Fifty years ago, Sir John Gorst, one of Britain's most notable advocates of child welfare, inspired the infant Labour Party with its first two Acts of Parliament—school medical inspection and the feeding of poor children. In 1906, in a book called "Children of the Nation", he showed that the death rate among mothers was nearly five per thousand and among infant children 150 per thousand—and in the poorest parts of England as much as 500 per thousand. Britain today has reduced the maternal death rate to one-tenth of that figure and the infant death rate to under one-seventh, and the differential death rate as between rich and poor children has practically disappeared.

It is impossible to express these statistics in national wealth and human happiness. Many factors have contributed to this great achievement—doctors, medical discoveries, ante-natal and post-natal care, full employment, and the National Health Service among them. I want to speak tonight of one factor: the noble army of midwives. I hope they will never change their Anglo-Saxon name for a modern fancy one. The midwife is the one who is with the mother when she performs her sublimest function. I want to ask the Mother of Parliaments to pay a well-deserved tribute to those who assist the mothers of Britain and to urge the Government to make that tribute a real one by improving conditions in the midwifery profession.

The work of midwives falls into two branches—some work in the hospitals and the others, the domiciliary midwives, in our homes. Nearly all of them are State-registered nurses with extra qualifications in midwifery. All are qualified in midwifery. Their work includes care of mother while baby is on the way, delivery of the baby, and care and training of the mother after childbirth. Modern science with gas and air on the one hand, and trilene on the other, have helped the midwife to help the mother. The old, crazy idea that pain at childbirth was part of the curse of Eve has been replaced by the ways of modern science. Some 90 per cent. of all mid-wives are trained and skilled in the use of analgesia, and I would congratulate the Ministry on the great work they have done in making these new resources of science available to the midwives.

Incidentally, midwives have delivered during the post-war infant "bulge," which is so well-known to educationists, some extra 1,250,000 children, and I hope that both education and health Ministers have noted that a second bulge began two years ago and that it appears that the birth rate is increasing by over 40,000 a year.

There is a shortage of midwives, both hospital and domiciliary, and there always has been. But the simple national picture at the moment is that there has been a slight decline in the total number of midwives between 1955 and 1957 but that 53,000 more babies were born in 1957 than in 1955. A bad position has become worse.

The shortage varies from area to area. I am glad to see the hon. Member for Stalybridge and Hyde (Mr. Blackburn), a keen supporter of the midwives' claim, here tonight. I remember that my hon. Friend the Member for Sunderland, North (Mr. Willey) recently spoke in the House of a shortage of one-third of mid-wives in Sunderland. Sheffield Regional Hospital Board, out of 63 maternity units, have 11 with a 50 per cent. deficiency and 26 with a 20 per cent. deficiency. In 1957–58, they had to close three units. There are grave shortages in the domiciliary service in South Shields, Manchester, Middlesex and Hertfordshire. I pick these out only as examples; they are no reflection on the regional boards or the local authorities concerned.

In the ten years since the National Health Service was introduced, the number of midwives dropped from 17,095 to 17,006, but 1,250,000 extra babies have been born. My own local authority is an excellent one, as is the local hospital group, but I am informed that my home town has two vacancies for midwives which have been advertised for three months without a single applicant. Portsmouth advertised a vacancy for a year and had only one applicant. From other local newspapers, I quote: a shortage of mid wives in Smethwick threatens the continuance of the domiciliary midwife services in the town. Seven midwives left in 1957. Only two were replaced. From another part I quote: A serious shortage of trained practising midwives is worrying the Sheffield Regional Board. Of the annual output of 2,600 trained midwives only half practise and fewer than one third are in practice after three years. A new maternity unit was completed at Spalding last May. By last November the local Press was reporting that it could not be opened because there were no midwives. The shortage creates a vicious circle. Midwives are overworked. They are supposed to have 36 hours a week off duty and five weeks holiday a year. In actual fact, they rarely get two consecutive nights off call. They get their holidays only by other midwives undertaking double districts during their absence, and when they return from holiday they return to do a double duty to enable some other midwife to have a holiday.

The supervisory midwife in a town, who is supposed to organise a local service, often finds herself out on field work, filling in for midwives while on holidays or sick, or non-existent because of a vacancy which cannot be filled. The profession claims that a midwife ought to attend a maximum of 55 cases a year singlehanded or 66 with a pupil midwife. In my own town, 17 domiciliary midwives delivered in 1957 1,573 babies, an average of 92 per midwife. Yet Southampton is comparatively fortunate, for we have a very fine pupil 'training unit. In other parts of the country the position is worse. One midwife I know had a case at 12.15 a.m. on New Year's Day and by 6th January she had dealt with seven. Another spoke to me of working 119 hours in one week, another of 95 cases in one year, 72 of them being night cases between midnight and 6 o'clock in the morning. Youngsters choose awkward times to come into the world.

