Changing Understandings of Miscarriage, Stillbirth and Neonatal Death in Australia in the Twentieth Century

BIRTH PAINS: CHANGING UNDERSTANDINGS OF MISCARRIAGE, STILLBIRTH AND NEONATAL DEATH IN AUSTRALIA IN THE TWENTIETH CENTURY

SUSANNAH RUTH THOMPSON B.A. (Hons)

A thesis presented in fulfilment of the degree Doctor of Philosophy School of Humanities, University of Western Australia

2 CONTENTS

ACKNOWLEDGEMENTS 4

ABSTRACT 6

LIST OF ABBREVIATIONS 7

INTRODUCTION 9

CHAPTER ONE 30 ‘The babies scarcely mattered’: Literature review and historical context

CHAPTER TWO 69 ‘A delicate girl has no right … to bear children’: The medicalisation of childbirth and discourses of responsibility and success

CHAPTER THREE 104 ‘It was as if she had never existed’: The invisibility of perinatal loss, 1940-1970

CHAPTER FOUR 136 Emerging change: The impact of theories of grief and loss

3 on constructions of perinatal death in the l970s and 1980s

CHAPTER FIVE 161 ‘I consider as much has been done as can be done’: Opposition and resistance to emerging understandings of perinatal loss in the 1970s and 1980s

CHAPTER SIX 181 ‘Awakened by angels’: re-inscribing the foetal body in the late twentieth century

CHAPTER SEVEN 203 ‘I’d just like to die with a bit of peace’: Renegotiating and reinscribing perinatal loss

CHAPTER EIGHT 221 The ‘pointless pregnancy’: reinforcing the inscription of ‘defectiveness’ at the end of the twentieth century

CONCLUSION 250

BIBLIOGRAPHY 256

4 ACKNOWLEDGEMENTS

The research and completion of this thesis was made possible through the provision of several grants and scholarships from the University of Western Australia [UWA], including UWA’s University Postgraduate Award and Completion Scholarship; the Graduate Research School travel funding; the Faculty of Arts, Humanities and Social Sciences Dean’s Postgraduate Research Award; various School of Humanities travel and conference grants; and a Postgraduate Students’ Association Conference Grant.

I owe a great debt to several staff members within the School of Humanities at UWA. First and foremost, my heartfelt thanks to my supervisors, Dr Andrea Gaynor and Associate Professor Charlie Fox, who were unfailingly supportive and encouraging throughout the entire course of this research. Both Andrea and Charlie were also wholeheartedly committed to developing my skills as a historian and university teacher, and provided invaluable opportunities for teaching and publication for which I am grateful. Associate Professor Rob Stuart has also been an unwavering source of support and his confidence in my ability as a novice historian has often helped me get through some particularly trying times throughout my time as a doctoral student.

Several individuals provided invaluable assistance throughout the course of this research. In particular, I thank Belinda Jennings, Reverend Robert Anderson, and Libby Lloyd at King Edward Memorial Hospital for Women in Perth for sharing their experiences of working with women who have experienced perinatal loss. Belinda and Libby also gave me access to unpublished documents and a vast collection of contemporary psychology and nursing scholarship. Robyn Waymouth, head archivist at the Royal Women’s Hospital in Melbourne, gave generously of her time and knowledge of the history of women’s health care at the hospital, and provided me with a space to work in the archives during my study trip to Melbourne.

I was particularly overwhelmed by the generosity and openness of the participants in the oral history component of this project. I wish to thank those women who shared their experience of losing a baby with me, either through the interview or through personal

5 correspondence and many long and open conversations. Their willingness to revisit painful memories has made this thesis possible.

I would never have been able to complete this research, much less juggle teaching responsibilities and family commitments, without the support of my extended family. Thanks to my parents, Peter and Christine Brain, instilling in me a love of learning and a (mostly) inquiring mind! Thankyou in particular to my wonderful mum who flew from Armidale to spend two weeks caring for Olivia and the running of the house at the very end of this project. My siblings, Matt and Rachael, Jonathan and Rosie, and David, have proved themselves yet again to be friends of the highest calibre, and I thank them for providing relief from the pressure of the thesis and for maintaining an interest in my work. A special note of thanks to the Pitt crew, who were supportive in so many ways! Finally, I am deeply indebted to my husband James, and daughter Olivia, my greatest champions and source of strength. Thank you for your dedication to this thesis, which has so occupied my time and energies and indeed has been the central focus of our family life for several years. It is without a hint of exaggeration that I say that this thesis would never have come to fruition had it not been for James, who willingly and cheerfully stayed at home to care for our baby, listened to me for countless hours as I worked through a particularly frustrating problem in my work, and who cheered me on to the end. This thesis is for you both, James and Olivia, and is inspired by the memory of Jude Lachlan Thompson.

ABSTRACT

Feminist and social historians have long been interested in that particularly female ability to become pregnant and bear children. A significant body of historiography has challenged the notion that pregnancy and childbirth – considered to be the acceptable and ‘appropriate’ roles for women for most of the twentieth century in Australia - have always been welcomed, rewarding and always fulfilling events in women's lives. Several historians have also begun the process of enlarging our knowledge of the changing cultural attitudes towards bereavement in Australia and the eschewing of the public expression of sorrow following the two World Wars; a significant contribution to scholarship which underscores the changing attitudes towards perinatal loss.

It is estimated that one in four women lose a pregnancy to miscarriage, and two in one hundred late pregnancies result in stillbirth in contemporary Australia. Miscarriage, stillbirth and neonatal death are today considered by psychologists and social workers, amongst others, as potentially significant events in many women’s lives, yet have received little or passing attention in historical scholarship concerned with pregnancy and motherhood. As such, this study focuses on pregnancy loss: the meaning it has been given by various groups at different times in Australia's past, and how some Australian women have made sense of their own experience of miscarriage, stillbirth or neonatal death within particular social and historical contexts.

Pregnancy loss has been understood in a range of ways by different groups over the past 100 years. At the beginning of the twentieth century, when alarm was mounting over the declining birth rate, pregnancy loss was termed 'foetal wastage' by eugenicists and medical practitioners, and was seen in abstract terms as the loss of necessary future Australian citizens. By the 1970s, however, with the advent of support groups such as SANDS (Stillbirth and Neonatal Death Support) miscarriage and stillbirth were increasingly seen as the devastating loss of an individual baby, while the mother was seen as someone in need of emotional and other support. With the advent of new prenatal screening technologies in the late twentieth century, there has been a return of the idea of maternal responsibility for producing a ‘successful’ outcome. This project seeks to critically examines the wide range of socially constructed meanings of pregnancy loss and interrogate the arguments of those groups, such as the medical profession, religious and support groups, participating in these constructions. It will build on existing histories of motherhood, childbirth and pregnancy in Australia and, therefore, also the history of Australian women.

LIST OF ABBREVIATIONS

AAPC: Association for the Advancement of Painless Childbirth

AJAN: Australian Journal of Advanced Nursing

AMA: Australian Medical Association

AMG: Australasian Medical Gazette

ANJ: Australian Nursing Journal

ANZJOG: Australian and New Zealand Journal of Obstetrics and Gynaecology

BOHP: New South Wales Bicentennial Oral History Project

CEA: Childbirth Education Association

CVS: Chorionic Villus Sampling

IMJA: Intercolonial Medical Journal of Australasia

JAN: Journal of Advanced Nursing

KCB: Karrakatta Cemetery Board

KEMH: King Edward Memorial Hospital for Women

MCB: Metropolitan Cemetery Board

MJA: Medical Journal of Australia

8 NICU: Neonatal Intensive Care Unit

NSW: New South Wales

PDMC: Perinatal Death Multidisciplinary Committee, Royal Women’s Hospital Melbourne

RWH: Royal Women’s Hospital, Melbourne

SAFDA: Support After Foetal Diagnosis of Abnormality

SANDS: Stillbirth and Neonatal Death Support group

SMH: Sydney Morning Herald

Vic.: Victoria

WA: Western Australia

INTRODUCTION

In May 1967, two women shared a room in a small private maternity hospital in Perth. Their room was situated next door to the nursery, where both women could hear the busyness of the nurses and the cries of newborn babies. These women were strangers to each other, but they shared a sad bond as mothers: one, a young unmarried woman, was waiting to give birth to a baby who would then be relinquished for adoption, despite her own misgivings. The other woman, Audrey, was recuperating after giving birth to a stillborn baby, her third child. When I asked Audrey what she remembered of her time spent in the hospital, she recalled that her baby was ‘whisked away’ and that she spent the next week recovering from a postnatal infection whilst the nurses ‘tiptoed around’ her. She then left the hospital without any knowledge as to why her baby had died, or where his remains had been buried. However, her dominant memory of this period is particularly poignant: ‘We [both] could hear the crying [of babies]. That’s all I remember of the hospital’.1

At the turn of the nineteenth and twentieth centuries, the ending of a pregnancy through miscarriage or perinatal death was an event of great regularity, and the risks to both mother and child posed by childbirth were ever-present concerns. A lack of knowledge of infection during childbirth proved fatal for many Australian women and their babies, whilst poor living conditions in cities led to large outbreaks of infectious diseases such as gastro- enteritis, pneumonia, diphtheria and tuberculosis as well as a high incidence of weanling diarrhoea, making infancy a particularly dangerous period of life.2 In the period between 1870 and 1914, 1495 stillbirths (often confused in the record with premature birth) and 5693 infant deaths were recorded in Perth alone.3 During the first three decades of the twentieth century, improved knowledge of the spread and treatment of infectious diseases saw a drop in both maternal and infant mortality rates. Particularly, advances in neonatal care, especially care for premature babies, saw the infant mortality rate begin to fall

1 Audrey, interview with Susannah Thompson [the researcher], 1 June 2005. Tapes and transcript in researcher’s possession. 2 See Michael Durey, ‘Infant Mortality in Perth, Western Australia, 1870-1914: A preliminary analysis’, Studies in Western Australian History, vol. 5, 1982, pp. 62–71. 3 Durey, ‘Infant Mortality in Perth, Western Australia’, p. 63.

10 markedly and remain stable after 1970.4 However, despite these advancements in medical knowledge of foetal development and the decline in infant mortality, miscarriage, stillbirth and neonatal death remain all-too common events in many Australian women’s (and their families’) lives. It has been recently estimated that as many as one in four pregnancies end in miscarriage and over ten in one hundred end in stillbirth and neonatal death.5

Despite the continuing incidence of miscarriage, stillbirth and neonatal death in the twenty- first century and the growing recognition that the death of a baby is likely to be an event of immense significance in a woman’s life, perinatal death remains a relatively silent subject both within the community and in historical scholarship. Oral history suggests that the traumatic nature of this event in women's lives has long been underestimated by many women’s families and friends, and it appears that many women continue to find that they are limited in the ways they are able to mourn and remember their loss.6 In a culture that is obsessed with the notion of a ‘good death’ – as I discuss further in the thesis - it is, as one oral history participant observed, a loss that defies the prescriptions of a good death, and is therefore a taboo subject.7 Since the 1970s there has been a growing body of literature concerned with the psychological impact of pregnancy loss on Australian women and their families within this culture of silence. Nancy Kohner and Alix Henley, psychologists and authors of When a Baby Dies, comment that ‘the death of a baby, whether at birth or in the weeks or months immediately afterwards, is no less a death than any other. It is no less important, no less heartbreaking than the death of an older child or an adult. It is certainly different, but it is not a lesser event’.8 Recalling the experience of losing her first child in 1977, a daughter who lived for ten minutes after birth, Pam wrote that ‘still today, and right

4 Even before the introduction of antibiotics and modern vaccines, by the 1930s the total infant mortality rate was half that of the figures for 1900. The infant mortality rate declined even further with advances in medical knowledge of disease and infections in the post Second World War period. See Fiona Stanley, Before the Bough Breaks: Doing more for our children in the twenty-first century, Canberra: Academy of the Social Sciences in Australia, 2003. 5 In 2004 the adjusted perinatal death rate (stillbirth and neonatal deaths combined) in Australia was 10.5 per 1000 births. See Australia’s Mothers and Babies 2004, AIHW National Perinatal Statistics Unit, Australian Institute of Health and Welfare, Sydney, 2006. 6 During the course of my research I was contacted by a number of women whose babies had died only recently. Overwhelmingly, these women believed that their families and friends were initially supportive after the event, but grew increasingly intolerant of the duration and intensity of their grief. One woman wrote that a few weeks after her daughter was stillborn her mother-in-law insisted that she ‘get over it’, and that no mention was made of the child. She commented that ‘it was like I had lost a dog or something’. Katie, personal correspondence with researcher, 5 May 2005. Email in researcher’s possession. 7 Christine, interview with researcher, 7 June 2005. Tapes and transcript in researcher’s possession. 8 Alix Henley and Nancy Kohner, When a Baby Dies: The Experience of Late Miscarriage, Stillbirth and Neonatal Death, New York: Routledge, 2001, p. 1.

11 this minute, I shed a tear when thinking of my precious little girl’.9 Coralie wrote in 2005 ‘this year in September [my daughter] would be thirty two years old and I must tell you that the pain, although less now than then is still there. Whenever we hear of a stillbirth happening to someone else my husband and I are still capable of sitting together and crying. It never goes away’.10

Privileging women’s voices: a feminist history

In my thesis I have sought to end what psychologist Margaret Nicol has termed ‘the conspiracy of silence’ surrounding perinatal death,11 evident in both the dominant constructions of this event as well as in historical scholarship. As such, my work stands firmly as a feminist history: that is, I seek to uncover an aspect of many women's lives that has previously been ignored in traditional historical scholarship, whilst also challenging the dominant ways of understanding this subject in the past – constructions of pregnancy loss which have categorically excluded women’s voices. Joan Wallach Scott argues that: Historians searching the past for evidence about women have confronted again and again the phenomenon of women’s invisibility. Recent research has shown not that women were inactive or absent from events that made history, but that they have been systematically left out of the official record … The story of the development of human society has been told largely through male agency.12

I have been inspired by existing feminist historiography that operates from the premise, as Jill Julius Matthews argues, that the experiences of women should be the central concern of the feminist historian.13 The study aims to build onto the existing scholarship that has provided insights into women’s lives which have traditionally been told from men’s

9 Pam, personal correspondence with researcher, 13 May 2005. Email in possession of researcher. 10 Coralie, personal correspondence with researcher, 19 May 2005. Letter in researcher’s possession. 11 Margaret Nicol, The Loss of a Baby: Understanding Maternal Grief, Sydney: Bantam, 1984, p. 3. 12 Joan Wallach Scott, ‘The Problem of Invisibility’, in S. Jay Kleinberg (ed.) Retrieving Women’s History: Changing Perceptions of Women’s Role in Politics and Society, Oxford, New York: UNESCO Press, c1988, p. 5. 13 Jill Julius Matthews, Good and Mad Women: The Historical Construction of Femininity in Twentieth Century Australia, Sydney: Allen and Unwin, 1984, p. 18.

12 perspective and which have remained silent in traditional histories.14 Being considered mentally ill, remaining unmarried or childless, working in the sex industry, being a victim of domestic or sexual abuse - these have all been ways in which Australian women have, willingly or unwillingly, transgressed the traditionally acceptable roles of wife and mother but are stories which, until relatively recently, have not been considered worthy of record.15 Whilst I acknowledge that women’s individual responses to perinatal death are diverse and that there is no universal or essential response to the death of a baby,16 my work is motivated from a conviction that pregnancy loss has been, and still is, a significant event in many women's lives in Australia, yet is an event which has principally been spoken about by voices other than those of women themselves. The underlying conviction of this thesis is that women’s lives - the daily, the mundane, the ordinary as well as the extraordinary - are important historically, and that the story of women’s lives should be told through women’s own understandings of their experiences.

However, to claim one’s work as ‘feminist’ in methodology is neither straightforward nor unproblematic. Despite popular misconceptions of feminism as merely concerned with ‘women’s issues’, feminist theory and critical approaches to history are as varied and diverse as women themselves. In my work I privilege women’s own accounts of the death of a baby through stillbirth and neonatal death, and their understandings of these experiences. But who exactly is this category of ‘woman’, and what is ‘experience’? Earlier feminist writers assumed that the category of ‘woman’ was unproblematic, self evident and a signifier of a collective and shared identity, but contemporary feminist writers argue that

14 Judith Allen vigorously rejects the empirical historian Geoffrey Elton’s assertion that ‘if men have said, thought, done or suffered anything of which nothing no longer exists, those things are as if they had never been. The crucial element is the present evidence, not the fact of past existence, and questions for those whose answer no material exists are strictly non-questions’. As Allen argues, this can ‘potentially hold the discipline prisoner of effective discourses’. Rather, she continues, the feminist historian should not be ‘satisfied with the smug exclusion “it is as if they had never been.”’ See J. Allen, ‘Evidence and Silence: Feminism and the Limits of History’, in Carole Pateman and Elisabeth Gross (eds.) Feminist Challenges: Social and Political Theory, Sydney: Allen and Unwin, 1986, p. 176. 15 Since the 1970s there has been a substantial (and growing) body of historiography concerned with the construction of ‘appropriate’ femininity in Australia and the ramifications of transgressing this cultural expectation. See for example Matthews, Good and Mad Women; Suellen Murray, A History of Menstruation in Australia, 1900-1960, unpublished doctoral thesis, University of Western Australia, 1996; Suellen Murray, More than Refuge: Changing Responses to Domestic Violence, Perth, WA: University of Western Australia Press, 2002; Joy Damousi, Depraved and Disorderly: Female Convicts, Sexuality and Gender in Colonial Australia, Cambridge, Melbourne: Cambridge University Press, 1997; Anne Summers, Damned Whores and God’s Police, Ringwood, Vic.: Penguin, 1994, Rev. ed. 16 As Joan Scott notes, for the feminist historian ‘perhaps the most difficult question of all is whether we can speak historically of a single category of woman’. See Scott, ‘The Problem of Invisibility’, p. 16.

13 we must resist essentialising ‘women’ as a single category of analysis. Scott, for example, suggests that: [R]eal men and women do not always or literally fulfill the terms either of their society’s prescriptions or of our analytic categories. Historians need instead to examine the ways in which gendered identities are substantively constructed and relate their findings to a range of activities, social organizations and historically specific cultural representations.17

Experience is a complex mode of analysis, and as such – forming as it does an important analytical tool in my own work – it is important that I articulate what I mean when I refer to ‘women’s experiences’. Feminist writers in the 1970s were understandably keen to address the absence of women in the historical record and so hailed ‘experience’ as a true and authentic mode of understanding how women have understood themselves within particular sociohistorical contexts.18 Similarly, philosophy and contemporary popular understandings hail ‘experience’, to quote Iris Marion Young, as being ‘knowledge that is more immediate and trustworthy than second hand knowledge’.19 Poststructuralist critiques however have dislodged the appeal to authenticity in these understandings of experience; poststructuralist feminists such as Young, amongst others, argue that feminist historians should not seek in vain the unmediated and ‘authentic’ experience of women in history but rather ‘the tactile, motile, weighted, painful, and pleasurable experience of an embodied subject; how this subject reaches out with and through this body; and how this subject feels about embodiment’.20

To reject women’s experience as factual, literal, and unmediated does not mean a rejection of the usefulness or value of seeking to understand women’s experience; it does, however, recognise that women’s experiences are discursive, framed within social rules, conventions, and other modes of discourse. In my work I have privileged women’s voices not because

17 Joan Wallach Scott, ‘Gender: A useful category of historical analysis’, in J. Scott (ed.), Feminism and History, Oxford, New York: Oxford University Press, 1996, p. 169 18 For primary source evidence of this, see for example Lynn Z. Bloom, ‘Listen! Women Speaking’, Frontiers: A Journal of Women’s Studies, vol. 2, no. 2, 1977, pp. 1-2. Contemporary feminist proponents of oral history have also written extensively on the debate surrounding the notion of ‘experience’ and its usefulness in oral history in the recent past. See for example Joanna Bornat, ‘Women’s History and Oral History: Developments and Debates’, Women’s History Review, vol. 16, no. 1, March 2007, pp. 19-39; Sherna Berger Gluck, Donald A. Ritchie and Bret Eynon, ‘Reflections on Oral History in the New Millennium: Roundtable Comments’, The Oral History Review, vol. 26, no. 2, 1999, pp. 1-27 19 Iris Marion Young, Throwing Like a Girl and Other Essays in Feminist Philosophy and Social Theory, Bloomington, Indiana: Indiana University Press, c1990, p. 12 20 Young, Throwing Like a Girl, p. 14

14 they are more authoritative or authentic than other discourses of perinatal death, but because an underlying aim of this thesis is to challenge the very notion that women’s bodies, and by extension perinatal death, can be understood using essentialist or absolutist terms. Elizabeth Grosz points out that what constitutes ‘knowledge’ in a particular culture is not simply a mode of survival, ‘of pure use value’, ahistorical and natural; rather, ‘knowledge is what is socially recognized as knowledge’.21 Working from a feminist perspective, I have sought to illuminate women’s voices in order to both challenge the dominance of medical knowledge of perinatal death as a form of absolute knowledge, and to accord the diversity of women’s experiences of perinatal death the historical recognition that they deserve.

Themes of the thesis

This research, then, is underpinned by several themes. The notion of authority is central to this thesis. I have been interested in those voices which have been dominant in speaking about perinatal death in the past in Australia (and largely by extension, other western cultures), and how the constructions of pregnancy loss as articulated by these voices have changed over time. Secondly, I consider the intersection of different groups’ constructions of perinatal death, with particular emphasis on the theme of silence and avoidance. For example, in the mid twentieth century, the medical discourse of perinatal death and the cultural prescriptions of ‘appropriate’ responses to death were powerful factors in shaping the twin expectations that most women would feel little long-lasting grief after the death of a baby, and that those who did find the experience traumatic should repress their grief and ‘move on’ by having another (live) baby.

Furthermore, I consider the ways in which these expectations have impinged on some Australian women’s ability to articulate their experiences of the death of a baby. I have sought to gain insight into how a group of Australian women have understood their own memories of the ending of a pregnancy or the loss of a baby, problematising the notion of experience by examining how individual women have interpreted their loss within the framework of cultural constructions of perinatal death. I view women’s experience within

21 Elizabeth Grosz, Volatile Bodies: Toward a Corporeal Feminism, St Leonards, NSW: Allen and Unwin, 1994, p. 147.

15 the lens of conforming to or transgressing cultural notions of ‘appropriate’ femininity, and consider how some women have continued to renegotiate their experiences over time and within the shifts in cultural expectations of ‘appropriate’ responses to grief and bereavement.

Finally, a persistent theme throughout this thesis is that of responsibility. Underlying constructions of perinatal loss throughout the twentieth century has been enduring notions of failure and blame, and I consider the ways in which women were held responsible for the death of their infants, particularly at the end of the twentieth century as prenatal diagnostic testing became considered a routine and ‘responsible’ part of pregnancy. Within this context, I also consider how the foetus has been inscribed within the framework of ‘viability’ throughout the twentieth century, and examine the ways in which those women whose babies were considered ‘unviable’ were expected to respond.

Sources

The sources I have used can be grouped into three broad categories. Firstly, I researched medical text books, clinical reports, case notes, lecture notes and published lectures, and articles in medical journals which give insight into medical constructions of perinatal death throughout the twentieth century in Australia. A crucial aim of this thesis has been to challenge the dominant discourses of perinatal death to include women’s own understandings of the death of a baby or ending of a pregnancy; because medical knowledge has been a powerful framework through which pregnancy and childbirth have been constructed throughout the twentieth century in many Western societies, I pay particular attention to the dominant construction of pregnancy loss as found in medical sources. Post-structuralist historians have generally understood notions of ‘discourse’ within a Foucaldian perspective,22 being primarily concerned with the relationships

22 Post-structuralist scholars note that Foucault did not use ‘discourse’ as a linguistic concept but rather as the production of knowledge through language. According to Stuart Hall, Foucault argued that discourse ‘constructs the topic. It defines and produces the objects of our knowledge. It governs the way that a topic can be meaningfully talked about and reasoned about. It also influences how ideas are put into practice and used to regulate the conduct of others’. In his later writings, Foucault ‘became even more concerned with how knowledge was put to work through discursive practices in specific institutional settings to regulate the conduct of others’. See S. Hall, ‘Foucault: Power, Knowledge and Discourse’, in Margaret Wetherell, Stephanie Taylor, Simeon Yates (eds.) Discourse Theory and Practice: A Reader, London, Thousand Oaks, CA.: Sage, 2001, pp. 72-75.

16 between power and knowledge and I consider the ways in which medical discourse has exerted influence in constructing understandings of the female body and normality and abnormality. Medical inscriptions of perinatal death and miscarriage are not necessarily the meanings given by individual women who have experienced a miscarriage or perinatal death, and in my work I have sought to consistently challenge the authority of medical discourse in creating absolute forms of knowledge by giving insight into how women have understood their own bodies and their experiences of giving birth to a deceased or seriously ill baby.

