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Midwives in Montana: Historically

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Midwives in Montana: Historically MIDWIVES IN MONTANA: HISTORICALLY INFORMED POLITICAL ACTIVISM by Jennifer Janna Hill A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in American Studies MONTANA STATE UNIVERSITY Bozeman, Montana November 2013 ©COPYRIGHT by Jennifer Janna Hill 2013 All Rights Reserved ii APPROVAL of a dissertation submitted by Jennifer Janna Hill This dissertation has been read by each member of the dissertation committee and has been found to be satisfactory regarding content, English usage, format, citation, bibliographic style, and consistency and is ready for submission to The Graduate School. Dr. Mary Murphy Approved for the Department of Liberal Studies Dr. David Cherry Approved for The Graduate School Dr. Ronald W. Larsen iii STATEMENT OF PERMISSION TO USE In presenting this dissertation in partial fulfillment of the requirements for a doctoral degree at Montana State University, I agree that the Library shall make it available to borrowers under rules of the Library. I further agree that copying of this dissertation is allowable only for scholarly purposes, consistent with “fair use” as prescribed in the U.S. Copyright Law. Requests for extensive copying or reproduction of this dissertation should be referred to ProQuest Information and Learning, 300 North Zeeb Road, Ann Arbor, Michigan 48106, to Whom I have granted “the right to reproduce and distribute my dissertation in and from microform along With the non-exclusive right to reproduce and distribute my abstract in any format in Whole or in part.” Jennifer Janna Hill November 2013 iv TABLE OF CONTENTS 1. INTRODUCTION .................................................................................................................................... 1 Historiography and Methodology ................................................................................................ 19 2. REPRODUCTION IN MONTANA .................................................................................................... 28 Early Montana ...................................................................................................................................... 32 Homestead and Depression-Era Birth ....................................................................................... 43 “Modern” Montana Birth .................................................................................................................. 52 3. THE MAKING OF MIDWIFERY ....................................................................................................... 64 The History of Midwifery ................................................................................................................. 65 Institutional Birth ............................................................................................................................... 78 The Challenge to Medical Bureaucracy ...................................................................................... 80 4. MONTANA MIDWIFERY ................................................................................................................... 90 Missoula, Montana .............................................................................................................................. 94 Respect .................................................................................................................................................. 101 Empathy ............................................................................................................................................... 103 Connection .......................................................................................................................................... 105 5. THE EXEMPTION .............................................................................................................................. 110 1989 Legislative Session ............................................................................................................... 117 The Lobbying Process .................................................................................................................... 123 The House of Representatives .................................................................................................... 125 Rural Access ........................................................................................................................................ 128 The Senate ........................................................................................................................................... 134 6. LICENSING IN THE LEGISLATURE ........................................................................................... 148 The Secrets of Success .................................................................................................................... 155 Gender ................................................................................................................................................... 157 Montana Identity .............................................................................................................................. 160 7. CONCLUSION ...................................................................................................................................... 165 v TABLE OF CONTENTS-CONTINUED APPENDICES ........................................................................................................................................... 177 APPENDIX A: Computation of Maternal and Infant Statistics ....................................... 178 APPENDIX B: Annual Maternal Deaths, 1920-2009 .......................................................... 181 APPENDIX C: Puerperal Fever in Montana, 1921-1925 .................................................. 184 APPENDIX D: Birth and Infant Death Rates by Race, 1989-2011 ............................................................................................ 187 APPENDIX E: Births by Location and Attendant, 1954-2009 ....................................... 192 APPENDIX F: Montana’s Rural Population per U.S. Census Bureau, 1900-1990 .................................................................... 195 APPENDIX G: C-Section Rates in the United States ........................................................... 197 APPENDIX H: Current Infant Mortality Rates by Country .............................................. 200 APPENDIX I: 51st Legislative Session Members ................................................................. 204 APPENDIX J: HB 458 Calendar of Activity ............................................................................ 209 APPENDIX K: HB 458 Text and Amendments ...................................................................... 211 APPENDIX L: Legalization of Direct-Entry Midwifery ..................................................... 217 BIBLIOGRAPHY ..................................................................................................................................... 222 vi LIST OF TABLES Table Page 1. Birth Data, 1910-1920. ......................................................................................................... 180 2. Maternal Deaths, 1920-2009. ............................................................................................ 182 3. Causes of Death, 1921-1925. ............................................................................................. 185 4. Puerperal Deaths, 1921-1925. .......................................................................................... 186 5. Infant Birth and Death by Race, 1989-2011. .............................................................. 189 6. Native American Birth and Death Percentages, 1989-2011. ............................... 190 7. Birth Location and Attendant, 1954-2009. ................................................................. 193 8. Montana’s Rural Population, 1900-1990. .................................................................... 196 9. U.S. C-Section Rates, 1997-2007. ..................................................................................... 199 10. Infant Mortality by Country, 2013. ............................................................................... 201 vii ABSTRACT States contiguous to Montana legalized direct-entry midWifery only in the 21st century, While the Montana legislature exempted lay midWives from the Medical Practice Act during the 1989 legislative session and approved a licensing protocol for Certified Professional Midwives in 1991. Midwives in Montana examines the historical context of the legalization of midWifery in Montana and identifies significant individuals, groups, and events in the confrontation over home birth in the state. Based on oral histories of legislative participants and draWn from primary and secondary source materials held by individuals and institutions throughout the state, this research compiles scattered documentary evidence to present the history of Montana midWives from territorial days through the legislative events of 1989 and 1991. The efforts of midWifery supporters in the Montana legislature prevailed over organized and well-funded opposition from individual physicians, medical organizations, and hospitals, and resulted in statutory changes that enabled the licensing of homebirth midWives. With a strong rural representation, the 1989 legislative body supported the availability of midwifery care for constituents unable to access urban medical
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