This may imply extensions of work involving serious economic considerations; but apart from such possibilities and apart from questions of housing, and of provision of additional domestic facilities for assisting the overworked mother, there is ample evidence that medical and hygienic measures by themselves can do much to relieve the excessive strain on the mother which childbearing under present conditions often involves. _The Course of Mortality from Childbearing_ The general course of mortality from childbearing (including deaths ascribable to pregnancy) in England and Wales is shown by the following table: _Average Annual Death-rates per 100,000 births from_ Puerperal Other Diseases Septic of Pregnancy Diseases and Childbirth 5 years, 1902-06 185 228 5 years, 1907-11 152 215 3 years, 1912-14 148 233 2 years, 1915-16 151 239 It will be noted that although there has been a marked decline of deaths from puerperal sepsis, the death-rate from other complications of childbearing has not declined. The decline in puerperal sepsis is general throughout the country, and evidences the greater care in midwifery both on the part of doctors and of midwives. The administration of the Midwives Act, 1902, has doubtless done much to secure this. The death-rate from conditions other than puerperal fever continues to differ greatly throughout the country. It is highest in Welsh counties, Westmoreland, Lancashire and Cheshire coming next in order of unfavourable portion; in many industrial, including textile, towns it is also excessive. The general conclusion reached by the writer in an elaborate official report on the subject is that “the quality and availability of skilled assistance before, during, and after childbirth are probably the most important factors in determining the remarkable and serious differences in respect of mortality from childbearing shown in the report.”—“The differences are caused in the main by differences in availability of skilled assistance when needed in pregnancy, and at and after childbirth.” _The Midwives Act, 1902_ This Act forbade any woman after April 1, 1906, who was not certified under the Act, from using the title of midwife or any similar description of herself. It forbade after April 1, 1910, any such woman from “habitually and for gain attending women in childbirth, except under the direction of a qualified medical practitioner”; and it forbade any certified midwife to use an uncertified person as her substitute. The Act defined the limits of function of the midwife by stating that the Act did not confer upon her any title to give certificates of death or of still-birth, or to take charge of any abnormality or disease in connection with parturition.