‘A lot of these people didn’t book a doctor. The farming people, or people in the money, they booked a doctor very often, but the ordinary workman couldn’t afford one, so you sent a medical aid form if you wanted the doctor – but you didn’t send unless you wanted him. If you sent a medical aid form, the county paid his fee. That’s why the poorer people didn’t book a doctor because they knew they could get him if they were in trouble. They relied on the midwife and the midwife had to have sense enough to know when a doctor was needed.’
Working as a salaried midwife for a nursing association in the 1920s did not necessarily guarantee a living wage. Many letters to Nursing Notes (the midwives’ professional journal) bear witness to that fact. The following is an extract from a letter written in November 1920, by a midwife on a salary of £84 a year:
‘I was hoping to invest in a pair of new shoes as I have not had any since last year, and these are beginning to be leaky, but it is impossible. My cotton frocks I have had for three years, and these are so patched that I am afraid that they will fall to pieces in the wash. My rainproof coat is getting so thin that it will not be rainproof any longer. My district is a large one. I have three villages and the nearest doctor is four and a half miles away, and the road is a very bad, uphill one to get to him. There is no telephone in either village and only one telegraph office, which opens at 9 a.m. and closes at 7 p.m. The roads in the winter are awful; sometimes one cannot use the bicycle as there is too much mud …
‘It is lonely as she [the midwife] cannot join in anything socially, as there is always something to pay … I cannot afford to join the Women’s Institute or anything else, and it is hard to see everybody else go off to the local entertainment and have to stay behind because of the expense.
‘It is not pleasant by any means to be called up at all hours in the night and go through woods and fields to cases – in all weathers. I should not advise any woman to take up midwifery, especially in a rural district, unless she had private means, as she would be almost a hermit because she could not afford to join in any social pleasures, and she would always be shabby and in debt. No, life is not sweet to a rural midwife, with the spectre of want always before her eyes.
‘There is one thing that I should like to tell you about, and that is the snobbery of the richer people in the country villages towards the village nurse. I think that is another reason why a midwife should not settle for very long in the country. Perhaps it is because the salary is so small that the big subscribers can afford to treat her so. They think they are helping her out of charity’.3
The development of a salaried profession
The Midwives Act of 1936 brought about fundamental changes to the organisation of maternity services. For some time, the midwife had been seen as the key link between childbearing women and the ever-increasing system of state-funded benefits, introduced in response to appalling infant and maternal mortality statistics (see Chapters 1 and 2). The state needed to create a new system that would bring the majority of midwives – who were working as private practitioners – under the tighter control of local authority co-ordination so that they could be their agents.
Under the 1936 Midwives Act, local councils were charged with providing an adequate, salaried domiciliary midwifery service, either directly or through voluntary organisations. This meant that, apart from those midwives who chose to work independently, all practising midwives would be salaried with guaranteed ‘off duty’ and annual leave. Although the clients would no longer have to pay the midwife directly, unless there was great hardship, they would have to pay the local authority for midwifery care. The new system was a great relief to midwives such as Mary W., who had been struggling to make a living as an independent practitioner:
‘Of course, before 1936, your income was very precarious because you had what you earned. The amount of deliveries you got was the amount of money you got. I was charging 30 shillings. I’ve always been paid, but sometimes by instalments, because people hadn’t a lot of money in the early 1930s. A lot of the men were only working half a week, then half a week on the dole, so they had very little income and there was a lot of poverty.
‘The 1936 Act said that the local authorities had to provide midwives for the people in its area. Well, the posts were advertised and we all applied. In fact, it helped the local authority to weed out the ones they didn’t want. It gave them more control over us. Some midwives didn’t get jobs and it caused a lot of hard feeling. There were four of us who had been practising independently in this area and I was one of the two who were chosen. One of the ones not chosen was a newly qualified SCM [State Certified Midwife] – she was a direct entrant [non-nurse] – and the other one had her SRN [State Registered Nurse] qualification but she hadn’t endeared herself to the authorities. She got a job the following year, but she never forgave me in all the time we worked together for getting the first job! She was a real thorn in my side. The re-organisation caused a lot of friction. Some of the ones that didn’t get jobs took compensation – there was a scheme for that – but they didn’t get much at all.’
After the 1936 Midwives Act and until the NHS was set up in 1948, midwives working for a nursing association or local authority were still responsible for collecting their fees, a task they described as extremely difficult when people could not afford to pay. In fact, many midwives said that the best thing about the advent of the NHS was that they no longer had to collect payment from their clients. Katharine L. explains the financial arrangements that existed in the late 1930s in East Anglia:
‘In an area like this, patients would pay into three funds. There was one where you paid one or two pennies a week to the hospital, so that if you went into the hospital you didn’t have to pay. There was another one for the District Nursing Association. That was two pennies a week. And then there was the HSA [Hospital Saving Association, a health insurance scheme]. And so if we had a patient that was paying two pennies a week into the District Nurses Association and she was going to have a baby, instead of having to pay us £2 10s for her delivery and aftercare, she only had to pay thirty bob [30 shillings]. They didn’t pay us; they paid the Association. But of course we had to collect it from the patient for the Association and that was hard.’
