Occasionally, working-class women would gain access to midwifery training by working in the fever hospitals where people with infectious diseases were isolated. This process was described by Ken W., a nurse whose mother was a handywoman and whose sister Florence managed to become a midwife against all the odds:
‘It’s interesting that many of the midwives, particularly working-class midwives, got into it through the fever hospitals because it was made very difficult for them to train to be midwives. It was very expensive – they couldn’t afford the uniform and books, and a lot of them couldn’t afford the schooling to take the exams. Whereas, with the danger of working in the fever hospitals and TB hospitals, they’d take anybody. It was a way in. And they got some nursing experience there.
‘My sister Florence had to leave school aged 14 as we all did. She was working as a maid in a boys’ boarding school in Yarmouth in the late 1920s, but then she got caught up with the Salvation Army – by the evangelist thing – and was accepted at their training college in Camberwell. The headmaster and his wife at the boys’ school were sympathetic to her wanting to train with the Salvation Army, so for a while she continued to receive the same pay from them, but an extra amount was put aside for her so that she could leave with an extra lump sum.
‘Florence won a scholarship. My mother couldn’t afford to let her go to the hospital. Couldn’t afford the uniform or the books. She was a bright girl. And that’s how she got into midwifery.
‘They never got paid as nurses in the Salvation Army and however poor my mother was, she used to save up and send Florence a postal order for a shilling.’
Florence, herself, describes the strain imposed on working-class women who found a way to enter midwifery training, an issue that several other midwives commented on:
‘When I went off to start my training, I was very fearful. You always felt as though you were inferior not having had the education. Although you had other experience that those nurses hadn’t in life and that, you didn’t have the head knowledge.’
Florence, like many midwives of the time, was driven by her religious conviction, her sense of ‘calling’. She once wrote to a friend:
‘I never lose sight of my humble beginnings – I sometimes wonder and feel it was presumption on my part to think or expect that I could be used as a Salvation Army officer, but it is equally wonderful to realise how God can, and does, use and fit the most unlikely person, once that life has been fully and unreservedly dedicated to His service.’
All the midwives we interviewed referred to midwifery as a vocation. Esther S. described how the Second World War gave her the opportunity to fulfill her childhood ambitions:
‘I lived and worked in the same area of Portsmouth that I was born in. I hadn’t had a higher education. It was the war that gave me the opportunity to do training. I got called up. Ever since I used to play nurses with my dolls – bits of rag as bandages, always making them better – I wanted to train to be a nurse. My mother said that it was there, right from those early days. But then, of course, there was no opportunity. We were quite poor. We lived in a “two-up and a two-downer” so we had very little cash. My father was an asthmatic so for every year there was three months he never worked. They were the days where you didn’t have no back up – if you didn’t have any money, you didn’t eat, unless you had a good mother like I had that saved a bit for the rainy day. So when I got to 14, I had to go out to work. There was no way that I could be educated. I say today, I do wish I’d had higher education, how wonderful it is! You people don’t know how lucky you are not being pushed out to work at 14.
‘I had no way of doing higher education. I left school and I went to work as an “Under Children’s Nurse”. I worked with two nannies – a “Princess Christian” and a “Truby King” [different schools of thought on nursery nurse training] – quite different ideas. One believed in warmth and one would bathe the baby in front of an open window!
‘Now, when the war came, there was an opportunity to nurse even though you had no qualifications. You had to take a hospital exam – sort of general knowledge – that’s how I got through. I volunteered. They were asking for people to go and nurse because of the war. There was this big notice in the hospital – a picture of a naval nurse with a big hat that gave the image of a nurse – and it said, “WHY NOT JOIN US? – COME IN NOW”, or something like that. It was a booking office. I said to my mother, who was taking me up there for treatment for my ears, “Come on, let’s go in and see what it’s all about.” And I said to the man, “I want to nurse.” I think he could tell how keen I was so he pointed me in the right direction. And that’s how I got called up. I did the SEN training [State Enrolled Nurse training, a less academic course than the SRN, State Registered Nurse training course]. I loved it, loved it!
‘When they started up a midwifery school, Matron asked me if I’d like to do my training and I said, “Oh yes.” I wanted to learn and I was so keen. I didn’t want to go out when the other girls did, I just wanted to stay in, go over me notes and study. As soon as we came off duty, my friend – who was like me and from up North – and I, we’d say, “Let’s go and have a bath”, and then one night we’d go to her room, one night we’d go to mine and we both went onto the bed and we’d study. There’s quite a bit to learn isn’t there? So that’s what we did.’
