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Modernizing Midwifery: Managing Childbirth in Ontario and the British Isles, 1900–1950

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Modernizing Midwifery: Managing Childbirth in Ontario and the British Isles, 1900–1950 Wilfrid Laurier University Scholars Commons @ Laurier Theses and Dissertations (Comprehensive) 2018 Modernizing Midwifery: Managing Childbirth in Ontario and the British Isles, 1900–1950 Gwenith Cross [email protected] Follow this and additional works at: https://scholars.wlu.ca/etd Part of the Canadian History Commons, European History Commons, History of Gender Commons, History of Science, Technology, and Medicine Commons, Social History Commons, and the Women's History Commons Recommended Citation Cross, Gwenith, "Modernizing Midwifery: Managing Childbirth in Ontario and the British Isles, 1900–1950" (2018). Theses and Dissertations (Comprehensive). 2035. https://scholars.wlu.ca/etd/2035 This Thesis is brought to you for free and open access by Scholars Commons @ Laurier. It has been accepted for inclusion in Theses and Dissertations (Comprehensive) by an authorized administrator of Scholars Commons @ Laurier. For more information, please contact [email protected]. MODERNIZING MIDWIFERY: MANAGING CHILDBIRTH IN ONTARIO AND THE BRITISH ISLES, 1900–1950 by Gwenith Siobhan Cross Bachelor of Arts, Auckland University, 2005 Bachelor of Arts, University of King’s College, 2007 Master of Arts, Dalhousie University, 2009 THESIS/DISSERTATION Submitted to the Faculty of Arts and Department of History in partial fulfilment of the requirements for Doctor of Philosophy in History Wilfrid Laurier University © Gwenith Siobhan Cross 2018 Abstract This dissertation considers the differences, as well as the similarities, between midwifery and childbirth practices in Ontario and in Britain in the first half of the twentieth century. Addressing the modernization of medical practices on either side of the Atlantic, the periodization of this project reflects the increasing concerns about maternal and infant morbidity and mortality alongside medical and political attempts to ensure the involvement of trained medical professionals during pregnancy and childbirth. In Britain, the establishment of the 1902 Midwives Act regulated midwifery so that only midwives approved by the Central Midwives’ Board were allowed to practice. British midwives helped to improved maternal and infant health and welfare by making childbirth a co-operative, medically-managed event in conjunction with physicians. The medical training of midwives and physician support meant that British midwives thus participated in, and contributed to, advances in obstetrics through their access to obstetrical medicine and technology. In contrast, physicians in Ontario worked to exclude midwives from participation in the modernization of birth management, emphasizing a physician-exclusive concept of “medicalization”. Under Ontario legislation, only physicians were legally allowed to act as primary attendants during childbirth, and nurses and midwives were prohibited from practicing midwifery. Nurses and midwives in Ontario, unlike their counterparts in Britain, were excluded from developments in obstetrics. This study challenges the medical profession’s claims that the exclusion of midwives in Ontario was necessary for maternal safety or the medicalization of childbirth. The British alternative, where midwives were seen as partners rather than obstacles, illustrates that medicalization in the interest of maternal and infant safety could be integrated, effectively and efficiently, with the work of midwives. By ensuring that midwives were trained medical professionals with access to obstetrical medicine and technology, greater numbers of British women had widespread access to affordable medical attention during childbirth, at an earlier date, than was possible for Ontario mothers having to deal with the physician-centred model. Comparative maternal and infant mortality statistics for the first half of the twentieth century indicate which was the more effective approach in saving mothers and babies. For my father, Dr. James Cross (1937–2006) Acknowledgements It is impossible to complete something as lengthy as the PhD without support from many individuals, and it is my pleasure to offer long overdue thanks to some of the people who have made this project possible. First and foremost, I would like to thank my supervisor, Dr. Cynthia Comacchio. She has provided invaluable feedback since this project’s nascent stages, read numerous drafts, and given the guidance to help me transform partial ideas into viable arguments. On top of her tremendous academic supervision, she has given encouragement in the form of cupcakes and good books. Her unwavering support (for a project that likely appeared at times unending) has made all the difference. My committee members, Dr. Heather