and with that solid support from the country, there is only one man who can stop this Bill from getting on the Statute Book, and he is the Minister of Health. I should be very surprised indeed if, after having been associated with a great Measure of social reform in the National Health Service, he could lend his name to the obstruction of a Bill as popular in the country and as desirable as this one.
Before I come to the details of the Bill or the attitude of the Government, I wish to say a few words about analgesia itself, because I think the term is sometimes misunderstoood. Analgesia means the relief of pain without the loss of consciousness. Anaesthesia, on the other hand, means the complete loss of consciousness and is impracticable in childbirth because for the majority of the time one requires the active co-operation of the mother. There are various ways in which analgesia can be introduced. But one is up against a problem at the outset in this matter. It is all very well devising means of getting analgesia in hospital, with a skilled doctor and a skilled anaesthetist present; for many years people have been able to get some kind of relief in that way; but it is another matter to get analgesia administered to a woman who is attended only by a midwife in her own home and far from all the resources and facilities available in great national hospitals.
A problem always has been to find some safe way of administering analgesia to a woman in her own home and with a midwife present. One method has been discovered and approved and is well known to many hon. Members as the gas and air machine. It is safe and it can be effective. There are other means. There is the new drug, pethedrine, which is still on the dangerous drug list, and trilene, which is very much written about now. But I wish to utter a word of warning in this matter.
Many people criticise the obstetrician and anaesthetist for being slow to give approval to the use of new forms of drugs. There may be some who are more conservative than others. There are such 694 people in all professions. But we should remember that these men carry the lives of hundreds of mothers and their young children in their hands in making a decision of that character, and they have to be extremely careful before they give general approval to the universal use of any particular drug or apparatus. I wish to emphasise that in this Bill we are not trying, nor are we competent to try, to discover which device is the best. We are politicians and not physicians. We cannot choose between gas and air on the one hand and pethedrine on the other. But this Bill is just as necessary whatever method is adopted. It is just as necessary to have the midwives trained and to have the apparatus supplied and transported to the home of the mother.
Why is this analgesia necessary? Some women have babies with relatively less pain than others. Some have an almost conscientious objection to any form of analgesia. There is no compulsion in this Bill on that matter. No woman is compelled to have analgesia. Any woman who prefers to have her baby without any form of relief is perfectly entitled to do so. However, research shows that an overwhelming number of women in this country who have babies want some form of relief in childbirth. The most constant complaint or criticism or observation which women make when questioned about their experience in labour is that they had insufficient relief in childbirth. In an investigation in 1946 I think only 6 per cent. refused. The remainder all wanted relief and most of them complained that insufficient relief was given.
Since this Bill was published I have had many hundreds of letters from women giving their account of what they feel about this matter. I do not propose to read lots of letters, but I want to give the House the general impression. The constant theme in these letters is that the women describe, to start with, the joyfulness with which they look forward to the birth. These are calmly soberly written letters; they are not hysterical letters. The women expect to suffer a considerable degree of pain, but then they describe how, in many cases, they have to suffer hour after hour of hard and unremitting agony. We must try to do away with that. I do not think that in any real sense all over the country 695 we can get painless childbirth but we can do a very great deal to relieve the worst pain suffered at present.
I do not underestimate the amount of work already being done in this field—the work of men like Dr. Minnitt who invented the gas and air machine; the work of Dr. Elam of the Wellhouse Hospital at Barnet, who has been a great pioneer in this field and who has fought and struggled to get the use of analgesia more widely extended; the work of the National Birthday Trust with which the name of Lady Baldwin was associated and with which the name of Lady Rhys-Williams is associated at present. We would not be anywhere near the present position in this matter if it had not been for the pioneer work of these people. Nor should we forget the work of the Central Midwives Board and the midwives themselves who have done work under conditions of great difficulty and carried out and admirable task.
It has been a long battle to get the acceptance of any degree of analgesia in childbirth. The battle has not been altogether against technological difficulties. To some degree it has been a battle against apathy and prejudice, and it is that battle which is being fought today even in this House of Commons. It is astounding, when we remember that it was a hundred years ago that this principle was first started, to consider how little progress has been made. In the survey in 1946, the number of women who got any relief who were attended by midwives in their own homes was astoundingly low. Only 7 per cent. in England, and only one woman in 433 in Wales got any relief Whatever when attended by a midwife in her own home.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Blenkinsop)
That was in 1946?
§ Mr. Thorneycroft
That is the figure I am giving. In Scotland not one solitary woman attended by a midwife in her own home got any relief at all. Perhaps the most interesting figure is that if we take all the women in the country whether in hospital or not, less than half got any relief. Another point that astonished me when studying these figures—and this is important from the point of view of this Bill—was the difference which existed between one area and another. In some 696 areas the figures were good. I think that West Sussex was a good area. But in Monmouthshire—which happens to be an area in which the Minister of Health and I represent constituencies—the figure was only 13 per cent. I mention that so that nobody can say that I am shooting at other people. The figure for Monmouthshire was deplorable and disgraceful.
All the time some improvement is taking place. Thank goodness it is. But the latest figures are that 43,500 women got some relief in analgesia out of a total of 350,000 women having babies and attended by midwives in their own homes. We can see that there has been some advance, but I hope that nobody will say that the situation is satisfactory. Let us remember that any woman who has a whiff of gas at any stage in the proceedings is counted as having analgesia in childbirth. The figures are still deplorably low. Improvements have taken place, but as far as I can see they show that the good areas go on improving, the energetic hospital goes on improving, but very often the bad areas remain just as bad as they ever were. I apologise for having detained the House with that background but I thought that it was necessary.
I come to the provisions of the Bill, which is intended to deal with that problem. It is a very modest Measure. I think it might have gone further, but it is a Private Member's Bill and Private Members' Bills must get agreement with everybody as far as possible. In particular I thought it proper, and indeed it is always necessary, not to impose additional public expenditure beyond that which has already been approved in principle by Parliament. I have stuck rigidly to that condition in every Clause of the Bill.
There are three things we try to do. First, we try to see that within the space of four years all midwives shall be trained in the administration of some form of analgesia. Second, we impose a duty on local health authorities to supply the apparatus, the drugs and the necessary transport to get both the midwives and the apparatus to the patient. Third, we impose a duty on all hospitals, public or private, to have the apparatus there ready and available for use in working order. Those are the three main things that we do in this Bill. If they were done, there would be a notable advance in this field.
697 First, I take training. In the normal case of childbirth there is perhaps not a great deal that either a doctor or a midwife can do. They can watch to see whether the case becomes an abnormal one. They can ensure cleanliness and so forth. But the one thing they are required to do where possible is to give some relief from pain. It is almost incredible that in 1949 we should consider people as qualified to attend as responsible persons at a birth when they have had no training whatever in the relief of pain and are provided with no drugs or apparatus for that purpose. Yet that is the position today. There are at present 17,000 midwives in practice. Of that number—so far as one can assess because it is difficult to get accurate figures—there are 7,000 midwives who have had no form of training in the administration of analgesia.
This Bill provides that under the auspices of the Central Midwives Board, who are a responsible and entirely admirable body for this purpose, by a target date of four years every midwife shall have had some training. We want to keep this matter pretty flexible and to have it done by the people who really understand it. I am authorised by the Central Midwives Board to say that in their opinion if we put our backs into it we can do it in that period of four years.
I have supplied two loopholes in this matter. I think that they are rather wide, but again I want to get the maximum agreement. The first is that there may be in Scotland in particular some of the older midwives who will never be satisfactorily trained in the use of the gas and air machine. There is a shortage of midwives. I do not want to cut down the number. I want to see every midwife trained, but I have put in a permissive Clause which allows the Central Midwives Board in England or Scotland to exempt a person if that is the only person in some small island off the Hebrides who can look after the birth of children but who really cannot do the training. The second loophole is that I have given the Ministry power to extend the period, and, surely, it is not asking very much for the Government to accept that provision, which is the minimum for which we should ask.
698 The next thing we do is to impose a duty upon the local health authority to supply the apparatus, drugs and transport. It is within the power of the local health authorities to do that now, and the best authorities are already doing it. Surely, it is not too much to ask that some of the less progressive authorities should try to attain a standard which is a little nearer to that of the better ones? Surely, in these days, a local authority ought to be able to supply some transport for the midwife to get to the case. It is necessary, not only for the apparatus of analgesia, but for the purpose of the midwife doing her job, that this should be done, yet there are local authorities who will allow neither a car nor a car-allowance to midwives. I have received a letter only today which was put into my hands as I came into the House. I am not going to read it all, but I should like to quote from it:With reference to your letter of the 18th inst., re the gas and air machine grant, I am a domiciliary midwife working under the National Health Scheme and paid by the local authority. I took my gas and air course by order of the local authority in June, 1948, and passed my exam on October 13th of that year. I average 50 cases per year and my mothers would like to have the gas and air, but I have made application to the local authority, and cannot get any satisfaction, so decided to buy my own rather than lose my patients.I want to pay my tribute to these midwives, and particularly to this one who was prepared to pay these expenses out of her own pocket—and they are not paid such a large amount—in order to help her patients. That should not be allowed. We are past the stage at which the amount of pain which a mother suffers ought to be determined by the question on which side of a local government boundary she happens to be. The licensing laws provide for local option, but we ought not to have any local option in this sort of thing, beyond the option of the mother to say whether she wants it or not, and if she does, it ought to be available.
The third point is that we impose a duty on a hospital to have the apparatus there so that it shall be available if people want it. We may have a situation in an over-worked hospital ward in which 10 women are having babies and where one machine has broken down. In that case, some woman has to do without it. We suggest that the 699 hospitals shall have a duty to ensure that the apparatus is available and a further duty to maintain it in working order. I shall read part of another letter as an example of what is happening. Believe me, this sort of thing is much more common than many hon. Members realise:For my confinement, I was fortunate enough to obtain a bed in the local hospital in the labour ward which had the gas and air apparatus. During part of the time I was given the gas and air apparatus, and later I managed to do without it during the birth of my baby. My baby having been delivered, it was decided that I would require to be stitched, and was told to use the gas and air once more. This time, as no further effort was required from me, I felt that I could administer this satisfactorily, but, this time, on feeling no effect from the gas and air, I asked the nurse if I was doing the correct thing. She examined the machine and informed me that there was no gas in the cylinder.This woman is not writing a hysterical letter. She said that she did not have the treatment because she preferred to do without it if she could. The letter goes on:'As I would like to see this particular Bill passed and everybody have the opportunity of relief in childbirth, I would just as much like to see this apparatus, obtainable at no small cost, used to the utmost advantage. It seems a great pity to me that a hospital equipped with such a machine for the relief of suffering should still require a mother to suffer pain because of a few minutes' work involved in changing a cylinder. I know mine not to be a solitary case. My baby was born as recently as 7th August, 1948.I want now to read an extract from a letter from Dr. Elam, the great pioneer at the Wellhouse Hospital:Will the Minister of Health tell us, perhaps, in how many hospitals in the Metropolitan area does a staff anaesthetist make weekly visits to the labour ward to carry out a careful examination of all gas-air or trilene machines?Yet this is vital to success. …Of course, in some parts of England, there is no pretence to give relief from pain. It is, I think, at least honest, and by no attempt at giving relief from pain I mean exactly what I say; there is no relief in normal labour, there is no relief in instrumental delivery. There is no relief during subsequent repair, necessitated by a difficult instrumental delivery. I am not telling you fairy tales. These things are true, and are acknowledged to be true.That is the letter of a man with 16 years' intimate experience of the working of hospitals in this country.
