HL Deb 20 June 1902 vol 109 cc1233-44


Order of the Day for the Second Reading read.


My Lords, I do not think I need detain your Lordships at any length in moving the Second Reading of this Bill, for I believe there is a general consensus of opinion in favour of something being done to remove the evils of the present state of things. This Bill, or rather a similar Bill, when before your Lordships on a former occasion, met with a very favourable reception. There are in this country some 10,000 or 15,000 women practising as midwives, and they are said to attend some 450,000 cases annually to which a doctor is not called in. Yet there is absolutely no qualification for these women, no guarantee that they are acquainted with their duties, and it is possible for any old drunken hag, with no idea of cleanliness or acquaintance with proper methods, to advertise herself as a midwife and carry on that business without let or hindrance. The consequences of this state of things are what we might very well anticipate. If your Lordships were to examine the reports of Coroners' Courts you would find that they give a very melancholy, but, at the same time, a very instructive, lesson as to the necessity of a Bill of this kind; and no less than 200 Coroners, out of about 250 in England and Wales have signified their approval of such a measure. Puerperal fever is said to be an absolutely preventable disease, and in the London hospitals it is practically unknown; yet throughout the country at large it is on the increase in consequence of the lack of fully-trained medical attention in cases of childbirth. Not only has there been an increase in cases of this kind, but a large amount of sickness and disease, incapacitating the mothers and inflicting great injury upon the children, has resulted from the ignorance of mid-wives. I need not remind your Lordships of the terrible suffering caused by permanent ill-health to mothers who are dependent for their daily bread on their own labour; and, with regard to the children, it is calculated that 40 per cent. of the cases of blindness are due to want of care at birth. That, I think, is a state of things which justifies an attempt at a remedy. There is no doubt that in matters of detail the question is fraught with great difficulty, and, while asking the House to assent to the principle of the Bill, I frankly admit that it requires very careful consideration in regard to details. I trust that the House will give it that consideration when we reach the Committee stage, but for the present I ask your Lordships to adopt the principle of the measure, which is simply to require the certification of a proper degree of knowledge and of good character on the part of midwives. The position of existing midwives who are really fit for their duties, and whose character is above reproach is specially safeguarded in the Bill, and they will not be injuriously affected by its provisions. When this Bill was previously introduced in your Lordships' House exception was taken to it on the ground that there was not sufficient local control. That has now been amended by giving the Comity Councils a large power of supervision in cases in the country. These, broadly speaking, are the provisions of the Bill. I have no reason to suppose that any opposition to the Bill at this stage is likely to be encountered, and I think I shall be consulting the convenience of your Lordships by moving, without further words, the Second Reading.

Moved, That the Bill be now read 2a.—(The Duke of Northumberland.)


My Lords, it is my intention to support this Bill, but I desire to draw the attention of the noble Duke in charge of the measure to one or two points which, I hope, may receive his attention before the Committee stage. The Bill gives very considerable powers to an independent Board which is to be created, including the power to take any proceedings that may be necessary under the Act. The Board will also have power to take certain fees from candidates for certificates, and to meet the expenses incurred out of the fees, but any balance of expenditure is to be charged on the rates. It is unusual to allow one body to spend money and then to hand the bill on to another body without any check or control. The expenditure of the Board has, I know, to be approved by the Privy Council, but that is an approval after the expenditure has been legally incurred, and therefore the control in that case is very imperfect. I would ask the noble Duke to consider before the Committee stage whether the control which is wanting here, and which I think he will agree with me is desirable, for I am sure he is as anxious as I am to avoid any unnecessary charge on the rates.


Hear, hear!


I would ask the noble Duke to consider whether this control could not be supplied by inserting in Clause 3 (Constitution and Duties of the Central Midwives Board), after the words "and generally to do any other act or duty which may be necessary for the due and proper carrying out of the provisions of this Act" the words "all questions of expenditure being subject to the previous approval of the Privy Council." The Bill further provides that the Board shall appoint a Secretary, who is to be paid such salary as the Privy Council may approve. But that leaves the Board at liberty to appoint such other officers as it pleases, whose salaries may be a charge on the rates. I would suggest, in order that the local rate account may be safeguarded, that the salaries of the other officers to be appointed should also be subject to the approval of the Privy Council.