Secondly, I researched those sources I considered would give me some insight into other popular constructions of perinatal death, such as the so-called ‘wives’ manuals’ or ‘women’s handbooks’, often written by medical professionals to disseminate ‘appropriate’ knowledge of sexuality and pregnancy to women; newspaper articles in major Australian newspapers; burial registers and gravestone inscriptions; and oral history interviews with allied health professionals including a social worker, midwife and chaplain. I have also analysed unpublished documents from the Social Work departments of two major maternity hospitals in Australia, King Edward Memorial Hospital for Women [KEMH] in Perth, Western Australia, and Royal Women’s Hospital [RWH] in Melbourne, Victoria. These sources gave great insight into how allied health professionals in the late 1970s to the turn of the twenty-first century critiqued the medicalisation of childbirth; re-inscribed the deceased baby; and spearheaded changing attitudes towards the care of women in hospital after a perinatal loss.

My primary source of evidence, however, is Australian women’s own accounts of perinatal death.23 I have utilised a diverse range of sources to give insight into some women’s experiences of perinatal death. These include women’s private letters and diaries; although, Katie Holmes observes, from the turn of the century women tended to write less about the death of a baby than their mothers and grandmothers as the language of sexuality became

23 When referring to ‘Australian women’ I am referring to women who, at the time of losing a baby through miscarriage, stillbirth or neonatal death, were residing in Australia. However whilst I may refer to them as ‘Australian women’, some involved in the project may not actually identify with this. Throughout the thesis I use ‘Australian women’ for the sake of brevity rather than to signify a homogenous group.

17 medicalised24 and I was largely dependent on women supplying me with letters and diaries held in their own private possession. I have also utilised existing oral history projects, such as the NSW Bicentennial Oral History Project [NSW BOHP]; letters to newspaper editors in the more recent past from self-described bereaved mothers; self-published and unpublished memoirs; and an oral history project of my own undertaking. The oral history component of this work in particular has provided me with a rich site of analysis of women’s own experiences of losing a baby through miscarriage, stillbirth or neonatal death.

Problematisation of sources

Having discussed my sources I will now consider some of the problems I encountered during the course of my research. Firstly, my evidence is drawn from a wide range of sources from a large time frame. Chapters Two and Three in particular draw upon sources from the turn of the nineteenth and twentieth centuries until the late 1960s. The remaining chapters generally draw on sources from discrete time periods; in Chapters Four and Five I analyse a body of sources from the 1970s and 1980s; and Chapter Six to Eight are concerned with evidence from the end of the twentieth century. In each chapter I have grouped sources according to theme with a broadly chronological structure in order to trace the changes in constructions of perinatal death and the ways these constructions have intersected and, at times, been in contradiction to each other at various points in the past.

Secondly, a persistent problem with researching an area of history which is characterised by cultural silence is the difficulty one faces in actually finding suitable and useful sources.25 Throughout my research, this thesis has been governed by the availability and accessibility of sources, particularly with regard to texts which give insight into medical constructions of perinatal death, such as medical records and case notes. Gaining access to medical records held by individual hospitals is a notoriously difficult task for a researcher in the humanities; even if access is granted, the use of such sensitive records can be fraught with ethical issues. Although I was consistently denied access to historical medical records – even if

24 Katie Holmes, Spaces in her Day: Australian Women’s Diaries of the 1920s and 1930s, St Leonards, NSW: Allen and Unwin, 1995, p. 71. 25 Anna Davin notes that ‘all historical research is of course laborious and slow. When the quarry is women it takes even longer. The evidence is scattered and often problematic: the historian pans much mud and sand for the occasional nugget’. See A. Davin, ‘Redressing the Balance or Transforming the Art? The British experience’, in Kleinberg (ed.), Retrieving Women’s History, p. 67.

18 they were to be de-identified – by the ethics boards of several large hospitals on the basis that my work was deemed to have ‘little value’ for the wider community,26 I was, however, fortunate in that I was given open access to unpublished archival documents from other departments in KEMH in Perth and RWH in Melbourne. As such, the later chapters are focused heavily towards an analysis of the situation in these two hospitals.

The sources that I have used in my research are very different in nature and care has been taken to analyse each source in terms of its historicity. That is, I have attempted to consider sources against the historical context in which they were produced and to consider the cultural and social forces which have shaped a particular construction of perinatal loss. I have been particularly interested in understanding how the medical inscription of a foetus as ‘viable’ has shaped constructions of pregnancy loss, and throughout the thesis I explore how the inscriptions of ‘viable’ and ‘non-viable’ have shifted in the past and in turn how this has impacted on the way women have experienced loss. Over the past one hundred years, the classifications of ‘viability’ have been altered and the terms ‘miscarriage’ and ‘stillbirth’ have at times signified different stages of gestation; the values inscribed upon the developing embryo/foetus have also shifted at times dependent upon changes in medical knowledge.

Oral history: providing a space for the reinterpretation of memory

The underlying motivation driving this research has been an attempt to rectify the lacuna in our understanding of the experience of perinatal death in the past; accordingly, an oral history project was undertaken which privileged the narratives of a group of women who had lost a pregnancy or baby at some point in Australia’s history.27 The methodological tool of personal narratives was an obvious choice for this particular project: oral history has

26 The Medical Ethics Board of KEMH in Perth, W.A. was particularly opposed to granting me access to medical records, even if my work was supervised by a staff member of their choosing who would ensure that any data collected was deidentified. In correspondence over several months in 2004, the Chairman of the Board advised me that the aims of my project were not sufficiently useful for the ‘community’ and alluded to the fact that a historian had no right to access medical information, even in a de-identified state. According to one committee member, who has asked to remain anonymous, this view was not shared by the entire Ethics Committee. 27 The interviews quoted were undertaken by me between November 2004 and October 2005. Copies of the transcripts and tapes are my possession. Each interviewee was asked for their preferred method of identification in publications and the thesis. Most chose their first names or surnames only while others preferred a pseudonym, which is noted in the relevant citation.

19 long been regarded as useful in illuminating concealed sources or hitherto historically- disregarded lives, particularly with regard to the experiences of ‘non-elite’ people whose narratives were absent from the traditionally valuable sources of records and archived documents.28 Although oral history is neither unproblematic nor uncontested amongst historians,29 many contemporary studies illustrate both the intrinsic complexity of oral history as well as its vitality in ‘reflect[ing] peoples’ memory of the past’.30

Kate Darian-Smith suggests that the oral history interview reflects an ongoing process in which ‘our memories are constantly negotiated in an interactive cycle of recovery and burial, in a process of exchange between the individual and society’.31 Thus the personal narrative is not static or fixed in the past, but rather is a complex interaction between the present and the many pasts that have intervened since the event actually occurred. Accordingly, proponents of the oral history method now recognise that its usefulness lies not in revealing so-called ‘universal truths’ but rather for its ability to shed light on the ‘psychological cost’ of an event in an individual’s life.32 Once criticised by empirical historians as subjective ‘myth-making’, subject to the ‘distortions of memory’, oral history has been defended precisely because it gives insight into the way in which individuals make sense of their experiences in the past. Treated as an object of historical analysis, it is precisely these ‘distortions of memory’ which are useful, argues Michael Frisch; he notes that ‘memory’ is a tool of analysis and can assist historians in ‘discovering, exploring and evaluating the nature of … how people make sense of their past, how they connect individual experience and its social context, how the past becomes part of the present, and how people use it to interpret their lives and the world around them’.33

28 Alistair Thomson notes that the oral history interview ‘provides access to undocumented experience … significantly, the ‘hidden histories’ of people on the margins: workers, women, indigenous peoples, ethnic minorities and members of other oppressed or marginalised groups’. See A. Thomson, ‘Making the Most of Memories: The Empirical and Subjective Value of Oral History’, Transactions of the Royal Historical Society, vol. 9, 1999, p. 291. 29 See Patricia M. Thane, ‘Oral History, Memory and Written Tradition: An Introduction’, Transactions of the Royal Historical Society, vol. 9, 1999, pp. 161-168. 30 Devra Weber quoted in Emily Honig, ‘Getting to the Source: Striking Lives: Oral History and the Politics of Memory’, Journal of Women’s History, vol. 9, no.1, 1997, p. 139. 31 Kate Darian-Smith, ‘War Stories: Remembering the Australian Home Front During the Second World War’, in K. Darian-Smith and P. Hamilton (eds.) Memory and History in Twentieth Century Australia, Melbourne: Oxford University Press, 1994, p. 156. 32 Alessandro Portelli, ‘The Peculiarities of Oral History,’ History Workshop Journal, no. 12, 1981, pp. 96- 107. 33 M. Frisch, A Shared Authority: Essays on the Craft and Meaning of Oral and Public History, Albany, NY: State University of New York Press, 1990, p. 188.

Anna Davin notes that the invisibility of women’s voices in traditional historiography often drives feminist historians to ‘look for other sources – to find echoes of the “voices from below” wherever they survive’.34 The use of personal narratives, then, was a vital tool in gaining a greater understanding of a hitherto silent experience of perinatal loss, and for most of the women involved, the very act of participating in this research was part of a very personal process of reinterpreting their long-buried memories of a lost baby – a process of reclaiming a part of their past that had been long denied and ignored by their communities. The motivations behind some older women’s quest to reinscribe their deceased babies were varied but several persistent themes emerge from the oral history interviews. Paul Thompson and Raphael Samuel argue that ‘we need as historians to consider myth and memory, not only as special clues to the past, but equally as windows on the making and remaking of individual and collective consciousness, in which both fact and fantasy, past and present, each has its part’.35 The usefulness of the oral history interview to this project, therefore, was in gaining insight into how women internalised, negotiated with and resisted the dominant medical constructions of perinatal loss at different stages in their lives.36

‘Finding’ women

Women were invited to be a part of the oral history project through a range of media requests, including radio interviews on ABC Radio National in Perth and Hobart, Tasmania, and 6PR in Perth; newspaper articles in Western Australian newspaper The Sunday Times and various publications of the Community Newspaper group; and through a

34 Davin, ‘Redressing the Balance’, p. 72. 35 Paul Thompson and Raphael Samuel quoted in Jean Duruz, ‘Suburban Houses Revisited’, in Darian-Smith and Hamilton (eds.) Memory and History, p. 176. 36 Feminist scholars in particular view oral history as a means to gain insight into how individuals have negotiated their experiences within particular discourses. Marilyn Lake, for example, notes that ‘the task of the historian of women is … twofold: first, to identify the variety of discourses in force at any one time and second, to explain why particular groups of women, in particular historical circumstances, were more likely to respond to some representations of their identity and experience than others’. See M. Lake, ‘Female Desires: The Meanings of World War II’, in Scott (ed.) Feminism and history, p. 431. Writing in specific regard to oral history and feminist history, Marie-Françoise Chanfrault-Duchet notes that ‘the life story approach in oral history makes it possible to go beyond the preconstructed discourses and “surface assertions” collected through survey research. It highlights the complexity, the ambiguities, and even the contradictions of the relations between the subject and the world, the past, and the social and ideological image of woman – that is, how women live, internalize, and more or less consciously interpret their status’. See M. Chanfrault-Duchet, ‘Narrative and Socio-symbolic Analysis’, in Sherna Berger Gluck and Daphne Patai (eds.) Women’s Words: The Feminist Practice of Oral History, New York: Routledge, 1991, p. 89.

21 feature piece in UWA’s staff newsletter, UWA News. I also discovered that women were told about the project by friends or daughters who had read one of the articles or heard me interviewed on the radio about my research and my request for interview participants.

Over 100 women responded to my request to be interviewed; the actual number of women interviewed for my research was twenty eight, with a number of other women sending me written correspondence; one father also wrote me a long letter about his experience of loss. The number of participants was reduced to twenty eight primarily out of sheer necessity – as the sole researcher, I was forced to limit myself to only interviewing a relatively small group of women in order to complete the project in a timely manner. Also amongst those not chosen for interview were several women who had experienced the death of a baby in a country other than Australia – mostly England – or had lost a baby only recently and so who regrettably fell outside the time frame considered for this project.

During the course of my research I frequently encountered interested acquaintances whose reactions to this subject ranged from the horrified – ‘how macabre!’ – to the sympathetic, and a common question was ‘and what about the men? Will you be interviewing fathers, too?’ This was a question I had myself grappled with early on in my research. Was I actually continuing the process of devaluing certain voices in the historical record if I omitted men’s experiences of perinatal death? Whilst I argue that men’s voices have long assumed dominance in constructing understandings of perinatal death in the past – in terms of the masculinist discourse of medicine - there are no histories of how fathers have understood perinatal death, and as such, the voices of fathers, like mothers, are silenced in historical scholarship.

With this is mind, it has been with reluctance that I have omitted the perspectives of bereaved fathers, yet this was an omission that was necessary. I have chosen to focus on women’s experiences of perinatal death for two reasons: firstly, I have approached this work with the conviction that, historically, women’s lives have been considered unimportant and unworthy of historical scholarship in general, and in my thesis I have attempted to contribute to the feminist tradition of rewriting women’s lives back into history. The second, and equally compelling, reason is purely logistical. The sheer magnitude of this research has meant that I have been unable to consider with any sort of

22 focus men’s understandings of the death of a baby or ending of a pregnancy through miscarriage. In my thesis I have briefly considered how meanings of perinatal death have been gendered in medical discourse and in popular understanding, whilst also exploring how gender roles have served to fix men to the role of silent protector in times of perinatal death. Although I received some written correspondence from fathers who had experienced the death of a baby, my work does not extend to include a systematic analysis of how men have negotiated their understandings of the death of a baby.

The particular group: analysis

Twenty eight women were interviewed about their experiences of losing a pregnancy through miscarriage, or the death of a baby through perinatal death. Two participants were interviewed but later requested that their involvement in the project be withdrawn. The group was diverse in some respects while displaying some similarities. With the exception of one interviewee, Astrid, all the interviewees had been born in Australia and all identified themselves as white, working-class or middle-class women. The majority of the group were still in relationships with the father of the baby concerned, although three of the women had separated from this partner and had remarried. Two interviewees had been single women at the time of their baby’s death, and had since married another partner.

Although I did not apply any other criteria for selection in the project except for a time limit, it was inevitable that, as self-selected interview participants, certain themes would develop from the project as a whole. Whilst each woman was shaped by her own particular social and cultural context, an analysis of the group is limited to the experiences of white women. Perhaps for a variety of reasons, I was not contacted by any women of non-white or immigrant background.

Process of interviewing

Over the course of 2004 and 2005, I visited most of the women in their homes, although several women elected to be interviewed in my office at UWA, and one woman chose to be interviewed at the home of a friend because she felt uncomfortable being interviewed while her family was present in the house. The interviews were all scheduled to accommodate the

23 women’s individual responsibilities including paid work, volunteer work, and childcare. Each interview lasted approximately two hours, and the women were asked general questions about their experience, such as when and where they had delivered their baby, where the baby was buried – if known – and their recollection of their treatment while in hospital. The flow of the each interview however was largely led by the woman concerned. This was particularly important because the age range of the group was from ninety one to twenty six years of age, and each interviewee had a sense of their own individual reasons for volunteering for interview.

Using oral history

Oral history has been an important way to uncover the hitherto silenced understandings of perinatal death in Australia’s past. Throughout the thesis I have considered the ways in which women have negotiated their experience of losing a baby or a pregnancy within the particular sociohistorical context in which the loss occurred. Rather than simply taking the personal narrative as a straightforward recollection of the past, I have sought to understand how a group of women have interpreted and reinterpreted their experiences within changing cultural constructions of perinatal death. For example, in Chapter Three I have used narratives of older women against the backdrop of the discursive authority of the medical profession and the cultural rejection of grief and death; these narratives are then revisited in Chapter Six where I seek to gain insight into how one’s memories are shaped and reshaped at different stages of one’s life, particularly against the backdrop of changing cultural responses to death and grief in Australia.

A primary motivation behind using oral history was to understand how women challenged or internalised medical constructions of perinatal death. This was particularly pertinent to women whose babies died in what I argue are the ‘emerging’ years; the period between the early 1970s and the late 1980s where the authority of the medical profession was being questioned and new models of understanding pregnancy and childbirth were being suggested. Many of these women, whose babies would now be in early adulthood had they lived, exemplified the process of the interaction between the past and the present, as they both recalled their compliance to medical authority whilst rejecting this compliance in their

24 lives more recently, as they acknowledged the influence of second-wave feminism in shaping their adult lives.

Structure of the thesis

Broadly speaking, this thesis is organised in a thematic-chronological structure. Because, as I discuss further in Chapter One, I am operating from the theoretical understanding that reproduction is not ahistorical, I consider understandings of miscarriage, stillbirth and neonatal death within changing social and cultural contexts in the past one hundred years in Australia.

In Chapter One, I locate my thesis in the historiography, and discuss the existing scholarship which has informed my research. Although there is little historical scholarship concerned with perinatal death in Australia, many feminist historians have located this topic within a wider study of women’s experiences of motherhood and maternity. Sociologists, feminist critics and psychologists have also produced numerous critiques of the medical discourse of pregnancy, with particular emphasis on notions of maternal responsibility during pregnancy. Feminist theory has also shaped this thesis, and I discuss in particular theories of ‘the body’ as a surface of social inscription, and the relevance of these theories to my work. There are also a number of studies on the changing responses to death and bereavement in Australia which greatly inform this thesis. I end the chapter with a brief historical context of the meanings of perinatal death prior to the turn of the twentieth century, arguing that although the medicalisation of childbirth in the early 1900s constructed a dominant understanding of perinatal loss, this event was imbued with a variety of meanings before the twentieth century.

In Chapter Two, I analyse the impact of the medicalisation of childbirth in terms of the positioning of the medical profession as authority in constructing meanings of perinatal death. The medicalisation of childbirth positioned medical knowledge as a powerful way of understanding and defining women’s pregnant bodies, and in this chapter I argue that the medical discourse of childbirth constructed miscarriage and perinatal loss as ‘failed pregnancies’. I also consider the way in which women’s behaviour was linked to miscarriage and perinatal loss; the development of the antenatal clinic as an ‘essential’ part

25 of a normal healthy pregnancy strengthened the idea that women should place their bodies under the supervision of the medical profession in order to avoid producing a deceased or ‘sickly’ baby. As the birth rate continued to fall dramatically in the early twentieth century, pronatalist concerns reinforced the perceived need for medical surveillance over the pregnant body in order to ‘preserve the (white) race’, and motherhood was ostensibly venerated as the ultimate fulfilment for women, not to mention an act of patriotism. Women were urged to fulfil their ‘patriotic duty’ by producing healthy, live babies; in this way, those women who ‘failed’ in this duty were not considered to be mothers, and were stigmatised for having failed to attain the goal of motherhood.

In Chapter Three, I consider women’s experiences of miscarriage or perinatal death within the culture of ‘death avoidance’ which shifted cultural understandings of ‘appropriate’ expressions of grief and mourning after World War I and World War II. Within their families and communities, many women whose pregnancies ended in miscarriage or perinatal death in the postwar years were expected to repress their grief and to respond stoically and silently. I argue that compounding this silence was the medicalisation of childbirth which had invalidated the language with which women could speak of pregnancy and sexuality, replacing it with the discursive authority of scientific understandings of the pregnant and sexed body. Because the processes of birth and dying had been shifted from the home to the hospital most women were subject to the medical management of perinatal death and the idea that, because the foetus held little individual value, the speediest and most healthy resolution was to shield women from their babies whilst in hospital.

In Chapter Four I explore the beginnings of a shift within two major maternity hospitals in Australia, KEMH in Perth and RWH in Melbourne, changes which were initially motivated by emerging research into the psychosocial impact of miscarriage and neonatal death and intensified by the concerns of second-wave feminism and the consumer health movements. This shift signalled the beginning of radical changes in the care of women who had suffered the death of a baby – for example, a move away from shielding mothers from their babies towards encouraging women to form bonds with their deceased infants. I have called this chapter ‘Emerging Changes’ because I argue that although some staff involved in caring for women whose babies died were supportive of these changes, it was a sporadic and slow process which would only be consolidated towards the end of the twentieth century.

In Chapter Five, I explore the extent to which the emerging theories of grief and loss in the 1970s and 1980s challenged the dominant construction of perinatal death. Women’s recollections of the experience of losing a baby during this period give insight into the gradual nature of these shifting understandings, and demonstrate the dominance of the medical profession in continuing to claim the right to speak about perinatal loss. Although some social workers and a number of medical professionals had begun the process of challenging the silence which characterised women’s treatment in the hospital setting, the prevailing beliefs that perinatal loss was both repugnant and ‘basically a sad event’, soon forgotten, limited the growth and acceptance of changing practices.

In the final three chapters of the thesis I explore the competing understandings of perinatal loss which emerged at the end of the twentieth century. Firstly, in Chapter Six I argue that the gradual shift away from shielding women from their babies in the hospital setting became formalised in official policy, at least at KEMH and RWH Melbourne, towards the end of the twentieth century. The last decade of the twentieth century saw the efforts of social workers and midwives in the 1970s and 1980s bear fruit with the formalising of hospital policy which better reflected current psychological theories of grief and loss; these measures had enormous impact on the way that some Australian women were able to memorialise and express their sorrow for the death of their infants.

In Chapter Seven I consider the ways in which some older women were able to reinterpret and revisit their memories of a long-ago death of a baby, within a wider cultural change towards a greater openness towards death and bereavement. The changing practices within the hospital, combined with the activities of the parent support group Stillbirth and Neonatal Death Support [SANDS] provided a space in which some women were able to reinterpret and recast their memories of a perinatal loss many years ago. In this chapter I also consider ‘memory’ as a useful tool of historical analysis; whilst oral history has been contested by critics as merely subjective, I argue that the personal narrative provides insight into the meanings which have been given to perinatal death and how these meanings have changed over time.

27 However, the rise of prenatal testing and the emergence of the notion of the foetus as a patient problematised these changes to a great degree. In Chapter Eight I consider the continuing construction of perinatal death as an instance of ‘failed’ pregnancy, framed within the neo-liberal values of individual responsibility and self-determination. The rise of prenatal diagnosis reinforced the inscription on the foetal body within the duality of ‘viable’ and ‘unviable’, inscriptions which were at times at odds with how some women viewed their unborn babies, and which renewed the notion of maternal responsibility in producing a ‘successful outcome’. I also explore the role of prenatal testing in cultivating the belief that technology had succeeded in conquering perinatal mortality; a belief which again rendered perinatal death as falling outside the bounds of what constituted a ‘good death’.

A note on terminology and spelling

Throughout the thesis I use the terms of miscarriage, stillbirth and neonatal death interchangeably with the briefer ‘perinatal death’ or ‘perinatal loss’. When referring to women’s experiences of the perinatal loss I have also used the terms ‘baby’ or ‘unborn child’ in favour of the more abstract and impersonal ‘foetus’ to reflect the way the oral history participants understood their pregnancies. I have also adhered to British spelling, for example, ‘foetus’, except for in direct quotes from sources which use ‘fetus’ and its variants. I have placed inverted commas around the usage of the words ‘deformed’, ‘defective’, and ‘abnormal’ and their variants to acknowledge that ideas of ‘deformity’ are social and cultural constructions inscribed on particular bodies at different times in the past.

My position in the thesis

In his book A Concise History of Australia Stuart Macintyre observes that the image of the historian as ‘observer of events has fallen into disrepute’. No longer is the historian accorded the authoritative role as lofty surveyor, ‘placed at a good distance’ from his subject. Rather, argues Macintyre, contemporary historians are expected to be ‘inside the history, inextricably caught up in a continuous making and remaking of the past’.37

37 Stuart Macintyre, A Concise History of Australia, Cambridge, Melbourne: Cambridge University Press, 1999, p. 291.

I began my research into the history of perinatal loss as a self-described ‘bereaved mother’. My first child was stillborn shortly after I was accepted as a doctoral candidate at the University of Western Australia, and my initial project - a study of masculinity in popular images of the Australian colonial bushranger Ned Kelly - was abandoned after my pregnancy ended. Initially, I was concerned that being placed so close to the subject would be detrimental. Would such a personal experience influence a neophyte historian towards making prejudicial and unbalanced conclusions?

However if, as Macintyre argues, the historian should be ‘inextricably part’ of history making, then my experience can be considered to be advantageous - both in theoretical and practical terms. My experience has given me both the requisite motivation and passion for the hard slog of writing a thesis, whilst also proving beneficial in that most of the women who responded to my requests for interview participants had felt compelled to respond because they knew that I was myself the parent of a deceased baby.