700 These are the things with which this Bill tries to deal—that the midwives should be trained, that the local health authorities, all of them, should provide the apparatus, the drugs and the transport, and that the hospitals should see that the apparatus is there and that it is maintained in working order. I should have thought that a Bill with such objects would have a good chance of reaching the Statute Book, but I must say, and I think the House can judge of my disappointment, that I met the Government Chief Whip last night and that he said it was the intention of the Ministry coldly and deliberately to kill this Bill.
§ The Parliamentary Secretary to the Treasury (Mr. Whiteley)
No. I think that is a very unfair statement. I said nothing of the kind. I said that the Government were accepting the principle of the Bill, but that they were doing all they can to advance this matter.
§ Mr. Thorneycroft
I am not denying for a moment that the Government claim that they are doing everything they can. I am not denying the work they have done; I have a great admiration for it. So far as this Bill is concerned, I state my belief that it is the Government's intention to kill it.
§ Mr. Thorneycroft
Indeed, they have published their intention in the newspapers. They have said that they are not going to vote against the Second Reading. I will tell the House, and I think the country has a right to know this, that, though they have decided that the Bill shall have its Second Reading, it will never get on the Statute Book. Does anyone imagine that because a Bill is read a Second time it will therefore reach the Statute Book?
§ Dr. Haden Guest (Islington, North)
Might I warn the hon. Gentleman that he is now getting very near party politics?
§ Mr. Thorneycroft
I am not indulging in party politics, and I am not going to make a party speech. As I have told the House, this Bill involves no increase in expenditure other than that which has already been approved by Parliament. It is true that, if the bad areas are to 701 be brought up to the standard already reached by the good areas, some money will have to be spent; that is to say, the backward areas will have to provide these gas and air machines, and that expenditure under our Rules of Order, makes it necessary to have a Money Resolution. The only way in which this Bill could possibly become an Act of Parliament would be for the Government to move that Money Resolution. If they refrained from doing that, the main part of this Bill would drop stone dead. I am not making a party speech; it is much better to be blunt and honest about this, and to see what is going to happen, instead of pretending that we are going to get the Bill on to the Statute Book.
§ Mr. Blenkinsop
If the hon. Gentleman is now arguing that, in point of fact, this Bill does not make any extra charge upon the Exchequer beyond what is already provided for, it is very difficult to see—although I am sure that the hon. Gentleman and all other hon. Members desire the relief of pain in childbirth—what added advantage this Bill has.
§ Mr. Thorneycroft
The House has already passed legislation which gives power to every local authority to make this apparatus available. Some local authorities do, and some do not. But this Bill makes it a duty—it turns a permissive power into a public duty—and, therefore, more money will be spent. But because of the Local Government Act and the grant system, under, our Rules of Order, a Money Resolution is required. If the hon. Gentleman wants details as to why that is so, he can talk with the Public Bill Office.
§ Dr. Segal (Preston)
On a point of Order. The last remarks of the hon. Member for Monmouth (Mr. P. Thorneycroft) are in flat contradiction of the final paragraph in the Explanatory and Financial Memorandum. There it is deliberately stated that little or no additional expenditure is involved by the Bill. If additional expenditure is involved, it ought to be clearly stated in the introductory memorandum.
§ Mr. Thorneycroft
That paragraph, in accordance with precedent, was drafted for me by the Public Bill Office. I hope that deals with the hon. Member's interruption.
702 Some hon. Members said that I was engaging in party politics. I am doing nothing of the sort. As a matter of fact, I pay a tribute to the officials of the Ministry of Health who have given me a great deal of assistance. The hon. Member for Epping who is going to second the Motion, is a loyal member of the Socialist Party, but the fact that she is taking the same side as I am in this matter does not mean that she is a less loyal member of the party. Such a long time has elapsed that we have forgotten what Private Members' Bills are about. This is not a battle between one party and another. The gauntlet which is flung down is not to the Tory Party, but to the back benchers of all parties who are supporting the Bill. Mothers do not suffer pain according to the party to which they belong. The demand for this treatment is coming from mothers all over the country, irrespective of party. They all suffer the same pain, and they all demand the same relief. As I say, I am astonished that the Government should refuse this request.
I saw in the "News Chronicle" a statement by the Government—which they put out as a little preparatory propaganda—to the effect that painless childbirth may delay other reforms. What other reform is to have priority over painless birth? Take the case of the local authority which is refusing to supply motor-cars or even to agree to give an allowance to its midwives. What priority is something else getting over painless birth in that instance? I should have thought it was time that somebody gave a bit of priority to this need. Indeed, unless we give some priority to it, I am afraid we are not going to get any real advance in this subject.
I do not want to elaborate the case against what the Government are going to say because I think it better that the Minister should get up early in this Debate and make the Government case so that we can answer it if necessary in the Debate. What we are trying to do in this Bill, I reiterate, has nothing whatever to do with party politics. We are trying to impose a duty on the bad authorities, to compel them to do something which the good authorities are already doing. We believe that is a wholly admirable course to adopt. We want women to get this relief, whether they are rich or whether they are poor. 703 A rich woman can go to a skilled anaesthetist at the present time and get this relief, but the majority of the people who are denied it are the poor. As I say, we want to see that they get it whether they are rich or poor, wherever they live, and whether they have their babies in an institutional confinement or in their own homes. I believe that when hon. Members have debated this Bill they will come to the conclusion that they share the opinion of women about it. We want to have this Bill, the whole Bill, and nothing but the Bill.
§ 12.7 p.m.
§ Mrs. Leah Manning (Epping)
I beg to second the Motion, and I do so with considerable pleasure.
I should like, first of all, to congratulate the hon. Member for Monmouth (Mr. P. Thorneycroft), not only for the facility and sympathy with which he moved the Second Reading of this Bill, but also for the fact that, having a very wide range of political topics on which he might have framed a Bill, he has had sufficient sensibility and sensitiveness to choose this subject. He gave us an interesting historical background, and told us that it is over 100 years since Sir James Simpson first used an anaesthetic to give relief from pain in childbirth. I think it is probably known to hon. Members that Queen Victoria had a whiff of something or other when she was producing Prince Leopold. I should like to take the House further back even to the dawn of creation. I would remind hon. Members that in a very interesting operation—I do not know whether or not to call it a Caesarian operation—performed on Adam, we are told that the man was put to sleep. It is not surprising that while Adam was the first man ever to produce another human being, he was also the last.
Not only this Government, but many Governments interested in the question of childbirth have done a great deal to help, and I wish to pay tribute to what has been done, in the field of pre-natal care. We all know that one of the most important things in regard to this great event in a woman's life is that she should be looked after in the months preceding the birth. We have done much to prepare the woman by looking after her health, and her nutrition. We are 704 doing more than ever today, to relieve her from the anxiety which she so often feels when she knows that a baby is coming, by letting her realise that things are much more secure, and that she need not regard with quite so much dread as in the past, the bringing into the world of another young mouth to feed.
Many doctors and clinics have also done a great deal on the question of the psychological preparation of the woman for motherhood. But the best psychological preparation that a woman can have is to know that, if she so wishes, she may have her baby without pain. If I may steal from my right hon. Friend the Parliamentary Secretary to the Ministry of Food, the title of her little book, I would say that women should have "Babies Without Tears." I wish that everybody in this House had read that book. It was one of the first books I read on the subject, and it greatly impressed me concerning the importance of this question of the psychological preparation of women for childbirth.
It is extraordinary—indeed, it is inexplicable—that in this field of surgery and medicine alone, we do not use what is common practice in every other kind of pain and difficulty. The alleviation of and the ending of preventable pain is something which every doctor seeks. If any of us had a whitlow and went to St. Thomas's Hospital to have it lanced, the first thing the doctor would do would be to administer a local anaesthetic; and yet that is a comparatively small operation. I have often wondered whether this hostility and prejudice, or apathy—because it is very largely apathy—is due to the fact that pain and travail in childbirth affect one sex only. If some doctors had a labour ward of men to look after, I think it is highly probable that for the defence of their own sanity they would give their patients something more than a towel and tell them to pull on it. I think everybody in this House—certainly every back bencher and also, I believe, the Parliamentary Secretary to the Ministry of Food—will be disappointed if steps are taken to prevent this simple, easy and inexpensive little Bill being brought safely to its delivery. I am sure that that is what we all desire.
I should like to mention a point which has not so far been raised, but is a point 705 of great national importance. I refer to the decline in the birth rate in this and many other countries of the West. It is well known that in all countries where women have been literate for at least two generations, childbirth is declining. Education increases imagination; it produces a perceptiveness and an awareness. That is why women are not always prepared to undergo what is regarded as "this normal function." We are often asked "Why cannot women today have children with the same ease as peasants and primitive women?" It is because of this awareness and imaginative perception in educated women. It is also because they know that they could have relief from pain if it was offered to them, that very often they are not prepared to go through with this very difficult period without the help which should be theirs by right. The outstanding example of that—and the hon. Member for Monmouth has mentioned it—has been the testimony prepared by women doctors, all of whom have had one or two children, stating what they feel about the absolute necessity for relief from pain in childbirth.
The hon. Gentleman has himself gone through this Bill in considerable detail, but I want very much to urge upon this House the great importance of Clause 3. We are all very much in favour of the training of midwives. We must persuade local authorities to see that midwives have the apparatus, drugs and means of transport which are necessary; but what are we to say about hospitals and maternity homes which already possess this apparatus but do not keep it up to scratch; hospitals which use them as door stops and where, as the hon. Member for Monmouth has pointed out, they are not ready for use when required?
I also have had the opportunity of a talk with Dr. Elam, who knows, perhaps, more about the use of apparatus of one kind or another for the relief of pain in childbirth in his own hospital than almost any other doctor in this country. He has told me that it is absolutely absurd to imagine that one can depend upon the return of the apparatus every three months to the person from whom it is obtained and expect it to be in good working order. I consider Clause 3 to be extremely valuable. As Dr. Elam has said, it is important that the chief anaesthetist on the 706 staff of a hospital should go into the labour ward at least once a week; should demand to see the apparatus and should be sure that it is in good working order. This is an extremely valuable part of the Bill, because in hospitals where the apparatus is available it is often not ready for use.
I believe that probably the core of the opposition which the Government may put forward is that we have already the necessary legislation in the National Health Act and that this is a matter for administration and not further legislation. But I can think of Act after Act in the sphere with which I am most acquainted, that of education, where we have had permissive legislation and where the Government have eventually been obliged to bring in legislation of this kind, otherwise every bad local authority would get away with doing nothing. Is it not shameful, as the hon. Member pointed out, that because a mother happens to be living in a particular local authority area she cannot have this relief from pain in childbirth, whereas if she were over the border in the next authority area she would have it freely? Have not we on this side of the House said over and over again what a shame it is that a bright child born in the area of a good local education authority should have the chance of going right on to the university, while an equally bright child born in another local authority education area, should end his schooling in an elementary school?
There are some excellent figures showing the difference between what is done by good and bad local authorities in this sphere. The hon. Gentleman referred to Monmouthshire, with which he is very well aquainted. In West Sussex, however, which is a good authority, 57 per cent. of the women have been able to get this relief in childbirth, and in Monmouthshire only 13 per cent.; in Leicester the figure is 64 per cent., and in Stockport only 15 per cent. In fact, a few years ago in the case of only 5 per cent. of confinements at home were our mothers able to have this relief. Before I conclude I would like very much to pay my tribute to the work which is being done in Queen Charlotte's hospital. They had a fine matron. She saw that every woman in her labour ward had all the help that was necessary. She saw that the nurses on 707 the district always had apparatus so that the women under their charge should have all the help that was necessary.
