1911 Encyclopædia Britannica/Midwife

MIDWIFE (Mid. Eng. midwif, mydwyf or medewife, from preposition mid, with, and wife, i.e. woman, in the sense of one who is with the mother, or from adjective mid, one who is the means of delivering the mother, a woman who assists other women in childbirth). As a class, midwives were recognized in Egypt in the time of the Jewish captivity. It was the universal practice in Europe until the middle of the 16th century, as it is to-day in the East, that women should be attended in confinement only by those of their own sex. From that period more attention was given to the practice of midwifery by the medical profession (see Obstetrics), while in continental Europe, towards the close of the 17th century, special schools were instituted for the proper training of midwives. But it was not until well on in the 19th century that any supervision or regulation was imposed on those who acted as midwives. Now in practically every European country midwives are under strict state control, they are required to undergo a course of thorough training, and their practice is carefully regulated by legislation.

In France midwives (sages femmes) are divided into a first and a second class. Those qualifying for both classes go through a two years’ course of training and must qualify both in the theory and practice of midwifery, as well as in anatomy, physiology and pathology. A midwife of the first class has a superior status and can practise in any part of France, while those of the second class are restricted in their practice to the department for which the certificate was issued. Their qualifications allow them also to vaccinate and to prescribe certain antiseptic preparations. They are not allowed to use instruments and must call in a medical man in difficult cases. All cases must be reported to a central officer. In Spain midwives are allowed to practise on the result of an examination after studies covering at least four half-years. The diploma is issued by the director-general of public instruction. In Germany midwives are appointed, recognized and authorized by the state. They can conduct confinements independently and without the aid of a medical man. They must be provided with a certificate from the police authorities, and must reside in special districts assigned to them by the authorities. In Austria midwives before they are allowed to practise must pass a strict examination, after having followed a six months’ course at one of the state schools of midwifery. They are subject to elaborate “instructions for midwives” issued from time to time by the ministry of the interior. In Italy a midwife must pass an examination and obtain a diploma from a recognized authority; but in order to obviate the difficulty which the poorer classes in the smaller communes would find in obtaining properly-authorized midwives, a certificate of permission to practise may be given to a certain number who have practised without the sanction of the law satisfactorily during a term of five years. These certificates are distributed by the prefect. In Russia matters pertaining to the appointment, transfer, dismissal and pay of midwives are under the charge of the medical department of the ministry of the interior. In each town of a province or region there is stationed one senior midwife and a number of junior midwives in proportion to the number of districts in the province. The examination of midwives and the issue of certificates of competency is carried out by the Medico-Chirurgical Academy and certain of the universities. A duly-licensed midwife, on presentation of her licence, is at once excluded from the tax-paying class to which she may have belonged. The general code of Russian laws lays down extensive rules for the carrying out of the duties of midwives. In Norway all midwives are licensed after examination and are under the control and inspection of the board of health. Provision is made for infirm and aged midwives. They are usually paid by the parish, but also receive fees according to the means of the person attended. In Sweden a certificate of competency and of having passed an examination does not give a midwife a right to practise until a note has been made on the certificate that the oath of office has been duly taken. All midwives are under the control of the board of health. When a midwife takes up her residence in a parish, or moves from one place to another, she must announce the fact within a month to the nearest appointed doctor and exhibit her certificate. In towns a midwife must put up a notice board outside her residence; she must not absent herself from home without leaving word as to where she may be found and at what hour she will probably return. In the country a midwife may be paid out of the poor rate. In Denmark, also, midwives are recognized by the state, and the practise of midwifery is almost entirely in the hands of women. In Holland a certain number of candidates are given free training by the state in return for their practising midwifery in scattered country districts at a fixed salary. Many of the states of the United States have also passed laws for the registration of midwives.

In England alone there was no regulation of any kind so late as 1902. Any person, however ignorant and untrained, could describe herself as a midwife and practise for gain. Several societies made continuous efforts towards the close of the 19th century to obtain legislation. A select committee on midwives’ registration reported in 1892 that the evidence they had taken showed that there was at the time “serious and unnecessary loss of life and health and permanent injury to both mother and child in the treatment of childbirth, and that some legislative provision for improvement and regulation was desirable.” A similar committee reported to the same effect in 1893. Eventually a bill was drafted with the object of securing the examination and registration of midwives, but, although introduced several times into the House of Commons, it was not successful until 1902. The Midwives Act 1902 forbids any woman after the 1st of April 1905 to call herself “midwife” without a certificate, or to act as a midwife for gain without a certificate after the 1st of April 1910. Existing midwives (those who held certificates in midwifery from certain recognized institutions, or produced satisfactory evidence at the passing of the act that they had been for at least one year in bona fide practice as midwives, and bore good characters) were allowed to claim certificates within two years from the 1st of April 1903. The act created a central midwives’ board, whose duties are, inter alia, to regulate the issue of certificates and the conditions of admission to the roll of midwives; to regulate the course of training and conduct of examinations; to regulate, supervise and restrict within due limits the practice of midwives; to publish annually a roll of duly certified midwives; to remove from the roll the name of any midwife who disobeys the rules and regulations laid down from time to time; to issue and cancel certificates, &c. There is an appeal to the High Court of Justice against removal of a name, but the appeal must be made within three months. Local authorities are required to exercise supervision over the midwives within their area; they must investigate charges of malpractice, negligence or misconduct; exercise the power of suspension and report convictions. They must supply the central board with the names and addresses of those practising within their area, and notify any death. The local authority must appoint a committee to carry out its powers or duties under the act, and may, if it think fit, delegate its powers to a lesser local authority, such as a district council. The act provides for penalties for obtaining a certificate by false representation or for wilful falsification of the roll. The act does not apply to Ireland or Scotland.  (T. A. I.)