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Reviews / Comptes Rendus
| Wendy Mitchinson, Giving Birth in Canada, 1900-1950 (Toronto: University of Toronto Press 2002)
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| WENDY MITCHINSON's book, Giving Birth in Canada, is a wonderfully rich and comprehensive social history of the controversies, practices, and realities of giving birth in Canada from 1900 to 1950, the period in which the "medicalization of childbirth" became a social as well as a legal reality. Mitchinson brings context, texture, and nuance to the professional/medical history of the physicians who supplanted the various midwives and others who had attended most new mothers in the 19th century. She argues convincingly against the romanticization of the midwife/home birth without minimizing its importance, and offers a glimpse into the professional and economic motivations behind the increasingly technologized model of medicine as it applied to childbirth. |
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In the context of much medical history which stubbornly refuses to recognize any but "professional" birth attendants, Mitchinson's exhaustive and well-researched portrayal of the early 20th-century birthing chamber in which midwives, nurses, and other helpers played a vital role, is a breath of fresh air. With the exception of Newfoundland where the British model of regulated midwifery was in force, the Canadian medical profession had successfully legislated female midwives out of official existence several decades before the first half of the 20th century. Having been forced underground, this was a disparate group of women. Sometimes the midwife or nurse was a frightened neighbour woman pressed reluctantly into service in an isolated community where no doctors practiced. In some cases she had acquired informal training by watching other births and learning from an older midwife. Often working to the point of exhaustion for Canadian families who could not afford to pay the physician's, or indeed any, fee, these women received scant remuneration. They had a strong presence in poor, isolated, immigrant, and Aboriginal communities. A few were exceptionally well-trained nurse-midwives who had emigrated from Britain or a European country where midwifery training was available. They were employed by agencies such as the Red Cross, Victorian Order of Nurses (VON) and Newfoundland Outport Nursing and Industrial Association (NONIA) and provided the labouring woman with service that was often superior to the physician's. All worked without legal protection of their midwifery work or official recognition. |
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Examining medical journals and internal disputes, Mitchinson also lets the doctors speak for themselves. She brings some interesting themes to life such as the resiliency of popular beliefs, shared by midwives and physicians alike, surrounding birth. Rather than questioning such folklore as the need for complete bedrest for ten days following delivery, and the belief that maternal impressions could mark a child, physicians used the language of science to validate them. Doctors' faith in the efficacy of science was just that: faith. |
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Physicians' debates on the nature of childbirth reflected the social ambivalence surrounding birth and medicine, particularly the increasingly technologized approach to medical care, and a heavy measure of economic self-interest. Some obstetricians posited that childbirth remained a natural function only for "uncivilized" women such as Aboriginals or "peasants" — fictional giants who could apparently work long days in the fields, squat down to have their babies, and be back at work within hours! By contrast, modern, educated, and sedentary women — those living the equally fictional middle-class domestic ideal — experienced childbirth as rife with pain and risk. Glancing jealously at more prestigious and higher-paying specialties such as surgery, physicians were anxious to ride their white horses, clad in shining armour glowing with the aura of science, and rescue womankind. Not all physicians agreed, however. Some saw birth as a natural process best left to follow its own course, and contested the increasing level of intervention. Many also lamented their own lack of hands-on training, and some borrowed heavily from the midwife's practical expertise as they gained ascendancy over the field. Mitchinson reminds us that some midwives, particularly those with formal training, also intervened in difficult births. However, it is equally clear from her case file evidence that physicians resorted to medical intervention much more frequently. These interventions often had a kind of spiral effect, with one intervention leading to another. As well, physicians were particularly keen to "do something" — whether it be forceps, inducing labour, or caesarian-section — for their paying patients. |
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Due to inadequate sources and its professional focus, the book tells us less about the average Canadian family's experience of childbirth. In her efforts to de-mythologize the home birth, the author sensibly points out that many working-class homes provided rude and inadequate birthing facilities compared with the hospital where a weary mother could get rest and professional care. However, the latter was hardly an option for most Canadian women, especially the geographically and economically disadvantaged who could not even afford the legally sanctioned physician to attend them, let alone consider going to a hospital — except perhaps as charity cases. Most took their chances with a nurse, midwife, or neighbout who would help them deliver at home and provide nursing services. One of the ironies of this story, as Mitchinson so aptly points out, is that the health and safety, if not the comfort, of these poor mothers was probably in better hands than that of their wealthier urban sisters. Maternal mortality rates remained considerably higher for physician-attended, than for midwife/nurse-attended births, until the 1940s, when other factors, including the introduction of antibiotics came into play. |
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What was the official response to the news that midwives had a better record? Physicians argued among themselves as to whether their own interventions might be causing the problem, and hospitals stepped up measures to prevent cross-infection. But, in their public face, both tried to explain away and/or suppress the unflattering information. Complicit in this conspiracy of silence were the very same public health authorities, nurses, and middle-class women health reformers who facilitated the many unsanctioned nurse midwife-attended births throughout parts of Canada. These women did indeed share with physicians a belief that science and technology could improve maternal health. However, I found Mitchinson too quick to lump them all together. It is not just a question of science, but of power. Many women reformers did complain about physicians' neglect of maternal health, and some even gave voice in public documents to the disparity in maternal mortality statistics. Like many women's voices, however, they were simply not listened to. Again context is everything. Having tried unsuccessfully, in the decades prior to 1900, to rehabilitate the midwife and improve training, reformers had little choice but to back the medical profession, with its by then well-entrenched medical monopoly. Not until the second wave of Canadian feminism would midwifery re-emerge, giving birthing women a real choice in their care. Perhaps midwives might yet serve to improve the poor North American maternal health indicators, relative to other industrialized nations where the midwife is not held in such contempt. |
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Despite an emphasis on the professional side of the debate, I did find Giving Birth in Canada a refreshingly comprehensive social history of childbirth. The book provides fascinating insight into the midwife/physician debate and the controversies surrounding birth and the technological model of medicine. It also touches on the social impact of granting a medical monopoly to health care workers who were both economically and geographically inaccessible, and provides background to understanding the mid-20th-century adoption of state-financed health care services, and the re-emergence of the midwife. |
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