Surely, this House is willing to give all the help necessary to women in their most helpless hour. Now that we know that this relief can be given safely and without any great expense, now that the obstetricians and the midwives are all in favour of it, we should not hold back from ensuring that that relief is given. Let us put this Bill on the Statute Book in the next few weeks. We are using science in every sphere today, from the electric cooker to the atom bomb. Why should we refrain from using it in this field to help all these women who need it so sorely? The hon. Member for Monmouth read several moving letters. I could have read dozens of letters sent to me from my own constituency but I shall only repeat the last words said to me before I came into this Chamber by my little secretary; she has already had two children and is expecting her third. Her words were, "Please, Mrs. Manning, see that they get this Bill through by August."
§ 12.20 p.m.
§ Colonel J. R. H. Hutchison (Glasgow, Central)
It is an interesting commentary on the characteristics of human beings that when we can eliminate politics from our considerations, our minds turn to humane questions. If we look at today's Order Paper we find that the first three Bills on it are entirely concerned with cruelty and suffering. But it would be a cynical commentary if we were to succeed—as we have already succeeded—in getting the first and later the third of these Bills, dealing with animals, through this stage and to refuse the one which deals with human beings.
There is at this moment a play running in London on just this theme. I would that the rules of this House allowed me to bring those actors here to make my speech for me. As Mark Antony said:For I have neither wit, nor words, nor worth, Action, nor utterance, nor power of speech, To stir men's blood;But if hon. Members had seen that play their blood would have been stirred as perhaps it has never been stirred before on this question. It deals with the early struggles of a countryman of mine—and I am sorry that there is no Scottish repre- 708 sentative son the Front Bench because we are concerned with this matter in Scotland just as we are in England—the struggles of the then Dr. Simpson to get chloroform recognised as safe and useful. He was referred to as the ungodly Dr. Simpson and the mad Dr. Simpson and it took years of struggle and endeavour on his part to get chloroform anywhere near complete recognition.
Medicine is a noble cause and it has to be tolerably sure. The world is crying out all the time so urgently and insistently for relief from pain, for cures from illnesses, that sometimes what can be hoped for in that direction tends to be exaggerated. So the medical profession occasionally have to put a brake on things so as to see that what they recommend and what they approve is tolerably safe and tolerably useful for its purpose.
We who have had a hand in the production of this Bill emphasise that in no way do we seek to impose on experts, we who are mere laymen talking upon a subject on which only human suffering stirs us and on which no great knowledge authorises us to speak. But great impulses come from a stirring of public opinion. The imagination is stirred, the demand builds itself up for something to be done so that, inevitably, research is multiplied and increased. We have had it in wars. We have had it largely through the constant campaigning of organisations like the National Birthday Trust, until we now have the report upon midwifery, which has recently been published, stating that there is now an insistent and widespread demand for adequate relief from pain in this way. That report is the finding of people who have gone deeply into the subject and who have reported only in the last few weeks.
Public opinion, which has been building itself up for some time, persuaded the Central Midwives Board to publish regulations in 1936—over which I will not go in detail again because my hon. Friend the Member for Monmouth (Mr. P. Thorneycroft) has done it so well—so that when a midwife had been trained, in cases where the doctor had examined the mother a month before confinement and where another responsible person suitable to the midwife and acceptable to the mother, was present, analgesia could in fact be given. But this step was only adopted in my country, in Scotland, in 709 1946—ten years later. Is that not a commentary upon, and an advocacy of, the Bill which we have before us today, a Bill to see that so far as is possible it becomes universal? In the year 1946, as my hon. Friend said, no single mother received analgesia at the time of the birth of her baby in Scotland! What a curious commentary on the country which produced Simpson and produced chloroform.
In 1945, the report of the working party on midwifery pointed out, that there were only 16,374 midwives to deal with 680,000 births which took place that year. That shortage in midwives is almost certain to continue. There is great competition for young women for many careers, for teaching, for nursing and for midwifery. Is it not all the more important then that we should see that we make the best possible use of the midwives we have? That is part of the purpose of this Bill—to see that the insufficient supply will, in fact, be fully trained so as to be able to give all the relief and all the help which is needed and to tackle all the problems which arise.
As my hon. Friend said, this Bill is very elastic. It allows great latitude, particularly in the matter of training. I want to give an example of the difficulties in training which might arise and of the situation which will continue if we make no provision whatever for training, such as that which the Bill provides. In one area in Scotland there are 53 midwives, only two of whom are trained in the administration of analgesia. They reckon they can train only 15 to 20 midwives a year and if training is not imposed now, the tendency will be to forget about it. New midwives, who applied for certificates since 1948, have to be trained, but how long a time, how many years, will it take for new entrants—for whom there is great competition—to overtake that backlog of untrained midwives so that we have the majority of midwives able to administer analgesia in the way we want?
There are misapprehensions, and today's Debate, I believe, will have done great good in clearing away some of these misapprehensions. One medical officer of health in Scotland believes that regulations still require that either a doctor or a second midwife should be present to administer analgesia. That indicates that the writer of that letter was 710 not even aware of the regulations which are in force at the present time. In the case of another local health authority in Scotland they cannot get transport for which we have tried to provide in the Bill. For two solid years they have had an application for a motorcar for one of their midwives. Is it not a scandal, in a case like this, that we should be exporting cars while vital services—vital both in the technical and real sense of the word—are waiting for a car to transport the midwife about the country?
Gas and air apparatus is very heavy. I will not go into the technicalities. My hon. Friend has spoken on the subject. My hon. Friend has spoken also about trilene. I have seen it and I have tried it. I have tried gas and nitrous oxide and trilene in order to see how they function. There was not an urgent occasion for my needing it. I was not trying to emulate Adam, about whom the hon. Lady the Member for Epping (Mrs. Manning) spoke. I wanted to see if they were fool-proof and I could think of no more suitable patient to try them out on than myself.
This Bill imposes a duty upon the hospitals. Again, the doctor is left in charge. I was delighted to see the hon. Lady on the Front Bench opposite nod assent when it was admitted that the Government accepted in principle what we want to do. The local health authorities are also favourable to the Bill. The Department of Health in Scotland says that it will not accept a scheme under which provision is not made for some form of training in the administration of analgesia and the supply of apparatus. There are only a few black sheep among these local authorities, but a few black sheep can denigrate the whole flock. The Midwives Board are favourable to us; the working party supports us, and today a leader in "The Times" urges the Government to accept this Measure. We have millions of silent advocates. Some have written to us. I will read no letters; we have heard some typical ones already. This Bill is needed, and it will tend to diminish the demand on restricted hospital space. Thousands of women in this country are waiting for today's verdict; it must be favourable. The life ambition of the poet of my 711 country, Robert Burns, was to "wipe away the tear from every eye." I, in my limited and humble way, would strive to follow so noble a purpose.
§ 12.32 p.m.
§ Dr. Haden Guest (Islington, North)
I am glad to have the opportunity of speaking in the Debate and of supporting my hon. Friend—if I may so call him upon this occasion—the Member for Monmouth (Mr. P. Thorneycroft) who moved the Second Reading of this Bill, even though at one point I thought that he got a little too political. I support it because I think that nothing could be of greater benefit in this country than the training of midwives in the giving of analgesia. It is, I think, the most important part of the Bill that all midwives should be trained in the giving of analgesia. The reason why, at the present time, many people in confinements do not get any form of analgesia is because the doctor cannot remain with them the whole time. Sometimes labours are protracted, especially those which are very painful, and it is impossible for the doctor to be present the whole time, whereas it is the duty of the midwife to be present. I imagine from the enthusiasm of the hon. Gentleman who moved this Bill that it is a subject new to him, and, if I may say so, I think that he got it a little out of focus.
A great deal of valuable work is being done to improve the conditions of child- birth by the establishment of the system of pre-natal control and care of women. It has done a great deal to abolish pain during childbirth and to keep women well. I do not propose to go into technical details. The hon. Gentleman who moved the Second Reading of the Bill mentioned the National Birthday Fund. It has been in existence for a considerable time. Shortly after its inception, it did me the honour of asking me to join one of its committees, and I have been associated with its work over a long period. I know what a great and valuable effect that work has had in the country. It has stirred up interest in this matter.
I can assure the hon. Member for Monmouth that he has informed medical opinion behind him; I say "informed" medical opinion because there are certain 712 medical practitioners still existing in this country who think that pain is good for women. Why, I do not quite understand, but they do. I have even found dentists who thought that, too. They are liable nowadays to lose their practices. This propaganda has stimulated the imagination of the people and I am glad that the matter has been brought before the House, and that the hon. Member for Monmouth had the good sense to choose a matter of this importance as the subject of his Bill.
The great value of this Bill is in connection with the training of midwives. Not only will it give the midwives training, but it will raise their status. I believe that the way to get more recruitment of midwives, as of nurses, is to raise their status and to give them a greater degree of responsibility. Nothing could be better for the midwife than real training in the giving of analgesia and enabling her to be trusted to give it under all reasonable conditions. If we can do this now, it is an opportune time, because there has been great progress lately in the treatment of women in childbirth.
There was a report, as recently as 12th February, in the "Lancet," of 5,000 consecutive cases of childbirth without a single death. We are in a position now medically, and especially if we can get midwives better trained, to improve the conditions of maternity beyond anything that even 20 years ago could have been thought possible. I hope that we shall be able to do that. I am rather doubtful myself whether under a Private Member's Bill this duty should be imposed on local health authorities, because it is a very difficult technical business, and local authorities differ very much among themselves. I think that might very well be left out of the Bill, and the Ministry should deal with it themselves. The important point in this Bill—and I trust the Parliamentary Secretary will give us some hope that it is going to be accepted—is the immediate programme for the training of midwives over a four-year period. That is, I think, a very valuable thing indeed.
One hon. Member in the course of the Debate talked about pain at childbirth as being one of the great preventatives of the increase of the population. I do not think that it is. As a matter of fact, Members may have noticed that the 713 birth-rate goes down in all countries as the standard of living goes up. That is a rather interesting and significant fact. Finally, I hope that the Government will be able to give an encouraging answer to the Debate and will, at any rate, be able to set up, at an early date, a plan for the training of midwives over a four-year period, because until the midwives are properly trained, real progress in this field of medicine is not possible.
§ 12.38 p.m.
§ Colonel Stoddart-Scott (Pudsey and Otley)
There are three points which I wish to raise. I do not agree with the hon. Member for North Islington (Dr. Guest), in accusing my hon. Friend the Member for Monmouth (Mr. P. Thorneycroft) of putting over party politics in connection with this Bill. I think that the House will realise that even Conservative women have labour pains. This subject, in my view, is one which we should not try to bring into party politics. It is an interesting fact that in the days when we had imposed upon us doctors' and dentists' bills they were probably the last bills ever to get paid. I think that is a significant fact, in that it indicates that the memory of pain is probably one of the shortest that we have. If people had remembered the aches and pains which they suffered before they called in the doctor or the dentist, and remembered also the relief that they got from the doctor or dentist, they would have paid their bills more quickly.