My Lords, I think there are much more serious objections to the Bill than the noble Lords seem to think. At the same time I do not undertake the responsibility of moving its rejection, because certain cases contemplated by the Bill may require regulation. But I cannot help thinking that those who have drawn up the Bill apparently had in mind large centres of population possessed of ample means for the purpose of obtaining medical assistance, and had not considered that in certain cases it may not be possible to get trained nurses. I am assured by the magistrates in five counties—Lancashire, Worcestershire, Warwickshire, Sussex, and Surrey—that in small villages the persons who perform what is necessary, and in nine cases out of ten without skilled assistance, also perform the functions of maid-of-all-work in the house during the few days in which the woman is unable to work for herself. If the Bill in its present form passes into law, it will, I am told by correspondents, inflict an inconceivable amount of suffering on the very poor. One or two of those who have written to me live in a place ten miles from any medical man. [The noble and learned Lord here read passages from the letter of a lady who had herself obtained a certificate and assisted in the nursing of the poor, and who protested against the Bill in its present form; and also from the letter of a Magistrate, who was in a position enabling him to form a good judgment, stating that there was very serious objection to the Bill on the part of the working population.] As I have said, I am not going to move the rejection of this Bill, but I thought your Lordships' attention ought to be called to the evils that may arise, so that when the Bill is considered in Committee you may look at it with care and see that no injury is done to the poorer classes.


My Lords, I think it would be a pity if on this question no voice was heard from the Episcopal Bench, firstly, because so large a portion of the time of most of us has been spent in direct contact with the working classes; and, secondly, because of the close connection which has historically existed between the class of persons specially referred to in this Bill and the members of the Episcopal Bench. I do not know whether your Lordships are aware of the fact that for many centuries no woman could practice as a midwife without the direct sanction of the Bishop of the Diocese. Even in the life-time of some Members of your Lordships' House it used to be part of the inquiry connected with the Bishop's visitation whether or not the midwives in the parish were duly authorised. The form of the question put some eighty years ago by a predecessor of my own to every parish clergyman was— Doth any woman in your parish take upon herself to execute the office of midwife? Are they all licensed? Who is not? I refer to this merely as a curious incident in the history of this matter, which is remarkable for the wide swing of the pendulum from one extreme view to the other. Not many hundred years ago no medical man was allowed, in many parts of Europe, to be present at a birth. I was reading the account, the other day, of times when a medical man who wished to investigate the subject clothed himself in woman's dress so as to be surreptitiously present for the purpose of scientific investigation. Even in the early part of the last century midwifery was treated in a much less respectful manner in the Royal College of Surgeons than other scientific matters that came before that body. Now we have gone to the very opposite extreme, and there are amongst the opponents of this Bill some who speak of the midwife as a person who practically should not exist at all. A medical man who gave evidence before the recent Committee of the House of Commons said a midwife was— An obsolete individual, an anachronism, a relic of the Dark Ages. The promoters of this Bill, one need hardly say, do not take either of these extreme views. We recognise, of course, the paramount necessity that in all ordinary circumstances there should be a ready appeal, at all events, to a fully trained medical man; but, at the same time, we recognise the natural—may we not say the wholesome—instincts which lead so large a proportion of the mothers of England of the poorer classes to prefer the aid of one of their own sex whom they have reason to believe, rightly or wrongly, to be fairly well qualified to aid them in the time of their need. It is calculated that 60 per cent. of the births that occur annually in England take place without the presence of a medical man. Recognising that desire on the part of mothers, we wish to do something which shall secure that the women who attend at such hours shall have at least some degree of competence for the task, and shall be under some sort of supervision as to the way in which they carry it out.