Furthermore, having been warned of the risk of being close to a subject I have consciously sought to distance myself from my own experience in order to risk essentialising the experience of other women and from making conclusions which sit comfortably with my own memories of losing a baby. Indeed, as Alistair Thomson notes, feminist historians have ‘debunked’ the traditional idea of the entirely objective historian, advocating in its stead the historian who examines their own subjectivity throughout the research process.38 Throughout my research I have uncovered evidence which is in stark contradiction to the ways I have understood my own loss; particularly in the oral history project I was often confronted with different ways of remembering the death of a baby. Whilst these factors may seem to be potential detractors to a balanced thesis, it is my belief that being so close to this subject has actually made me more conscious of the need to be both participant and observer, an intertwining of both Scott and Macintyre’s ideals of the role of the historian.39 My own experience of losing a baby served to remove any lingering feelings of historical

38 A. Thomson, ‘Memory as Battlefield : Personal and political investments in the national military past’, The Oral History Review, vol. 22, no. 2, 1995, p. 55. 39 Macintyre cites Ernest Scott’s description of the ideal historian: ‘Historical events, like mountain ranges, can best be surveyed as a whole by an observer who is placed a good distance from them’. Scott quoted in Macintyre, A Concise History of Australia, p. 291.

29 authority on my behalf, whilst helping me appreciate the complexities and intricacies of such an experience and the diversity of response after the death of a baby.

30 CHAPTER ONE

‘The babies scarcely mattered’: Literature review and historical context

In her study of the RWH in Melbourne, Janet McCalman notes that, in an age of high maternal, mortality stillbirths or the deaths of newborn babies at the turn of the nineteenth and twentieth centuries often went unrecorded.40 Indeed, this observation could similarly be applied to the sparse treatment of stillbirth and neonatal death in the historical record: whilst there is a wealth of scholarship concerned with women’s experiences of pregnancy and childbirth, motherhood and sexuality, there is no Australian historical study which focuses on either the experience of losing a baby through stillbirth or in the newborn period, nor on the changing cultural and social constructions of perinatal death in the past.

In this chapter I begin by reviewing the historiography of perinatal death, and in doing so I discuss the chief concerns of this work and the related theoretical considerations. I also present scholarship from other disciplines which give insight into the ways in which the maternal and foetal bodies have been understood by contemporary writers in the social sciences and humanities, including feminist philosophers, anthropologists and sociologists. Lastly, I frame the remaining chapters of the thesis by examining the historical context of perinatal death, considering the ways in which perinatal death was understood prior to the turn of the nineteenth and twentieth centuries.

The history of death and grief

Writing with reference to her own pioneering research into the history of bereavement in Australia, Joy Damousi observes that the cultural silence towards death and grief which characterised much of the twentieth century in Australia has, to some degree, extended to the scholarly community as evidenced by traditional attempts to recreate a ‘more wholesome, dignified and comforting image of our past’.41 With this in mind, several historians in recent years have begun the process of filling in the gaps in our understanding

40 Janet McCalman, Sex and Suffering: Women’s Health and a Women’s Hospital, Royal Women’s Hospital Melbourne, 1856-1996, Carlton, Vic., Melbourne University Press, 1998, p. 156. 41 Joy Damousi, ‘History Matters: The Politics of Grief and Injury in Australian History’, Australian Historical Studies, vol. 33, no. 118, 2002, p. 101.

31 of attitudes towards death and bereavement in Australia’s past, with particular emphasis on the gendered expectations of the expression of grief. As Damousi observes, the study of grief and loss in the past constitute a significant category of historical analysis; ‘emotional life’, she argues, ‘is an important, and ever-changing, part of our social and cultural history’.42

Patricia Jalland and Damousi argue that the early twentieth century would see a radical shift in cultural expectations of ‘appropriate’ responses to death and grief. The trauma of World War One served to reinforce the nineteenth century belief that the ‘appropriate’ masculine response to death was characterised by a silent stoicism – an expectation of ‘appropriate’ behaviour which, in the interwar years spread to women as well.43 Both Jalland and Damousi note that whilst it is apparent that there did exist a kind of ‘code of silence’ that was reserved for those who had served in either the Great War or World War Two, which was only occasionally broken when in the company of fellow servicemen, other family members - and in particular wives - were expected to abide by this silence.44 In her study of changing patterns of bereavement in the twentieth century, Jalland argues that stoicism – and a corresponding public restraint of sorrow – was increasingly considered the only acceptable response to the mass slaughter of young men in war, with letters indicating that many families felt that this was a response that honoured and respected the memory of those who had died. 45

42 Joy Damousi, Living with the Aftermath: Trauma, Nostalgia and Grief in Post-war Australia, Cambridge: Cambridge University Press, 2001, p. 196. 43 From both wars, but particularly the Great War, there also existed the common misconception that returned servicemen would be able to resume their former lives with few difficulties, a misunderstanding that forced many men to internalise their horrific memories and which created a protective silence around their experiences in the war. The cultural restriction of male grieving was not new to the twentieth century – Patricia Jalland notes that men in the nineteenth century in Britain and Australia had little opportunity to at least publicly express their sorrow after the death of a loved one, yet the cumulative impact of the two world wars extended this expectation to women as well. See P. Jalland, Changing Ways of Death in Twentieth Century Australia: War, Medicine and the Funeral Business, Sydney: UNSW Press, 2006, p. 35. 44 Damousi’s study of wives of servicemen in several of Australia’s wars shows the impact of this silence, with the wife of one World War One veteran commenting that men ‘kept it under covers. They didn’t express themselves … Men talked among themselves … but they wouldn’t talk to the women about it all’. Truda Naylor quoted in Damousi, Living with the Aftermath, p. 101. 45 Jalland cites an excerpt of a letter from a son to his mother; whilst he acknowledged that ‘yours is a great sorrow,’ he exhorted her to ‘not give way … we must think of the thousands that have been bereaved by this awful war’. See Jalland, Changing Ways of Death in Twentieth Century Australia, p. 95. As Jalland argues in her earlier research, the expectation of stoicism was a long tradition in Australia, derived from the struggles and hardships of life in the bush, but notions of stoicism, privacy and survival were strongly reinforced by the two World Wars. See P. Jalland, Australian Ways of Death: A Social and Cultural history, Melbourne, New York: Oxford University Press, 2002, p. 326.

Writing about maternal grief following the Great War, Damousi notes that whilst motherhood was ostensibly revered, maternal love was not considered to be ‘true love’ and ‘therefore could never attain the status of “true” loss’.46 Although women’s grief initially preoccupied the Australian press and the grieving mother was seen as symbolic of the great sacrifice made by the Australian nation in wartime, by the 1920s and 1930s, argues Damousi, women’s loss was ‘public[ly] neglected’. As the categories of ‘mother’ and ‘widow’ were conflated into ‘women’, the experience of losing a loved one in the War became ‘marginal to the memory of war because they were no longer defined by their ‘sacrifice’.47 Tanja Luckins argues that the cultural expectation of repressed sorrow after the World Wars had the greatest impact on women in Australia, because of the traditional assumption that women are ‘naturally’ nurturers.48 In terms of rituals and the enactment of mourning, then, the repression of expressive sorrow undoubtedly had most impact on the way that women had customarily mourned their dead. In relation to deaths in war, women in particular were expected to lay their own feelings aside and to emulate the stoicism of their sons and husbands. The impact of this expectation of appropriate feminine bereavement responses after the two world wars would also extend to other deaths; particularly in the case of a stillbirth or neonatal death, the expectations of ‘appropriate’ mourning after pregnancy loss were sharply gendered.

Despite these attempts to fill the gap in our knowledge of death and bereavement in the past, relatively little attention has been paid to the historical understandings and experience of perinatal death in Australia; although some historians have made reference to perinatal death, this has been in the context of a wider focus. For example, Jalland’s otherwise invaluable work on death in Australia makes passing reference to the simplicity of funerals for stillborn babies in the late nineteenth century, yet she does not examine in detail as to why this was the case.49 Despite its frequency both in the past and in the contemporary times, the history of stillbirth and neonatal death is a significantly under-researched area of feminist history in Australia.

46 Joy Damousi, The Labour of Loss: Mourning, Memory and Wartime Bereavement in Australia, Cambridge, New York: Cambridge University Press, 1999, p. 27. 47 Damousi, The Labour of Loss, pp. 30, 35-37. 48 See Tanja Luckins, The Gates of Memory: Australian People’s Experiences and Memories of Loss and the Great War, Fremantle, WA: Curtin University Press, 2006, p. 55. 49 Jalland, Australian Ways of Death, p. 121.

Maternity and Motherhood

Notwithstanding the paucity of scholarship specifically concerned with the experience of perinatal death in the past in Australia, some historians have paid brief attention to this issue as part of a wider study of the history of obstetrics and women’s experiences of pregnancy and childbirth. Many historians have challenged the so-called ‘ideology of motherhood’ of the early twentieth century which constructed motherhood as a happy, supremely fulfilling experience in women’s lives, seeking instead to gain insight into the ways women themselves experienced pregnancy, childbirth and motherhood, as well as the ways in which some women in Australia’s past have defied cultural expectations of ‘appropriate’ femininity. Marriage and motherhood were the dominant, most socially acceptable roles available to Australian women, at least for the first half of the twentieth century, and pregnancy, childbirth and childrearing have therefore occupied a significant share of feminist historiography.

The veneration of the figure of the ‘mother’ at the turn of the nineteenth and twentieth centuries has been well documented by feminist scholars.50 Kerreen Reiger in particular observes that the construction of the ‘maternal citizen’ was part of a wider anxiety that Australia must consolidate its position as a strong, healthy nation. Implicit in the construction of the maternal citizen was the rhetoric of nation-building, and the white Australian mother was seen to be the ‘lynchpin of hearth and home’; furthermore, the success of mothers’ ‘nest building efforts’ would ensure the future of Australia and its people.51 Katie Holmes observes that motherhood was constructed as a ‘crucial stage on the path to a woman’s mature expression of her femininity’ in the early twentieth century; however, whilst women would be fulfilled by motherhood, the medicalisation of childbirth resulted in the expectation that ‘women’s most natural function should be supervised by

50 See for example Kerreen Reiger, The Disenchantment of the Home: Modernizing the Australian Family, 1880-1940, Melbourne: Oxford University Press, 1985; Joan Eveline, ‘Feminism, Racism and Citizenship in Twentieth Century Australia’, in P. Crawford and P. Maddern, Women as Australian Citizens: Underlying Histories, Carlton, Melbourne University Press, 2001, pp. 141 - 177; M. Lake, ‘How Men Gave Birth to the Australian Nation: Nationalism, Gender and Other Seminal Acts’, Gender and History, vol. 4, 1992, pp. 305- 22; Kerreen Reiger and Margaret James, ‘Hatches, Matches and Despatches’, in V. Burgmann and J. Lee (eds.) Constructing a Culture: A People's History of Australia since 1788, Ringwood: Penguin, 1988, pp. 1- 17. 51 Reiger, Disenchantment of the Home, p. 39.

34 men’.52 Jill Matthews attributes this focus on the mother to the increasing anxiety over the composition of the population in Australia. Population ideology, she argues, was firmly based around notions of racial purity and belief in the superiority of white British stock, emerging from Enlightenment ideas of moral, economic and civil progress.

Furthermore, scholars argue that the regulation of women’s bodies was particularly focused on the pregnant body.53 The rise of antenatal care and the ‘infant welfare’ movement were crucial components of the surveillance over the maternal body in order to preserve the (white) race; the notion of ‘scientific mothering’ went hand-in-hand with the cultural veneration of motherhood-as-citizenship.54 It was widely believed, as Reiger argues, that Australian women needed instruction and education in the ‘scientifically correct and morally approved’ manner of motherhood and maternity in order to prevent the deterioration of the race and to assist sturdy little Australian babies in flourishing.55 Damousi observes that, although the grief of bereaved mothers had been publicly neglected after World War One, a ‘different kind of war’ became forged in the 1920s and 1930s in Australia, underscored by the rhetoric of nation-building; within this landscape, the figure of the mother and motherhood itself became a central focus.56

The increased scrutiny over the pregnant body and the understanding that women of childbearing age were vital to Australia’s efforts in the project of nation-building increased expectations placed upon women, argues Joan Eveline, to ‘bear even children they did not want’57 and to place their bodies under the supervision of the medical profession to ensure that these pregnancies came to fruition. Eveline, amongst others, argues that the infant welfare movement was motivated by eugenics and the concern over racial hygiene; in particular the Maternity Allowance from 1912 was designed to reward ‘appropriate’

52 Holmes, Spaces in her Day, p. 71. 53 Matthews, Good and Mad Women, p. 75. 54 Fiona Paisley, ‘Feminist Challenges to White Australia, 1900 – 1930s,’ in Diane Kirkby (ed.), Sex, Power and Justice: Historical Perspectives on the Law in Australia, Melbourne: Oxford University Press, 1995, p. 253. 55 Reiger, Disenchantment of the Home, pp. 128-129. 56 Damousi, Labour of Loss, p. 38. 57 As Eveline argues, legislation was enacted to ensure this; the Western Australian Criminal Code Act 1902, for example, outlawed infanticide and the abandonment of children, and provided for up to fourteen years imprisonment for abortion. See Eveline, ‘Feminism, Racism and Citizenship’, p. 152.

35 procreation, with non-Caucasian women excluded from receiving the bonus. As Eveline argues, the clear message was that white babies were prized.58

The place of the unborn child in the rhetoric of pronatalism has considered by writers although only in abstract terms. Marilyn Lake and Farley Kelly, for example, argue that the (white) unborn child was constructed as the future Australian citizen,59 but there has been little in-depth consideration of the values inscribed on the ‘imperfect’ foetal body and the cultural meanings of the death of such a foetus, an omission that is particularly surprising considering many writers acknowledge that eugenics, ‘to be well born’, played a significant role in the regulation of the female body. Eveline, for example, notes that the white mother was considered to be the ‘saviour of the race’;60 Reiger also observes that ‘unable to force women to bear more children, the State placed emphasis on improving the ‘quality’ of those children who were born; their health and upbringing became matters of professional concern’.61 Although notions of ‘defectiveness’ are considered in these studies, there is no systematic analysis of how perinatal loss may have been constructed within these inscriptions on the foetal body.

Bryan Gandevia’s social history into high infant mortality rates in the nineteenth century also touches on meanings of perinatal loss, but does not provide a broader analysis of the diversity of understandings. Gandevia notes that high infant mortality in the latter years of the nineteenth century was considered to be an issue of grave importance for the colonies and later, the newly Federated nation; accordingly, the issue of ‘maternal neglect’ became increasingly considered to be at the root of the problem of the shockingly-high rate of infant mortality. For example, although the Registrar-General of New South Wales [NSW] noted the problem of lead contamination in drinking water and its impact on infant health in the mid 1850s, he carefully sidestepped discussing any possible remedial measures, declaring instead that deficient mothering was to blame: ‘the great sacrifice of life ... exhibited ... is the result of a sinful degree of neglect and recklessness, which call for the

58 Eveline, ‘Feminism, Racism and Citizenship’, pp. 150-151. See also Paisley, ‘Feminist Challenges’, pp. 252 – 254. 59 Marilyn Lake and Farley Kelly (eds.) Double Time: Women in Victoria – 150 Years, Ringwood, Vic.: Penguin, 1985, p. 259. 60 Eveline, ‘Feminism, Racism and Citizenship’, pp. 150-151. 61 Kerreen Reiger, ‘Vera Scantlebury-Brown: Professional Mother’, in Lake and Kelly (eds.) Double Time, p. 291.

36 most earnest consideration’ by those entrusted with ‘the education, the moral training and the government of the people’.62 The figure of the expectant mother, then, was imbued with weighty and serious responsibility.

According to several historians, the introduction of the Maternity Allowance or ‘Baby Bonus’ in 1912 by the Fisher Labor government was explicitly designed to encourage and reward ‘good’ mothering practices and to discourage ‘undesirable’ people from procreating.63 Scholars rightly show that Asiatic and indigenous mothers were excluded from receiving the Allowance, an explicit way of excluding such women from the ‘national project’ of maternity. Fiona Paisley, for example, further explores the role of the State as ‘father’ in the lives of Aboriginal mothers, whose attachments to their babies and children were constructed as inferior, with great ramifications beyond exclusion from the Maternity Allowance scheme.64 Although Reiger, for example, notes that the issue of the Allowance extending to instances of stillbirths was a matter of debate,65 a serious omission from most arguments that the Maternity Allowance was a reward for ‘appropriate’ procreation is a focused examination of the exclusion of women who produced stillborn babies. The exclusion of women who delivered a stillborn baby – women who were constructed as ‘failed mothers’, as I argue in Chapter Two, is just as instructive to the historian seeking to understand the motivations behind pronatalism.

Maternal responsibility: antenatal care

Sociologists and historians alike have written extensively on the construction of antenatal care in the early twentieth century as an ‘essential’ and ‘responsible’ response to one’s pregnant condition. The British sociologist Ann Oakley observes that antenatal care, as an articulated concept, did not exist prior to the twentieth century, yet by the 1930s the expectation that women would place their pregnant bodies under the supervision of a doctor

62 Bryan Gandevia, Tears Often Shed: Health and Welfare in Australia since 1788, Rushcutters Bay, NSW: Pergamon Press, 1978, p. 79. 63 As Eveline argues, the Maternity Allowance was ‘naturalised to the assumed whiteness of the legislation: ‘the more young Australians we have,’ [Prime Minister Fisher] declared, ‘the wealthier the country must be’. See Eveline, ‘Feminism, Racism and Citizenship’, p. 151. See also Gandevia, Tears Often Shed, p. 130; Paisley, ‘Feminist Challenges’, p. 253; Reiger, Disenchantment of the Home, p. 89; Damousi, The Labour of Loss, pp. 38-39. 64 Paisley, ‘Feminist Challenges’, pp. 252–269. 65 Reiger, Disenchantment of the Home, p. 86.

37 was fast becoming an accepted custom in both Britain and Australia. Driving what Oakley has conceptualised as the ‘claim[ing] [of] the care of pregnant women as its expert territory’ was a widespread fear that ‘race suicide’ was imminent if the high maternal and infant mortality rates were not halted – a fear particularly heightened in the newly federated Australia particularly after the great losses of the Great War. Childbearing, argues Oakley, ‘became singled out as an activity of proper concern to the state – one in which it was essential for the state to intervene in the interests of maintaining and improving the quantity and quality of the population’.66

The key to improving the quantity and quality of the population was, in essence, an appeal to the ‘regulated and scientific’ approach as postulated by the medical profession; Damousi argues that the elevating of white motherhood as a ‘new science’ was borne not only out of the ‘modernist tendencies’ of the period but was also a ‘response to the broken bodies which had returned’ from the Great War.67 The great tragedies of the First World War served to reinforce the notion that the fledgling nation needed a more robust and ‘racially hygienic population’.68 McCalman observes that this view was to some extent borne out of the sheer numbers of babies being born to syphilitic mothers in the early twentieth century;69 however, the births of venereal disease-affected babies only served to strengthen eugenic ideals. Several historians problematise the incidence of syphilis and other sexually transmitted infections, arguing that the attempted eradication of venereal disease became a crucial part of efforts to ‘moralise’ the lower classes. Stephen Garton, for example, argues that the interwar years were host to the prevailing view that ‘undesirables’ should be restricted in their procreation, for the nation’s sake; the concern over ‘race suicide’, brought about by what Eveline sees as ‘the war, influenza and poverty, and the feared influx of Asia’s ‘millions’70 strengthened the activities and concerns of eugenics groups.71

66 Ann Oakley, The Captured Womb: A History of the Medical Care of Pregnant Women, Oxford: Blackwell, 1984, p. 34. 67 Damousi, The Labour of Loss, p. 38. 68 Damousi, The Labour of Loss, p. 38. 69 McCalman, Sex and Suffering, pp. 135-136. 70 Eveline, ‘Feminism, Racism and Citizenship’, p. 152. 71 Stephen Garton, ‘Sound Minds and Healthy Bodies: Re-considering eugenics in Australia, 1914-1940’, Australian Historical Studies, vol. 26, no. 103, October 1994, p. 164.

38 As Lisa Featherstone notes, to be a woman within eugenic discourse was ‘simply to be a mother. Marriage equated maternity, femininity equaled motherhood’.72 However, she continues, the ideal of motherhood was ‘just a representation – bearing little resemblance to the reality of lives of real, flesh and blood women’.73 The ideal of motherhood, however in conflict with the real lives of Australian women, became the justification and impetus for the scrutiny over women’s bodies in the early twentieth century. Irish sociologist Jo Murphy-Lawless argues that, within the context of the growing cultural expectation that the pregnant woman would place herself under the care of a doctor in order to conceive a healthy, robust baby, antenatal care was a coercive measure; the medical profession began to rely on ‘scare tactics’ in order to convince women of their inability to monitor their pregnancy satisfactorily, and the ensuing need for medical supervision.74

Furthermore, according to Deborah Lupton, the surveillance of women’s bodies was part of the shift to remove women’s authority over their bodies and their babies: she argues that ‘women were depicted as the sites of production, alienated from their work by medical praxis, the baby the end product, the uterus the labourer and the doctor the supervisor’.75 Oakley also suggests that antenatal care can be seen as part of an effort to control women’s bodies, particularly when the declining birth rate intersected with fears of ‘race suicide’ and the ‘hygiene’ of the race. She argues that, in seeking to exert control over women’s bodies, antenatal care was symbolic of an unequal alliance between mothers and doctors, with the ‘main imperative for mothers … to solicit and pay attention to medical advice’.76

The intertwined factors of the medicalisation of childbirth and the cultural avoidance of death had great impact on the way that pregnancy loss and baby death was understood both

72 Featherstone cites the example of eminent Melbourne obstetrician, Sir Walter Balls-Headley, who insisted that maternity and domesticity should be the sole occupations for women; intellectual pursuits, for example, would upset the reproductive processes and Balls-Headley, argues Featherstone, ‘felt that the position assumed during study would compress the uterus, this, combined with tight lacing, would lead to uterine dysfunction’. Walter Balls-Headley quoted in L. Featherstone, ‘Race for Reproduction: The Gendering of Eugenic Theories in Australia, 1890 - 1940’, in Martin Crotty, John Germov, Grant Rodwell (eds.) A Race for a Place: Eugenics, Darwinism and Social Thought and Practice in Australia, Callaghan, NSW: Faculty of Arts and Social Sciences, University of Newcastle, 2000, p. 183. 73 Featherstone, ‘Race for Reproduction’, p. 183. 74 Jo Murphy-Lawless, Reading Birth and Death, Bloomington and Indianapolis: Indiana University Press, 1998, p. 19. 75 Deborah Lupton, Medicine as Culture: Illness, Disease and the Body in Western Societies, London, Thousand Oaks: Sage, 1994, p. 70. 76 Oakley, The Captured Womb, p. 257.

39 within the medical community and by much of Australian society. Jalland argues that the professionalising of medicine hastened the cultural avoidance of death because institutions came to be synonymous with healing, so that the ‘death of a patient represented failure and death became a topic to be evaded’.77 The evasion of death was particularly marked in the maternity hospital, which as I discuss in following chapters, had become constructed as a site for birth, not death. Perinatal death, accepted with a certain sense of philosophical acceptance prior to the turn of the twentieth century, transgressed both the notion of a ‘good death’ and the increasing view that modern medicine had been able to control perinatal death.78

As I argue in Chapter Two, the medicalisation of childbirth had seen the steady decline in both infant and maternal mortality rates, cultivating the notion that perinatal death was avoidable providing the pregnant woman placed her body under the supervision of the medical profession. McCalman observes that the decline in maternal mortality and significant discoveries in obstetrics from the 1940s onwards, such as the discovery of the Rhesus factor, led to a new focus on the foetal body; the rise in perinatal medicine as a sub- spectrum of obstetrics shifted the concerns of the medical profession and also supported the notion that, as had been the case with the maternal mortality rate, medical knowledge had the ability to conquer perinatal mortality.79

Murphy-Lawless argues that a significant component of the medicalisation of childbirth was the construction of pregnancy and childbirth as a time of ‘dire peril’ for women and their unborn children; however, as the incidence of deaths in childbirth fell, she argues, obstetrics was ‘loathe to let go of its use of the risk-death pairing’.80 Coupled with advances in perinatal medicine, antenatal care and the ‘active management’ of labour were perceived to be the means by which this risk could be minimised, and as perinatal mortality declined incidents of stillbirth and neonatal death served to ‘expose the obstetric system at its most vulnerable point, revealing such guarantees about its capacity to deal with risk to

77 Jalland, Changing Ways of Death, p. 194. 78 Anthropologist Michael C. Kearle observes that a ‘bad death’ was one where the individual was ‘taken prematurely’. With secularisation and advances in medical knowledge, death became anticipated and the notion of ‘dying on time’ was the distinction between a ‘good’ and a ‘bad’ death. See M. C. Kearle, Endings: A Sociology of Death and Dying, New York: Oxford University Press, 1989, p. 122. 79 McCalman, Sex and Suffering, pp. 239-240. 80 Murphy-Lawless, Reading Birth and Death, p. 198.