Other midwives described having to learn long chunks of textbooks by rote. This situation persisted throughout the 1950s, 1960s, and 1970s. There was little encouragement to question or debate issues. In effect, in pre-NHS days, as now, much of the learning took place while on placement in the community. The quality of the learning experience depended to some extent on the teaching skills of the community midwife and the relationship between student and teacher. Esther S. described the limitations imposed by class differences between her and her somewhat aloof community midwife:
‘My midwife, Mrs T., she was very prim. She had a daughter named Deirdre – “Deirdre,” I thought, “What a name!” She used to say it like ‘Dayahdray’ [posh accent and laughter]. And I’m so ordinary and there’s this “Deirdre” at boarding school and everything. Every morning we’d sort the work out, which meant that yours truly did the work and she’d come in and organise me. “Oh, yes … yes, Nurse …” [Autocratic tone of voice] She had no sense of humour and she was very proper.’
An authoritarian approach to midwifery teaching was described by many of the midwives we interviewed. These extracts from the unpublished autobiography, Storks Nest by midwife Mary Thomson, vividly describe the first days of training at Rotten Row Hospital, Glasgow, in the early 1930s:
‘And then rustling along the corridor she (the tutor) came. Like a starched and goffered advertisement for somebody’s laundry, she swooped down upon us with perfection streaming from the crown of her small, white cap to the bows on her highly polished shoes. Her long, straight back was held stiff and unyielding, and she bristled all over with efficiency. It flew from her like electric sparks and shocked us into breathless wonder. She looked down her long, thin nose at us, and like the Ancient Mariner “she held us with her glittering eye”. Her gaze wandered over each of us in turn, and what she saw didn’t seem to please her much for she shook her head sadly and managed to sap the last ounce of self respect that had survived the onslaught of Sisters Lindsay and Martin …
‘“Well, now that you are here, I hope you are prepared for hard work and study,” she said, as if she had finally made up her mind to make the best of a bad job. She spoke quickly and her words tumbled over each other like a cataract. “I hope you all have your textbooks and copy books ready for your first class tomorrow morning at nine o’clock sharp and remember, I don’t tolerate latecomers to lectures and tutorials, which will be arranged for your off-duty periods, and except for illness, no excuse will be taken for missing any one of them, and don’t forget you are here to learn and I am here to teach and if any of you are not prepared to comply with my methods you would be better to say so no
w and take yourselves off before it is too late, and now if you are all ready, I’ll take you round the hospital.”
‘The next day she continued by proceeding “to give us a short talk”. She began by criticising the way we had put on our uniforms and said we looked like a set of trollops. We would have to tighten up here and let down there, and as for our hair, that just about gave her a fit. We must all get it pinned tightly back from our faces and we were not to come into her lecture room looking like a set of street women.’
Mary’s high ideals of becoming a ‘ministering angel on a mission of mercy’ were soon shattered:
‘What did I find? I found what every other nurse finds in those first few weeks – that scrubbing, cleaning, polishing, sluicing, bed-panning, and who the hell do you think you are and what the devil are you doing here attitude from seniors, are the basic laws on which ministering angels are created … The new pupil is always beneath the notice of seniors and superiors. She is just a pair of hands for thrusting mops and dusters into and a pair of feet for scampering up innumerable flights of stairs and trekking miles and miles of corridors. She is Sister’s sore head and Staff Nurse’s pain-in-the-neck, and if she never had an inferiority complex before, she will certainly develop one before the first week is over.’1
Midwifery training was clearly physically demanding and, it would appear, intellectually unstimulating. Midwives described a situation in which most formal teaching took place in off-duty periods. This could mean spending a day at lectures having had no sleep the previous night. Student midwives were left to work on their own from early on in their training, particularly on the district, and all the midwives said that this was a most valuable preparation for ‘being a practitioner in your own right’.
Organisation of services
In the 1920s, once a midwife qualified, she could work in a variety of settings, including maternity hospitals (voluntary hospitals); in maternity departments of Poor Law Infirmaries (about to be renamed Local Authority or Municipal Hospitals under the Local Government Act of 1929); and in small maternity homes and newly built small hospitals. She could also work as a district midwife employed by local authorities; as a municipal midwife employed by nursing associations; as an independent (self-employed) practitioner; or, finally, attached to large teaching hospitals.2
The midwives we interviewed had worked in many of these areas. At the beginning of her midwifery career, Mary W. worked as an independent midwife on the district in the Yorkshire mining town where she grew up. As today, independent midwives would have to buy all their equipment, and the financial returns could be precarious since they were dependent on the number of bookings available. However, in the early 1930s, independent midwifery was the only option available to Mary W., as she explains:
‘One of the reasons I went on to the district was because at that time no married woman, unless she was a widow, was employed in a hospital. [This was because midwives had to live in the Nurses’ Home.] District midwifery was the only thing you could do – or district nursing. As a married midwife, it was the only thing left for me to do. But I never really wanted to go back into hospital once I got used to the district because there’s a lot to be said for being an independent practitioner. Of course, the supervisor used to come round, but not very often, and you were your own boss in a way – got used to your own village, your own practice and doctors. We were on call 24 hours a day – if you got a call in the night, you still had to do your day’s work the next day. In my biggest year, I did 99 cases, but usually about 80. It varied according to population. It was very satisfying being an independent practitioner.’