Similar overwork takes place in hospital maternity units. The number of hospital confinements rose from 395,000 in 1955 to 428,000 in 1957, in which year there were fewer midwives than in 1955. Incidentally, if we are to reduce the hospital nurses' working week from 56 hours to 44 hours, that in itself involves 3,000 extra hospital midwives.

Here are two other grave features of the shortage. One is that 50 per cent. of all midwives are over 40. It is an ageing service. The other is that while the number of pupil midwives has increased by over 1,000 in the past ten years only 30 per cent. of all who qualify practise for more than three years. Midwives simply do not remain in the service. The causes are clear.

The National Consultative Council on the Recruitment of Nurses and Midwives has recently advised the Minister about the need to make the profession of hospital midwives more attractive. I endorse their recommendations, as indeed I understand the Minister does. I hope that regional boards will carry them out. They suggest the relieving of midwives of work which can be done by auxiliaries, the organising of the hospital service so that the midwives can do work at all stages—ante-natal, delivery and lying in—and take a case right through, the need for informed advice to young nurses about the midwives' profession and the treatment of pupil midwives as adults. I am glad that the Minister has removed the shocking anomaly which downgraded qualified nurses financially during the year in which they were doing their Part II midwifery training. But all this is mere detail.

A majority of the Consultative Council's Committee went further, and it is their viewpoint that I want to support tonight. They hold, as I do, that the shortage in hospitals and, I would add, in the domiciliary service is due to the inadequacy of the salary and the few opportunies for promotion. It is here that we have to break the vicious circle of overworked midwives, and that overworking discourages the young trained midwife from entering the profession. It is not my business to suggest a salary scale. But I would mention just a fact or two. When salary scales are adjusted the midwife always seems to be at the end of the queue. For years midwives and health visitors had parity of salary. Recenty the health visitor's salary was stepped up by £50 a year, but that £50 was not given to the midwife. Both are doing important work, and I suggest to the Minister that he restore that parity.

The opportunities for promotion are small. A town needs only one supervisory midwife, and the additional salary she receives for that post is very little. Hospital matrons are graded according to the number of their patients, but the matron of a maternity unit can rarely hope to be in charge of such a number of beds as her sister matron; her task is to make a few beds serve many of the nation's mothers. Indeed, in most hospitals the position is even worse than that. There are very few maternity matrons. Most maternity units are incorporated into general hospitals under hospital matrons, and there the highest post that a midwife can hope to obtain is that of sister midwife, at £667.

I believe that the financial attractions of a profession ought to be two-fold: an adequate basic scale, and an adequate number of attractive posts for extra ability and responsibility. On both these counts, the midwifery profession's salary scale falls down. The domiciliary midwife receives £504 rising to £641 a year. On the other hand, Canada is advertising in British newspapers for midwives, offering a 40-hour week and £1,020 a year. Kenya and Uganda are offering £813 rising to £1,173 a year. I am glad that midwives are going to the far corners of the Commonwealth, but that is all right only if we are building up an adequate supply for both home and Commonwealth. Four pupil midwives left Southampton last week to go abroad.

It costs £600 to train a midwife. If we lose her from the profession of midwifery after three years, as we so often do, we have wasted the best part of our nation's investment in that midwife.

There are other hardships in the service which affect domiciliary midwives in particular. There is the problem of transport for herself and transport for the gas cylinders. There is the need for housing; a midwife who serves a district must live in it. A midwife who is giving a 24-hours-a-day service has also to look after herself and has no domestic help. Some local authorities have done much to alleviate this side of the problem, but even the best local authorities, those which do most, still face a shortage. The root problem is financial.

We have done much about childbirth to guard the nation's mothers and babies and give them ever improving opportunities, but we have by no means achieved all that can be done. It seems a great pity that what has been done so far is endangered by a shortage in this vital profession. Our achievements in this respect are, in no small measure, due to the sacrifices and devotion of an under-staffed and overworked profession.

When I was a schoolmaster, I used to read to my classes Addison's eighteenth century "Vision of Mirza"—the bridge of life with broken arches at the beginning and the arches and even the bridge itself breaking down towards the end of life. In the past fifty years, we have rebuilt the first arch of the bridge, and today almost every child that is born passes safely over the first year of life into childhood and, later, to manhood or womanhood. I am happier about that than about anything else in British life.

Mrs. Gamp died many years ago. She has been replaced in modern life by a highly skilled, scientific and kindly professional woman in uniform. All that remains now is for Britain to give the modern midwife the professional reward and status to which her work entitles her, and I hope that this debate will contribute towards that end.