40 be meaningless’.81 In other words, perinatal death transgressed the ideals and aims of obstetrics to produce ‘successful issue’. In this thesis I explore how the construction of perinatal death as an instance of ‘failure’ impacted the ways in which women experienced the death of a baby, having transgressed the expectations placed upon them to produce ‘successful issue’.

The ‘bad’ woman

Trangressing ‘appropriate femininity’ is a common theme in feminist scholarship in Australia. Through her analysis of case records of female inmates in lunatic asylums, Matthews provides a disturbing insight into the impact of such transgressions – which she notes is based around the idea of ‘normative heterosexuality’ - of which motherhood is a crucial component.82 In Matthews’ analysis, transgressing ‘good’ motherhood does not extend to women who lost babies, although she does consider the expectations placed upon mothers to behave in ways that were considered ‘appropriate’ to their position in society.83

Lake and Kelly consider the role of feminism at the turn of the nineteenth and twentieth centuries in promoting notions of ‘good’ motherhood through their lobbying for the ‘mother’ to be considered valuable to the cause of nation-building. The so-called ‘pronatalism push’ meant that women were ‘confronted with exacting new standards of mothering and housewifery’; these demands were predicated upon ideas of national responsibility. ‘Modern methods’ of mothering were valorised as helping women achieve and fulfil their domestic ‘responsibilities’; critical to the assessment of women’s success was the regulation of mothering – exemplified, argue Lake and Kelly, by the image of the baby on the scales.84 Neither Lake and Kelly or Matthews consider the possibility of women failing as mothers even before their babies could be measured on those scales.

Whilst not a feminist history, Neville Hicks’ study of the 1904 NSW Royal Commission into the Decline of the Birth-Rate [RCDB] is a useful analysis of the expectations placed upon Australian women at the turn of the nineteenth and twentieth centuries; as he argues,

81 Murphy-Lawless, Reading Birth and Death, pp. 198 & 214. 82 Matthews, Good and Mad Women, p. 111. 83 Matthews, Good and Mad Women, pp. 173-197. 84 Lake and Kelly (eds.) Double Time, p. 259.

41 the Report is fairly littered with references to women’s ‘selfishness’ in choosing to restrict their family size. Women who were apparently practicing contraception to limit their family size were labelled as lazy, self-absorbed, and a threat to Australia’s future health and security. Delaying childbirth or avoiding pregnancy was equated to a lack of commitment to the nation and the selfish desire to avoid the ‘natural’ obligations of femininity, and witnesses to the Commission openly called for such women to be stigmatised.85 This stigma, however, could be problematised in light of the Report’s continual conflation of spontaneous and ‘criminal’ abortion; the focus on women’s childbearing activities was, as Hicks observes, of such significance at the turn of the twentieth century that an analysis of the meanings given to miscarriage and perinatal death is warranted.

Several feminist writers have sought to chart the developments in birth control and contraception in Australia’s past, and in doing so have considered the apparent disparity in women’s inscriptions on the foetal body and those inscriptions produced by the medical profession and government authorities. As part of her research into induced abortion, Judith Allen notes the sheer prevalence of miscarriage and perinatal death in Australia at the turn of the twentieth century and argues that pregnancy, despite being culturally venerated as the avenue for ‘appropriate’ feminine fulfilment, was not always welcomed in reality. Rather, for some women it was a devastating event. For already overburdened and often impoverished working-class women, induced abortion and, to a lesser extent, infanticide and concealment of birth, were common forms of contraception; therefore, argues Allen, for many women the death of a child was accepted with a sense of relief, as ‘one less mouth to feed’.86

Furthermore, Allen argues that infanticide was often used as a last- resort form of birth control, although the practice did lessen in the early twentieth century as regulation over birth was tightened. Previously however the regulation of births and deaths, including stillbirths and neonatal deaths, was virtually non-existent; despite a few arrests being made of women charged with infanticide at the turn of the century, many a suspicious infant

85 Neville Hicks, This Sin and Scandal: Australia’s Population Debate 1891-1911, Canberra: Australian National University Press, 1978, pp. 33-35 & 51. 86 Judith Allen, Sex and Secrets: Crimes involving Australian women since 1880, Melbourne: Oxford University Press, 1990, pp. 26-27.

42 death was accepted as a stillbirth by the public and officials alike.87 Because of this lack of official intervention, Allen argues that this indicated that childbirth and its associated dangers were seen to be women’s business and treated with far less ‘shock and moralism’ as would be the case in contemporary Australia.88 Allen’s otherwise significant and useful study ignores the substantial body of source material which suggests that fatalism may be but one response to pregnancy loss in the past. Stefania Siedlecky and Diana Wyndham too do not explore the complexity of meanings of perinatal loss in the early twentieth century within their argument that women’s increasing agitation for safe, effective and reliable birth control is evidence that most Australian women viewed their pregnancies as burdensome.89

A more useful analysis to the concerns of this thesis is found in the work of Lynette Finch and Jon Stratton, who explore the changing ideas of what constituted a ‘child’ amongst the working-class and middle-class respectively at the turn of the twentieth century, arguing that there was a shift towards constructing the foetus as a human entity deserving of protection – both medical and legal. Finch and Stratton note that the value placed upon unborn children was a notion which gradually spread to the working class at the turn of the twentieth century.90

Medicine and perinatal loss

McCalman’s comprehensive study of the RWH in Melbourne focuses on medical developments which saw both the maternal and infant mortality rates significantly decline in the early twentieth century. McCalman argues persuasively for the medical profession’s role in this decline, yet any impact on the constructions of pregnancy loss is not afforded a

87 Allen, Sex and Secrets, p. 33. 88 Allen, Sex and Secrets, p. 33. 89 Stefania Siedlecky and Diana Wyndham, Populate and Perish: Australian Women’s Fight for Birth Control, Sydney: Allen and Unwin, 1990, passim. 90 Lynette Finch and Jon Stratton, ‘The Australian working class and the practice of abortion 1880-1939’, Journal of Australian Studies, vol. 23, 1988, pp. 45-64. See also Lynette Finch, The Classing Gaze: Sexuality, Class and Surveillance, St Leonards, NSW: Allen and Unwin, 1993, p. 70. However, one cannot conclude that the ‘respectable’ classes completely imposed the notion of the foetus as human on the unsuspecting working-classes. Letters from working-class women in Britain at the turn of the twentieth century provide insight into the diversity of inscriptions of the foetal body; for example, one woman wrote of her deep sadness at losing her first child: ‘We had a little girl, which we had always longed for, only to lose it as soon as it came into the world, for I have no strength in my inside (the doctor said) to bring a child into the world’. Another commented that, after her stillbirth, ‘I did nothing but cry. I could not get what I ought to have’. See Letter 120 and Letter 49 quoted in Margaret L. Davies (ed.) Maternity: Letters From Working Women, London: Virago, 1978, pp. 76 & 152.

43 systematic analysis. McCalman asserts that ‘the mothers mattered, the babies were scarcely mentioned’; this conclusion, however, requires further consideration. In Sex and Suffering McCalman notes that this was primarily borne out of the medical profession’s need to focus on maternal mortality without further examining how this may have affected understandings of perinatal loss at this time.91

Reiger’s study of the ‘forgotten women’s movement’, childbirth reform in the late 1960s and 1970s, addresses the gaps in McCalman’s analysis and moves beyond the positivist approach that the medical profession usually acted in the best interest of pregnant women and their babies. Although Reiger makes only brief mention of changing understandings of perinatal loss, her work provides the social and historical framework for changing attitudes towards pregnancy in the 1960s and 1970s; in later chapters I discuss Reiger’s work in greater detail.92

Although the cultural construction of pregnancy and childbirth as satisfying and fulfilling events in many Australian women’s lives has been convincingly challenged by writers such as McCalman and Reiger, the reach of these studies do not extend to include the historical experiences of those women whose pregnancy ended in a stillbirth or neonatal death. Where Our Bodies, Our Babies makes an invaluable contribution to enlarging our knowledge of the particular social context in which dramatic changes to childbirth practices were able to occur, this thesis extends this research to reclaim perhaps the most historically silent aspect of pregnancy, perinatal loss The growing recognition that perinatal death was a significant event in a woman’s life – a recognition couched within the context of social change which Reiger has explored in depth - would dramatically change the way that perinatal death – like other aspects of pregnancy and childbirth - was managed within the clinical setting.

Contemporary scholarship of perinatal loss

I now move my attention away from the historiography of maternity and motherhood in

91 McCalman, Sex and Suffering, p. 156. 92 Reiger, Our Bodies, Our Babies: The Forgotten Women’s Movement Carlton, Vic.: Melbourne University Press, 2000.

44 Australia to consider contemporary literature concerned with perinatal death and pregnancy and notions of responsibility in general. Whilst little attention has been paid to perinatal death as an historical subject, there is a significant body of scholarship which analyses the constructions of perinatal loss in contemporary Western societies. Due to the extent of these works, these texts have been selected as examples of the range of literature about stillbirth and neonatal death in western societies including the United States of America, the United Kingdom, and Australia.

For the purpose of this literature review I have assessed these texts using the key themes which underpin my own research, asking questions such as: have these writers examined women’s own understandings of perinatal death and have they acknowledged the silence surrounding women’s voices? If so, have they sought to examine women’s own understandings of perinatal death, and how was this information accessed and analysed? Do these texts implicitly or explicitly challenge the medical model of perinatal death and its authority over knowledge concerning the loss of a baby? Have these authors considered the historicity of perinatal death, or is it viewed as fixed and unchanging, interpreted through the grid of scientific understandings of stillbirth and neonatal death?

American cultural anthropologist Linda Layne has contributed perhaps the richest body of work on contemporary meanings of pregnancy loss in North America within what she terms the rise of the ‘consumer culture’. Layne’s research into contemporary pregnancy loss is predicated upon the understanding that pregnancy, and by extension pregnancy loss, is socially constructed, rather than an essential or an ahistorical event. She argues that, since the emergence of the abortion reform movement in the 1960s and 1970s, motherhood has become something to be ‘achieved’ rather than a status ascribed to women by virtue of their femaleness; furthermore, in a culture of individualistic effort, pregnancy is interpreted in terms of ‘production’. In making parallels to the measuring of worth in a business context, Layne notes that the ‘successful production’ of a baby can be ‘credited as a moral achievement, the result of self-discipline and labor, [and] that the inability to bear children is often attributed to a moral failing on behalf of the woman’.93 If reproduction is viewed in

93 Linda Layne, ‘‘True Gifts from God’: Motherhood, Sacrifice and Enrichment in the Case of Pregnancy Loss’, in L. Layne (ed.) Transformative Motherhood: On Giving and Getting in a Consumer Culture, New York and London: New York University Press, 1999, p. 171.

45 these terms then pregnancy loss or early newborn death is by extension, as Layne argues, viewed as ‘an instance of failed production’.94

Notions of maternal responsibility in the late twentieth century fit more broadly within the discourse of individual responsibility and the emphasis on personal achievement evident in many Western cultures, including Australia. Layne argues that pregnancy loss is a ‘moral problem’ for those women whose babies die. In a cultural context where pregnancy is constructed as an ‘achievement’ and the birth of a healthy baby as a ‘success’, pregnancy loss is constructed as a ‘failure’.95 Layne observes that Western cultures ‘often [understand] pregnancy in terms of capitalist production and [deem] moral stature and worldly success to be the result of purposeful, individual effort’.96 Furthermore, Layne applies anthropologist Emily Martin’s idea of the ‘currency of health’ to explore how women who suffer the ending of a pregnancy or death of a baby are caught between the tension of the ‘out-of- controlness of most fetal and early infant deaths and the cultural mandate to be in control of one’s body/self’.97

Feminist scholars have increasingly critiqued the rise of what is termed the ‘maternal/foetal conflict’, a privileging of the foetal body over the maternal body with the expectation, as Susan Markens et al note, that ‘women as mothers [should] subordinate their own needs to their children’s. With regard to pregnant women, this expansion of maternal responsibilities to the gestational period signals a shift in the focus of pregnancy from the health of the woman to the health of the fetus’.98 Ruth Hubbard, for example, argues that the ‘selfish mother’, intent on fulfilling her desires at ‘the expense of her unborn child’, is part of a tradition of portraying mothers as ‘bad for their children’. 99 Katha Pollitt notes that the

94 Layne, ‘True Gifts from God’, p. 170. 95 Layne, ‘True Gifts from God’, p. 169. 96 Layne, ‘True Gifts from God’, p. 169. 97 Martin argues that the cultural model of the immune system emerged as a new form of Social Darwinism in the late twentieth century; she notes that whilst the ‘relative strength of immune systems is sometimes understood in terms of an individual’s or group’s genetics … it is also frequently understood to be the result of an individual’s conscious efforts at self-improvement’. A similar model, argues Layne, can be applied to perinatal loss; after the emergence of abortion activism motherhood shifted from a ‘status that was ascribed to one that was achieved … a moral achievement’. See Layne, ‘True Gifts from God’, pp. 169-170. 98 Susan Markens, C.H. Browner, Nancy Press ‘Feeding the Fetus: Interrogating the Notion of Maternal/Fetal Conflict’, Feminist Studies, vol. 23, no. 2, 1997, p. 353. 99 Ruth Hubbard, ‘The Politics of Fetal/Maternal Conflict’, in Gita Sen and Rachel Snow (eds.) Power and Decision: The Social Control of Reproduction, Boston, Mass.: The Harvard Centre for Population and Development Studies, c1994, p. 312.

46 discourse of maternal responsibility positions women as antagonists towards their foetuses; the behaviour of men in as contributing to the wellbeing of their partner’s pregnancy is rarely, if ever, implicated.100 Feminist philosopher Rebecca Kukla observes that the rise of the mother-as-antagonist has been reinforced with the increasingly widespread use of prenatal screening techniques, which she terms the ‘project of turning the uterus into a public theater and the fetus into its lead actor’; as it became revealed through ultrasound and later, other technology, the foetus became imbued with greater significance in medical discourse at the expense of the maternal body.101

Lupton argues that the discourse of ‘good mothering’ has been always been a corollary of the medicalisation of childbirth; however, in contemporary times this has been extended to the moment of conception and even to those women planning to fall pregnant. She argues that ‘once again, the primary emphasis of such discourses is upon the health and well-being of the foetus’.102 Barbara Katz Rothman considers the inscription of ‘perfection’ upon the foetal body; in contemporary Western societies, she argues, reproduction is viewed as ‘products of conception’ – but not in the manner of the terminology used by the medical profession. Rather, for Rothman, the phrase ‘products of conception’ signifies the disturbing trend towards the pursuit of reproductive ‘perfection’ and demonstrates the ‘commodification’ of procreation. She claims that reproductive technologies capitalise on the commodification of the foetal body; ‘we work hard, some of us, at making the perfect product, what one doctor calls a “blue ribbon baby”’.103 The growth of reproductive technologies has fundamentally and radically changed how the pregnant body is supervised by the medical profession; until the 1970s, supervision meant watching the labouring

100 Katha Pollitt, ‘Fetal Rights: A New Assault on Feminism’, in Molly Ladd-Taylor and Lauri Umansky (eds.) ‘Bad’ mothers: The Politics of Blame in Twentieth Century America, New York: New York University Press, c1989, pp. 295-296. 101 Kukla cites a 1981 article in the Journal of the American Medical Association to support this assertion; according to Kukla, the article signifies the shift away from the maternal body toward the foetal body. The author of the article argued that ‘the fetus could not be taken seriously as long as he remained a medical recluse in an opaque woman; and it was not until the last half of this century that the prying eye of the ultrasonogram … rendered the once opaque womb transparent, stripping the veil of mystery from the dark inner sanctum and letting the light of scientific observation fall upon the shy and secretive fetus … The sonographic voyeur, spying on the unwary fetus, finds him or her a surprisingly active little creature, and not at all the passive parasite that we had imagined’. See Rebecca Kukla, Mass Hysteria: Medicine, Culture, and Mothers’ Bodies, Lanham, Maryland: Rowman and Littlefield Publishers, 2005, p. 111. 102 Lupton, Medicine as Culture, p. 155. 103 Barbara Katz Rothman, The Tentative Pregnancy: Prenatal Diagnosis and the Future of Motherhood, New York: Viking, 1986, p. 2.

47 woman, but reproductive technologies have served to render what was once invisible as visible.104

Yet in arguing that women are expected to produce ‘perfection’ through self-sacrifice, few scholars consider the potential values inscribed on the ‘imperfect’ foetus – one might argue that, in attempting to turn the maternal/foetal dichotomy on its head, they have only succeeded in privileging the maternal body without consideration of the diversity of values embedded in the foetus.105 Layne notes that the issue of foetal personhood and the rise of the ‘maternal/foetal conflict’ has been a crucial focus of feminist scholars since the end of the twentieth century and are ‘central to arguments about women’s right to terminate pregnancies’. Pregnancy loss, therefore, has been ‘careful[ly] … avoided’ by feminist writers. This has been a central concern in Layne’s work; as she argues, ‘because the ambiguous status of fetuses is central to both pregnancy loss and abortion, pregnancy loss provides an ideal arena from which to explore alternative ways to conceptualize maternal/fetal relations’.106

Scholars concerned with the medicalisation of disability in the recent past have provided useful insight into the possible inscriptions on the foetal body produced by the medical classifications of ‘viable’ or ‘non-viable’. Melinda Tankard Reist’s study into ‘defiant birth’ – the experiences of women who have chosen to continue their pregnancies despite medical opposition on grounds of ‘foetal abnormality’ – provides useful insight into the construction of the ‘imperfect’ conception. Reist argues that, as prenatal testing has become increasingly considered a routine part of pregnancy in Australia, it has become couched within a discourse of ‘denial’ or ‘courage’. She claims that ‘women are often led to infer that it is only those who are weak-willed and avoidance-seeking who do not avail themselves of all medical technology has to offer’.107

104 Rothman, The Tentative Pregnancy, pp. 26-28. 105 Rothman, for example, makes the unequivocal assertion that ‘the meaning of the abortion lies in the meanings the pregnancy holds for the woman. If a woman sees a pregnancy as an accident … then in her definition the fetus is not a person and not meant to be one’. See Rothman, The Tentative Pregnancy, p. 5. 106 Linda Layne, Motherhood Lost: A Feminist Account of Pregnancy Loss in America, New York: Routledge, 2004, p. 28. 107 Melinda Tankard Reist, Defiant Birth: Women Who Resist Medical Eugenics, North Melbourne: Spinifex Press, 2006, p. 4.

48 Rothman’s thesis in The Tentative Pregnancy is similar, although from a different theoretical vantage as a feminist scholar. Reproductive technology, she argues, is constructed as the ultimate expression of women’s choice to decide which babies they will or will not bear; however, whilst this is an attractive proposition – the definitive symbol of women’s reproductive freedom - the reverse is true in reality. Reproductive technologies and the ensuing values embedded in the so-called ‘products of conception’ are the ‘illusion of choice’; the authority of the medical profession in naming and classifying what is deemed ‘imperfect’, the delivery of results in scientific language, and social concerns over the cost of ‘imperfection’ all contribute to this illusion.108

Linked with the coercive nature of prenatal screening is the ‘diminished personhood’ of the ‘imperfect’ foetus, argues American anthropologist Gail Landsman. Both Landsman and Layne observe that, in a ‘consumer culture’ women’s moral worth is made intrinsic to the products of their womb; to give birth to a disabled infant then, by extension, is to have failed to attain ‘perfection in foetal outcome’.109 The women interviewed for Landsman’s study – all of whom were mothers of children with disabilities – had been reassured by medical professionals that their behaviours had not contributed to their respective children’s disabilities but, as Landsman notes, the expectation of maternal responsibility strongly shaped the women’s own narratives. In her study, Landsman interrogates the seemingly-harmless and, one might argue, positivist rhetoric that ‘God gives special kids to special parents’; rather, argues Landsman, at the heart of this discourse is the expectation that the pregnant woman will take all possible precautions to avoid producing a child with a disability. Although women may be reassured that they ‘did nothing wrong’, the expectation of maternal responsibility strongly leads to the prevailing view – amongst women concerned and their communities – that any individual woman has the power and available choices to self-manage and self-control her pregnant behaviour, to gain mastery

108 Rothman, The Tentative Pregnancy, p. 14. 109 Gail Landsman, ‘Does God Give Special Kids to Special Parents? Personhood and the Child With Disabilities as Gift and Giver’, in Layne (ed.) Transformative Motherhood, p. 135.

49 over reproduction and produce ‘perfection’.110 To fail in this, then, strips women of the protection assured by the discourse of maternal responsibility; to produce a disabled or stillborn baby then shifts the woman to the margins, to become the ‘other’.111

Historicisation of perinatal death

A number of other texts have considered the incidence of stillbirth and neonatal death in western societies from an historical perspective. Many of these texts have considered both changes in knowledge and also gendered meanings of these understandings, whilst others are motivated from an empiricist methodology which devalues women’s own understandings of loss. Here I will discuss a range of these texts and in doing so will provide some historical contextualisation for my study.

Lawrence Stone, amongst others, argues that the high infant mortality rate in early modern Europe and Britain served to limit parents’ emotional investment in their children, particularly infants. He argues that the parent-child relationship amongst the wealthy upper- class of Europe and Britain was ‘usually fairly remote’, and suggests that ‘one reason for this was the very high infant mortality rates, which made it folly to invest too much emotional capital in such ephemeral beings’.112 For poor parents, another pregnancy signified yet another burden; although he does not cite primary evidence such as letters or diaries, Stone claims that ‘the absence of birth control, the struggle to find enough food to feed the hungry mouths, must have made children less than welcome’.113 In his history of bereavement, psychiatrist Colin Murray Parkes argues that most parents ‘expected’ to lose infants and young children and accepted these losses ‘more readily’ than parents in contemporary times.114 According to Stone, the practice of wet-nursing is indicative of the

110 Landsman, ‘Does God Give Special Kids to Special Parents?’, pp. 138-139. Linda Layne argues that the deceased foetus or newborn is a ‘liminal being’, a source of both ‘power and danger’. She notes that ‘in the United States … dead newborns combine the potency of women’s life-giving power with the destructive, polluting power of life-forces gone awry; thus, it is not surprising that such entities should be subject to taboo. Dead embryos or newborns are an unwelcome reminder of the fragility of the boundary between order and chaos, life and death. In Western cultures, the ‘abnormal’ foetal corpse is constructed as particularly dangerous; as Layne argues, ‘[w]hen pregnancy loss involves a visible malformation, the status of both mother and baby are affected’. See Layne, Motherhood Lost, pp. 62-65 111 Landsman, ‘Does God Give Special Kids to Special Parents?’, p. 139. 112 Lawrence Stone, The Family, Sex and Marriage in England 1500-1800, London: Weidenfeld & Nicolson, 1977, p. 105. 113 Stone, The Family, Sex and Marriage, p. 107. 114 Colin Murray Parkes, Bereavement: Studies of Grief in Adult Life, Middlesex: Penguin, 1978, p. 148.

50 ‘better classes’ indifference towards their children,115 whilst Edward Shorter postulates that the custom of referring of infants as ‘it’ in early modern Britain and Europe was further proof of the ‘indifference’ with which adults viewed infants and children.116

Several historians of childhood have roundly rejected these arguments; Linda Pollock, for example, notes that whilst the practice of wet-nursing was a hazardous one, many literate parents recorded their anxiety over the wellbeing of their infants whilst in the care of wet- nurses. She rejects Stone’s claim that wet-nursing, fraught with danger and often leading to the infant’s death, ‘made the appalling level of infant mortality much easier to bear [because] at least the parents did not see them or know about’ any deficiencies in their care.117 Rather, argues Pollock, the ‘continuance of wet nursing was more evidence for the inertia of social custom than evidence for the neglect of infants. Furthermore, it is clear from these texts that infants sent to a wet-nurse were not ignored by their parents; frequent visits were made, particularly if the child was ill’.118 In her extensive analysis of the private diaries of European and British parents written between 1500 – 1900, Pollock argues that although some parents were apparently accepting – and at times indifferent – of the loss of an infant, most parents did welcome the birth of a baby, albeit at times with anxiety over their ever-increasing family, and often viewed baby death with sadness. For example, British mother Mrs Housman recorded in her diary her grief after the stillbirth of her child, writing that: ‘the last Time prevented our Enjoyment of a living Child; at once disappointed our Hopes, and cutt of [sic] our Expectations, which was a great Trial to our weak Graces’.119

Rosemary Mander and Rosalind Marshall argue that wealthy upper-class families in Western European cultures in the sixteenth and seventeenth centuries invested a great deal of emotion in their infant offspring, and in the event of baby death sought to memorialise their deceased babies through the medium of art. Analysing depictions of deceased babies

115 Stone, The Family, Sex and Marriage, p. 105. 116 Edward Shorter quoted in Linda A. Pollock, Forgotten Children: Parent-Child Relations from 1500-1900, Cambridge, New York: Cambridge University Press, 1983, p. 218. Pollock notes that diarists in the nineteenth century continued to use ‘it’ to refer to their children, but their diaries clearly demonstrate that they were not ‘indifferent’ to their children; she argues that ‘the calling of a child ‘it’ has no connection with the possessing of a concept of childhood’. p. 218. 117 Stone, The Family, Sex and Marriage, p. 107. 118 Pollock, Forgotten Children, p. 216. 119 Pollock, Forgotten Children, pp. 205-207.