I believe that if a woman remembered some of the pains she went through when she brought into the world her first child many women would be very much more reluctant to have a second child. I believe, too, that if many of the men folk could see the pain and suffering some women go through in delivering their children they would be much more reluctant to become a father on a second or third occasion. The House should approach this Bill with a realistic attitude and give it a Second Reading, and see that no obstacle whatever is put in its way of its getting on to the Statute Book.
One of the questions which has been discussed is that of expenditure. I do not see why expenditure should be any bar to this Bill getting on to the Statute Book. In the Ministry of Health Supplementary Estimates, which we discussed a 714 few weeks ago, there was an item for £23,000, for which the Minister had asked in his original Estimates last year. That money was to be spent upon refresher courses, but the Minister did not spend it during the year for which he had Parliamentary sanction. That money would be well spent on refresher courses for midwives.
If it comes to a question of expenditure upon apparatus and motorcars for midwives, the local health authority can decide upon the priorities, and, if directed by the Minister of Health, could do so without additional expenditure, simply by putting motorcars and apparatus for midwives first, and giving them a priority. I do not agree either with the hon. Member for North Islington that it would be difficult to make it obligatory on some local authorities to do what this Bill intends that they should do. I do not know whether he means local health authorities or just local authorities.
§ Colonel Stoddart-Scott
But the National Health Service Act makes it obligatory on local health authorities to set up health centres, and there is no reason why a Private Member's Bill should not also make local health authorities train their midwives and provide them with the necessary equipment and transportation for that work.
Finally, I should like to reinforce the remarks of the hon. Lady the Member for Epping (Mrs. Manning) about the Royal Commission on population, whose Report is to be published within the next three months. I am quite convinced that one of the recommendations of the Commission will be that everything possible must be done to remove some of the burdens of childbirth and some of the objections, such as fear of pain, which mothers very often make the reason for limiting the size of their families. I believe the Royal Commission will make many and varied suggestions and recommendations, and by passing this Bill we shall be forestalling some of those recommendations—perhaps the most important of them, which will be put forward to help us to deal with our population problems.
§ 12.45 p.m.
§ Mrs. Ridealgh (Ilford, North)
It gives me great pleasure to be able to support this Bill. One thing that concerns me is the matter mentioned by my hon. Friend the Member for Epping (Mrs. Manning) regarding the apathy shown to the sufferings of women. Last week these benches were nearly full because of the sufferings of animals. Today they are practically empty when the subject concerns the sufferings of women. Members might be taken to task for their feelings in relation to what the human animal suffers in bringing forth its young.
As a mother of two children I have a very vivid recollection of the real pain I suffered. Any mother who has not received any special treatment would say the same. She would remember the pain that she had suffered. I understand it is universally accepted by obstetricians that if a mother has confidence in herself and remembers that this is a normal function she has no pain whatever. If one has confidence in oneself it might help to diminish the pain, but I am not prepared to believe that women have no pain in childbirth. The vast majority of women suffer agonising pain when giving birth to children, and if there is anything we can do to relieve that pain, we should be prepared to do it. It is suggested that it is not pain but contraction, and that it is fear of pain that makes a woman believe that she is in pain. The fear is, indeed, very real, and possibly it does form a vicious circle, whereby this contraction and fear are combined to give the idea that this pain is very real.
Dr. Dick Reid gives all his patients a course of ante-natal training, and I understand that he teaches women what to expect during confinement. He claims that by this ante-natal training, 70 per cent. of his cases are painless. That may or may not be true, but all mothers are not able to get Dr. Reid's special antenatal training and, therefore, we ought to provide wherever possible the necessary drugs, whatever they may be, that will induce analgesia. The Bill does not seek, as the hon. Member for Monmouth (Mr. P. Thorneycroft) said, to impose the type of drug that shall be used. That is very wise, because there is a great deal of research going on in this matter to help women to bear pain. There are various methods of inducing 716 analgesia. The only thing we have to be exceedingly careful about is that no drug shall be used that will interfere with the labour of the mother or with the life of the child. That is extremely important.
There are ways and means, which are now being tested out, whereby a mother is relieved, and I agree with my hon. Friend, the Member for Epping that there has been too much apathy and too great a tendency to consider that this is a normal function. I am quite sure that a mother is not prepared to go through nine months of pregnancy and the confinement and then to lose her baby. That is the last thing she would want to do. She would rather do without relief of pain if that were what it meant. Various methods of relief have been brought forward. The hon. Member for Monmouth mentioned pethedrine, which does by injection relieve pain, but that can only be permitted if the doctor has given his approval, and the midwife who administers it does so, I think, with four doses of pethedrine with four hour intervals between.
The hon. Member also mentioned the Minnitt apparatus, which has been approved by the Midwives' Council, and which administers 55 per cent. air and 45 per cent gas. I understand that it works very well. Pure gas can only be given by a qualified doctor, and, therefore, there has to be this break-up of the air and gas. While the method is safe and effective, it is slow in working. There is this much to be said for it, that it does give confidence to the mother, and that is extremely important; the fact that a mother has confidence diminishes the pain she is suffering. The snag with the Minnitt apparatus is that it is bulky and difficult to carry about. It is not a portable apparatus, which makes it necessary for the midwife to have a car at her disposal. "Trilene" was also mentioned. It also is very effective, but it is in its experimental stages and has not yet been universally used. It is a portable apparatus, but it does not induce analgesia quickly, although it is very efficacious in that it has a very long acting time and will last over the whole of a pain until the next contraction. There is another apparatus which has not been mentioned, and that is the Chasser Moir apparatus. It is a very small apparatus which gives pure 717 gas in limited quantities and is quick acting. It acts within 10 to 15 seconds and lasts for 2½ minutes. It gives a certain amount of gas and then a certain amount of air.
There are various ways by which mothers could be relieved of pain, and I support the demand that these reliefs should be made compulsory. It is true that we can give powers to local authorities to do this and that, but whether the local authorities will act is another matter. I consider, with Members on both sides of the House, that the time has come when we should demand these compulsory provisions in regard to training and apparatus, so that the woman who desires to be relieved of pain shall get that relief.
§ 12.54 p.m.
§ Dr. Stephen Taylor (Barnet)
My hon. Friend the Member for Epping (Mrs. Manning) made a great-hearted plea in support of this Bill, and I found myself in agreement with almost everything she said. She asked why there has been this delay in midwifery in the application of analgesia and anaesthesia; in other words, why is pain relatively neglected by the doctors? The answer is really a technical one. It is simply that any anaesthetic stops muscular contraction. Indeed, one of the major purposes of giving an anaesthetic in a surgical operation, apart from the abolition of pain, is to obtain muscular relaxation, and that has been the chief technical difficulty in finding an anaesthetic or method of analgesia suitable for midwifery purposes. We were then asked about gas and air. The straight answer is that we all want to see it applied in every case, but we must not run away with the idea that this will give anything like complete relief.
The Parliamentary Secretary to the Ministry of Food (Dr. Edith Summer-skill)
It will at least give some relief.
§ Dr. Taylor
I entirely agree. Everyone should have gas and air. But the right hon. Lady speaks as though we have not started—she really does not realise how far our Labour Government have already gone in this matter.
§ Dr. Taylor
Looking at my right hon. Friend, I cannot possibly see how she could be my grandmother.
The hon. Member for Monmouth (Mr. P. Thorneycroft) is a very shrewd politician in this matter. He presented his case very convincingly, and he gave statistics to show how many midwives have been trained, how many remain to be trained and how many mothers are receiving analgesia. What he failed to point out was the situation in 1938. It was not then a question of 10,000 midwives being trained in the use of analgesia but 500. In 1946 the figure was 4,000, and in 1947 it had reached 7,000. If this rate of progress is continued, within four years we shall have trained all the midwives, because there are only 17,000 remaining to be trained.
The hon. Member failed to point out that for 20 long years Conservative Governments did very little about this problem. He failed to point out that the progress in training has taken place only since my right hon. Friend started operations in the Ministry of Health and put pressure on the local authorities, the result being that 3,000 extra midwives have been trained every year. We ought to be proud of this, and some of my hon. Friends ought to have thought a bit more about it before supporting this Bill, because the fact remains that in four years, all midwives will have been trained without it.
§ Dr. Taylor
The Bill is absolutely unnecessary in that respect, unless, of course, we get a Conservative Government, which I hope to goodness we shall not. In that event we might need it. The hon. Member for Monmouth also failed to tell us that instead of 43,000 mothers receiving analgesia little more than 1,000 mothers received it in 1938. That is the rate of progress we have made. We have not got the latest figures, which perhaps the Parliamentary Secretary will be able to give us when he replies. The rate of progress has been 27,000 mothers for 1946–47, and 43,000 mothers for 1947–48. It will be seen that in one year we doubled the number of mothers receiving analgesia, and I hope that the latest figures will show that we have again doubled it.
§ Mrs. Manning
My hon. Friend is giving us the overall figures, but can he tell us how much of this represents improvements in areas where the local authorities are good authorities and do not need to be put under an obligation, as against poorer local authorities under permissive legislation?
§ Dr. Taylor
That is the point to which I was coming. My hon. Friend speaks of permissive legislation. She has not studied the National Health Service Act, because under that Act all major local authorities have to submit their midwifery plans to the Ministry of Health which have to include analgesia schemes, and if the Ministry do not approve of the plans they can send them back to the local authorities to be remodelled. In other words, the Ministry have full compulsory powers to apply analgesia since the passing of that Act. What more does my hon. Friend want except to give pleasure to the hon. Member for Monmouth.
I want to say a word or two about the technical problems, which are very great indeed and must be faced. The hon. Member for Monmouth spoke of the extreme pain inflicted in stitching-up after delivery. I entirely agree with him. It is an absolute disgrace that this still continues, but it will not be removed by the application of analgesia. Stitching-up after delivery requires full anaesthesia. The gas-air apparatus does not give adequate anaesthesia for stitching-up and we must hasten the provision of proper anaesthetic apparatus, which, of course, must be maintained in good condition, as must be every piece of analgesic apparatus. We must make available proper anaesthetic apparatus and anaesthetists for the administration of anesthetics after delivery for stitching-up. It is a disgrace that some doctors still use the barbarous practice of not giving an anaesthetic for stitching-up afterwards. The sooner it is ended the better. It will not be ended, however, by the Bill.
Now, about the actual gas-air machine. Hon. Members must realise the unfortunate limitations of the machine because it cannot get a very high concentration of gas. In order to get a high concentration of gas it is necessary to have oxygen as well. It is only with a gas-oxygen anaesthesia that really good relief is obtained. My right hon. Friend the 720 Parliamentary Secretary to the Ministry of Food made a reference to a grandmother and the sucking of eggs. But she will agree, I am sure, with the figures given by the Medical Women's Federation in their recent inquiry into the value of different forms of anaesthesia and analgesia in midwifery—a very good report, if I may say so, and one on which I should rely very much indeed, because the women were skilled medical observers who had themselves had one or more babies. It did not, however, cover a typical cross-section of the population, because the average medical mother is a little older than the average mother because of the time she has spent in her medical training. Ninety-six of these mothers had had gas and air. Of those, 33 were completely satisfied with it, 40 found it helpful and 23—a quarter of them—said it was useless. We must face the fact that although we want to make this apparatus available for everyone, there will always be a certain proportion of mothers who will not get relief from it.