MacDougall and Dr. Tracy Penny-Light have offered guidance from the very beginning of my doctoral studies and throughout every stage of research. They have encouraged me to pursue resources and studies I may otherwise have overlooked, and this project is richer for their involvement. I would also like to thank the many librarians and archivists who have provided their assistance. Their knowledge and expertise helped me to navigate the collections and strengthened my research. They also shared my joy at surprising discoveries: an unopened box of chloroform capsules, fabric swatches for nurses’ uniforms, and pre-cut patterns for ‘breast slings’. Chatting with the archivist about the potential efficacy of 75- year-old chloroform remains one of the highlights of my research trips. There are many friends and colleagues who have supported me throughout this project. In particular, I would like to thank Alistair Edgar, Anthony Gus Hampton, Michaela Ramsden, and Jeremy Wiebe for your encouragement and chocolate. I am also fortunate to have had the support of my siblings and family. To my sister, Megan Boyko, you have been my sounding board over the years and I owe you so much—and probably a new phone battery. Finally, I would like to thank my parents: Cilla Cross and Dr. James Cross (1937– 2006). My father’s academic pursuits made the rest of us believe it was possible. This dissertation is dedicated to him. Contents Tables and Figures vii 1. “Like the study of snakes in Iceland”: 1 Unlicensed Midwifery and the Medicalization of Birth 2. “Mine Was a VON Baby”: 39 The Role of the Visiting Nurse in Maternity Care 3. From Sairey Gamp to State Certified Midwife: 70 The Professionalization of Midwifery in the British Isles 4. “A great help to all mothers”: 124 British Midwives and Analgesics 1930–1950 5. “Need Our Mothers Die?” The Great Depression and 170 State Concerns about Maternal and Infant Mortality 6. “The First Servant of the State”: 199 Professional Discourses on Maternity Concerns 7. Conclusion 221 References 226 vii List of Tables Table 1: Victorian Order of Nurses, Maternal Death Rates 58 Table 2: Central Midwives’ Board Examinations 89 Table 3: Administration of Gas-Air Analgesia in Labour 154 Table 4: Trend of maternal mortality in Canada and 184 certain other countries maternal deaths per 10,000 live births Table 5: “Total Death Rates per 1,000 Births from 194 all Causes connected with Childbearing” List of Figures Figure 1: Victorian Order of Nurses, “Hour by Hour” 67 Figure 2: National Birthday Trust Fund Chloroform Capsules 136 Figure 3: The Minnitt Gas Air Apparatus 142 Figure 4: Queen Charlotte’s Gas-Air Analgesia Apparatus 145 Figure 5: “Queen Charlotte’s” Gas-Air Analgesia Apparatus Model “C” 147 Figure 6: Midwife Transporting Analgesic Gas-air Machine by Bicycle 149 Figure 7: National Birthday Trust Fund, Breathing Apparatus 150 1 1 “LIKE THE STUDY OF SNAKES IN ICELAND”: UNLICENSED MIDWIFERY AND THE MEDICALIZATION OF BIRTH In 1904 the English journal Nursing Notes and Midwives’ Chronicle published a series of articles on “Foreign Midwives and Their Work,” which outlined midwifery regulations and practices in countries across Europe and around the world. Before addressing midwifery in each Canadian province, the author offered the following commentary: “We will now turn to a short summary of the present state of Colonial midwifery, merely noting in passing that an investigation of the subject shows that, like the study of snakes in Iceland, there are next to none.”1 From a legislative perspective this assessment of midwifery was strikingly accurate for Ontario. In 1897, with much physician support, the Ontario Liberal government of Arthur Sturgis Hardy criminalized midwifery.2 While unlicensed midwives did continue to practice in the province, their work could not be officially recognized. Beginning in the early nineteenth century and gaining prominence during the interwar years, an active campaign, by the Ontario Medical Association and the provincial Department of Public Health, promoted physician-attended birth as the only safe option for expectant mothers.3 Nevertheless, 1 J. Wilson, “A Postscript to ‘Foreign Midwives and Their Work,’” Nursing Notes (April, 1904), 55. 2 The Ontario Medical Act, Revised Statutes of Ontario, 1897, c. 176, s. 49. 3 Although local health boards of health were established in response to infectious disease beginning in 1832, these boards were disbanded following the infection and offered no continuity of effort. The long-term commitment to public health was established with the Ontario Department of Public Health as part of the Public Health Act (1882). This Act was inspired in part by a similar response to public health in the United Kingdom and the Public Health Act for England and Wales (1875). The 2 hospital births were not predominant until the late 1930s and both unregistered
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