Childbirth in the 19th century
In the 19th century, Māori women were most likely to give birth in a specially constructed shelter. The tapu or sacredness of birthing mean that it could not be performed in an ordinary dwelling. The umbilical cord was tied with flax fibre or thin stems of makahakaha, a creeper which grows on sandy beaches. The cut end would be smeared with oil (titoki).
In the 19th and early 20th centuries, most Pākehā women gave birth at home supported by midwives, family or neighbours. Midwives often stayed in the house for days before and after the birth. Middle-class women sometimes engaged a doctor if they could afford to do this. Women also gave birth at small, private maternity hospitals (usually in urban areas) run by doctors, nurses or midwives.
Most midwives were lay practitioners without formal training. They gained skills by having their own children or working with experienced midwives.
Government concerns about high maternal and infant death rates led to the compulsory training and registration of midwives in 1904. New hospitals (known as St Helens hospitals) provided subsidised maternity care and midwifery training. Women could give birth in the hospitals or use their midwives at home. Registered midwives managed most births. Doctors were called if complications arose. Lay midwives gradually disappeared.
Male and female midwives
A midwife is a person trained to assist women during pregnancy and childbirth. The name is derived by adding the Middle English word ‘mid’, meaning ‘with’, to ‘wife’, a woman. Midwives have traditionally been women, though male midwives have existed in small numbers. In 2004 there were nine male nurses with midwifery training and two who were midwives with nursing training in New Zealand, compared to 3,584 female registered nurses with midwifery qualifications and 196 female midwives.
This did not immediately result in better outcomes for women. In 1921 New Zealand had the second highest maternal mortality rate in the western world. An investigation that year found that puerperal sepsis – blood poisoning caused by bacteria entering the vagina and uterus, often via hands or medical equipment during or after childbirth – was the main cause of maternal death. The infection had been known about in general terms as ‘childbed fever’ and feared long before this.
While the Department of Health still recommended that birth should be attended by midwives, doctors thought medical care was essential. New procedures emphasising absolute sterility led to birth becoming a medical event managed by doctors in hospitals.
Deaths from sepsis fell after 1927. This was due to improved hygiene practices rather than changes in the location of births.
Home to hospital
In 1920, 65% of Pākehā women gave birth at home or in one-bed private maternity homes, often run by women. By 1935, 78% gave birth in maternity hospitals where doctors were in charge. From 1939 free maternity care was available at public hospitals. Private hospitals were subsidised and could charge additional fees. the few independent midwives could deliver babies in private homes. Only 17% of Māori women gave birth in hospital at this time, but the proportion rose to 50% by 1947.
Painless childbirth through use of anaesthetic drugs administered by doctors was an attractive prospect for women, many of whom argued for universal access to pain relief. Some doctors believed that the use of drugs would lead to increased birth rates, because women would not be put off having children.
Along with pain relief, medical interventions like Caesarean section (delivering a child through an incision in the mother’s abdomen) were associated with the rise in hospital births. Caesarean sections increased from 2.2% of births in 1930 to 5.9% in 1935.
Hospital is a foreign country
For women of some cultures, giving birth in hospital was particularly challenging if that was not the norm in their homeland. Indian women, for example, were used to giving birth at home surrounded by female relations who conducted important rituals. Immediate, close contact with the baby was expected. This was a world away from New Zealand maternity hospitals, in which women often spent most of their labour alone and were separated from their baby after the birth.
The hospital experience
For many women, giving birth in hospital was a positive event, especially if a trusted family general practitioner (GP) delivered the baby. For others it was a frightening and sometimes humiliating experience. Because of strict hygiene requirements, women were stripped and washed on arrival. Pubic areas were shaved and enemas administered to prevent contamination from bowel movements.
Women laboured in beds on their backs often with their feet in stirrups, a less than optimum position for childbirth. Busy doctors and nurses bound by strict hospital routines were sometimes unsympathetic birth attendants – some women described being slapped, verbally threatened or criticised for their performance in labour. Fathers were excluded.
Women given drugs – sometimes without their consent – were often so heavily sedated they could not remember giving birth. Some felt a sense of loss and confusion. Sedation also affected the baby.
Most women knew little about childbirth and were not much better informed after giving birth. Former Auckland mayor Catherine Tizard described her experience of birth in 1951 as a time of ‘absolute alienation from everything and everyone in the world.’1