§ Dr. Summerskill
I do not think the figures which the hon. Gentleman has given are quite fair. Already there is evidence that apparatus in hospitals and elsewhere is not always carefully looked after. It is absolutely essential that if an analgesic or anaesthetic is to be efficient the apparatus must be looked after properly. I think it would be wrong, therefore, to quote the figure of 23 as being absolutely valid.
§ Dr. Taylor
I am afraid that I must dissent from the view of my right hon. Friend, for a very simple reason. The report on maternity in Great Britain—again, a very good report—to which the hon. Member for Monmouth referred, by the Royal College of Obstetricians and Gynaecologists and the Population Investigation Committee, covered some 15,000 women chosen from the general population, all of whom had had their babies between 3rd and 10th March, 1946, which was the week chosen for the study. These women had much greater satisfaction from the gas-air apparatus than had the medical women of whom I have spoken. They were a general sample of the population, with the general run of the apparatus in use. My suspicion is that medical women would be a little "choosey" about the places where they had their babies. They 721 would certainly be the very first to complain if the apparatus was out of order, and would be likely to get better treatment in this respect than the average population.
I want to compare gas-air with gas and oxygen. Gas and oxygen were given to 56 of the women. Thirty-one were completely satisfied, 18 found it helpful and seven useless. My plea, therefore, is for a realisation that gas and air is not the perfect analgesic, but that gas and oxygen is a little better—as, indeed, anyone would expect it to be. I should think that every anaesthetist would admit it to be so, for very obvious reasons, one of these being that the higher concentration of gas thus gets rid of more pain.
There is one further complication about gas-air apparatus. Anybody who has used it will know that it calls for co-operation of a very simple kind on the part of the woman. She has to press the button on the face-piece; that lets the gas into her lungs. She has to time her action a little carefully, so that the blast of gas and the loss of consciousness coincide with the labour pains. That is a little difficult, particularly for the simpler women. It is because of this slight difficulty, and because of what has already been mentioned—the unfortunate habit of gas cylinders to run out from time to time—that we must not expect too much of gas-air. Anybody who has given any large number of anaesthetics knows how this emptying of cylinders can complicate matters. These things are very heavy to carry about; one gets stuck at most difficult moments in midwifery without a spare cylinder, perhaps somewhere out in the country; the pressure gauges on these cylinders are by no means perfect. For these reasons I beg the House not to expect too much of the gas-air analgesia apparatus. Everybody wants to see the fullest possible analgesia for every woman in childbirth, but this is not the perfect machine. We have not yet got the perfect machine for the midwife. We must press forward and get it, but, pending the perfect machine, we want every woman to have this other machine. They can, however, obtain its use under the National Health Service Act without this additional Bill.
The hon. Member for Monmouth asked a rhetorical question: What should be the greatest priority in the midwifery ser- 722 vice? His reply was, the relief of pain. But that is the second priority. The first priority is the safety of the mother and child. I suggest that he should have looked at a report issued yesterday on neo-natal mortality and morbidity, published by the Ministry of Health, written by a joint committee of the Royal College of Obstetricians and Gynaecologists and the British Pediatric Association. If he had read that, he would have found that some 15,000 babies' lives are still being lost because of technical inefficiency in obstetrics. If he wanted to select a particular part of the Health Service in order to introduce legislation to put pressure upon local authorities, he might very well have selected the provision of specialist care for every mother in childbirth. That would have been just as reasonable, and, in my opinion, more important; but either of these jobs can be done, and all the evidence is that they are being done, under existing legislation; that they will be done under the National Health Service better than has ever been done before; and that they will be done and finished within the four years which the hon. Member sets as his target.
One other criticism of the Bill is that it places upon the Central Midwives Board certain statutory obligations which should be—and, indeed, already are—placed upon the Minister of Health. That Board, which cannot be criticised in this House, would be made by the Bill an instrument of legislation with regard to local authorities. Many hon. Members will know that there is no proper channel for criticism of the General Nursing Council, and this applies also to the Central Midwives Board.
§ Dr. Summerskill
My hon. Friend has referred to the report, published yesterday, on neo-natal mortality. I think he has forgotten one important statement in that report: that many of the poor, exhausted mothers who lost their babies in the first month would have benefited if they had had analgesia.
§ Dr. Taylor
Oh, yes, my right hon. Friend is absolutely correct, but no one is opposing analgesia, an analgesia for every mother. We are merely saying that we are getting on faster than ever before under any previous Government. If we continue the present rate we shall 723 have done it inside the four years in which the hon. Member for Monmouth wants it done, and therefore this Bill is completely unnecessary.
§ 1.10 p.m.
§ Mrs. Nichol (Bradford, North)
I should like to add my congratulations to the hon. Member for Monmouth (Mr. P. Thorneycroft) on introducing this Bill. If he did it with a little heat on occasion, I think that is forgivable and, anyway, I would not give a rusty pin for anyone trying to do something good, who if he fears he may be thwarted, does not show a little heat. I am pleased that the hon. Member moved the Second Reading in the way he did.
I welcome this Bill, in spite of the speech of the hon. Member for Barnet (Dr. Taylor). I speak feelingly as one of the millions of mothers who produced a child without any anaesthetic at all and even had stitching up afterwards without any anaesthetic. I remember only too well, when people were standing around me and urging me to let nature have its way, that I was calling down a thousand curses on their heads, wishing that they could do something to give me a little help. In those days there was only chloroform, which would have to be administered by a qualified doctor, as it would now, but now there are other forms of analgesia which have been discussed in this Debate. It is completely unthinkable that there should be the slightest chance of any woman in this country not having the opportunity of getting this form of relief if it is humanly possible.
I might have been deterred from entering the Debate, having been reminded by my hon. Friend the Member for Barnet of the progress this Government have made and of the powers they possess were it not for the fact that my right hon. Friend the Parliamentary Secretary to the Ministry of Food so obviously disagrees with some of his points and feels extremely strongly about the matter. I would back my right hon. Friend every time. Not only is she a fine administrator, but she is a doctor of very wide obstetrical, as well as general medical experience, and she is a mother. It is obvious that my right hon. Friend has very great interest in the passage of 724 this Bill and, with her experience and her great loyalty to this Government, she would not be so keen if there was already enough provision, as my hon. Friend the Member for Barnet has suggested. To my mind the great point about the Bill is that it will place compulsory powers on local authorities. We all know that permissive legislation is an absolute godsend and refuge to weak authorities. We have seen it over and over again, as my hon. Friend the Member for Epping (Mrs. Manning) mentioned, in the matter of education. Where it is possible to drive a horse and cart through an Act of Parliament, that will be done by weak authorities. If the Bill is unnecessary as my hon. Friend the Member for Barnet indicates, one would think that only a little sweet reasonableness is needed on the part of the Government in order to get these extra powers for which the hon. Member for Monmouth is asking. Surely, there need not be all this fuss and bother if we are so near achieving what the hon. Member for Monmouth wants.
As a lay person, naturally, I am not going into the detailed questions of which are the best methods. As a lay person and a mother who feels very keenly that women are suffering the tortures of the damned every day, every hour—while this Debate has been going on hundreds of mothers have been going down to the very depths of pain and misery producing new life—I am only concerned that we should get quickly some method which is safe, practical, useful and beneficial. If the Minnitt system is out of date, heavy and difficult to transport, let inventors bring out something else. They would do it if it were something to do with the atom bomb. Scientists have been working overtime on all sorts of methods for fresh destruction of life, yet we have to lag behind and excuses are made when it is a question of less pain in producing life.
I had the honour to serve on the committee of the hospital which was mentioned by the hon. Member for Monmouth and I am glad that tribute has been paid to the Wellhouse Hospital at Barnet. I was a member of the committee for many years and we were tremendously excited when the Minnitt apparatus was introduced at that hospital. In spite of its drawbacks and the occasions when it 725 failed to give relief, it was greatly appreciated by scores of women who passed through the hospital as maternity patients. If fresh apparatus is needed, let us get on with it.
Every hon. Member is a practised speaker and we have all sat at political meetings and heard our favourite points go one by one. That also applies to speaking in this House. During the Debate, which has lasted for two hours, most of the points emphasising the need for this Bill have been made. My hon. Friend the Member for North Islington (Dr. Guest) thinks that the memory of pain in childbirth is no deterrent to increased families, but I would tell him that that is very contrary to the experience of most of us. We know that some women have very big families, but enough is not generally known about scientific birth control in order to allow those who wish to do so, to regulate and space their families. Husbands also feel very keenly about this matter of analgesia and I know that many fathers have their hard times when their wives have babies. They, too, have difficult "confinements." They feel it very keenly and are just as keen on this Bill as are the women in this country. My hon. Friend is wrong if he does not think it acts as a deterrent.
I did not say it was not a deterrent. I said it was not the chief deterrent. I have been frequently assured by a woman after her confinement that she will never have another baby; then she has had five or six.
§ Mrs. Nichol
I shall not comment on that. Perhaps it has not always been from free choice. There is one thing an older woman never does to a younger woman who is about to have a baby. She never takes her into a corner and tells her what a ghastly time she will have. The tendency is to say, "It is all right, it will be lovely when it is all over and you have a lovely little baby," but we think at the time "I hope she has a doctor who has the sense to give her some relief." As a mother who has produced a child the hard way, I am glad to give my support to the Bill.
I am glad that my hon. Friend the Member for Barnet emphasised the amount of good work which this Govern- 726 ment have done. I, too, am sensible of what they have done, and at dozens and scores of public meetings I have made use of the fact that we have made such progress and stressed that it was done under very difficult conditions. When the war ended there was no surplus of good things in this country except the good will and loyalty and the will of our people to win through to economic recovery. Nothing else was left. We have made this progress, and it is startling progress, in the teeth of enormous difficulties, but for goodness' sake do not let us stand in the way of giving, by means of this Bill, that extra push which will make it impossible for bad authorities to shelter behind legislation where it is weak enough to allow them to do so.
§ 1.21 p.m.
§ Dr. Segal (Preston)
I could not find myself in more complete and utter disagreement than I am with some of the points which were raised by my hon. Friend the Member for Barnet (Dr. Taylor). When he spoke of the fact that any anaesthetic retards muscular contraction one is bound to agree with him up to a point. I have to remind him, however, that this Bill deals not with the use of anaesthetics in childbirth but analgesics. It has yet to be proved that analgesics, if properly administered, have the slightest effect of retarding the power of muscular contraction. I, too, wish to leave politics entirely outside the consideration of this issue. My hon. Friend, however, went on to say that this Bill was unnecessary because the powers for which it asks already exist under the National Health Service. I would remind him that what we want to emphasise is not that these powers exist, but that a clear categorical directive should be to every local authority in the country that it must be regarded as their bounden duty under the National Health Service Act to administer analgesics whenever they are required.
My hon. Friend gave us figures from a very authoritative report of the Medical Women's Federation. But he omitted to mention certain other figures in that report. I would here make the proviso that we should realise there is a limit to the extent to which the actual degree of pain endured by any patient can be translated into figures. There is a vast mass of pain which can- 727 not be fully registered in terms of statistics. Having made that proviso, I should like to refer to certain figures which are in this report, and which for some reason or other my hon. Friend omitted to mention. I feel very strongly that this Bill is urgently needed today. I feel that it will make a definite contribution towards encouraging large families in thousands of homes in the country.
