DISCUSSION 75 



These provisions might be secured if the English method of con- 

 trolling the midwife problem were somewhat modified and adopted 

 in this country. This might be done if the boards of education were 

 empowered to standardize schools for midwifery, issue certificates, 

 adopt rules and regulations governing the practice of midwives after 

 graduation, and if they were supervised and controlled by the local 

 departments of health. 



(A request was made that Miss Van Blarcom give a brief account 

 of the training of midwives in England.) 



Miss Van Blarcom: I might preface this by saying that the train- 

 ing and control of midwives in England is entirely under a central 

 midwives' board, which was appointed by aru Act of Parliament 

 in 1902. 



The central midwives' board does not itself undertake any of the 

 training or instruction of midwives, these being carried out in ma- 

 ternity hospitals, which are recognized by the board as training 

 schools, or under the authority of a registered medical practitioner, 

 recognized by the board as a teacher of midwifery. 



The training which is given to the pupil midwives, I found upon in- 

 vestigation this summer in London, is analogous to the training which 

 is given in the large hospitals in this country to obstetrical nurses. 

 The reasons, I think, are perfectly obvious to an audience of this 

 sort. They feel that midwives must know something of hygiene, of 

 anatomy, and of the rudiments of nursing if they are to care for 

 the mother subsequent to delivery, and to give the proper care to the 

 child. All of the pupil midwives are taught something of hygiene, 

 of cleanliness, a slight knowledge of anatomy and physiology. Of 

 course, they only attend normal cases and are obliged to call in a 

 physician upon the appearance of any symptoms suggesting an ab- 

 normality. 



The Midwives' Act forbids any woman not licensed and not holding 

 a certificate issued by the central midwives' board to practice as a 

 midwife. In order to secure a license and a certificate from the cen- 

 tral midwives' board, a candidate must present a diploma from a 

 recognized training school for midwives, together with a certificate 

 as to her moral character, and must satisfactorily pass the examina- 

 tion given by the board. 



Having in this way secured a license to practice, the midwife is 

 required to observe the rules and regulations adopted by the board. 

 The rules which the board has adopted relate to her person, equip- 

 ment, duties to mother and child, obligations with regard to disin- 

 fection, obligations in securing medical assistance, and responsibility 

 in returning notifications of births and deaths. 



These rules are enforced through the agency of what are termed 

 the local supervising authorities, which are councils of the counties 

 or county boroughs throughout England and Wales. 



Violation of these rules is punishable by fine, suspension or even 

 exclusion from practice'. 



Practising midwives are required to register annually with the local 

 supervising authorities, these registrations being forwarded to the 

 central midwives' board, and the hope is entertained that in the near 

 future they will also be required to take short post-graduate courses 

 of training at intervals of two or three years, as long as they practice. 



