District Nurses and the Central Midwives Board

A recent addition of the personal collection of Mary Doyle, Nurse Dundon McGuane, District Nurse of Brockworth, led to interesting questions regarding ownership of case registers, the history of district nurses, the Central Midwives Board and trends in pregnancy care.  It can be found on our Gloucestershire Archives online catalogue under D14737.  It’s a small collection, but covers a fascinating time in British and Irish medical and social history.

To establish context, we begin in 1902, with the passing of the 1902 Midwives Act, which was designed to regulate the practice of midwifery.  It ordered that midwives be certified practitioners and established penalties for those without certification.  The exception to this was those giving assistance in emergencies.  The act established the Central Midwives Board, which continued to exist until 1983, whereupon updated legislation and multiple mergers with other nursing organisations formed the current Nursing and Midwifery Council.  The Central Midwives Board was responsible for the regulation of the certification and examination of midwives, admission to the Roll of Midwives and annual publication of the Roll, along with regulating the practices of the midwives and the appointment of examiners.  Training would take at least three months, whereupon certified midwives were encouraged to keep case registers of their attended deliveries. These registers passed from district nurse to district nurse, each successor picking up where the last left off, often hopping across the country during her working life.

Innocuous covers, but holds information on: the name and address of the patient, her age, date of booking, and expected date of delivery; the name of the doctor, when they were booked, if they were called in case of an emergency and if they were present at the delivery; the previous number of children and miscarriages the patient has had; any antenatal care given, the date and time of the midwife’s arrival/patient’s admission; the date and hour of the baby’s delivery; the weight, sex and health of the infant; the date of the last visit/discharge; the condition of the mother after giving birth; along with any drugs given during labour and finally any additional remarks.  It’s a lot of information for such small books, and obvious why the closure periods are necessary!

The establishment of the NHS in July 1948 altered the ways midwives worked and how babies were delivered.   With the cost of an attending medical professional no longer covered directly by the patient, and doctors no longer obligated to attend a woman’s confinement, there was a gradual move from antenatal clinics to GP surgeries.  It is worth noting, however, that at this point 45% of babies were still delivered at home by midwives.  The UK remains dependent on midwives during pregnancy, with over half of all births being attended by one during labour, as compared to the U.S where the figure is only 8%.

 

Of the records produced by the Central Midwives Board, case registers from district nurses are some of the most fascinating.  Not only do they contain an insight into childbirth and how the role of midwives has changed, they also bring up an interesting question regarding ownership.  Due to the sensitive information contained within the registers, such as details of the deliveries, most are closed for 101 years with subject access only exceptions.

 

A recent accession under D14737 highlighted an interesting question over ownership of these registers.  There are two things worthy of note on the very first page of each volume.  Firstly, the registers must not be destroyed under any circumstances, as they would serve as evidence in defence of the midwife in case of any disputes over the baby’s delivery and health occurred.  Secondly, the registers were considered the property of the midwife.  Only if she were unable to keep the register was she to hand it over to “the Local Supervising Authority or to the Institution for which she works”.  This means that in some cases, registers were passed from one midwife to another, presumably once a midwife retired and another took her place, and were held long after a midwife ended her post before they made it to health authorities or archives.

 

Thus, even after the establishment of the NHS in 1948, these registers belonged to the nurses, and not the organisation to which she belonged.  As a result, these registers come to us largely through personal collections of former district nurses and their relatives, and partly through Health Authorities. The Cheltenham District Area Health Authority deposited the largest number of registers from various district nurses, totaling 339 volumes in total.  Keeping in mind that many of these registers will be closed if dated after 1918 (unless you are either the mother or the child referred to in the register, in which case a subject access request can be ordered), the various collections that contain Midwife Case Registers are available to order on our online catalogue are:

 

• D4130/1 (Moreton-In-March register of cases)
• D7174/2 – 4 (Esther Ann Roberts of Cinderford registers of cases)
• D8038/1 (Harriet Organ of the Forest of Dean register of cases)
• D14737/1 – 3 (Mary Doyle of Brockworth registers of cases)
• HA16/1/1 – 6 (M. M. Jones of Gloucester registers of cases)
• HO11/70/1 – 10 (Dilke Memorial Hospital in Cinderford held registers of cases)
• HA7/1 – 339 (Cheltenham District Area Health Authority held registers of cases)

 

In the case of the latter two, they collected case registers from their nurses over a significant period of time, rather the nurses holding on to their registers until they were given or deposited to us.  The blurry line over who owns these registers – the nurses, the hospitals, or the health authorities – show the changing methods of childbirth since the advent of the NHS, and who is considered responsible for the women and their childrens’ care during pregnancy, labour and the initial postnatal months.

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It came to my attention during the planning of this blog post that the 70^th anniversary of the National Health Service blithely passed me by and as such this topic is more relevant than I had originally anticipated.  Happy coincidence aside, this was greatly appreciated when researching topics for discussion, as there is nothing like anniversaries for causing a surge in written articles on various aspects of a topic (and here I am contributing to this deluge of information…the circle continues).