In this connection we are not quite abreast of other countries. I believe I am right in saying that in France legislation was passed regulating this particular matter in 1803; in Belgium in 1818, and in Austria in 1810. We alone among the nations of Europe have trusted to the common sense of those concerned, without interfering by means of legislative enactments. The evidence given before the Select Committee on Infant Life Protection, of which I had the honour to be a member, as to the mischief which took place from the incompetence of those who were professedly giving such help at that hour has impressed itself on the minds of practically all the coroners of England, and upon no small number of the medical profession. And, though all the doctors are not by any means agreed as to the way in which the wrong should be set right, they are unanimous as to the existence of the very grave evils which proceed from the lack of training on the part of these women. It was stated in evidence that at one of the great hospitals for women fully 25 per cent. of the cases were due to evils resulting from badly-managed confinements. Though it is subsidiary to the general question, I do not wish to pass over the case of the very large number of girl mothers who are without homes, and who, through the fault of others far more than their own, are forced to seek help where they can find it in the hour of their direst need. What have these girls—and their number is enormous—to look to or to do? If you turn to a certain class of newspaper, you will find many advertisements of homes for this special purpose, each of which is said to be "under the management of" one who describes herself as a "midwife." That is not illegal; it is not undesirable; something of the kind there must be. But is there any class of human beings, if we consider the circumstances, who more need to be inspected and supervised than those who are taking part in the bringing into the world of unwelcome children? It needs no special knowledge to realise the possibility, nay the probability, of terrible evils of the vilest sort. There should be some kind of certification of such persons.

It is, however, on far larger and more general grounds than that, that I join the noble Duke in asking your Lordships to read the Bill a second time. I am not quite certain that I correctly caught the grounds on which the writers of the letters, which the noble and learned Lord on the Woolsack quoted, based their objections to the Bill. What the Bill says is that from and after January 1st, 1910, no woman shall "habitually and for gain" attend women in"] childbirth, unless she be certified under the Act. That does not prevent a neighbouring mother of experience rendering all the assistance in her power in the cases referred to. As to the observations of the Lord Chancellor that the Bill apparently had been drawn up by those who were unfamiliar with the needs of rural districts, I would point out that the Member who was in charge of the Bill in the House of Commons represents a large rural constituency, and is, therefore, presumably in touch with the needs of such communities. The Bill will effect a reform, not noisy or conspicuous, but sorely needed; a reform very far-reaching in its results, and one which affects the lives of both mothers and children in very many homes in England. If there are points, such as those to which your Lordships' attention has been called by the Lord Chancellor, which can be met, the promoters of the Bill will, I am assured, be most glad to further their Amendment, so that the Bill may issue from the Committee in the best possible form. It is a matter which, in a very literal sense, concerns the life of thousands "from the cradle to the grave."


My Lords, this is a Bill which affects almost entirely the poorer classes of this country, and the object of the promoters is, I take it, to avoid the misfortunes which occur at childbirth owing to the operation being performed by unskilled and unsuitable persons. To that extent I imagine that the Bill commands general and universal support, and I did not gather from the observations of the noble and learned Lord on the Woolsack that he dissented from the principle of registration suggested in the Bill. Of course, a great deal of the success of the measure will depend on the way in which its details are made to work, and on the manner in which the Central Mid-wives Board, intended to be set up, carries out the duties that are imposed upon it. I do not myself see that the price which these women charge for their services need be materially increased by the operation of this Bill. If the Central Board takes the view, as I suppose it will, that it should place on the register as qualified midwives, not women who possess the necessary knowledge to be medical practitioners or trained nurses, but women who are of cleanly habits, and have sufficient knowledge to attend cases of this description without causing danger to life, it does not appear to me that the charges for their services need be materially increased, or that the number of those who practice as midwives need be materially diminished. I am glad to see that the Bill, as amended in the other House, provides that at least two of the members of the Central Board must be women, for I regard it of great importance that women should be properly represented on a Board which is to control a matter of this kind. In addition, the local control of the midwives has now been placed under the County Councils. The Bill has met with opposition from some portions of the medical profession on the ground that it will give, as they think, a status to these women which will make them to some extent competitors. I understand that doctors with small practices attend confinements now for 10s. 6d., and I think it will be found that qualified midwives will still be able to charge small sums for their attendance. The noble Duke will perhaps explain in Committee the meaning of the two dates in Clause 1–1910 in the first Sub-section, and 1905 in the second Sub section—which I have not yet been able to make out to my satisfaction. I think the Bill is one which should command general support; but it is important to prevent the regulations under it taking such a form as to make it compulsory on the poorer classes to pay higher fees than they can afford.


