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23rd October 1956.
Dear Dr. Tizard:
You have asked me to make a statement for discussion relating to the problem,—Should a mother have her baby in hospital or at home?
It would be generally agreed that this is one of those problems which must be approached from several diverse angles; no one answer can be given, and what you have asked me to do is to speak from the point of view of the psychologist.
The psychologist is concerned with the mother as a person and
with the baby as a human being starting on the long road of emotional development.
The Mother.
The essential feature from the mother's point of view when she is about to have a baby is that she shall have confidence in a doctor and also in a nurse. The team is not good enough. Confidence here means that she can take it for granted that what is known in medical science will be applied. I am referring particularly to the physical side of midwifery. The best psychology for a prospective mother is confidence on the physical side. So much of psychology can work itself out naturally if the setting is reliable. This does not mean that nothing must ever go wrong, because a mother is quite capable of accepting human fallibility provided she has had time and opportunity to gain faith in the person who is responsible.
These conditions can be fulfilled in a hospital, but in practice they are more likely to be fulfilled when the general practitioner is able to take responsibility. What is obvious in the small town is also true in the large town, although in the latter case the general practitioner's position tends to be weakened by the existence of specialist clinics.
There are prospective mothers who are apprehensive by nature, and who therefore feel more confident in a clinic, always provided that they are treated as persons and that they know the personnel. Every advantage that can be gained from a clinic on the psychological side can be wiped out, however, if the relationships are impersonal, or if the management is mechanic