51 in family portraits, Mander and Marshall note that most of the paintings of deceased infants were for at least semi-public display, but some, like the depictions of the noblewoman Catherine de Medici’s stillborn twins, were clearly for individuals’ private consumption – but whatever intent was behind the depiction of these babies, it is clear that some families viewed the death of a baby as a significant event.120

Milton Lewis focuses on the health and population benefits gained from the medical takeover of pregnancy and childbirth, arguing that although infant mortality was largely reduced at the turn of the twentieth century due to improved sanitation, it was the curbing of the dangerous activities of unqualified, ‘incompetent’ midwives which would prove the most significant step in the reduction in the infant mortality rate. Taking a positivist approach to writing history, Lewis notes that the medical profession were ‘quite justified’ in seeking to gain control over pregnancy and childbirth, arguing that the regulation of midwifery was a necessary and progressive step towards a healthy and stable Australian population.121 With reference to this thesis the limitations of this approach are obvious; Lewis considers both perinatal death and the foetal body as fixed and unchanging and does not ground his analysis in terms of changing social and cultural contexts and perinatal loss as subject to sociohistorical constructions.

Critiques of medical authority

As Patricia Crawford points out, the main biological events in an individual woman’s life are often focussed on reproduction and its processes, yet these apparently ‘natural’

120 For example Catherine, the wife of Henri II of France, delivered the infants – a boy and a girl – after a lengthy and difficult labour. Both children were named; Mander and Marshall suggest that perhaps the girl, Victoire, was named to reflect the pious Catherine’s belief that the child’s soul had triumphed victoriously over death into eternal life. A 1556 painting in Catherine’s prayer book shows a small child: ‘his eyes are open and he holds his hands in an attitude of prayer’. Behind this presumably living child are the twins, tightly swaddled with their eyes closed. However else Catherine was expected to grieve, there clearly was the expectation that these stillborn infants should not be forgotten as members of the family. In a similar manner, a painting depicting the quadruplets of the Dutch Dordescht family, born in 1621, show the three surviving babies positioned vertically, with the third of the quad, Elisabeth, who lived only ninety minutes, lying on a pillow with her eyes closed. Each baby is named in the painting: another apparent recognition that the death of a baby need not be hidden and sorrow avoided, but rather acknowledged and grieved, albeit in a manner dependent upon the particular familial context. Rosemary Mander and Rosalind K. Marshall, ‘An historical analysis of the role of paintings and photographs in comforting bereaved parents’, Midwifery, vol. 19, 2003, pp. 230-242. 121 Milton Lewis, ‘Maternity care and the threat of puerperal fever in Sydney 1870 – 1939’, in V. Fildes, L. Marks and H. Marland, Women and Children First: International Maternal and Infant Welfare, London: Routledge, 1992, pp. 29-47.

52 experiences are often interpreted through discourses other than those of the individual woman herself.122 In particular, medical constructions of perinatal death have had important implications on the ways in which meanings of stillbirth and neonatal death have been constructed and understood.

In Australia as in many other Western nations, birth was once the exclusive female domain of midwives and family members, with the majority of women giving birth at home; however by the twentieth century pregnancy and childbirth had been ‘taken over’ by the burgeoning medical profession. The central obsession of the medical profession was women's bodies, and it was stressed by the medical profession, politicians, religious groups and advocates of eugenics alike that women had a responsibility to breed healthy, strong Australian citizens. For example, Angela Booth, a leading advocate of eugenics and member of the Victorian Eugenics Society, stressed that white women had ‘racial’ responsibilities’ to procreate.123 With the medicalisation of childbirth, the female reproductive processes of menstruation and pregnancy were constructed at this time as abnormal rather than normal, as sicknesses rather than healthy bodily functions.124 Pregnancy was treated as a ‘delicate’ time, often described in euphemistic terms such as the ‘time of trouble’ or ‘the difficulty’.125 Furthermore, women's own knowledge of the changes occurring in their bodies during menstruation and childbirth was largely dependent upon the medical profession's dissemination of information; as such, most women lacked even a basic understanding of the reproductive process. Instead, they were urged to spend their pregnancy preparing the baby's layette and calming their spirits and nerves in order to give birth to a healthy baby.126

Using a Foucaldian approach, Lupton traces changing discourses of illness and disease in a Western sociohistorical context, with a particular emphasis on examining the contemporary tensions between a growing disquiet with medical ways of knowing illness and disease, and the continuing expectation that medical knowledge can and should provide solutions to infirmity. Although primarily concerned with a sociological analysis of medicine’s

122 Patricia Crawford, ‘From the Woman’s View: Pre-industrial England, 1500-1750’, in P. Crawford (ed.) Exploring Women’s Past: Essays in Social History, Carlton: Sisters Publishing Limited, 1983, p. 63. 123 See Lake and Kelly (eds.) Double Time, p. 259. 124 Lupton, Medicine as Culture, p. 135. 125 Reiger, Disenchantment of the Home, p. 85. 126 Reiger, Disenchantment of the Home, p. 85.

53 relationship with the body in the past, Lupton considers the historicity of the female body in medical discourse, arguing that ‘women’s bodies have historically been represented and treated in medicine as especially threatening to the moral order and social stability of society’ primarily because of the construction of female sexuality as ‘dangerous’ and ‘uncontrollable’.127

Lupton’s critique of the medical discourse of feminine sexuality is underpinned by the argument that women have traditionally been constructed by medical discourse as the poorer version of man: sick, weak and unstable, incomplete to man’s completeness, inexplicable and irrational to man’s rationality. Lupton considers the role played by medical understandings of female sexuality in shaping constructions of ‘appropriate’ feminine sexuality. In her book Medicine as Culture Lupton uses this analytical tool to locate what she refers to as a key theme of the early twentieth century: that motherhood would serve to diffuse ‘women’s dangerous sexuality’. Because the female body was constructed as inherently diseased within medical discourse, the assumption of medical control over pregnancy and childbirth led to a reconceptualisation of the processes of reproduction as a potentially pathological state; accordingly, argues Lupton, the pregnant body was cast as a ‘medical problem’ subject to ‘medical surveillance’.128 Femininity and sickness were conceptualised as being intrinsic to each other on the one hand, whilst maternity and motherhood was cast as being crucial to taming the potentially ‘dangerous’ female sexuality.

In critiquing medical surveillance of pregnancy and childbirth, Lupton’s research provides a useful analysis of the historical development of the medical profession and its assumption of control over reproduction, challenging the notion that ‘rational’ scientific knowledge is a core and essential body of knowledge about the female body and reproductive processes. However Lupton does not take a strictly cultural approach to constructions of the female body and female sexuality; indeed, she is well cognisant of the debates surrounding subjectivity and embodiment which have characterised much feminist scholarship in recent years. The female body, she suggests, is subject to both cultural constructions of health and ill-health, as well as the biological differences between the male and female bodies, such as

127 Lupton, Medicine as Culture, p. 132. 128 Lupton, Medicine as Culture, p. 136.

54 the uniquely female ability to conceive and bear children.129 Further to this, she resists the idea that women’s experiences of pregnancy and childbirth can be essentialised, instead suggesting that amongst women themselves there is a diversity of engagement with or resistance to medical constructions of reproduction, and an equally diverse ‘degree of interpretation’ amongst women as to the lived experience of uniquely female reproductive processes.130

Layne also critiques the medicalisation of childbirth and the medical inscriptions on the maternal and foetal bodies as objects to be ‘fixed’ using medical knowledge and interventions. She argues that the pathologising of pregnancy has led not only to women’s own understandings of their body becoming devalued, but has also served to reinforce the expectation that the pregnant body – encapsulating both the maternal and foetal bodies – requires supervision and control in order to produce ‘successful’ outcomes. She argues that the medicalisation of childbirth in contemporary times has fostered an expectation that perinatal death should not occur: The overreporting of neonatalogy’s “miracle babies”, combined with the underreporting of pregnancy losses … has led to a situation in which expectations concerning reproductive outcomes are higher than the level of medical competence … The experience of loss represents a clash between people’s expectations regarding the efficacy of biomedicine and the actuality.131

Within this context, Layne argues, perinatal death is still considered ‘taboo’ in Western cultures; the death of a baby transgresses the prevailing view that medical expertise can ‘save’ babies’ lives. Perinatal death therefore is not only the loss of ‘innocence’ for expectant parents, but its emotional impact is further worsened by a widespread faith in medical science’s ability to produce healthy babies.132

The body

Since the 1970s there has been a considerable amount of feminist scholarship concerned with the regulation of women’s bodies throughout history; Elizabeth Grosz, for example, argues that whilst many feminist writers who are concerned with issues surrounding

129 Lupton, Medicine as Culture, p. 148. 130 Lupton, Medicine as Culture, p. 143. 131 Layne, Motherhood Lost, p. 95. 132 Layne, ‘True Gifts from God,’ pp. 171-172.

55 women’s bodies – such as pregnancy and childbirth, for example – they are nonetheless ‘[reluctant] to conceptualise the female body as playing a major role in women’s oppression’ focusing instead on gender as the sole category of historical analysis.133 For Grosz, the body is ‘the primary object of social production and inscription, and can thus be located within a network of socio-historical relations instead of being tied to a fixed essence’.134 She argues that in order to adequately understand subjectivity and the cultural construction of ‘femininity’ and ‘masculinity’, one must also recognise the body as ‘pliable flesh … the unspecified raw material of social inscription that produces subjects as subjects of a particular kind’.135

However, as Maynard and Purvis point out, in rejecting the notion of the sexed body as natural and invoking in its stead the argument that sexuality is wholly socially constructed, feminist writers utilising this mode of analysis risk creating instead a new form of essentialism by rejecting any explanations of nature in their arguments.136 In order for contemporary feminist writers to avoid either cultural or bodily essentialism, the answer, argue Maynard and Purvis, may lie in an acknowledgement that sexuality can be both natural and constructed: ‘while bodily features and functions might be there as givens, the meanings and significance attributed to these, together with the various ways in which sexuality is expressed, are in some sense ‘constructions’ because they are historically and culturally located’.137

Despite the insistence that the body – as opposed to gender – is the primary theoretical vantage point for the feminist historian, the work of Grosz and others has great relevance to this research. Susan Bordo notes that ‘our bodies are trained, shaped, and impressed with the stamp of prevailing historical forms of selfhood, desire, masculinity, femininity’,138 whilst Grosz argues that bodily inscriptions can occur violently – in prisons, psychiatric hospitals, and so on – or in more subtle, insidious forms. Furthermore, these more

133 Elizabeth Grosz, Space, Time and Perversion: Essays on the Politics of Bodies, New York: Routledge, 1995, p. 32. 134 Elizabeth Grosz, ‘Notes Towards a Corporeal Feminism’, Australian Feminist Studies, no. 5, 1987, p. 1. 135 Grosz, Space, Time and Perversion, p. 32. 136 Mary Maynard and June Purvis (eds.) (Hetero)sexual Politics, London, Bristol, PA.: Taylor and Francis, 1995, p. 3. 137 Maynard and Purvis, Hetero(sexual) Politics, p. 3. 138 Susan Bordo, Unbearable Weight: Feminism, Western Culture and the Body, Berkeley, CA.: University of California Press, c1993, pp. 165-166.

56 insidious forms are no less coercive than violence used to restrain and oppress the body. Through the inscriptions of cultural values, norms, and the organising of the body into social groups, argues Grosz, ‘bodies are made amenable to the prevailing exigencies of power … the body is more or less marked, constituted as an appropriate, or as the case may be, an inappropriate body’.139

The theory that the body is a surface for cultural inscriptions has great relevance to this thesis. Particularly with the rise of ultrasound technology and prenatal testing in the latter decades of the twentieth century, the foetal body became ‘disembodied’ from the maternal body in medical constructions of pregnancy, and later, in popular understandings of foetal development. The increasingly routine use of ultrasound, for example, was hailed for its ability to ‘lift the corner of the veil’ into the womb,140 promoting the image of the foetus as separate to the mother. This had the effect of transforming, argues Hubbard, the ‘cultural status of embryos and fetuses … [and] render[ing] pregnant women transparent’.141 Advances in obstetrical technology which sought to monitor the development of the foetus increasingly rendered women as merely a receptacle whilst the status of the previously- hidden foetus was elevated to individual patient. Within the context of these developments in perinatal medicine, Iris Marion Young observes that ‘pregnancy does not belong to the woman herself. It is a state of the developing fetus, for which the woman is a container; or it is an objective, observable process coming under scientific scrutiny; or it becomes objectified by the woman herself as a ‘condition’ in which she must “take care of herself.”’142

Placing this thesis in the historiography

This thesis both extends and challenges existing historiography of women’s lives in Australia. Since the 1970s, feminist scholars have built a rich body of scholarship which challenges the traditional view that women’s lives were unimportant, unworthy of historical research, and indeed, that women played insignificant and merely dependent roles in

139 Grosz, Volatile Bodies, pp. 140-142. 140 See for example B. Smulders and M. Croom, Safe Pregnancy: The Complete Handbook to a Healthy Pregnancy, South Melbourne: Ibis, 2005, p. 260. 141 Hubbard, ‘The Politics of Fetal/Maternal Conflict’, p. 312. 142 Young, Throwing Like a Girl, p. 160.

57 Australia’s history. However, whilst invaluable in addressing some of the gaps in historiography of the experience of pregnancy and childbirth in the era of childbirth reform, this body of work does not extend to include perhaps the most forgotten of childbirth experiences – that is, miscarriage, stillbirth and neonatal death.

This thesis, therefore, fills a lacuna in our knowledge of the social construction of maternity and motherhood; in doing this, I analyse the range of knowledge about miscarriage and perinatal death in Australia in the twentieth century. Certain groups such as the medical profession, social workers and psychologists, community support groups and popular writers have sought to understand the experience of losing a baby through miscarriage and perinatal death. Throughout my research I have primarily been interested in analysing how constructions of perinatal death over the last one hundred years in Australia have changed. I have also considered how these meanings have, at times, competed and been in contradiction with each other. For example, towards the end of the twentieth century, the foetal body was imbued with greater significance and women were expected to ‘take care of themselves’ in order to produce a healthy baby; many feminist critics argue that at this time the foetus became privileged over the mother.143 At the same time, however, the rise of perinatal medicine and the growing ease with which the medical profession could ‘screen’ foetuses for defects led to a greater scrutiny of the perceived value of an unborn child. The persistence of the idea that a perinatal death was a ‘failed pregnancy’ was also at odds with many of the changes which were occurring at the time in terms of the care of bereaved women, and notions of ‘successful birth’ and inscriptions on the ‘inappropriate’ foetal body problematised how women understood their experience of the death of a baby or ending of a pregnancy.

In this thesis I complement existing feminist scholarship concerned with contemporary understandings of maternal responsibility and the discourse of failure and blame. I consider the ways the pregnant body has been placed under surveillance by the medical profession in order that ‘abnormality’ may be detected in both the foetal and maternal bodies, and I explore how this has challenged some women’s own understandings of their body and those of their deceased children. I am also particularly interested in the notion of authority

143 See Mira Crouch and Lenore Manderson, New Motherhood: Cultural and Personal Transitions in the 1980s, Yverdon, Switzerland: Gordon and Breach Sciences, c1993, p. 31.

58 which underpins medical supervision of the pregnant body and which has had powerful ramifications for women experiencing a miscarriage or perinatal death. Because medical discourse positioned itself as authority based on an appeal to ‘science’, it also claimed the right to ownership of the deceased body, bringing with it the right to testing and disposal often in a manner in contradiction to a woman’s wishes. The authority of medicine lies in its power to surveille and classify the foetal body which has had significant impact on the way perinatal death has been constructed and managed in Australia’s past.

However, in this thesis I challenge some feminist scholars’ reluctance to conceptualise the foetal body in terms other than a source of conflict - a body which is privileged over the maternal body. I consider the foetal body as a surface of cultural inscription and in terms of its ‘docility’, to acknowledge Michel Foucault’s work on the body and oppression.144 For example, contemporary debates surrounding abortion laws and foetal rights clearly see the foetal body as fixed and essential; although understandings of the foetal body from the pro- abortion or the pro-life perspective are clearly at odds, what is similar to both sides of the debate is an understanding of the foetal body as ahistorical and biological. Whether the foetus is conceived of in terms of biology – a collection of cells in a host body (the maternal body) – or in human terms – as a life-in-waiting – both positions do not consider the foetal body as subject to sociocultural inscriptions, and it is my aim in this work to provide an analysis of changing understandings of the foetal body within the changing historical context.

Historical Context: Understandings of perinatal death in the late eighteenth century

In Chapter Two, I argue that the medicalisation of childbirth positioned doctors as an authoritative voice in constructing understandings of perinatal loss. Prior to the medicalisation of childbirth, however, miscarriage, stillbirth and neonatal death were

144 Foucault argued that ‘discipline produces subjected and practiced bodies; “docile’ bodies”’. See M. Foucault, Discipline and Punish: The Birth of the Prison, trans. Alan Sheridan, New York: Vintage Books, 1979, p. 138. Jana Sawicki notes that, although Foucault did not write specifically on women’s bodies, he had ‘planned to do so’, intending to ‘locate the processes through which women’s bodies were controlled through a set of discourses and practices governing both the individual’s body and the health, education and welfare of the population, namely, the discourses and practices of “biopower.”’ See J. Sawicki, Disciplining Foucault: Feminism, Power and the Body, New York: Routledge, 1991, p. 67.

59 imbued with a host of meanings. I now consider some of these meanings and in doing so provide a historical context for the remainder of the thesis.

For many in the medical profession prior to the turn of the twentieth century, it was widely believed that some instances of pregnancy loss, and in particular early pregnancy loss, were inevitable – the development of the foetus in utero was widely believed to be an unfathomable mystery.145 The lack of the profession’s involvement in pregnancy and childbirth stands as testament to this: motherhood and maternity were believed to be beneath the concern of the medical profession and were largely dealt with by women.

Historians have generally agreed that there was indeed a general disinterest in infant welfare amongst the medical profession, and it would appear, a corresponding disregard for the welfare of babies in utero. In an age of high maternal mortality, saving women’s lives was of primary concern.146 The baffling loss of many women’s lives during childbirth was perceived by many in the medical profession and government as an affront to the colonies’ standing as part of the civilised world. Indeed, the colonies, and later the newly federated Australian nation, lay claim to the dubious distinction of the highest maternal mortality rate out of England and continental Europe; a distinction that was especially significant for Australia, considering the widespread belief that would become part of the founding rhetoric of the new nation in 1901 that the people of this new land must ‘populate or perish’. Accordingly, the health and welfare of the Australian mother as maternal citizen was privileged over the welfare of the unborn baby.

Some modern historians have tended to believe that women shared the same fatalistic acceptance as the medical profession with regards to the ending of their own pregnancies in loss. In her history of midwifery in New South Wales, Adcock argues that the sheer frequency of pregnancy loss and baby death at the beginning of the twentieth century rendered the experience as an inevitable part of life, particularly considering the fact that for most Australian women, maternity and motherhood were the principal occupations and

145 See for example Royal Commission into the Decline of the Birth-Rate and on the mortality on infants in New South Wales [RCDB], vol. 1, Report and Statistics, Sydney: NSW Government Printer, 1904, p. 38. 146 McCalman, Sex and Suffering, p. 156.

60 were thus viewed with a certain resignation of fate: Families were large and babies were born at home. The number of small graves in cemeteries everywhere is evidence enough that the neonatal and childhood mortality rate was extremely high. From letters and other written matter of the day it would seem the women accepted philosophically the numerous pregnancies, miscarriages and infant deaths.147

Certainly the frequency of pregnancy loss or baby death is not in doubt - many women would have been affected by some form of pregnancy loss or the death of an infant or older child. The personal narratives of women living in Australia in the mid 1800s, as recorded in private letters and diaries, are testament to the frequency of pregnancy loss and perinatal death, with some women experiencing more than one death of a baby or older child. Christiana Cameron, a Presbyterian minister’s wife in the New England region of NSW, for example, wrote at length about the deaths of two of her daughters within a fortnight in 1867; although she wrote more briefly about her stillborn baby, a daughter named Sarah, the child was still included in the family tree and counted as a member of the family, albeit absent.148

Particularly in small communities the frequency of stillbirth and neonatal deaths at the turn of the century is astounding by contemporary standards and lends weight to the argument that the sheer regularity of the incidence of stillbirth and neonatal death led to a sense of fatalistic acceptance. For example, the small mining town of Hillgrove near Armidale, NSW, buried at least six stillborn babies or babies dying shortly after birth in a single period of three months between September 1890 and January 1891.149 Several years later in 1894 the Dumaresq Shire Council records note that the Bounsell family lost twin newborn babies, with their mother, Elizabeth, dying shortly after the birth of another daughter a year later; similarly, the Spicer family of Hillgrove buried 4 newborn babies between 1890 and 1895.150 Those who attended births in the late nineteenth and early twentieth centuries - usually untrained midwives or peripatetic physicians who delivered the child in the family’s home– were often also well acquainted with perinatal death. Wilhemina Haub, for example,

147 W. Adcock, With Courage and Devotion: A History of Midwifery in New South Wales, Warnambool, Vic, 1984, p. 31. 148 Christiana Cameron, ‘Diary, 1861-1906’, in Donald McLeod Cameron Collection, A0216, University of New England and Regional Archives. 149 Dumaresq Shire Council Records for Hillgrove, Kilcoy and Black Mountain, Reading Room Reference Section, University of New England and Regional Archives. 150 Dumaresq Shire Council Records for Hillgrove, Kilcoy and Black Mountain.

61 was a rural Western Australian midwife whose meticulous case notes record several incidents of miscarriage, stillbirth and neonatal death, usually after a prolonged and obstructed labour. The great distances that Mrs Haub traveled often meant that she arrived after the baby had already been delivered, and her notes reveal that she was not unused to finding upon arrival that the child had either been born dead or was seriously ill and not expected to survive.151

As I mention in the literature review, Allen argues that in an age of restricted and highly unreliable contraception pregnancy was often an unwanted event in some women’s lives and for many overburdened, fatigued mothers, miscarriage was often a blessed relief – one less mouth to feed.152 Mary Taylor, a farmer’s wife in Albany, Western Australia, noted in her diary that she had received a letter from her niece Josephine, informing Mary of her recent miscarriage. Although Josephine’s own response to her miscarriage is not known, her aunt was filled with relief and wrote that ‘I am so thankful that the dear girl has lost her baby’.153 According to Margaret Anderson, the possibility of miscarriage often far outweighed the grim reality of the continuation of the pregnancy which could be ‘both a painful and a relatively violent and dangerous experience’.154 Women, it seems, were well aware of the shockingly high maternal mortality rate, as well as the injuries that could result for those who did escape death.155

For some particularly desperate women, concealment of birth and infanticide were the drastic measures taken to attempt to render their pregnancies as invisible events. Although infanticide and spontaneous miscarriage are two completely different outcomes of pregnancy, it is telling that some women apparently acted upon the routineness of stillbirth

151 Wilhelmina Auguste Haub, Midwives Notification Register of cases attended notes, 1912-1920, ACC4208A, Battye Library. 152 Allen, Sex and Secrets, p. 27. 153 Mary Taylor quoted in Margaret Anderson, ‘Helpmeet for Man: Women in Nineteenth Century Western Australia’, in Crawford (ed.) Exploring Women’s Past, p. 95. 154 Anderson, ‘Helpmeet for Man’, p. 96. 155 McCalman’s rich analysis of case notes of the Women’s Lying-in Hospital (later the RWH Carlton) are testament to the physical and mental trauma women faced in pregnancy and childbirth at the turn of the twentieth century. Mrs J.C., for example was twenty-nine, and having begun her childbearing at age sixteen, had borne nine children and suffered three miscarriages. McCalman notes that the ‘last confinement, fifteen months before, had been a nightmare. Her womb was now too tired and she laboured for two days, forceps were needed and she haemorrhaged afterwards. She had spent two months in bed, and now the pain was constant. On examination it was seen that the perineum was “quite gone to within the margin of the anus – parts bluish and congested.” ’ Dr Stephen Burke, Case Notes 1, 9 July 1884 quoted in McCalman, Sex and Suffering, p. 101.