The proof of this is given in some of the figures contained in this report of the Medical Women's Federation. Table 2 shows that 196 women were asked:After your first confinement did you dread a second?The replies showed that in no fewer than 14 per cent. of normal confinements of qualified women doctors and 25 per cent. of abnormal confinements was a second confinement actually dreaded. It must be remembered that this is in what the leading article of the "British Medical Journal" describes as "a privileged section of the community" in that the standard of obstetrical care which they receive is much higher than that available to the ordinary expectant mother. Yet in no fewer than 14 per cent. of normal births and 25 per cent. in the case of abnormal births among qualified women doctors a second confinement was dreaded.
§ Dr. Taylor
My hon. Friend asked me why I had not quoted those figures. I did not do so because they have no relevance. Every one is agreed about the desirability of analgesia in childbirth.
§ Dr. Segal
My hon. Friend says that these figures have no relevance. My view is that they point to the desperate necessity of having this Bill passed into law for the benefit of the vast majority of our expectant mothers who have not the access to skilled medical help which the wives of doctors or married women doctors have at their disposal.
Another striking figure was contained in this report. These women were asked how many of them actually thought that administration of an analgesic was necessary in the confinement. The figures here are even more significant. No less than 92 per cent. thought that analgesia was necessary in their confinement. Only 4 per cent. said categorically that they thought that it was unnecessary. Having 728 read out those figures I turn to a further set of figures quoted in the "British Medical Journal" of the same issue, wherein it is stated that in the Metropolitan Boroughs only 5 per cent. of mothers confined at home, and 48 per cent. of those confined in hospital, were given relief. Let us think of the degree of dread which must encompass the minds of the 95 per cent. of mothers confined in their own homes.
A great deal has been said this afternoon about the difficulties of the Minnitt apparatus and the difficulties of its portability. Whereas it may be available in hospital it is certainly difficult to make it available in the majority of homes. Parenthetically, I should like to say that the granting of a motorcar to every midwife in the country should not be required by reason of the need to transport the Minnitt apparatus to the home of the mother who is undergoing confinement, but should be granted as of right to every midwife in the country regardless of this issue of analgesia in childbirth.
Another set of figures in the same report is also significant. Not only did 92 per cent. think that analgesia was necessary, but 25 per cent. actually stated that they wanted more analgesia than they actually received. This same report goes on to ask that the reasons for this should be sought:Are obstetricians disinterested in obstetric analgesia? Could more effective drugs have been given? Did the mothers react abnormally?These are highly technical questions which should be left to the medical profession to decide for itself. But when the report proceeds to ask whether obstetricians—that is, the specialist in the carrying out of confinements—are disinterested in obstetric analgesia, surely we can ask ourselves to what extent the ordinary general practitioner, so harassed with a heavy round of other patients to visit may be found to be—whatever the reasons—disinterested in administering analgesia in an obstetric case? He knows, and it is no fault of his, that the more analgesia he administers the longer the confinement may possibly take. With a number of other cases to attend, perhaps even more urgent than that of a woman in childbirth, he knows that he cannot give the necessary time and care to her case which he would like to give.
729 The corollary is equally true. When a doctor in attendance on a case finds that he is not pressed for time, and that he can concentrate entirely on the one case in hand, there is nothing that can equal the satisfaction the doctor receives, that deep inner self-satisfaction, that feeling that he has delivered a woman of a baby with as near a complete absence of pain as possible. There is a very real satisfaction in the happiness which he sees in the mother, even the degree of the absence of trauma in the child through the mother having had a normal steady confinement, which has not had to be interrupted because of the doctor being hard pressed. I have found in my own experience that it is one of the deepest and most profound types of satisfaction that a doctor can ever derive from his own medical practice. I only wish that doctors in our country today were sufficiently numerous and sufficiently unduly pressed for time so that they could devote to every confinement which they attend that degree of care and patience necessary both in the interests of the mother and the child.
If very often the doctor finds problems in the administration of an analgesic, to what extent would the midwives find it difficult? They are sometimes left in remote districts with the sole responsibility for the confinement on their hands. Every doctor realises what an enormous amount of research work still has to be done on this subject. But that is no excuse for administering at least some form of analgesia under proper safeguards, however imperfect that it may be, so that the mother should know in advance that she can be absolutely assured of some form of relief, even if it is nothing more than providing her with a free supply of chloroform capsules which she can crush in the folds of a handkerchief and inhale from time to time when she feels a severe pain coming on. It may well be a far from perfect form of analgesia, but it is a tremendous source of psyohological comfort and relief to the patient to know that she has within her grasp means of relieving at least the greatest severity of the pain which she is undergoing.
We reached the stage many years ago when doctors were entitled to a free supply of ampoules of N.A.B. for the treatment of syphilis. Surely now doctors and midwives all over the country 730 should feel that they may have available an unlimited supply of these chloroform capsules or some other simple, self-administered analgesic to be used with a degree of discretion and restraint, and that the patient herself should know that there is some form of relief. Every midwife in the country should be able, long before the confinement, to assure the expectant mother that there will be some form of analgesia made available at the time of confinement.
There are a great many other points upon which one would like to dwell, but these few points alone may serve to show how deeply many doctors feel about the issues dealt with by this Bill. To my mind there is no excuse whatever for the Government not giving their fullest support to the Bill, and seeing to it that it will become in the very near future a directive to every single local authority and every midwife in the country. I believe that if we could remove the dread of the mother in childbirth we should go a long way to promoting the happiness and welfare of both mothers and children in tens of thousands of homes all over the country.
§ 1.33 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Blenkinsop)
We may congratulate ourselves this morning that we have been discussing a matter which is, I am sure the concern of the whole country. In this discussion which we may regard as useful, valuable and helpful, our only concern is to see that the greatest possible provision can be made on the lines that have been reviewed for the relief of pain in childbirth. The only difficulty that may arise is regarding the technical point as to whether or not this Bill is the way in which that can be done.
I would urge that upon all hon. Members, because as is perfectly evident, this is a matter that transcends any party view. Feelings have been expressed very strongly, and rightly so, in all parts of the House. The desire is for a much wider provision than is available at the present time. I feel that most of the discussion today has been on the subject of the actual desire for a wider provision, and why that wider provision is needed, and not so much on the subject of whether this is exactly the instrument one would use to obtain that wider provision. 731 I believe, particularly through the operation of the National Health Service, that in this country we are making rapid and most encouraging progress in dealing with this matter, and that it is through the greater use of this machine which we have at the present time that we shall find the solution to the problems that hon. Members on all sides of the House have raised in so feeling a manner this morning.
We are therefore not divided at all in our desire for the objects of this Bill. I am sure that no one has really suggested that there is any desire on the part of the Ministry to check in any way the development of this work. I think that the hon. Member for Monmouth (Mr. P. Thorneycroft) would agree that the Ministry have been trying, particularly during the last 12 months, to ensure a wider use of analgesics and that wider provision which every one desires. Just before the National Health Service came into operation my right hon. Friend made it clear to every local health authority that, in dealing with proposals which they were submitting to the Ministry under the scheme which was to come into operation for their midwifery services, they must ensure that all domiciliary midwives should be trained as rapidly as possible; that the apparatus should be fully available and that proper facilities for transport also should be made available.
This is something on which there is no sort of division of opinion. The fact that hon. Members on all sides of the House have quoted cases of authorities where the provision is not what we all wish those local authorities to have is surely merely a sign that in the short period in which this Health Service has been in operation we have not yet done what we are convinced can and must be done within a short period of time ahead. I wish to say something about what has been done during these last two years. I do not think that on this subject it is of any great value to quote figures, even as recent as 1946, because fortunately the main development and the main drive has come since that date. Obviously this is a need which many of us feel should have been met long ago but that does not relieve us from our responsibility for seeing that now we must do everything we can. We should 732 have in mind however what is in fact being done.
With regard to training, my right hon. Friend agrees that the first issue is to secure the full and adequate training of those who are to do this work. With that in mind I can say that there are now 230 training institutions—
§ Colonel Hutchison
May I interrupt to ask whether the figures which the Parliamentary Secretary is about to quote include Scotland, or are they just for England?
§ Mr. Blenkinsop
I shall make specific reference to Scotland in a moment.
There are district schemes in some 49 counties and county boroughs. As from 1st January; 1948, all new midwifery pupils are being trained. Some of the figures are rather startling. I shall not mention those that have already been quoted. It is true that in 1938 out of a total of approximately 16,000 midwives only about 500 were trained in analgesia. The hon. Member for Monmouth mentioned roughly 10,000 as being the number of those who have been trained today. He mentioned a total number of practising midwives of 17,000. I am not sure whether that is accurate. I agree that the figures are rather difficult to arrive at. The figure I have for 1947 was 13,000, and I should rather question whether the total number of practising midwives was as high as 17,000 today. In fact, I think that it is lower than that. We all know that there are very many who have qualified as midwives who do not practise.
Some recent figures have become available for the last year and I quote those of the big cities of Birmingham, Bristol, Leeds, Leicester, Liverpool, Manchester and Sunderland. In these large cities over the period from July to December of last year, which is the period from the introduction and operation of the National Health Service scheme, some 4,230 cases had analgesia administered under the domiciliary service as against only 4,000 in those cities during the whole of 1947. That shows the extent of the development in that year. In London at the end of 1946 there were only 50 out of the 148 council's midwives who were trained and qualified. By the end of last year, 148 out of 155 were trained and qualified. 733 Similarly, in London in 1946 the administration of analgesia in the domiciliary service was used in only three per cent. of the cases. From July to December of last year the figure had risen to an average of 44 per cent. In December of last year alone it had risen to 60 per cent.
I know that it can be said that that percentage is still too low and that there is still more to be done. It can be said that this is a figure for a particularly progressive, vigorous and keen authority. I understand that is the point that hon. Members have been making. We all wish to ensure that other authorities are raised to the level of such an authority as London which is obviously tackling the problem in a vigorous and effective way. We must set ourselves to solve the practical problems which are holding up development in all these cases. I hope that we shall have the co-peration of every one in the House, because this is in no way political or, I should have thought, argumentative.
We wish to ensure above all that the transport problem is dealt with effectively, because in local authority areas that causes the greatest difficulty. The present analgesics apparatus—and I stress the word "present"— is undoubtedly very heavy and cumbersome. Transport is required for it to be utilised in the domiciliary service. That can be done by the provision of local authority transport. It is now the responsibility of the local authority under the Health Service scheme to provide ambulances and other services. It has been specifically pressed upon local authorities that they must regard the provision of transport for midwives for this purpose as being of the utmost priority and urgency.
Because we regard the matter in that light we have been making special arrangements with the motorcar manufacturers to ensure high priority for midwives. I entirely agree with hon. Members who say that this is not purely a question concerning midwives who administer analgesia. It is true that transport is essentially and urgently needed for all midwives particularly in rural areas. I assure hon. Members that we are taking the effective practical measures to ensure that motorcars get to the midwives. It is that sort of practical issue with which I am sure that we are all concerned in this House today.
§ Mrs. Nichol
When the hon. Gentleman speaks of giving the "utmost priority," would he admit that that is weaker than making it compulsory. The words "utmost priority" surely are not as strong as the word "compulsory."
§ Mr. Blenkinsop
These considerations are always comparative. There must be escape clauses. One does not provide motor cars automatically by order, unfortunately, or we would have lots of things in this country which we would all like just because we had ordered them to be here. The provision of motor cars is a practical issue. We must ensure that they are provided. This is essentially a matter of administration and of the sort of arrangement which we have made with the motor car manufacturers themselves to ensure that midwives are treated as doctors are treated. Therefore, we cannot take this problem purely in isolation. We must give consideration to other priorities which are also vital.