My Lords, I agree with what was said by the noble and learned Lord on the Woolsack on this question, and I cannot help feeling that the promoters of the Bill have entirely left out of account the country villages and small hamlets where surgical assistance is very difficult to get and trained nurses are out of the question. With regard to the registration of these woman, no midwife can be admitted under this Bill unless she produces satisfactory evidence to the Central Board. How on earth is a poor woman in the extremity of Cornwall, for instance, to produce satisfactory evidence to a Board in London? Again, a guinea for registration is an exorbitant sum to charge, and a sum which many poor women would find it absolutely impossible to pay Then there is a Clause which provides that, when the Central Board has made Rules, those Rules are not to be passed unless approved by the General Medical Council. What possible reason is there for referring Rules framed by such a thoroughly competent body as this Central Midwives Board will be to the General Medical Council? No doubt the medical profession are anxious to have these cases within their cognisance, but there are thousands of mothers in this country who cannot afford to have a doctor on these occasions, and upon whom this Bill would inflict the greatest possible hardships. To show how stupid the Bill is I would call attention to the Clause which provides that a midwife is not to attend abnormal cases. How is an unfortunate woman to know whether a case is abnormal or not? Many of the details in the Bill require Amendment, and I hope these points will be considered in Committee.


My Lords, there seems to be a general consensus of opinion in favour of the Bill being read a second time. Therefore, I shall not trespass on the time of the House to say anything on the general question. The various Amendments which have been foreshadowed may very well be left to be discussed when we reach the Committee stage. I should not have risen now but for the speech of the noble Lord who has just sat down. The noble Lord seemed to indicate that it would be difficult for a woman in Cornwall to satisfy the Central Board in London of her fitness to exercise this important calling. If the noble Lord had paid the promoters the compliment of reading the Bill with care he would have found in the third Clause that part of the functions of the Central Board are to appoint examiners and to decide upon the places where, and the times when, examinations shall be held. There is nothing in the Bill to the effect that all the examinations are to be held in London.


I was not referring to the question of examinations, but to the case of the existing midwives, who are to be required to provide evidence, satisfactory to the Board, that at the passing of the Act they had been for at least one year in bonâ fide practice as midwives, and that they bear good characters.


No doubt it is right that those who are at present in practice, so to speak, should be tenderly dealt with, and that is the desire of the promoters of the Bill. There is no intention to interfere suddenly with those who are qualified to carry on their occupation, but I am sure the House will agree that if a woman is not qualified it is in the public interest that she should be interfered with. The noble Lord opposite asked—How is an unfortunate woman to know that danger is likely to occur? The answer to that seems to me to be very clear and simple. The purpose of the Bill is to ensure that women who act as midwives shall have sufficient knowledge and training to know when to call in medical assistance. It is seven years since I had the honour of moving the Second Reading of a similar Bill in your Lordships' House. Since I have been a Member of the Government I have not, of course, taken part in promoting the Bill or in agitating for it, but I think I may be allowed to express my satisfaction that, after all these years of agitation on the part of those who are interested in the subject, there is now so good a prospect of legislation. I hope the Second Reading of the Bill will be agreed to and that it will be fully and carefully considered in Committee, for no more important and far-reaching measure of social reform has been before the House for a long time.


I sympathise most strongly with what the noble and learned Lord on the Woolsack and Lord Thring said as to the position of women in rural districts, and I should certainly decline to support any measure which I thought would place them in a worse position. I think the clause in the Bill has been overlooked which provides that any woman who, within two years from the date of the Act coming into operation, claims to be certified, shall be so certified provided she hold a certificate in mid wifery from several bodies named, or such other certificate as may be approved by the Central Midwives Board, or produces evidence, satisfactory to the Board, that at the passing of the Act, she had been for at least one year in bonâ fide practice as a midwife, and that she bears a good character. It is merely a question of whether she has been in practice as a midwife and bears a good character; and' a letter from the squire, the parson, or the doctor of the village, to that effect would be considered satisfactory evidence by the Central Board. The noble Lord opposite complained that it was proposed to charge a guinea for registration and that many women would be unable to afford this sum. The wording of the Bill is that the fee is not to exceed the sum of one guinea, and it will be within the power of the Board to reduce that fee in accordance with the circumstances of the case. I may say that the promoters will be quite willing to accept any Amendments that will carry out the intention that the Bill should not bear harshly on those who carry on their avocation satisfactorily.

On Question, agreed to; Bill read 2a, and committed to a Committee of the Whole House on Friday, the 4th of July next.