62 and neonatal death by using it as an alibi for their acts of infanticide. According to Allen, infanticide was not an uncommon event and whilst some women were charged with the offence, few were indicted. With the absence of any legislation that regulated the issuing of birth and death certificates for newborns, this practice was difficult to police and more often than not, presiding judges and sympathetic juries dismissed the charges. Allen argues that in a climate of such a high infant mortality rate: Official and professional surveillance over late nineteenth century obstetrics, confinement and infant and maternal death was minimal. Police, coroner, medical and community decisions regarding dead infants took place in a context in which the high infant mortality rate was normal and in which child care and social security provisions for unmarried women were virtually non-existent. A certain fatalism accompanied the death of babies … The lack of regulation of infant births, deaths, burials and adoptions underlined the reality that this was women’s business, to be managed by them as best they could.156

However, other sources give insight into a more nuanced analysis of the diversity of understandings of perinatal death. Burial rituals can provide clues as to the degree of validation afforded to a loss,157 and cemeteries around Australia stand as evidence of at least the degree of public validation given by some parents after their newborn babies died or were stillborn. In the Australian context, letters and diaries from the nineteenth century indicate that some women mourned the untimely loss of their infants and did not hesitate to share their grief with their sisters or other female relatives. Margaret Wyndham, for example, was one woman in the late nineteenth century who felt free to discuss childbirth in letters to her daughters and daughter in law. In a letter dated 7th September 1868 Margaret implored her daughter in law Fan to ‘take care of herself’ during her pregnancy, noting anxiously that ‘we know so little how things may happen that is it never wrong to take very precaution. You are so well formed that I have no doubt please God all will go well as it does with thousands of women but when … the mother loses her life it is so sad for those left behind!’ 158

In the light of other evidence the claim that the high incidence of induced abortion was evidence of many women’s view that spontaneous miscarriage was a ‘blessed escape’

156 Allen, Sex and Secrets, p. 33. 157 For a broader discussion of the symbolism of rituals, including burial rites, see Paul Connerton, How Societies Remember, New York & Melbourne: Cambridge University Press, 1989, pp. 44-53. 158 Wyndham Family Papers Dalwood Station, 1827-1870 c.1900, University of New England and Regional Archives, A611 v 3024/1.

63 requires a more nuanced analysis. A philosophical acceptance, rather than fatalism, would perhaps be a more subtle analysis of parents’ attitudes towards their deceased offspring.159 Jalland, for example, cites the example of well-known Western Australian pioneer, Georgiana Molloy, whose first baby died after nine days in 1830; for Molloy, the death of her baby was scarcely viewed with fatalism but was considered a tragedy, even though she credited her religious beliefs in helping her accept the child’s death. Molloy wrote to a friend who had recently lost a baby that ‘I could truly sympathise with you, for language refuses to utter what I experienced when mine died in my arms in this dreary land … Oh! I have gone through so much … It was so hard’.160

Jalland argues that although infant mortality was common the death of an infant in the nineteenth century could be the ‘supreme test of faith’ for middle-class Australian families. As she notes, the proliferation of religious material aimed to comfort and explain the death of an infant or young child gives insight into the emotional and mental anguish many parents suffered after such a loss.161 In the years preceding the First World War and the accompanying cultural rejection of the Christian notion of the afterlife, it is apparent that for many families the loss of a baby was interpreted through the lens of ‘God’s will’. Furthermore, in choosing to individualise the stillborn child or deceased newborn can be held as strong evidence for an individual family’s affection for that particular child and its place as a valued family member.

Whilst it is apparent that many babies were buried with scant ceremony and little memorialisation, the many headstones memoralising individual stillborn and young babies in cemeteries around Australia stand as evidence of at least the degree of public validation given by some parents after their newborn babies died or were stillborn. Such public declarations of parents’ attitudes towards their newborn babies can be instructive to the historian, particularly in the absence of sources such as letters and diaries that may reveal bereaved parents’ private feelings towards their deceased infant. Many parents who chose to memorialise their babies on the headstones of family graves or separate individual graves

159 Jalland notes that the death of a baby was viewed as a tragedy by many parents in the nineteenth century, arguing that ‘most Victorians believed that the death of a child was the most distressing and incapacitating of all. What consolation could any parent find on the death of a beloved child?’ See P. Jalland, Death in the Victorian Family, Oxford, New York: Oxford University Press, 1996, p. 119. 160 Jalland, Australian Ways of Death, p. 293. 161 Jalland, Australian Ways of Death, pp. 70-71.

64 identified with the dominant Christian understandings of death, such as the inscription on the family grave of baby William Newell, buried in the family grave at St George’s Anglican Church, Hurstville NSW, with an older relative. The headstone on this grave reads: In affectionate remembrance of Sarah Ann The beloved wife of William Newell, who departed this life 25th January 1883. Aged 69 years. The hour of my departure at last O Lord let trouble cease and let thy servant die in peace Now oh My God let troubles cease in peace

Now Also in affectionate remembrance of William … infant son of Robert W. and Annie Newell … Aged 3 days who died 5th November 1881 Suffer little children to come to me.162

It appears that religious faith and a belief in eternal life for children of believing parents helped some parents to accept the death of their beloved infants somewhat philosophically. Jalland observes that many parents were able to accept the deaths of their infants – albeit after some time – because of the prevailing Christian view that ‘a benevolent God had removed their children prematurely from a world of pain, sin, and temptation to a happier world with God’.163 The parents of George Mallery Cowley, who died and was buried in Armidale in January 1894 aged 3 weeks, marked their infant son’s grave by declaring that their comfort lay in the belief he was ‘safe in the arms of Jesus’.164

What is also apparent is the great degree of variation at the turn of the century. Certainly not all parents chose to publicly individualise their child, or were financially able to do so; similarly, some district burial registers record only the surname of the child with the simple notation ‘stillborn’ whilst other stillborn children were given first names; likewise, some parents chose not to name infants who died in the month after birth. However, although there seems to be a wide variation on the manner and degree of memorialisation it does appear that for some parents, it did matter greatly if the child was born alive or not, with some registers taking care to note how long a child was alive, if only for a minute or two. The Spicer family of Hillgrove in NSW, for example, defy the argument that children in

162 St George’s Hurstville, ‘Names and inscriptions of all available headstones as at 30th November 1961 in the graveyard of the above church’, ML MSS 573, Mitchell Library. 163 Jalland, Australian Ways of Death, p. 71. 164 Gravesite of George Mallery Cowley, Anglican section, Armidale Cemetery, Armidale NSW.

65 large families were viewed as replaceable and therefore their deaths accepted more fatalistically;165 all four babies were named, even William and Reuben, who lived three minutes and two hours in 1894 and 1895 respectively.166

However memorialisation – or lack thereof – cannot be the sole marker of parents’ attitudes towards their deceased infants. Economic restrictions could mean that working class families were largely unable to access many avenues of publicly mourning a stillbirth or death of a newborn child. Particularly in the case of memorialisation in a cemetery, the cost would have often proved prohibitive and some parents were either content to bury their child in their backyard or in an anonymous grave, or were forced to do so;167 certainly there was a vast difference in cost to bury a child privately or as part of the government burial provision. The fee for a grave plot in private ground in Karrakatta Cemetery in 1901 was £1.11.6; the burials of stillborn babies and ‘indigent persons’ was the exception to this rule, when a fee of 10s. 6d. was charged to cover the cost of the iron number plate that served as the grave’s only marking.168 In the Karrakatta Annual Reports, stillborn babies and paupers were classed together as ‘government burials’, making it difficult to assess the number of babies buried in the communal graves. Des Tobin and Graeme Griffin note that over 30 000 babies were buried ‘without plaques and often without any burial ceremonies in a windswept plot’ at the back of the main cemetery in downtown Adelaide.169 Cemetery lists for the main Brisbane cemetery also give some indication of the sheer number of stillborn babies buried at this time, most likely without ceremony and certainly without the distinction of individual graves.170

165 Jalland has also refuted both the claim that the high rates of infant mortality meant that Victorian parents ‘limited’ their emotional investment infants and young children. She argues ‘[c]olonial parents did not feel that several remaining children would compensate for the loss of any one, however alarming the child mortality statistics … most Australian parents grieved at the deaths of their children’. See Jalland, Australian Ways of Death, pp. 73 & 121. 166 Dumaresq Shire Register records for Hillgrove, Kilcoy and Black Mountain. 167 The Cemeteries and Burials New England NSW Database, held in the Department of Archaeology, School of Human and Environmental Studies at the University of New England, record several examples of deceased infants being buried on the family’s property. For example, S. Saunders, a gold miner at Rocky River near Armidale buried his unnamed infant daughter under a pine tree on ‘Theleme’, Williams Road Uralla in 1863. 168 Karrakatta Cemetery Board [KCB] Minutes, 23 December 1903. Unpublished document held in KCB archives. 169 Des Tobin and Graeme Griffin, In the Midst of Life: the Australian Response to Death, Carlton, Vic.: Melbourne University Press, 1997, Rev. ed., pp. 116-117. 170 Twenty-six stillborn babies were buried in the same plot, 89A, of the South Brisbane Cemetery, between 1897-1898. The records identify these babies only by surname (for example, ‘McKenzie, Stillborn’) and their sex was not recorded. See http://www.brisbane.qld.gov.au for detailed burial registers of Brisbane cemeteries.

66 The issue of perceived ownership of the deceased body would have also limited some families’ access to the body of their stillborn child. Whilst most women gave birth in the family home, thus giving death a sense of normalcy and a degree of family control over the burial of the deceased, poorer women who delivered their baby in the lying-in hospital for destitute women were likely to have never seen their baby after delivery, let alone had the choice about burial methods. However, although Leonie Liveris argues in her history of the Karrakatta Cemetery Board [KCB] in WA that there was little memorialisation of even privately buried stillborn or newborn babies,171 tangible evidence suggests otherwise, with some parents erecting grand monuments to their babies and many recording their child’s birth and death as part of the family headstone. This option, was of course, restricted to those who were able or willing to pay the normal fee for the burial of a child, highlighting the sharp economic barriers that restricted the ways that Australian women were able to publicly mourn their babies and leading perhaps erroneously to the belief that these women did not afford their child the same status as their more affluent counterparts. Ken Inglis has argued that the anonymous ‘pauper’s burial’ was a deep social disgrace in the late nineteenth century, and gives insight into the way that stillborn babies of the working-class were conceptualised.172

At this time undertakers enjoyed a certain degree of autonomy in terms of burial fees charged, and the issue of stillborn burials was debated several times in the first decade of the twentieth century between the KCB and representatives of the undertaker trade in Western Australia. In particular, the Board was keen to spare parents the necessity of engaging an undertaker – and thus paying a higher fee – and proposed and moved in a Board meeting in September 1905 that parents be permitted to leave bodies at the cemetery gate, ‘appropriately contained in a box,’ with only a minimal fee charged to cover the cost of the lead number plate. In justification of this decision, the Secretary of the Board cited the Crown Solicitor of Western Australia’s opinion that bypassing the services of an undertaker was quite safe; the minutes of this meeting note that ‘the Crown Solicitor gave it

171 Leonie Liveris, Memories Eternal: The first 100 years of Karrakatta, Claremont, W.A.: Metropolitan Cemeteries Board, 1999, p. 61. 172 Ken Inglis, ‘Passing Away’, in Bill Gammage and Peter Spearritt (eds.) Australians 1938, Fairfax, Syme & Weldon Associates, 1987, p. 241.

67 as his opinion that stillborns could be buried anywhere (even the backyard) and remain until it became a nuisance, or the Health Department ordered exhumation’.173

Not surprisingly, the undertakers of Perth were none too pleased with this arrangement, calling upon the Board to reverse their decision. A meeting of influential undertakers met in June 1907 with the express purpose to object to the practice of stillborn babies being discreetly left at the cemetery gates, arguing that ‘we should be protected by the Board’.174 At two subsequent Board meetings the KCB voted to adhere to the decision, despite the undertakers’ constant letters.175 In reality, however, it appears that few parents chose this method of burial; those who were able to make an active choice preferring to engage an undertaker and those who were financially unable had to be satisfied with their child being buried in a mass grave.

Supervising the pregnant body The turn of the nineteenth and twentieth centuries saw women’s bodies, or more precisely, their wombs, become subject to intense scrutiny. Some in the medical profession began to lament the ‘deplorable’ situation of high infant mortality, particularly at birth, with the retiring President of the Queensland chapter of the British Medical Society, Dr Wilton Love, urging his colleagues in 1907 to value obstetrics for its role in saving the lives of Australia’s ‘potential citizens’: Were this mortality to occur in cattle or sheep there would be a Parliamentary Select Committee appointed to inquire into the matter, and legislative action would be taken and Government assistance forthcoming. But it is only children – children, the potential citizens of the future – who are thus removed, and no heed is paid to the warning voice and no action is taken to save the stricken multitude.176

Dr Love’s impassioned call to his colleagues would be heeded. By the turn of the century, pregnancy and childbirth were largely ministrated to by fellow women, but within the context of the concern over the declining birth rate and the high childbearing mortality rates, the self-described ‘medical men’ increasingly saw it as their duty to assume

173 KCB Minutes, 27th September 1905. Unpublished document held in Karrakatta Cemetery archives. 174 Messrs C. Coulson, W.F. Deslanes, T.J. Hogan, W.C. Bowra and M. O’Dea, letter to KCB, 4 June 1907. Unpublished document held in KCB archives. 175 See KCB Minutes, 7 June 1907; KCB Minutes 31 July 1907; KCB Minutes August 28 1907. 176 Wilton Love quoted in R. Patrick, A History of Health and Medicine in Queensland, 1824-1960, St Lucia: Queensland University Press, 1987, p. 158.

68 governance over the treatment of this ‘pathological’ condition. In his Presidential Address to the Intercolonial Medical Congress in 1902, Sir Walter Balls-Headley, inaugural lecturer in obstetrics and gynaecology at Melbourne University affirmed the separate roles of the sexes and articulated the importance of the medical profession in assisting women to fulfil their ‘natural’ role of mother: ‘the object of women’s development is the propagation of the race, but the advantage of the degree of propagation is dependent on the environment’.177

The environment Balls-Headley was appealing to was, of course, a direct reference to the scientific environment of obstetrics-controlled pregnancy and birth which, it was argued, would produce strong, healthy babies. McCalman argues that the great losses of the Great War ‘fanned anxieties over race suicide’, linking the loss of young men to the loss of ‘unborn citizens’, promoting the idea within medical discourse that a manipulation of the ‘environment’ would help improve the quality, not just the quantity, of babies born to Australian mothers.178 That is, amidst the rising concern over Australia’s declining birth rate, the foetus held a position of abstract value within the rhetoric of nation-building, amplified by the great losses of World War I. Although the lives of women as maternal citizens were privileged in this nationalistic discourse, the foetus was nonetheless valued for its potential value as future citizen. It is within this context that the medical profession assumed authority over pregnancy and childbirth, and I now move to Chapter Two to explore the ramifications of this on constructions of perinatal death in the early to mid twentieth century.

177 Walter Balls-Headley quoted in Hicks, This Sin and Scandal, p. 33. 178 McCalman, Sex and Suffering, p. 156.

69 CHAPTER TWO

‘A delicate girl has no right … to bear children’: the medicalisation of childbirth and discourses of responsibility and success

In 1906, a newly-graduated doctor, Mary de Garis, witnessed first hand the risks that childbirth posed to both mother and child at the turn of the century. As part of her training at the women’s lying-in hospital in Carlton, Melbourne (later to become the RWH), de Garis observed a total of fifty nine cases of eclampsia: fourteen mothers died, whilst all the babies were stillborn.179 Three years earlier, as a medical student at the University of Melbourne, de Garis had recorded in her lecture notes the telling statement that likely shaped her understanding of the role of the doctor in childbirth: ‘the parturient woman is a surgical case … the successful obstetrician must be well versed in modern surgery’. The high rates of maternal and infant deaths, she was taught as a student, were primarily caused by an ignorance of modern obstetrical knowledge and recklessness on behalf of untrained birth attendants and their patients,180 and her early experience as a resident likely confirmed this view.

I begin this chapter with an excerpt from de Garis’ lecture notes to exemplify the increasing medical interest in pregnancy and childbirth at the turn of the nineteenth and twentieth centuries. In this chapter I explore the impact of this interest – manifest in the medicalisation of childbirth - with a particular focus on the dominant involvement of the medical profession in constructing meanings of perinatal death in Australia from the turn of the century and for many decades beyond. Three key themes underpin this chapter and these are discussed in a broadly chronological fashion throughout: firstly, the positioning of the medical profession as the authority in matters related to childbirth and pregnancy, with particular emphasis on the profession’s authority in constructing ideas of the foetus and the pregnant body – cultural inscriptions which were drawn more generally from scientific ideas of the body; secondly the growing expectation that ‘responsible’ women would place themselves under the care of a doctor whilst also constructing notions of what constituted

179 Mary de Garis, ‘Case Notes’, contained in Book: Student’s lecture and clinical notes, MHM02030, Medical History Museum [MHM] archives, University of Melbourne. 180 Mary de Garis, Lecture notes from Rothwell Adam’s lectures, Lecture XVI, 3 April 1903, in Book, MHM archives.

70 ‘appropriate’ behaviour for pregnant women and the linking of this behaviour to foetal wellbeing; and thirdly, notions of what constituted ‘successful’ birth, or its reverse, ‘failed’ birth, which were derived from expectations of ‘responsible’ motherhood as well as inscriptions on the foetal body.

Because of the dominance of the medical profession in shaping understandings of perinatal death for a large part of the twentieth century, this chapter necessarily encompasses a reasonably large time frame whilst also utilising a variety of sources from this period – including medical journals and medical textbooks, the Report of the 1904 NSW RCDB, medical records and case notes, and oral testimony of some women whose babies died during this period. The time frame and themes of this chapter overlap somewhat with Chapter 3, in which I discuss further the impact of the medical profession’s authoritative voice in constructing meanings of perinatal death as framed within the cultural context of a shifting away from the public expression of grief after the two World Wars towards the expectation of ‘spartan control’.

Pathologising pregnancy: the medicalisation of childbirth

In her study of medical inscriptions on the female body, Lupton argues that women’s bodies had been regarded as ‘the poorer version of man, the ‘other’ in medical discourse’ for centuries. Accordingly, pregnancy and childbirth were seen as pathological states worthy only of the ministrations of fellow women.181 Evan Willis notes that in Australia the field of obstetrics held an inferior status within the medical profession prior to the medicalisation of childbirth, a status so low that the 1858 Medical Act did not require medical practitioners dealing with obstetrics and gynaecology to be qualified, a situation which remained unchanged until 1886.182 However the concern over the perceived ‘race suicide’ and the declining birth-rate led to a greater degree of interest in infant and maternal mortality in the early twentieth century; witnesses to the 1904 NSW RCDB, for example,

181 Lupton, Medicine as Culture, pp. 133-135. 182 Evan Willis, Medical Dominance: The Division of Labour in Australian Health Care, Sydney: Allen and Unwin, 1989, Rev. ed., p. 96.

71 decried the medical profession’s lack of involvement in obstetrics and pointed the finger of blame squarely at untrained midwives.183

At a national level, the first major survey of health was carried out in 1916 ‘concerning causes of death and invalidity in the Commonwealth’; the primary cause of concern was the shockingly high maternal and infant mortality rates, attributed again to the medical profession’s lack of authority in this area.184 The consolidation of medical dominance over midwifery was finalised in the late 1930s; this consolidation was the result of the widespread concern over the infant and maternal mortality rates in the early years of the twentieth century which led in turn to the consolidation of the medical profession into a position of dominance and control over allied health occupations. Various midwifery registration acts from 1915 to 1920, culminating with the incorporation of midwifery into nursing in 1928, signalled the beginning of medical dominance over pregnancy and childbirth.185

Although the late nineteenth century was characterised by a sense of inevitability towards stillbirth and neonatal death amongst the medical profession, several eminent physicians began to argue that stillbirth and miscarriage were preventable in many cases provided the pregnant body was carefully supervised and guided by the tenets of science and so-called rational knowledge. James Jamieson, for example, a well-known obstetrician at what would become the RWH Melbourne, and lecturer at University of Melbourne, spent several years scrutinising the pregnancies of over 500 women; 3113 pregnancies were reported, with just under two-thirds producing what Jamieson termed ‘successful’ issue. From these results, Jamieson concluded that the reduction of ‘pregnancy wastage’ was the key to increasing the population of Victoria, rather than simply an increase in fertility rates, and that this aim could only be achieved through careful supervision of the pregnant body.186

183 Based on the ‘large amount of evidence’ given to the Commission, the Report was unequivocal in apportioning blame to midwives. The Report stated that ‘whilst medical schools and universities in this State [NSW] and elsewhere have been giving increasing attention to the teaching of this art to medical students and whilst much progress has been made by the art itself, in consequence of recent scientific discoveries, the vast majority of women who practice as midwives, monthly nurses, or accoucheuses are uneducated, untrained, and unsuitable’. See RCDB, vol. 1, p. 32. 184 See I. Loudon, Death in Childbirth: An International Study of Maternal Care and Maternal Mortality, 1800 - 1950, Oxford: Clarendon Press, 1992, p. 463. 185 For a detailed discussion of the progression of the subordination of midwifery see Willis, Medical Domination, p. 111. 186 Hicks, This Sin and Scandal, p. 35.

As medical scrutiny increased over women’s bodies, the pregnant body was also reinscribed by science. In her social history of menstruation in Australia, Suellen Murray notes that whilst medical ideas of reproduction are positioned as essential and fixed to biology, the discourse of medicine is itself socially constructed, reflected in and participating in the construction of ideas about femininity. By the turn of the century, dominant ideas of femininity and the female body were intrinsic to science: as Murray notes, ‘reproductive differences were fundamental to definitions of sex and gender, and, at the turn of the century, femininity was ‘naturally’ and biologically determined by femaleness’.187

The feminist critics Catherine Belsey and Jane Moore point out that an appeal to ‘nature’ in terms of defining women and women’s bodies has always been a powerful tool against change.188 In the context of the discursive authority of the medical profession in understanding women’s bodies, this assertion is relevant to this thesis. In constructing the pregnant body as unstable and irrational, in need of masculine supervision and surveillance,189 the medical profession made a trenchant claim to the fixed nature of women’s bodies. Ironically, however, it was precisely this appeal to nature that precipitated change. That is whilst women’s bodies had long been defined in relation to men’s bodies – the ‘rational’ sex – it was the appeal to nature which cemented medicine’s self-proclaimed authority in not only describing, but dealing with, the pregnant body, a shift away from the female-only domain of pregnancy and childbirth.

The medicalisation of childbirth was a cultural shift which not only professionalised the activities of those involved with the care and management of pregnancy and childbirth, but – of most significance to this thesis – constructed dominant and authoritative understandings of the foetus, as well as the ending of a pregnancy through miscarriage or

187 S. Murray, ‘Being Unwell: Menstruation in Early Twentieth Century Australia’, in J. Brash, J. Long and J. Gothard (eds.) Forging Identities: Bodies, Gender and Feminist History, Nedlands, WA: University of Western Australia Press, 1997, p. 137. 188 Catherine Belsey and Jane Moore, The Feminist Reader: Essays in Gender and the Politics of Literary Criticism, Houndmills, Basingstoke, Hampshire: Macmillan Education, 1989, p. 3. 189 As Philippa Martyr observes, the medical profession at this time was overwhelmingly male. The 1891 Victorian census revealed that of 777 medical practitioners in the state, just one was female. By 1901, out of 743, fifteen were women. See P. Martyr, Paradise of Quacks: An Alternative History of Medicine in Australia, Sydney, 2002, p. 162.