§ Colonel Hutchison
Does the hon. Gentleman realise that doctors have first priority just now, that midwives have second and veterinary surgeons third?
§ Mr. Blenkinsop
I do not know whether the hon. and gallant Gentleman is suggesting that we should take the doctors off the first priority list. I am willing to consider that if he is proposing it. I am merely trying to explain the fact that we are anxious to secure the practical ends which I am sure every hon. Member is anxious to secure, but we do not believe that this Bill, with the objects of which we fully agree, is in administrative practice a Measure that can bring us a single extra motor car or relief for one single extra patient.
On the question of the training of midwives, the hon. Member for Monmouth said that he has provided what he himself regards as too wide an escape clause. The hon. Gentleman says that he has provided the Minister with the opportunity of extending the period of time within which training can be accomplished, and he mentioned the fact that he had particularly in mind the difficulties in Scotland. He has not, however, given the Minister that opportunity direct; he is giving the Minister the opportunity on the application of the midwives' board, which is rather a different matter.
735 In any case, I think it is only right that we should see whether, in this respect, if we are giving in the escape clauses an opportunity of escape from the four-year time limit, we can, as appears reasonably clear from the continued development of our own vigorous drive on this issue, secure exactly the same ends as those sought by this Bill. If this is so, I frankly cannot see the value of this Bill at all. I feel that this Bill is superfluous in that sense.
Hon. Members have mentioned the fact that we are taking out one particular, though vitally important, element of our National Health Service, and making it a specific duty to take that particular element of the Service out of the consideration of the rest of the Service. On principle, I do not think this is a good way in which to develop the Service as a whole. I do not think anyone will object when I say that we are concerned with the development of the Health Service as a whole.
§ Sir Patrick Hannon (Birmingham, Moseley)
Is it not a fundamental fact that one aspect of our National Health Service is that the safety of childbirth should be a first consideration in regard to the preparation of the future of the child?
§ Mr. Blenkinsop
Yes, indeed, safety of childbirth, but, if I were to quibble, I would say that actual safety in childbirth is not really the issue of this Bill. I do not want to argue that detailed point. I suggest to hon. Members that, if we isolate particular portions of our National Health Service provisions, in providing special statutory provisions for this or for some other separate element, conception of a National Health Service as a whole, covering the whole of our health requirements, is likely to be wrecked, and that we should be in danger of breaking it down when we want to ensure its success over the whole wide field. I do not believe that this is the way to ensure the very best possible service in this direction, or, indeed, for any other provision within the Health Service.
I want to secure the co-operation of hon. Members in the House and outside in the country in seeing that those local authorities which are now backward in the provision of these facilities are 736 forced to make the provisions which they ought to be making. All the evidence that I have, even in the case of local authorities against whom objection has been taken that they are backward in their duties, goes to show quite clearly that, during the operation of the National Health Service in the last year, with all the new responsibilities and the new drive which the Ministry has put into it, enormous progress has been made.
§ Mr. Blenkinsop
My right hon. Friend has issued very clear directives to local authorities about the preparation of their schemes, and, when the schemes have been submitted, the Minister has again carefully analysed them to ensure that this provision is made.
Therefore, I cannot see how it can be suggested that the provisions of this Bill can in any way give us an additional service to that which has already been provided or is being provided. I am fully conscious of the need for this service, and we are fully conscious of the fact that, in many areas, there is nothing like the provision there ought to be. For that very reason, we welcome this discussion, because we feel it will give us added strength in our endeavours to ensure the highest possible service throughout the country. I do not see why, after some nine months of the operation of the National Health Service, with the new powers which it provides, and almost before there has been any opportunity of seeing some of the first results of our campaign, it is really necessary to bring in this special, and to my mind superfluous, Bill.
I promised that I would say something about the position in Scotland, because that is different, as in fact the hon. Member recognised. It is true that the training of midwives in Scotland did not commence until 1946, and that means that there is much more leeway to be made up in Scotland than elsewhere. In spite of that, very good progress has been made. It is very difficult to get the detailed figures of total numbers in Scotland, but the latest figures which I have suggest that approximately half of the practising midwive3 in Scotland have 737 now been trained. Again, nothing more can be done by the passage of this Bill, because, at best, it only ensures the opportunity of lengthening the period of training if it is required.
I hope hon. Members will treat this matter on the serious and sincere basis of trying to secure the very best service that can be made available in the country, and I believe that, if we can have co-operation of hon. Members on this issue, we can ensure the provision of everything they desire in this Bill. They are not concerned with duties merely for the sake of duties, or with penalties merely for the sake of penalties, but because they believe that the Bill will help to secure the easing of pain in childbirth. I honour their view in that regard, but I believe that, if we give full support to the endeavours of the Ministry and the local authorities in pressing forward the measures we are already taking, which are clearly bringing the type of response we want, we shall secure the full aims of this Measure, without having to impose new duties on the local authorities and new penalties on the hospitals.
§ 1.59 p.m.
§ Lady Tweedsmuir (Aberdeen, South)
On behalf of those, both in this House and outside in the country, who support this Bill, I should like to say that I am shocked and very astonished to know that the Government have not seen fit to allow it a Second Reading.
§ Mr. Blenkinsop
I hope I have not said anything to suggest that we are not allowing complete freedom in regard to the Second Reading of this Measure. This is merely a matter of administration, and we do not think that this Bill takes us any further.
§ Lady Tweedsmuir
Perhaps that is almost worse. To allow the Second Reading of this Bill, in the tone suggested by the Parliamentary Secretary, implying that the Bill will be killed in Committee, is merely giving hope to the people in the country that we shall finally receive this Measure, whereas I gather from the Parliamentary Secretary's reply that the Government do not think that this is a suitable Measure to go upon the Statute Book. Presumably, they will discover some technical defects during the Committee stage, and the Bill will be quietly and effectively killed upstairs, without 738 anyone knowing anything about it. The Parliamentary Secretary said that the Bill was superfluous, and that is the Government's view. In my opinion, the reply which the hon. Gentleman has made to the arguments put forward was quite superfluous. This Debate has not ranged only upon the emotional side in regard to the necessity of providing adequate means of analgesia in childbirth. In my submission, it has been a very practical Debate, and hon. Members have stuck very much to the point. This Bill has been modified and a great deal of consultation has gone on with the various bodies concerned in order to make it, from a technical point of view, a Measure which would be acceptable to the Government at this time.
The Parliamentary Secretary gave as his main objection that we were trying to take one particular aspect of the National Health Act out of its context and were seeking to treat it separately. We have done that deliberately because all social reform in our long history has been most effective where public opinion has concentrated on one particular aspect and has pushed the Government of the day to get on with it.
§ Lady Tweedsmuir
I feel that that is the crux upon which the whole of this Debate depends. We have brought forward this Bill because we do not feel that adequate powers do, in fact, exist. In the National Health Act, there are already permissive Sections. What we are seeking to do is to make those permissive Sections a question of obligation on local authorities and all concerned with the care of women in childbirth.
The Parliamentary Secretary and others have laid particular stress on a certain circular which was issued to all local authorities asking them to draw up an adequate scheme for the supervision of midwifery services in their areas. I have a copy of that circular—No. 118/47, 10th July, 1947.. I will read a section of it because I think it substantiates my argument that, in fact, there are permissive Sections in the Act, but no obligatory powers. The Minister says that he is "confident" that all local authorities will make special efforts to provide ade- 739 quate training for midwives. He then says that "he understands" that the requisite apparatus is now readily obtainable and that if, "as he trusts," the authorities have now been able to provide midwives, etc., etc. It has been shown over and over again, as the hon. Lady the Member for Epping (Mrs. Manning) said in regard to the Education Acts, that where there are permissive Sections the matter can well be left in abeyance for a time.
§ Lady Tweedsmuir
It is no good being sympathetic towards the Sections; we have to get down to the practical difficulties, and see how we can solve them.
§ Mr. Blenkinsop
The practical issue which we want to get down to is the actual provision, and I am suggesting that the experience of the Health Service is securing the actual practical provision.
§ Lady Tweedsmuir
The figures which the Parliamentary Secretary gave us were very encouraging regarding the training of midwives, but I submit that their training is not sufficient. What we want to do, as has been said over and over again, is to make the various apparatus available. There are three things which we consider ought to be obligatory upon those who are responsible for the care of mothers in childbirth—first, to ensure efficient apparatus; secondly, to ensure the maintenance of that apparatus, and, thirdly, to provide adequate transport for that apparatus, and, I may say, for the midwives also. We have seen that, even now, there are some local authorities who have made a success of what they undertook in this respect.
With regard to transport, the Parliamentary Secretary said that it was difficult to get cars at this time owing to priorities, and so forth, but I would remind him of the case of Newport where, at the present time, the authorities not only do not allow cars or car allowances to midwives, but have certainly not ordered any cars either. Reference has also been made to the varying degrees in which local authorities have varied, in their success, from 13 per cent. in Monmouth to 57 per cent. in West Sussex.
§ Lady Tweedsmuir
That is certainly encouraging, but not nearly enough. We appreciate, of course, the difficulties that confront local authorities over the question of training midwives, because there is an acute shortage of them. It is for that reason that my hon. Friend the Member for Monmouth explained, when he opened the Debate, why we had allowed certain escape Clauses. The Parliamentary Secretary criticised those Clauses, but we are perfectly willing to meet him on the Committee stage on any small point like that. What we want is to have the main purpose of this Bill carried out, which is to make it a statutory obligation on local authorities to provide the necessary transport and apparatus.
Regarding the shortage of midwives, the Working Party's report on midwives has been quoted from various parts of the House. Some of the most interesting parts of that report deal with the reasons for dissatisfaction among midwives, which is responsible for such a very large wastage among them. The two particular points which I wish to mention, and which are applicable in this Bill today are these. First of all, midwives feel that they are unable to do full justice to their jobs or their patients unless they are able to administer analgesia and have it available. In that connection, I would like to read to the House a resolution passed at the annual meeting of representatives from 160 branches of the Royal College of Midwives held in May, 1948. It said:That pupil midwives should be given adequate instruction in the use during labour of seditive drugs and other forms of analgesia. Midwives trained in the use of such drugs and other forms of analgesia which may be used by midwives should be required to use them by their employing authority and the necessary drugs and apparatus should be provided.We do not go quite so far as that.
§ Mr. Blenkinsop
That resolution was passed in May, 1948, and on 1st January the provision had already been made that all pupil midwives should be so instructed. Therefore, as far as that part of the resolution was concerned, it was already out of date.
§ Lady Tweedsmuir
The end of the resolution says, as I read out:Midwives should be required to use analgesia by their employing authority, and the necessary drugs and apparatus should be provided.Furthermore, they go on to say, in connection with the training of midwives, that where the older midwives have not yet received training in analgesia, they should in fact receive that training free.
When we came to the question of transport, which is the second and perhaps almost the greatest cause of dissatisfaction among midwives, the Parliamentary Secretary seemed to think that he would easily be able to persuade local authorities to provide adequate means of transport. I should like to read to him a portion of the Working Party's report which was, after all, only published in 1949, regarding the question transport. It says:We arc left in no doubt that in this matter many local authorities and some District Nursing Associations have failed badly in their duty, both to their employees and to the patients for whom they are providing a service.It is because we feel the provisions of analgesia in childbirth is a matter of urgency that we are trying to bring it forward in the terms of what we think is a very reasonable and modest Measure.