Midwives and doctors
In pre-NHS days, midwives often found themselves competing with doctors for maternity cases. Rivalry between midwives and the medical profession had existed for centuries and is well documented in Jean Donnison’s Midwives and Medical Men.4 Early midwifery campaigners such as Alice Gregory steered midwifery along a course that publicly acclaimed the superiority of the medical profession:
‘If we are unduly aggressive in our dealings with doctors, who are not very enthusiastic about our arrival on the scene to start with, we help to put the clock back and discredit our profession. Of course, there are some irreconcilables among the medical profession, with whom one can do nothing. I grieve to say I have heard of one lately, whose determined opposition has caused the abandonment of the midwife’s work in a country village; but I think that such implacable hostility is the exception if the midwife treats them respectfully as her professional superiors.’5
Arguably, the subordination of the profession was reinforced by legislation that ensured that the services of a doctor had to be employed in all situations where there were complications – a ruling that also ensured a regular income for the medical profession. The parallels between the subordination of the all-female midwifery profession and the position of women in society are obvious. In spite of such social pressures, however, most midwives we interviewed saw themselves as equals to doctors. Many, such as Edie B., who worked alongside male doctors in a maternity home, described positive working relationships:
‘On the whole, we got on well with the doctors. Mind you, you didn’t let them get away with things. I remember one woman, she’d been in labour quite a long time and the doctor came to see her and he said, “You must pull yourself together. It’s your baby. Yo
u’re having it, and you must do the work.” You know the sort of attitude. And the woman said, “Can I have a cup of tea?” Doctor said, “Not until you’ve had your baby.” So I said, “Well, anyone who’s doing such hard work deserves a nice cup of tea.” She got her cup of tea!
‘I once did a forceps because the doctor collapsed! Well, it wasn’t good for her to do it. She was on the point of collapse. “Oh, I don’t feel very well. Do you think you could manage?” I said, “Well, if you tell me the position and where exactly to put the instruments, where to feel, I’ll have a go, but you must take responsibility.” However, the baby was all right. I was so relieved. I went about with an imaginary medal on my chest! I enjoyed that, the feeling of power, you know. No, our doctors were very nice. They respected us and treated us like equals. They trusted us and you thanked that feeling of trust.’
Elizabeth C. also recounted tales of putting on forceps, in her case because of the lack of experience of many of the doctors who arrived when she sent for help at home births:
‘You often put the forceps on for them because a lot of the doctors didn’t know what they were doing. They didn’t sort of know which end was which! They hadn’t done it, you see, so they depended on you. They may have been there, responsible for whatever cropped up, but that didn’t always ease your mind because something could be done that shouldn’t be done.’
District midwife Margaret A. remembers the outrage and frustration she felt over one doctor’s practice:
‘This was the most terrible doctor. She was booked by this girl having her first baby and it was coming a bit before its time. She had a fairly long labour and the doctor arrived, did an examination, put forceps on and dragged out a little four-pound baby. She tore the girl’s cervix and killed the baby. There was a lot of talk about this afterwards and Kath [her sister and midwifery partner] heard that the doctor had been telling people that it was my fault – “the midwife didn’t send for her soon enough”. With her next baby, she booked the same doctor. It was a normal birth at term this time, but she had a retained placenta. After an hour, we had to call this doctor out. She came in and inverted her uterus! [Pulled the uterus out through the vagina.] The poor soul was taken up to the general hospital where they managed to peel the placenta off the uterus – though it was firmly adherent – but the girl died of shock. It was an avoidable death. But that doctor was a terrible liar and she always tried to put the blame on anyone else.’
Midwives engaged by wealthy families to ‘live in’ often found themselves playing a servile role to the doctor whose services were also engaged. Midwife Elsie K. remembers:
‘There was one case, she was a doctor’s wife and although I’d been hired to live in, she was to be delivered by another doctor, a specialist. In those days, we often had a coal fire in the bedroom and I used to put the rubber gloves the doctors gave me to boil up, in a little pan on the fire. On this occasion, it was a second baby and I knew it was nearly ready to deliver, so I let his gloves boil for a couple of minutes and then I handed them back to him. And he said, “I like my gloves boiled for ten minutes, Nurse.” So I said to myself, “All right Sir, you shall deliver this baby without gloves.” And I put them back on the fire. And of course, he had to deliver without gloves because the baby was imminent. You see, I’d been watching the patient!’
By the time the NHS was set up nearly half a century after the first Midwives Act, a strong precedent had been established in Britain. Midwives were the recognised practitioners of normal childbirth, and doctors were only called to labours with complications. By 1948, the power struggle between professionals had shifted away from the birthing room and into the antenatal clinic. Mary W. saw this period as a turning point in midwifery:
‘The midwife’s status has gone down such a lot recently. It started around the time of the NHS Act, I think, when the doctors started doing more and more antenatal care and the midwives said, “Oh well, the doctor gets paid for it – he’ll do it”. Instead of sticking up for their own status, they let their status go, and that’s where the midwives started to go down.’