73 perinatal death. In The Disenchantment of the Home Reiger argues for the importance of the period between the 1880s to the 1930s in terms of changing understandings of pregnancy, childbirth and motherhood, noting that it ‘charted not only the rapid growth of gynaecology as a professional specialty but increased interest in obstetrics on the part of both doctors and some women’s organisations’.190 By the end of this period of professionalisation, obstetrics and gynaecology were almost exclusively seen to be the domain of the medical profession, with perhaps the most significant developments being the normalising of antenatal care as an ‘essential’ part of the experience of pregnancy, and the shift away from home birth to hospital birth under the watchful eye of the male- dominated medical profession.191

An appeal to the rationality of science: medicine as authority

I now consider the positioning of the medical profession as authority in constructing understandings of perinatal death within the context of the medicalisation of childbirth. The principal factor in achieving a reduction in ‘pregnancy wastage’ was seen to be ‘rational’ scientific knowledge of the pregnant body. As noted earlier, the medical profession was keen to gain control over obstetrics, armed with and supported by an appeal to this ‘modern scientific’ knowledge. It is apparent that the medicalisation of childbirth was driven by two linked aims: to end the midwife’s unregulated activities and to gain control over obstetrics by claiming an authority over the pregnant body. In order to achieve these aims, the supposed culpability of midwives in producing ‘poor’ results – that is, high rates of infant and maternal mortality - became a powerful tool in medical constructions of perinatal death in the early twentieth century.192 Later in this chapter I consider the linking of maternal behaviour to birth ‘outcomes’, but in the early years of the medicalisation of childbirth, it was the figure of the untrained birth attendant who bore the burden of responsibility for high infant mortality and whose activities were scrutinised and discredited as the medical profession sought to establish authority over obstetrics.

190 Reiger, Disenchantment of the Home, p. 84. 191 Reiger, Disenchantment of the Home, p. 84. 192 See for example, ‘Editorial’, Australasian Medical Gazette [AMG], March 20, 1903, p. 116.

74 Although the mid eighteenth century saw the birth of the lying-in hospital for destitute women, most women during this period still gave birth at home, attended by female relatives and friends, whilst those expectant mothers of some means were often attended by a midwife, who was unregistered and most likely had not had any formal training.193 However by the turn of the century the practice of midwifery was starting to be a topic of hot debate amongst the medical profession who were keen to establish an authority over pregnancy and childbirth. Within the context of a rising anxiety over high rates of infant and maternal mortality, midwives and the so-called ‘monthly nurse’ soon found themselves to be the bane of the ‘medical men’ of obstetrics and gynaecology in Australia, and initially bore the brunt of the blame for the high rates of stillbirths and neonatal deaths. Ironically, midwives came to be seen as interlopers upon the ‘rightful’ domain of the medical profession.

In his analysis of the medical profession’s bid to assume authority over pregnancy and childbirth, Willis notes that the caricature of Sairy Gamp – the dirty, incompetent creature of Charles Dickens’ creation - became an image synonymous with midwifery in general; he argues that ‘its usage must be seen as an attempt to discredit midwives as a whole and as an element in the strategy of male medical takeover’.194 Ida Saunders, for example, an obstetrician during the 1920s in Sydney, recalled in an interview for the NSW BOHP that her ‘daily rounds’ to the homes of childbearing women were made difficult by the presence of untrained midwives; one in particular – ‘an old gamp’ – was described as Saunders as ‘unhygienic’ and ‘incompetent’.195 Whilst Willis acknowledges that one cannot deny that ‘ghastly’ mistakes were made in cases of flagrant ignorance, he argues that an underlying motivation in the drive to discredit midwifery was the ‘fear of competition’. Willis observes that the oft-cited claim that the unsupervised and untrained midwife was ‘ignorant and

193 Willis, Medical Dominance, pp. 98-122. 194 Willis, Medical Dominance, pp. 100-101. 195 Ida Saunders recounted her experience of visiting a labouring woman in a terrace house in inner-city Redfern, NSW; she was called because the mother was bleeding profusely; upon her arrival, she was greeted by the ‘old gamp’ who ‘had a black serge skirt, she had a bit of tape around her back and a pair of scissors that had been dangling near her buttocks on this old serge [skirt] that she’d been sitting down on anybody else’s buttocks for years and cut it … that [kind] of thing was still going on’. The interviewer then asked Dr Saunders if the midwife was trained, to which she replied ‘God only knows who she was!’ Ida Saunders, interview with Bronwyn Hughes, 1987, NSW BOHP, ORAL TRC 2301/130.

75 dangerous’ was ‘used as an ideological weapon in the struggle for control over childbirth, even in the face of available evidence to the contrary’.196

Indeed, the issue of ‘meddlesome and ignorant midwifery’ was a constant topic in medical journals at the turn of the century in Australia. One indignant doctor articulated popular sentiment within his profession with regards to this issue in a letter to the Intercolonial Medical Journal of Australasia [IMJA], arguing that: I am against a class of women being registered as [midwives], because I learnt when on a recent visit to England that this branch of work is fast slipping away from the medical man. The public get the idea the midwife’s training and skill is exactly the same as the doctor, and, seeking a saving in money, they naturally engage only a midwife. The doctor is called in when the eleventh hour strikes – called in Sir, to save the midwife at her suggestion. Often these eleventh hour operations are extremely risky as regards the patient; the case does badly and the medical profession gets another pushdown.197

The biomedical sciences in Britain and Australia were characterised by a discourse which linked nature with women and culture to men; Lupton notes that the dichotomy of women as fixed to nature became a crucial component in the struggle for control over obstetrics. During this period, she argues, ‘women as mothers and as midwives were represented as irrational and irresponsible, their knowledge based on tradition rather than experience, needing the guidance of men who possessed scientific knowledge’.198 That is, the particularly gendered medical discourse of childbirth relied upon the construction of women as the irrational, emotion-driven sex who, as a rule, was incapable of understanding rational knowledge, the ‘natural’ domain of men. Irrational, emotional midwives were, according to several key figures in obstetrics, the primary reason behind many baby deaths and birth injuries due to ‘defective care of the newborn by ignorant or careless [midwifery]’.199

Some medical men blamed the lack of ‘proper’ training for midwives and were incensed that some women acted as though they had the right to deliver babies simply because they

196 Willis, Medical Dominance, p. 102. 197 Anon. (signed ‘Self-Preservation’), Intercolonial Medical Journal of Australasia [IMJA], 20th January 1909, pp. 631-633. 198 Lupton, Medicine as Culture, p. 70. See also Grosz, ‘Notes Towards a Corporeal Feminism’, p. 5. 199 See RCDB, vol. 1, p. 38.

76 were women; one Dr W. Taylor ironically commented in the AMG in 1901 that: The … midwife is a by no means insignificant poacher upon the medical domain. Armed with a certificate obtained after a few months’ residence at a lying-in hospital, she boldly launches forth as an experienced accoucheuse, and attends confinements without a doctor being present, and handing over the patient when confined to the care if a relative or neighbour, carries out her daily round of visits like a medical practitioner … To turn out these so-called certificated midwives in the manner, and in the short time that I am given to understand is the custom at some of the lying-in hospitals, is to create a danger to a section of the community that is unwarrantable.200

Other doctors echoed these sentiments, openly critical of midwives simply due to the fact that it was a solely female occupation in competition with the medical profession. Medical witnesses to the NSW RCDB branded the lay midwife as ignorant of science, particularly in regards to hygiene; uneducated; and generally unfit for the task, with particular scorn reserved for the fact that often the only qualification being that the midwife was often a mother herself.201 The role of attendant nurse began to be articulated as the only role available to an attendant woman in the birthing room. Dr R. Arthur, for example, proclaimed in the AMG that: The most real and imminent danger …. is the monthly nurse. This worthy woman has been the ruin of many a rising doctor’s reputation. She has worked the mischief, and he has got the blame. Let it be laid down as a canon of midwifery that the doctor is responsible not only for himself, but for the nurse … the wisest thing is for the doctor to insist on being allowed to choose the nurse, or otherwise refuse responsibility. This granted, he can select one who he knows will carry out his instructions strictly - no less, no more.202

Private case notes also reveal some doctors’ opposition to the continuing involvement of midwifery in matters of pregnancy and confinement: for example, the well-known Melbourne obstetrician, Felix Meyer, alluded to midwifery incompetence in one of his casebooks from the late nineteenth century. In a case in 1889, that of a Mrs Melross of Carlton, Dr Meyer recorded that the child was dead upon his arrival, ‘possibly stillborn’, with the cord twice around its neck; his use of a rare exclamation remark in otherwise characteristically sparse and succinct case notes suggesting his obvious displeasure at his

200 W. Taylor, ‘The position of the medical profession, with special relation to the state of Queensland,’ AMG, 1901, p. 507. 201 The Report’s authors argued that ‘in many cases [of midwifery ‘incompetence’] such a woman’s only qualification is that she ‘is a mother herself’. See RCDB, vol. 1, p. 32. 202 R. Arthur, ‘Aseptic Midwifery’, AMG, March 21, 1898, p. 110.

77 authority being undermined in a birth that ended badly: ‘Mrs Melross wished to send at 6.30 [for the doctor] but the nurse overruled her!’ 203

‘Building better babies’: antenatal care and the consolidation of medical authority

With untrained and unsupervised midwives clear scapegoats, many doctors believed that the only means of preventing ‘poor’ birth outcomes was a stricter supervision of the pregnant body, both during pregnancy and with medical attendance at the birth. Within this context pregnancy was increasingly rendered as potentially pathological, as the words of Rothwell Adam in a lecture to University of Melbourne medical students in 1914 demonstrate: ‘An antenatal clinic is for the definite purpose of observing and treating pregnant women who are suffering from pathological conditions which may prevent their pregnancy processing to a successful issue, and for the care of the unborn child, so that it may be born healthy with a good prospect of surviving and becoming a useful citizen’.204

The records of the NSW Bush Nursing Association give insight into the increasing importance placed upon the role of antenatal care in producing a healthy baby. The sparse notes of the Midwifery Register Book for the Yetman, NSW area yield little information, except perhaps to highlight the particular difficulties facing both expectant mothers and midwives in the bush, but it is significant that patients’ attendance - or lack thereof - at antenatal clinics was recorded. For example, Linda S. of Warialda, a country town in NSW, delivered her third baby in 1941; the male infant died fifteen hours after birth. The case notes are typically brief: the mother’s condition is noted as ‘satisfactory’ and she was discharged from the Bush Nursing hospital ten days after delivery. Significantly, under ‘further notes’, the attending midwife recorded that the ‘babe was in very poor condition after birth … the patient had no prenatal treatment’.205 Similarly, Beryl R. of Yetman, NSW was delivered of her first child at her home in 1941 at age twenty one; the child was stillborn before the midwife’s arrival and the otherwise-brief case notes record that the

203 Felix Meyer, ‘Case Notes’, contained in Meyer, Felix Henry and Family Papers, 1872-1936, ACC 75/69, MHM archives. 204 Rothwell Adam quoted in McCalman, Sex and Suffering, p. 158. 205 Case 2 Linda May Smith, Midwifery Register Book, Yetman area, NSW Bush Nursing Association Records, ML2815, 48 of 64, Mitchell Library.

78 patient lived ‘eight miles out of town and transport problems prevented more frequent [prenatal] visits’.206

Further to the importance of antenatal care, medical intervention in the guise of the timely use of instruments at the hands of the doctor was heralded as a means of ‘saving’ future Australian babies; this appeal to intervention also served to reinforce medicine’s authority over childbirth. Drs Allen and McGregor, for example, waxed lyrical about the use of instruments and the ability of doctors to prevent infant death, but also placed responsibility upon the doctor to use them judiciously, trusting in his own rational, measured judgment: An accoucheur’s hand should be firm, and yet gentle … having made up his mind to the right course, he should pursue it without let or hindrance, without wavering, without loss of time. Moments in such cases are most precious; they often determine whether the mother shall do well, and whether the babe shall live or die. How many a child has died in the birth, in a hard and tedious labour, from the use of instruments having been too long delayed? Instruments, in a proper case and judiciously applied, are most safe … many hours of intense suffering and many years of unavailed regrets from the needless loss of the child might have been saved if instruments had been used the moment mechanical aid was indicated.207

A crucial factor in the medicalisation of childbirth and specifically in the establishment of antenatal care as a routine part of pregnancy was the positioning of the doctor as a figure of authority.208 By the 1940s, the authority of the medical profession in obstetrics was entrenched in Australia, as the majority of women attended prenatal clinics and delivered their babies in hospital. The proliferation of pregnancy and infant-care manuals suggests that many women were aware of the expectation that they should submit themselves to the doctor’s authority. Women's magazines regularly featured articles that celebrated pregnancy as a ‘special’ time for women that required special care and attention, particularly regular medical attention.209 Women were encouraged to shun advice from other women, urged to rely instead on medical advice: ‘the first cardinal rule for all prospective mothers to follow is ... avoid all female relatives, friends and neighbours and

206 Case 19 Beryl Weir Reeves, Midwifery Register Book, Yetman area, NSW Bush Nursing Records. 207 Monfort B. Allen & Amelia C. McGregor, The Glory of Woman, Sydney & Melbourne: Walker R. Hayes & Co, 1896, p. 165. 208 Reiger cites the opinion of Bruce Sutherland, a colleague of Lance Townsend, who was professor of obstetrics at the University of Melbourne during this period; in the former’s recollection Townsend expressed his delight over the legal ban on domiciliary midwifery: ‘He was saying, ‘Well, that’s taken care of them!’, he was out to stop the home deliveries and that how he did it … I think it was the power-control and Townsend wanted the power to control; that’s why he did it. He wanted the midwives out, and that was it, so the boys were even more in the box seat’. Bruce Sutherland quoted in Reiger, Our Bodies, Our Babies, p. 22. 209 Holmes, Spaces in her Day, p. 71.

79 never let them know of your condition. The second is, engage your doctor early, at the sixth week if possible. Follow his instructions to the letter, in any trouble go to him, and to him only, immediately’. 210

The authority of the doctor was rarely questioned by women in childbirth in the medicalised era; as Reiger observes, women at the time were increasingly aware of the risks of childbirth and therefore placed their confidence in the doctor to ensure the safety of the birth.211 In the postwar years, the hierarchy of power – in which women were placed firmly at the bottom – was reinforced as many doctors were returning servicemen. One midwife interviewed by Reiger commented that ‘you never queried people in those days. You were junior; they were senior, and in no way would you ever query them’.212 Doris B., a theatre nurse in the 1940s and 1950s, remembers vividly the hierarchy of power which existed in the hospital; for example, following the death of both mother and baby following a caesarean section, Doris recalled that the operating surgeon indicated that the deaths should not be discussed amongst the staff. ‘Of course,’ Doris recalled, ‘we complied with this request’.213

A significant part of the cultural acquiescence to medical authority was, as briefly discussed previously, the displacing of the language of sexuality and pregnancy from the vocabulary of ordinary Australian women, invalidated as it was by the authoritative language of the medical profession.214 Murray argues that ‘limited everyday language [was] available for speaking about menstruation … Non-medical public discussion about menstruation was

210 Holmes, Spaces in her Day, p. 71. 211 Reiger, Our Bodies, Our Babies, p. 22. 212 Mothers were expected to acquiesce to medical authority but junior medical staff, nurses, and midwives were also subject to this expectation. A doctor, who later supported the midwifery push for autonomy, is quoted by Reiger as saying that ‘there never was much criticism of medical treatment of anything. It was just accepted and that was it; you were the boss. The patients didn’t ever have much to say at all really’. See Reiger, Our Bodies, Our Babies, p. 22 McCalman notes that the hierarchies of the military shaped the structure of the hospital: ‘The hospital had an unquestioned etiquette which cemented the structure of authority: the honoraries were the generals, the residents the lesser officers, the medical students the officer cadets, the matron the NCO, the charge nurses the corporals and the pupil nurses were the privates. the orderlies who cleaned, carried, cooked and served were merely a labour corps’. See McCalman, Sex and Suffering, p. 148. 213 Doris B., conversation with researcher, 25th July 2005. 214 Although McCalman does not write from a feminist perspective, her discussion of the self-proclaimed medical right to speak about sexuality is useful. She argues that ‘medical men enjoyed a freedom denied all other respectable people of speaking and thinking frankly about human sexuality. During a century when it became increasingly difficult to discuss sexual relationships and contraception, medical men alone were free to speculate and philosophise’. See McCalman, Sex and Suffering, p. 35.

80 silenced in the everyday lives of women around the turn of the century’.215 Applied to sex, pregnancy and childbirth, Murray’s observation is particularly pertinent: the increasing secularisation and medicalisation of the body invalidated women’s own understandings of their pregnant bodies and positioned medical knowledge as authoritative; by extension, women suffering perinatal loss were subject to the medical discourse of perinatal death within the context of the dominant medical constructions of pregnancy and childbirth.216

For example the many women’s handbooks – or ‘wives’ manuals’ – were most often written by members of the medical fraternity as a means to disseminate medical knowledge deemed ‘appropriate’ for women. The so-called ‘wives’ handbooks’ played a significant role in diminishing women’s ability to understand their bodies by promoting the idea that only those well-versed in modern scientific knowledge of pregnancy were qualified to understand the pregnant body. The authors of The Motherhood Book – ‘compiled by a distinguished group of experts and specialists in health, maternity, infant and child welfare’ made available for the Australian audience – exhorted pregnant readers to be mindful of the necessity for medical supervision to ‘prevent petty discomforts and to guard against real tragedies’. Pregnancy, the authors argued, ‘should be a natural function, but civilisation too often causes irregularities, and medical advice should not be dispensed with either from over-optimism, false modesty, or shyness … the wise modern mother does not procrastinate about this visit [to the doctor]’.217

Therefore, such works can also been seen as an attempt to combat the ‘foolish’ advice of interfering neighbourhood women with an appeal to the higher order of scientific rationale. In one handbook, doctors Allen and McGregor admonish expectant mothers to ‘[do] away with gossiping croakers’, warning that dire consequences would follow should women rely

215 Murray, ‘Being Unwell’, p. 138. 216 Although women are not uninformed and unreflective social actors, medical knowledge of pregnancy and childbirth – and therefore, by extension perinatal death – was an authoritative way of viewing the female body. Feminist theorist Grosz uses the experience of menstruation, for example, to give insight into the body as both a ‘means by which power is disseminated and a potential object of resistance’. She argues the experience of menstruating, for example, ‘the archetypal ‘symptom’ of women’s unique biologies’ is ‘not simply responses to hormonal and biological imperatives, but are effects, in the first instance, of the ways in which menstruation is represented in culture, and as the way it is lived or experienced by women – its meaning for them. In a culture where it is regarded as a wound, a sign of castration, lack or imperfection (as is common in patriarchy), it is likely to be experienced as a dreaded burden or debilitation, or unpleasant or painful’. See Grosz, ‘Notes Towards a Corporeal Feminism’, pp. 14-15. 217 Anon., The Motherhood Book: For the Expectant Mother and Baby’s First Years, London: Amalgamated Press, n.d., p. 23.

81 on the local midwife’s advice rather than their doctor’s: ‘If [midwives] have had bad cases, many of them have probably been of their own making; such nurses, therefore, ought … be shunned’.218 In The Mother’s Handbook, the authors warn readers against placing their faith in the experience of other mothers who falsely claim that antenatal supervision is unnecessary: There is still a tendency [amongst women] to belittle the necessity for constant medical supervision throughout the whole nine months … [some] pin their faith to ‘Nature’, or adopt a ‘let’s wait till something is wrong’ attitude. Those however with a wider experience realise that, until we all live as Nature wishes, we cannot expect a birth to be quite a ‘natural’ process, and that there are a large percentage of tragedies of motherhood which could easily have been avoided had the routine antenatal examination been given.219

Responsibility and blame: the ideology of the [good] mother

The success of the medical profession in severely curtailing the midwife’s activities as well as the construction of antenatal care as a routine part of pregnancy shifted the profession’s focus from the midwife to the expectant mother. In more general terms, the figure of the mother had taken on new symbolism and significance at the turn of the century. In the context of Federation in 1901, suffragists had demanded that mothers be granted equal rights as citizens and ‘independent, self-governing individuals’.220 Previously, Australian mothers had been considered to belong exclusively within the private sphere and were thus neglected in issues of authority – for example having scarce claim to their husband’s income or even automatic guardianship over their children should they be widowed.221 The early feminists’ redefinition of ‘the mother’ as an important entity to the fledgling Australian nation, combined with the alarm over the maternal mortality rate, produced a focusing on the pregnant body previously unseen in Australia’s past; this scrutiny constructed notions of maternal responsibility in producing a healthy baby. As Featherstone points out, early feminists played a vital role in attempts to educate women of childbearing

218 Allen & McGregor argued that, in order to avoid miscarriage, ‘the most serious calamity’ for a woman, the young wife must ‘by a popular work of this kind be enlightened, or loss of life to her unborn babe, and broken health to herself, will, in all probability, be the penalties of her ignorance’. See Allen & McGregor, The Glory of Woman, pp. 186-187. 219 Mother’s Handbook, p. 32. 220 Marilyn Lake, Getting Equal: the History of Australian Feminism, St Leonards, NSW: Allen and Unwin, 1999, p. 72. 221 Lake, Getting Equal, p. 73.

82 age as to their proper role in Australian society; these efforts relied on casting the childless woman as disgraceful and shameful, even antagonistic, to the project of nation-building.222

With the concern mounting over the declining birthrate, (white) children became conceptualised as the key to the nation’s future health, and (white) motherhood was accordingly venerated as the noblest feminine duty.223 As I briefly mentioned in the literature review, the introduction of the Maternity Allowance in 1912 was part of the process of the veneration of motherhood, but was also a tacit recognition that childbirth was a dangerous time for Australian women.224 The Great War also heralded cause for further concern; McCalman notes the parallels drawn between the dangers of active service and mothering that ‘impressed the concerned with the concept of ‘wastage’ of the nation losing potential citizens and soldiers to disease and poor mothering’.225 Prime Minister Fisher, speaking about the Maternity Allowance, drew striking comparisons between the perils of childbirth and active service: ‘Statistics show ... that maternity is more dangerous than war’.226

The introduction of so-called ‘mothercraft’ classes and antenatal care in the first two decades of the twentieth century was ostensibly meant to address the perils of pregnancy and childbirth through the monitoring of the health of mother and developing baby. As antenatal care began to be considered the normal process for pregnant women, mothers ironically bore much of the burden of responsibility of producing healthy babies. The ‘wise woman’, declared the Medical Journal of Australia [MJA] in 1921, consulted a doctor ‘as soon as she realises she is pregnant … and is prepared to follow his directions throughout the long months of her grossesse until she and her infant can be left to enjoy life and health as the world’s most useful citizens’.227 Postnatal checks measured mothers' success in

222 Featherstone cites the editor of the AMG as insisting in 1904 that ‘it must be instilled into the minds of young married women that barrenness is a disgrace and a sign of weakness. If a social stigma were attached to a woman who was known or believed to be deliberately attempting to defeat the ends of married life … we should hear no more about the declining birth-rate’. See Featherstone, ‘Race for Reproduction’, p. 183. 223 Philippa Mein-Smith argues that the white mother took on a symbolic importance within the context of the concern over racial hygiene: ‘[M]aternity connoted moral responsibility and public duty to ensure the future of the race. Women’s duty as white mother … corresponded with a code of moral motherhood where moral purity equated to racial purity’. See P. Mein-Smith, ‘Maternity and Eugenics’, in Crotty et al, Race for a Place, p. 141. 224 See for example Reiger, Disenchantment of the Home, p. 86; Damousi, The Labour of Loss, p. 38. 225 McCalman, Sex and Suffering, p. 156. 226 Lake, Getting Equal, p. 206. 227 Editorial, ‘Pre-maternity Care’, Medical Journal of Australia [MJA], 26 November, 1921, p. 488.

83 terms of her previous antenatal clinic attendance and her child's adherence to ‘normal’ weights and measurements;228 whilst a number of government officials and medical men championed the control of maternal behaviour as a means of ‘saving the race’. The infant welfare specialist Truby King, at times revered and reviled but still influential in the early twentieth century in New Zealand and Australia in the push for universal antenatal care and infant routines, declared that ‘the problem of right or wrong feeding and nutrition in early infancy determines the health and fitness of the being throughout life and largely determines the fate of the race’. 229

The idea that maternal behaviour could adversely impact the development of the unborn child was not original to the twentieth century.230 In relation to attitudes towards childcare in seventeenth century England, Crawford argues that a pregnant woman was charged with the responsibility to care for herself in mind, body and spirit lest her child be afflicted in the womb, and be born with a ‘deformity’.231 In a similar vein in nineteenth century Australia, folklore abounded amongst women as to certain foods and activities to avoid, lest their unborn child be harmed; in an indirect way, self-administered practices of abortion in the early twentieth century are also indicative of popular beliefs of activities that were believed to prove injurious to the developing foetus – for example, douching or bathing in hot water, as well as falling down stairs or inserting slippery elm, used to open the neck of the womb and induce miscarriage. 232 In the early twentieth century, women themselves internalised notions of maternal responsibility; one British woman who suffered ten miscarriages believed that her pregnancies had ended because of ‘weakness’, but also, she claimed sadly, because of her own ‘ignorance and neglect,’233 whilst one mother wrote that ‘I have lost

228 Lake and Kelly (eds.) Double Time, p. 259. 229 Truby King quoted in Patricia Grimshaw, Marilyn Lake, Marian Quartly & Ann McGrath, Creating a Nation, Ringwood, Vic.: Penguin, 1994, p. 228. 230 The twelfth century bishop Albertus Magnus espoused the belief that some women should be held culpable for miscarriage, because of their evil deeds or intrinsically evil nature, arguing that ‘some women habitually give birth in the sixth month, and abortively, for they do not produce something with the nature of man but rather a certain fleshy and milky matter. This can happen for a variety of reasons: either because the matter of the menses is corrupt, or because of too much motion on the part of the woman which breaks the womb, or on account of other evils that befall her. [Some] engage in a good deal of activity when they are pregnant. They move from place to place, from town to town: they lead dances and take part in many other evil deeds. Even more frequently they have a great deal of sex, and they wrestle with men. They do all these things so that they might be freed from their pregnancy by the excessive motion’. See Helen Rodnite Lemay, Women's Secrets: A Translation of Pseudo-Albertus Magnus's De secretis mulierum with Commentaries, pp. 101-102. 231 Patricia Crawford, ‘From the Woman’s view, p. 65. 232 Allen, Sex and Secrets, p. 27. 233 Letter 35, in Llewelyn-Davies (ed.), Maternity, p. 62.