Much has been said on the technical question of the particular machine or drug that should be used. I do not think we are qualified to discuss that matter. The fact that we have not got a perfect machine or a perfect drug is, in my opinion, beside the point. We welcome the fact that three new forms of apparatus are at the present moment being tried out, and also new forms of analgesia; it is not for us in this House to discuss the merits or demerits, but what we are trying to put forward in the Bill is that while we have the Minnitt apparatus which has been proved and trusted, that at least should be made available to every woman who desires it and who is medically fit to use it. However, we hope that in making this provision it does not mean that the whole question of research will be allowed to lapse. One always feels that in questions such as this, one has got to make a priority out of something which is such a crying need.
There is one question which I would like to ask the Parliamentary Secretary. 742 In the Working Party Report on midwives, with reference to research, they say:We recommend that the Medical Research Council be asked, as a matter of urgent public interest, to set up a Committee to solve, as quickly as possible, the problem of finding a safe and effective analgesic agent for midwifery and of devising for its administration apparatus that is light, simple and requires a minimum of maintenance.They go on to say as regards midwives:Without the addition of this weapon to her armamentarium"—which, I must say, is a word I would not use; it is almost as bad as "ironing out bottlenecks" or "facing a stab in the back"—the midwife cannot play her proper part in the health team.I should, therefore, like to ask the Parliamentary Secretary whether, in fact, the Medical Research Council has been asked to undertake this task.
There is one wider aspect of this Bill which is of the greatest importance. I feel that if the Bill does become law it will reinforce the case for a unified administration of the maternity service. At present, as we all know, this service comes under three separate administrative bodies—the regional hospital boards and boards of governors of teaching hospitals for consultants and maternity nurses in hospitals; the local authorities for domiciliary midwives; and thirdly, the executive councils for practitioners undertaking midwifery. We should remember a certain letter which was written to "The Times" in July last year by Sir William Gilliat, who is President of the Royal College of Obstetricians and Gynaecologists. He said:This College has consistently deprecated this division of control. We reiterate our conviction that the care of the pregnant woman, whether at home, at the clinic or in hospital, is a responsibility which cannot be discharged with the maximum safety to the two lives at stake, if it is shared between different administrative bodies"—as it is now.The importance of full co-ordination for reducing maternal and infant mortality is so great that the duty of providing a co-ordinated scheme for all aspects of maternity work must be placed unequivocally on one authority at Regional Board level.In this Debate we have had a remarkable unanimity of opinion from all quarters of the House except, perhaps, 743 from the hon. Member for Barnet (Dr. Taylor). We have also had valuable reinforcement from the right hon. Lady the Parliamentary Secretary to the Ministry of Food, and also particularly from the hon. Member for Preston (Dr. Segal) who, with his very skilled experience, has helped this Debate considerably. This is one step forward in what has been a very long fight against prejudice. A book which all of us seem to have been perusing before this Debate, called "Maternity in Great Britain," says that it has been a fight against not only prejudice, but also against the low status of midwives and, to a certain degree, the prejudice of certain sections of the medical profession, in which, I regret to say, the hon. Member for Barnet seems to be included.
§ Dr. Taylor
I really must protest at that. My prejudice is in no way against analgesia. It is against the miserable Bill of the hon. Member for Monmouth (Mr. P. Thorneycroft).
§ Lady Tweedsmuir
I shall always regard the hon. Member as a diehard reactionary. These are the kind of things which this House should ventilate, and ventilate strongly, because one has to remember that in this country women are, as a whole, very inarticulate on this subject. Furthermore, it is true to say that as a race they are proud, and they will not have it said that there is any burden which they cannot bear without complaint. They would rather go through hell than be accused of either weakness or fear.
We have to remember also the other large body of women in this country who, with the dumb patience of the human race, will bear these long hours of pain feeling that labour is a visitation of nature and, therefore, is to go unquestioned. It is for these people that we must try to speak in this House today. It has been suggested by several hon. Members that perhaps this fear of unrelieved labour in childbirth is a deterrent to the birth-rate. Well, we shall await the Report of the Commission on Population with the very greatest interest. I think it is true that with a wider spread of education, those who have had children unrelieved must certainly have an unconfessed fear of going through that same primitive experience once more.
744 The Parliamentary Secretary seems to indicate that we are to get a Second Reading of this Bill. If the Government do block this Bill in Committee unreasonably, I can only say that this fight will be carried on in this House and outside until we get what we want. Letters have been read today; I would like to read an extract from a letter written by a woman who is unknown to me, which I think is typical of many which many hon. Members must have received. She says:It is a fact that if men were to do the child bearing, either the population would be sadly depleted, or a Bill for The Alleviation of Pain for Fathers' would be put through the House in record time!She continues by saying that she hopes that we shall all, when the subject is broached, refuse to be put off with the usual vague promises, but really see that something practicable and definite is done. She concludes:It should horrify everyone to learn that so many of the women in the country have their babies the 'hard way.' And it is a hard way; I know—I have three!".The Government have the power, through legislation, to alleviate what is a crying necessity at this time. They would also render a very great service to the community at large by providing analgesia in childbirth for every woman, rich or poor, whatever her habitation and however remote, in that they would stress the normality of childbirth, which is, after all, the most creative of all human acts instead of leaving it, as at present it so often is, a cause of suffering and dread. Lastly, on behalf of all who support this Bill, I say that if we do not get it through the final stages, this fight will be waged to the utmost of our power to ensure that justice is done for the women of this country, in the name of humanity and our nation's self-respect.
§ 2.20 p.m.
§ Sir Patrick Hannon (Moseley)
On this Friday the House of Commons is really at its best. I think everybody will appreciate the importance to our social and legislative system of giving private Members an opportunity of introducing Bills on a Friday. All the discussion this afternoon centred around the great incentive of the removal of pain from human suffering and also from animal suffering, and in that respect I think the House of Commons is at its very best. 745 There have been many speeches this afternoon—a speech of eloquence by the hon. Member for Monmouth (Mr. P. Thorneycroft), with the fullness of the emotion which he feels, and the charming and touching speech of the hon. Member for Epping (Mrs. Manning) which made a great impression on the House, as also did the speech of the noble Lady the Member for South Aberdeen (Lady Tweedsmuir). If the Parliamentary Secretary will listen to me for one moment while I speak common sense to him he will give full attention and careful thought to the proposals submitted by the noble Lady, who sits beside me.
I have never seen in the Debates of this House anything so intimately affecting the future of humanity, based on humanitarian principles, so ungraciously accepted on the Front Bench as this Bill was by the Parliamentary Secretary. He tried by a variety of devices to remove the responsibility for dealing with this subject from his Ministry.
§ Mr. Blenkinsop
In what way am I trying to run away from responsibility? It is already the responsibility of the Ministry, and my whole claim has been that we are carrying it out, as was perfectly evident from the figures I mentioned.
§ Sir P. Hannon
What the Parliamentary Secretary has been doing has been to argue that when any local authority is dilatory and has no regard to its obligations, there should be no compulsory powers to enforce those obligations.
§ Mr. Blenkinsop
I must intervene again. The hon. Member must not be allowed to get away with statements of that kind. If he can give me any case in which a local authority is not carrying out its proper obligations for this kind of provision we shall see into it. I hope he will let me know of such a case, In that case, as in others, we will gladly look into it.
§ Sir P. Hannon
I am quite sure that the hon. Member will receive abounding evidence. We have heard the instance of Newport quoted by the noble Lady. There may be many Newports in the country. As far as we possibly can we want to bring local administration to the highest possible level and that is why 746 this Bill has been introduced this afternoon.
As one of the oldest Members of the House I am proud to be present this afternoon and to see how this Bill has been received in the interests of humanity. I am the father of six children and I can easily recall instances in which pain and sorrow animated my whole being in circumstances which could have been amply provided for, if only the substance of this Bill had been in effect at the time. Cardinal Newman said that the definition of a gentleman was one who never inflicted pain. I hope the House of Commons will be identified with that sentiment. I hope the House of Commons will never allow pain to be inflicted upon a mother and child, upon even dumb animals. The House of Commons has always been regarded as an upholder of right and justice in dealing with every human principle which affects the welfare of rich and poor in the body politic of the nation.
§ 2.26 p.m.
§ Mr. Lipson (Cheltenham)
I am sure the House was very much moved by the eloquent and convincing speech of the noble Lady the Member for South Aberdeen (Lady Tweedsmuir). That speech stood out the more because of its contrast with the speech made by the Parliamentary Secretary to the Ministry of Health. I must say, and I say it with regret, that I do not think I have ever heard in this House a speech which reflects less credit on the Minister who made it than the one we have heard this afternoon. His attitude towards this Bill is this: he is willing to wound but afraid to strike. He is not prepared to take upon himself or upon the Government the responsibility of refusing a Second Reading of this Bill because it would then be known to the whole country, but apparently the attitude of the Government is that although the Bill will get a Second Reading, they will take steps to ensure that it shall not be made the law of the land.
§ Mr. Blenkinsop
If the hon. Member would allow me, I must intervene. Surely he is concerned as we are, with the issue of the actual provisions and not primarily with the vague promises which this Bill includes and which make no practical pro- 747 vision at all for the increase of the actual services.
§ Mr. Lipson
If that is the Minister's feeling about the Bill, why does he not come out in the open and say quite frankly that the Government will vote against the Second Reading? He knows perfectly well that there is no pressure which is so effective on local authorities, who are not prepared to do what they ought to do, as the fact that they are compelled to do so by Act of Parliament. He also knows that his Ministry, by withholding a grant from a local authority which does not do its duty, as laid down in an Act of Parliament, can take effective measures to ensure that it will do so.
If the Government put unreasonable obstacles in the way of the passage of this Bill into law it will be to their eternal shame and discredit. What is the real reason why the Government are opposed to this Bill? Are they afraid that it will do too much? Do they want to take to themselves the whole credit of dealing with this particular problem? The Parliamentary Secretary did not give a single sign, not a single proof, that any possible harm could be done by the passage of this Bill. It must be clear to him, as it is to everybody else, that this Bill will prove the most valuable ally that he could possibly have if he is sincere in saying that through the National Health Service Act the Government want to ensure that this provision shall be made.
I, therefore, appeal to the Minister. I hope he will convey to his right hon. Friend that they must think again about this Bill, because this is a matter which touches the conscience of the people. I am sure that if the Government will reconsider their attitude and not oppose the Bill, but provide reasonable facilities for its passage, they will bring credit to themselves and benefit to those whom the Bill is intended to serve.
§ 2.29 p.m.
§ Mr. McCorquodale (Epsom)
I apologise for intervening, for I have not been here for the whole of the Debate; I heard only the last three speeches and I did not hear the Parliamentary Secretary. What I want to say on behalf of my hon. Friends is that the House as a whole has shown a general desire to see this Bill on the Statute Book. Very few 748 hon. Members, except the Parliamentary Secretary, have spoken against it. What we want to ask him is this: I understand he will allow the Bill to have a Second Reading, but will he see that his Minister and the Government carefully study what has been said in this Debate and take everything into consideration, including the general desire of almost everybody in the House that something further should be done than is being done at the present time? If the Parliamentary Secretary does that I can assure him that nobody will blame the Government for changing their minds in this respect when they decide they can make a useful Measure out of this Bill.
§ Question put, and agreed to.
§ Bill read a Second time, and committed to a Standing Committee.