Day-to-day work
The midwives we interviewed all had vivid memories of their day-to-day working lives. Although the work was demanding and not easy to organise in the days before cars, telephones and mobile phones they all described it with affection, humour and often a good deal of passion. For instance, Edie B., who worked mostly in nursing homes and hospitals, stated:
‘It was a happy time. I’m glad I chose that profession. It’s lovely. But you have to be dedicated to it. It’s very hard work. Talking to you brings it all back. It was lovely.’
District midwives’ usual form of transport was either by bicycle or foot until well into the 1950s. Mary W. remembers these arrangements very positively:
‘You missed a lot when you came off the bike. Although it was hard work you knew all the people along the way. All the shopkeepers knew you – “There’s the Nurse going along”. On your old bike, trundling along. Patients would be outside houses sometimes and shout, “How are you? Got time to come in and have a cup of tea on your way back?” And things like that. You’ve lost a lot in the car.’
On the other hand, sisters Katherine L. and Margaret A., who worked together on the district in East Anglia, found that bicycling became too arduous:
‘We were on bicycles and then we had that terrible winter of ‘47 and we thought, “We can’t go through another winter like this”, so we went and told our committee – “Sorry Dr. Allen I think we’ll have to leave, we can’t go through another winter like this”. And then we discovered that through one of our old patients, a General, we’d inherited £200. He’d given them £200 to buy the nurses a car – and they hadn’t done a darn thing about it! However – we got a car. And we always had a car after that. We had a lot of clobber to carry around you know, bags, gas and air, oxygen, blocks to raise the beds up to save your poor old back [this would apply mainly to their practice after 1948].’
Midwives were called to a birth by a knock on their door, usually from the woman’s husband or one of the children. In the daytime, when they were out doing their ‘nursings’ [postnatal visits], they would leave information as to their whereabouts, as Margaret A. and Katherine L. recall:
‘Every morning we would go out and write on a slate that was outside the front door. We would start with the first call and list them down to the bottom. If the labour happened during the day they would come round to the house, see the slate, take note, and come round and get us or find us. The slate was in a big sort of plastic bag so that if it rained the chalk didn’t all get washed off. It worked well. But funnily enough, we found that most people start off labour at night.’
Mary T. describes how people would come to the home she shared with midwife Elsie Walkerdine in order to call Elsie out to labours:
‘In those days, Elsie kept the maternity box at home. One man came for Elsie – “All right father”, she said (for Elsie always called the patients “mother” or “father”, never by Christian names). “Take this and I’ll be along in a minute.” I went with Elsie, and it was snowing. Up the High Street [Deptford] we walked and there was two people on the pavement as we were approaching. It was a policeman and this young man. “Ah,” he said. “I’m glad you’ve come along, Nurse. Tell this copper what I’ve got in this parcel, will you? I don’t bloody well know.” So the policeman turned round and said, “Why didn’t you tell me you’d been to get the midwife?” He said, “You didn’t ask! You asked me what I had in the box!”’
Elizabeth C. remembers a messenger coming to the house she shared with her friend, another midwife. The labouring woman obviously had experience and knew that she was about to push the baby out (a phase of labour that midwives refer to as ‘fully dilated’):
‘The woman used to clean for my friend and I took this message from her. She said, “She said to say she’s fully DELIGHTED!” I knew what she meant and we had to hurry!’
Fathers a
nd children at births
Beyond calling out the midwife, it seems that fathers played virtually no role in the labour. On the whole, neither they nor the other children were present at the birth. Elizabeth C., who worked on the district in Battersea, explains:
‘It was very rare for the fathers to be there, but they came in and out with anything you wanted. The men didn’t want to be there and the wives didn’t want them there either. But the women nearly always had their mums or a neighbour to help. Battersea was an area where they all helped one another. It was a tight-knit community.
‘One lassie and her neighbour had fallen out over something or other and they hadn’t spoken for ages. The day Mrs. B. went into labour, the neighbour come in and said, “I’ll take your Marion and look after her while you’re in bed – but I haven’t finished with you yet!” [laughs]’.
Mary T. used to accompany her friend, Elsie Walkerdine, to births in Deptford. Occasionally, Elsie would ask her to come and ‘hold the girl’s hand and encourage her’, but on the whole she used to look after the husbands:
‘Normally, I used to sit downstairs and keep the husband company, you know, chatting away – you usually found something to talk about. And all of a sudden you’d hear a little squeal and a bit later Elsie would appear and say, “Father, you’ve got a nice baby boy!” I remember one bloke, in the excitement he goes, “I’ve got a boy, I’ve got a son!” and he hit me on the back so hard he nearly knocked me choppers out!’
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