In pre-NHS days, community midwives who were not working independently were employed by nursing associations, as retired midwifery tutor Mollie T. explains:
‘Prior to ‘48, there were many charitable and religious organisations that contracted to the local authority to provide a midwifery service. In the 1930s we lived in a small village on the Kent coast, and we had there what was called a “Jubilee Nurse”. These Jubilee Nurses were women who were selected from the villages, as being competent and sent to train at Plaistow Maternity Hospital as midwives. They were given a smattering of nurse training and sent back to their villages and the money that paid for this came out of Queen Victoria’s Diamond Jubilee Fund. You know, their safety record was quite excellent.
‘In our village, she was always called either by her surname, or “the Jubilee”. She had got terrible “white leg” which must have been from childbirth followed by pelvic infection, and she used to get around the village on her own two feet, puffing and blowing and she must, at the time I remember, have had a heart condition, for she was always distinctly blue on exertion. And my mother always used to tell me to go and get a chair for Mrs. So-and-so. Most people said, “Oh, the Jubilee’s here. Get a chair for her leg.”
‘She used to cover quite an area, at least two other villages along a seven-mile strip of the coast. She must have got there either by lifts or people coming to get her. She was in no state to cycle.’
When Elsie B. worked as a district midwife in Devon in the 1930s, she was employed by a Nursing Association:
‘I’m only talking about Devon now, but other counties were the same. You had a Devon County Committee, which was based at Exeter. A county medical officer used to deal with the midwifery and you also had a midwifery inspector, and one for health visiting. You then had Nursing Superintendents – who you now call Nursing Officers and all sorts of funny names! We had a very good one and two assistants. But each area had its own local Nursing Committee [Association]. They used to collect subscriptions from people who belonged to this area. The people then got a free service for general nursing services. They paid, if I remember rightly, about one pound and five shillings for each confinement if they were members of the Nursing Association. And then we got our pay from the Association.
‘You were on full call with half a day a week off and three weeks holiday a year in those days. It used to work out about 90–100 deliveries a year. The most deliveries I did in one day was four in 24 hours. In all I delivered over 2,000 babies. You did the antenatal, delivery and full postnatal nursing, so you followed the women all through, which was nice. One area I worked you had 28 miles of road in the parish and you rode a bicycle.’
With the coming of the Second World War, Nellie H. changed from private practice to become a ‘council midwife’:
‘After I’d finished my training and worked for a while on the district, my sister asked me to come and join her working at Leigh-on-Sea in Essex. We had our own private business there, nursing and midwifery. We were there for quite a few years but then, of course, the war came. I didn’t want to stay there doing nothing much in particular ‘cause there wasn’t much work, so I said to her, “Well, I think I’m going to try to get a job somewhere. What about you Rosie?” “Oh, I’m going to stop here and look after my mothers, never mind about the war,” she said. I applied to the council. They were always glad to get hold of anyone those days. I s’pose we’d got the reputation because when the doctor from Southend-on-Sea came to see us, he said, “Would you like to be evacuated with about 50 mothers?” So I said, “Oooh – well, I don’t know, I s’pose I could manage it.” “Oh yes,” he said, “You’ve got a very good reputation here you know.”’
These reminiscences give an indication of some of the advantages and disadvantages of midwifery practice before the establishment of the NHS. Midwives worked long hours with little time off, but in return they had the satisfaction of providing continuity of care for their clients using all their midwifery skills.
Payment for maternity services
Home births were cheaper than hospital births and, subsequently, they had lower status as far as some people were concerned. Middle-class women tended to opt for the maternity home or hospital care, presumably on the assumption that higher fees assured better care. Edie B. remembers the charges in the maternity home where she worked in the 1920s:
In Nellie H.’s private nursing home in the south of England just before the Second World War, the financial arrangements were as follows:
‘We used to charge £5 every time a baby was born – £5 and the mothers stayed in a fortnight. We looked after them night and day – £5 – for everything! The middle-class women paid the same but they gave you good presents!’
Private enterprise flourished in the private nursing home where Mary W. worked during her training in the early 1930s:
‘This nursing home belonged to the matron herself, you know. She was the proprietor, and there we had various prices for rooms. And the women in the most expensive room never went home before a month. Matron used to stand at the bottom of the bed and she would say, “You know the doctor and I have been having a little talk and he thinks you’d be much better if you stayed another fortnight.” More money, you see!’
Women who could afford the fee often chose to book the services of a doctor for a home birth. In the early part of the twentieth century, problems arose when a doctor needed to be called in an emergency and people could not afford to pay the fee. After 1919, a system operated whereby the local authority was obliged to pay the doctor’s fee in the first instance and would recover the costs later from the patient if possible. Before 1919, midwives were forced to pay the fee themselves when their clients could not afford it – or else face disciplinary proceedings and possible removal from the register if they did not fulfil the requirements of the rules by sending for medical aid. Elsie B., a district midwife working in Devon, recalls:
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