84 two of my four babies, and had a miscarriage. If I had taken more care before birth, I quite believe that those children would have lived’.234 Another argued that women needed to ‘take care’ of herself particularly in the early stages of pregnancy to avoid the many cases of ‘deformed and deficient’ children.235

The twentieth century medical discourse of maternal responsibility, however, differed from these various notions because the construction of maternally reckless behaviour was posited as having both a scientific basis as well as impacting upon the health of the nation as a whole. As mentioned, Matthews argues that the twentieth century saw the formation of the so-called ‘population ideology’ that used motherhood as a vehicle for pronatalist aims. Within the context of the population ideology, notes Matthews, ‘each birth, each death, each illness or infirmity became a political event, to be counted and measured and placed in a pattern’.236 In order for such accountability to be achieved, population ideology relied upon the construction of an ‘ideal mother’ – what Matthews terms as ‘the strategies to instill in each woman the desire and need to be feminine’.237 The ideal mother, then, was necessarily part of the duality of ‘appropriate’ and ‘inappropriate’ motherhood. This ideal can be extended to include the construction of the ideal pregnant woman, who was positioned as the epitome of expectant womanhood, the patriotic mother-to-be, of femininity wholly fulfilled in childbearing and, in years to come, childrearing.

Maternal behaviour, foetal welfare and the 1904 NSW RCDB

The linking of maternal behaviour to foetal wellbeing is strongly evident in the Report of the 1904 NSW RCDB. Witnesses to the Commission, a group which included members of the medical profession, clergy, and government authorities, felt strongly that women who transgressed boundaries of ‘appropriate’ femininity were partly to blame for high infant mortality rates. The 1904 NSW RCDB was initially called to investigate the decline in fertility rates in Australia. Witnesses to the Commission were, according to Neville Hicks, principally concerned with Australian women’s apparent selfishness as they sought to limit the number of pregnancies. However, whilst principally concerned with the ever-present

234 Letter 75, in Llewelyn-Davies (ed.) Maternity, p. 101. 235 Letter 74, in Llewelyn-Davies (ed.) Maternity, p. 101. 236 Matthews, Good and Mad Women, p. 75. 237 Matthews, Good and Mad Women, p. 15.

85 problem of criminal abortion, the Commission extended its scope to include discussions of the health and vitality of the foetus in utero and in the early weeks after birth, signalling a new focus on the health and welfare of the unborn and newborn child.238 Whilst some doctors who gave evidence at the Commission were convinced that some degree of ‘pregnancy wastage’ was inevitable, given the mystery of foetal development in utero,239 and although the Report made no formal distinction between neonatal deaths and deaths in the first year of life,240 it is quite clear that its authors of the report believed that the neonatal period was a crucial time for a baby. The appallingly high infant mortality rate was attributed in part to the ‘birth injuries’ caused by untrained midwives, but also due to ‘poor’ mothering, particularly of unmarried mothers.241

Viewed in this light, the Report of the RCDB is a rich site to explore the role of the medical profession in the construction of cultural expectations of ‘appropriate’ femininity in the early twentieth century. Within the discourse of the ‘ideal’ expectant mother, pregnant women were expected primarily to display a sense of gratitude for their pregnant condition - pregnancy being the ‘natural’ fulfillment of their femininity. The focus on induced miscarriage and infanticide and the criticism of women who engaged in such practices demonstrates the expectation that ‘appropriate’ femininity translated to a submission of oneself to the duties of maternity and motherhood, and provides an insight into how women who ‘transgressed’ this expectation were perceived – an insight which has ramifications for the focus on perinatal death, which was in itself seen to be a transgression against ‘successful’ motherhood. Clearly underlying many of the Commission’s conclusions was a conviction in the woman’s role – that is, as wife first, followed by mother. Part of the binary opposition of ‘appropriate’ womanhood was the construction of ‘inappropriate’ feminine behaviour. That is, certain types of women and certain activities which

238 The introduction to the Report of the NSW RCDB states that ‘during the progress of the inquiry, application was made … by which the scope of our inquiry was extended to include “a general investigation of the mortality of infants in this state; whether it is, to any extent, preventable, whether it is increasing, and its relation to the prosperity of the State.”’ See RCDB, vol. 1, p. 5. 239 The Report’s authors commented that ‘[m]ore than one medical witness has referred to the fact that many newborn children come into the world so badly equipped for the struggle of life that, despite all possible care, their death during infancy is unpreventable … [when] death occurs in the first two months of life, a considerable part is due to ante-natal causes, and in the present state of embryonic life, is irremediable’. See RCDB, vol. 1, p. 38. 240 See RCDB, vol. 1 p. 37. 241 The Report found that the principal causes of infant mortality (under two months of age) were caused by ‘defective viability … defective care of the newborn by ignorant or careless midwives [and] maternal indifference’. See RCDB, vol. 1, pp. 38-39.

86 transgressed ‘appropriate’ femininity were held as partly responsible for the high rate of babies dying before or shortly after birth.242

The Report of the RCDB also gives insight into how the foetus was conceptualised within the medicalisation of childbirth. Stillbirth due to ‘defective’ midwifery was viewed as particularly heinous as it equalled the loss of an otherwise useful Australian citizen; the Report’s authors argued that ‘a number of lives are lost to the State by the children being killed in the process of birth, either willfully, or through negligence and ignorance of the midwife in attendance’.243 Many medical doctors at the time inscribed religious ideas of conception and the sanctity of life onto the foetal body; in one popular women’s handbook, Drs Allen and McGregor stated that conception was the ‘generating of an immortal soul’.244 Although not all medical witnesses to the RCDB constructed the foetus in such terms – one doctor, for example, referred to induced abortion as ‘getting rid of the products of conception’245 – it is obvious that many regarded the practice of criminal abortion as tantamount to murder, and were clearly baffled that women – the ‘saviours of the race’ – could, apparently, so casually disregard the lives of their unborn children. Religious witnesses to the Commission were explicit in their condemnation of women who brought about an end to their pregnancy in such a manner: ‘We recognise the grave immorality and criminality of inducing miscarriage,’ declared one witness, ‘[as it] ignores the sanctity of human life’. Another summed it up in one word – ‘murder’.246

A major concern of the RCDB was the frequency of induced miscarriages, which were, according to the many medical and religious witnesses to the Commission, conveniently ‘excused’ as spontaneous miscarriages by cunning women who were trading on the prevailing attitude of miscarriage as an inevitable, common event: There is a remarkable unanimity of opinion among the medical men, who are perhaps better able to judge than any other persons in a community, that deliberate interference with the function of procreation has … become extremely common …

242 Mein-Smith notes that ‘for the pronatalist school, quantity spelt quality, because numbers counted in displays of vigour, in war and sport, and in claiming terrain. The angst about differential fertility was as much about numbers as quality: social reform required restricting the sexuality of the unfit and encouraging motherhood among the “better classes.” ’ See Mein-Smith, ‘Race for Reproduction’, p. 146. 243 See RCDB, vol. 1, p. 33. 244 Allen and McGregor, The Glory of Woman, p. 95. 245 See RCDB, vol. 1, p. 23. 246 See RCDB, vol. 1, p. 28.

87 [as well as] the great and growing frequency of the occurrence of induced miscarriages.247

Concern was expressed that women would have the temerity to ‘interfere’ with their reproductive responsibilities, but the growing incidence of induced miscarriages provoked moral outrage in the witnesses to the Commission, and the language of the final report makes it clear what they believed was being destroyed, apart from the ‘natural’ course of motherhood: it was, the Report’s authors stated, the purposeful ‘destruction of embryonic life’, a deliberate tampering with the natural progression of conception.248

Many witnesses to the Commission appeared somewhat baffled that women should reject their natural roles of wife and mother. Childless women – whether married or unmarried - were objects of scorn; barrenness - and not a lifetime of bearing and raising children - made a woman look old, declared one medical witness to the RCDB.249 Others openly called for childless women to be stigmatised;250 the implication of this call for those women whose babies died within the culture of ‘death avoidance’ is explored more fully in Chapter Three.

The RCDB Report affirmed the dominant view that women’s primary and natural role was to bear children.251 Part of the ‘gross immorality’ of preventing conception, or worse, terminating a pregnancy, was the havoc it would wreak on a woman’s reproductive system, further harming her chances of producing a healthy child. Various medical witnesses to the Commission reported that the practice of preventing conception of interrupting the natural process of conception was to invite dire consequences upon oneself: The practice … is the cause of many dire evils, far worse than any bad consequences that could naturally result from the bearing and rearing of a family.

247 See RCDB, vol. 1, p. 28. 248 See RCDB, vol. 1, p. 15. Feminist historians have confirmed that the witnesses’ worst fears were, indeed, true: many Australian women had procured miscarriage, either at their own hands or through a ‘professional’. As Allen has pointed out, unmarried motherhood certainly spelt financial crisis for an unmarried woman, not to mention the shame and stigma associated with pregnancy outside of wedlock. Other women were already overburdened with children and the thought of yet another mouth to feed led women to desperate acts upon their own bodies: Women did incredible things to bring on miscarriage. One woman took a dozen packets of Epsom salts [and] finished up in hospital. There was a lot of demoralisation, young girls got pregnant and there were a lot of bashings amongst families’. ‘Shirley’, recollections of life in Casino, NSW during the Depression era, quoted in Siedlecky and Wyndham, Populate and Perish, p. 26. 249 Dr John Harris quoted in RCDB, vol. 1, p. 19. 250 See RCDB, vol. 1, pp. 19-20. 251 See RCDB, vol. 1, p. 24. McCalman notes that whilst ‘respectable’ women were expected to not enjoy sexual intercourse, on the contrary ‘thwarted sex’ – that is, childlessness - was treated with suspicion; childlessness was constructed as leading to all manner of nervous and physical ailments, as the result of the ‘disappointed womb’. See McCalman, Sex and Suffering, p. 125.

88 The nervous system is deranged; frequently distress of mind and body are caused, the general health is often impaired and sometimes ruined, and inflammatory diseases are set up which disable the reproductive organs.252

Witnesses to the RCDB clearly believed that judgment would be cast upon a woman procuring a miscarriage: that evil behaviour only invited evil or deleterious consequences – in this context, reproductive difficulties in the future. The findings of the Commission reinforced the notion that women needed supervision and guidance to fulfill their feminine role; the number of ‘women with a twist in them’ strengthened the perceived necessity for antenatal care and a strict supervision of the pregnant body. Dr Scot-Skirving, for example, viewed women who ‘prevent[ed] or unload[ed] children when children are on the way’ as evidence of the need for medical surveillance over the pregnant body; he argued that although many women were ‘absolutely good women in the best sense of the word’, some Australian women shirked their responsibilities – ‘there seems to be a twist in them in that way’.253

‘Defective’ conceptions

Although many witnesses to the Commission constructed the foetus as a human-in- waiting, the Report and other medical texts from the early twentieth century give insight into the notion of what was perceived as ‘appropriate’ humanity. Underscoring the findings of the RCDB was the strong eugenics rhetoric which decreed that parents must take responsibility for producing genetically fit – and thus, nationally valuable – offspring.254 Frank Dikotter observes that eugenics and modernity went hand-in-hand, arguing that eugenics was less a set of clear scientific principles than ‘a modern way of talking about social problems’ with an emphasis on race fitness and the avoidance of ‘degeneracy’ and

252 In his evidence to the 1904 NSW RCDB, Dr C.W. Morgan alluded to the fear of ‘sick nerves’, which I discuss in greater detail in Chapter Three. He argued that the practice of preventing contraception ‘can lead to deleterious effects on the nervous system, even to the extent of leading to insanity’. See RCDB, vol. 1, p. 18. 253 Dr R. Scot-Skirving quoted in RCDB, vol. 1, p. 23. 254 Mein-Smith notes that ‘eugenics’ in Australia - derived from the Greek word eugenes meaning literally ‘to be born well’ - was ‘all about birth and making better people by selective breeding’. She argues that ‘as population growth rates slowed, ‘populate or perish’ phobias came to centre less on migration than on birth and deaths … The emphasis on whom to include as opposed to exclude – white, “native-born” – grew stronger, with profound consequences for the concept of maternity’. See Mein-Smith, ‘Maternity and Eugenics’, pp. 142-144.

89 ‘deficiency’.255 Christina Gillgren argues that calls for state-driven sterilisation of individuals with an intellectual disability in Western Australia were framed by fears of racial degeneration and the declining birth-rate in the early decades of the twentieth century; these calls were driven to a large extent by some in the medical profession.256

Although state-driven sterilisation was never fully accepted in Australia, failing to heed such advice nonetheless led to stern reproach in medical journals and popular texts, and many writers called for such ‘irresponsible’ and ‘undesirable’ people to be held culpable for ‘imperfect’ conceptions. The Australian physician D.G. Ritchie, for example, argued that ‘sickly men and women should not marry. People should be ashamed to have a puny baby’.257 Women’s manuals echoed this notion, emphasising that deaths in utero or shortly after birth could be avoided in the first instance if ‘unsuitable’ people avoided conception altogether. The authors of The Glory of Woman intoned that ‘parents are to be blamed for the natural, primitive defects of their children, for it is an inevitable law of nature that constitutional qualities and deficiencies are hereditary’.258 Some stillborn babies and babies dying soon after birth were believed to be the result of such deficient couplings; similarly the ‘delicate’ young woman who ‘foolishly’ fell pregnant before gaining strength sufficient for the task had only herself to fault when she inevitably could not bring the child into the world alive: A delicate girl has no right, until she be made strong, to marry. If she should marry, she will frequently, when in labor [sic], not have strength to bring a child into the world, which, provided she be healthy and well-formed, ought not to be. How graphically the Bible tells of delicate women not having strength to bring children into the world: For children are come to the birth, and there is not strength to bring forth’.259

255 Frank Dikotter, Imperfect Conceptions: Medical Knowledge, Birth Defects and Eugenics in China, Hurst and Company, London, 1998, p. 3. 256 In her discussion of ‘deficiency’ - centred in this case around constructions of intellectual disability - Gillgren cites the opinions of ten ‘known medical men’, reprinted in the West Australian on the 12th March 1926: ‘We consider it to be the duty of the medical profession to impress upon the public the immense importance of hereditary tendencies in dealing with mental defectives .. we are strongly of the opinion that sentiment and ignorance should not be allowed to interfere with a means of treatment by which the capacity to produce an imbecile progeny would be arrested’. See C. Gillgren, ‘‘Once a Defective, Always a Defective’: Public Sector Residential Care 1900-1965’, in C. Fox et al, Under Blues Skies: The Social Construction of Intellectual Disability in Western Australia, Nedlands, W.A. : Centre for Disability Research and Development, Faculty of Health and Human Services, Edith Cowan University, 1996, p. 67 . 257 D.G. Ritchie quoted in Siedlecky and Wyndham, Populate and Perish, p. 111. 258 Allen and McGregor, The Glory of Woman, p. 46. 259 Allen and McGregor, The Glory of Woman, p. 89.

90 There also abounded the idea that ‘debauched’ behaviour resulted in the conception of a ‘feeble’ foetus, with the medical expectation that such a ‘defective’ foetus would die – which was perceived by some to be a beneficial event.260 Journal articles used graphic Biblical imagery to demonstrate that the ‘sins of the fathers’ would be visited upon generations to come, an idea which, in the twentieth century was based around the quasi- science of eugenics and notions of heredity which decreed that healthy parents would give birth to healthy offspring.261 So-called ‘ladies’ handbooks’ explicitly adopted this rhetoric, urging newly married women to ‘improve their health’ so that they may give birth to a ‘sturdier, more noble’ offspring – with the underlying implication being that, in turn, ‘deficiency’ bred ‘defective’ offspring which in a civilised society, should never be allowed to happen.262 The construction of the unmarried mother as particularly sinful, for example, was vividly illustrated in a 1949 sex education film from the United States which was approved for use in NSW by the incumbent Minister of Health; in the film, ‘Joan’ became pregnant whilst a single woman and became ‘sick to the stomach in the morning’. Her sin brought shame on the family and, Siedlecky and Wyndham observe, it was implicit in the film’s message that Joan’s baby did not survive because it had been conceived out of wedlock.263

Thus a significant part of apportioning blame was the construction of certain ‘types’ of women as being particularly susceptible to miscarrying or producing a stillborn child. Medical students in the early twentieth century at the University of Melbourne were lectured on the ‘degenerate’ woman who selfishly put pleasure above the welfare of her unborn child: Mary de Garis’ lecture notes record the statement that ‘women who pursue a life of social pleasures, and women of dissolute habits, badly fed and badly housed, are

260 De Garis, ‘Lecture notes’ Lecture XXXI, 1 July 1903. 261 Siedlecky and Wyndham, Populate and Perish, p. 114. 262 The authors of The Glory of Woman stated that it was a responsibility of marriage that parents should ensure that they were ‘free of hereditary disease, his or her organization sound and complete, his or her mind and body free form all those habits and vices which tend to weaken our powers, debase our feelings, and render us morally degraded, and he or she in the full, regular and natural exercise of all those powers and faculties which God … has so beautifully and harmoniously adapted to the wants of our condition … It is high time that parents should recognise their obligations to understand these sources of hereditary influences better than they do; and mothers in particular – for if they properly understood them … they would do far more towards perfecting the human race and ridding the world of vice and immorality than all the benevolent and moral reform societies in existence’. See Allen and McGregor, The Glory of Woman, pp. 45-47 (my emphasis). See also Eulalia S. Richards, Ladies Handbook of Home Treatment, Warburton, Vic.: Signs Publishing Company, 1939, Rev.ed., p. 34; Allen and McGregor, Chapter III: ‘Like Begets Like’, The Glory of Woman, pp. 27-37. 263 Siedlecky and Wyndham, Populate and Perish, p. 28.

91 extremely liable to [miscarriage]’.264 In particular, the ‘indifferent unwed mother’ was a target. The Western Australian Statistical Registers from 1901-1914 classified deaths under one month according to the mother’s marital status, and attributed a number of deaths of illegitimate children under one month to ‘want of care’ and starvation due to lack of nourishment.265

Writing in a cultural and social climate that offered limited ‘appropriate’ roles to women beyond wife – first- and then mother, the March 1903 editorial of the AMG pinned much of the blame for ‘pregnancy wastage’ and early infant mortality on women conceiving outside wedlock. In an argument which relied on the construction of women as ‘naturally’ nurturers, the editor claimed that illegitimate infants were more susceptible to poor development in utero; coupled with this was the supposed absence of maternal feelings in unmarried mothers. This potent combination, he warned, would lead to a ‘frightful waste of life’ which would be a ‘relief to the mother’ – a situation that was inevitable until unmarried women stopped conceiving children.266

The Report of the 1904 NSW RCDB echoed these sentiments, attributing high infant deaths to ‘maternal indifference and the social and economic disabilities of the [unwed] mother’.267 Not surprisingly, the Report’s authors felt that the solution lay not in easing these obstacles but primarily in restricting the procreation of the ‘undesirable’ unmarried woman. Although the Report made no distinction between neonatal deaths and deaths in the first year of life, it is quite clear that its authors believed that the neonatal period was a crucial time for a baby. Seeking to exert control over women who relinquished their babies at birth to foundling homes, the Report recommended that all relinquishing mothers be required to stay with their newborns for at least the first few weeks, in order to breastfeed their babies and thus reduce the incidence of newborns ‘pining’ to death.268

264 de Garis, ‘Lecture notes’, Lecture XXXI 1 July 1903. 265 From 1901, the Statistical Registers grouped deaths of infants into ‘illegitimate’ and ‘legitimate’. In 1907, for example, fifteen infants falling into the former category were listed with cause of death as ‘want of care’. Statistical Register of Western Australia, Perth, WA: Government Printer, Commonwealth Bureau of Statistics WA Office, 1903-1907. See also Statistical Register of the Colony of Western Australia, Perth, WA: Government Printer, 1898-1902. 266 Editorial, AMG, March 1903, p. 117. 267 RCDB, vol. 1, p. 39. 268 RCDB, vol. 1, p. 45.

92 Wives’ handbooks: constructions of ‘responsible’ motherhood

In an age of frequent pregnancy loss and the prevailing attitude that women could prevent miscarriage, women’s handbooks during this time were also instrumental in placing much of the onus for a successful birth upon the woman. As I mention previously, Crawford notes the responsibility placed upon a pregnant woman in seventeenth century England to care for her mind, body, and spirit lest her child be afflicted in the womb and be born with a ‘deformity’.269 The popular medical handbooks of the early twentieth century persisted with this idea, even to the point of placing the blame squarely on women’s shoulders in the some instances of miscarriage. In a ‘wives’ handbook’ published for an Australian audience, the American doctor Frederick D. Rossiter, for example, gave an exhaustive list of prohibited activities which pregnant women should avoid: ‘long walks, purgatives, riding in a carriage or on the cars, overwork, worry, fear, fright, sexual intercourse, irritation of the breasts, falls, vomiting [and] convulsions’ were all listed as possible causes of miscarriage and premature birth.270

The medical authors of The Glory of Woman were convinced that miscarriage and stillbirth were the greatest tragedies to befall a woman at the turn of the twentieth century – not primarily because of the loss of the individual child, but because it could potentially rob her of one of ‘earth’s greatest blessings’ – the role of mother. Miscarriage, they mourned, was untimely in every sense of the word: A premature labor (the premature expulsion of the child before the end of the seventh month), in the graphic language of the Bible, is called ‘an untimely birth’, and ‘untimely’ in every sense of the word it truly is. ‘Untimely’ for mother; ‘untimely’ for doctor; ‘untimely’ for monthly nurse; ‘untimely’ for all preconcerted arrangements; ‘untimely’ for child, causing him ‘untimely’ death. A more expressive word for the purpose it is impossible to find.271

Furthermore, this particular handbook explicitly linked miscarriage to a failure to place

269 Crawford notes that, even before the birth of psychoanalysis, the subconscious played an important role in eighteenth century understandings of maternal responsibility. She argues that ‘not only did the woman contribute to the nourishment of the foetus: her imagination shaped the child’s appearance. The likeness of a child to its father or other relations was believed to be the consequence of the mother’s thoughts … Maternal longings were taken seriously, as any frustration of the mother’s wishes would affect the child’. See Crawford, ‘From the Woman’s View’, p. 65. 270 Frederick M. Rossiter, The Practical Guide to Health, Melbourne: Signs Publishing, 1913, 3rd ed., p. 455. 271 Allen and McGregor, The Glory of Woman, p. 186.

93 oneself under medical care – both in person, and from knowledge gleaned from suitable literature such as women’s handbooks - during pregnancy. The authors warned that miscarriage could generally be prevented by paying heed to medical advice, and advised that it was an expectant mother’s duty to ‘be enlightened [through medical advice], or loss of life to her unborn babe, and broken health to herself, will, in all probability, be the penalties of her ignorance’.272

‘Failing’ as a woman

The discourse of maternal responsibility and the construction of the ‘good’ mother are crucial to understanding the construction of miscarriage, stillbirth and neonatal death as instances of ‘failed’ birth and ‘failed’ pregnancy. Psychoanalysis in the early twentieth century understood miscarriage to be inherently linked to the maternal subconscious.273 The authors of The Mother’s Handbook linked the equilibrium of the mind in producing a healthy, happy baby, arguing that the expectant mother must remain full of happiness always, for ‘happiness, which comes from inside … is the basis of all health … and it means there is none of that nerve strain of fear and anxiety which acts as a poison to the system… every mother should keep herself [happy] because a healthy, happy mother makes a healthy, happy baby’.274

The authors of The Glory of Woman argued that some women subconsciously fled from

272 Allen and McGregor, The Glory of Woman, p. 187. 273 Reiger notes that pregnancy was often spoken about in euphemistic terms, such as the ‘time of trouble’, ‘the difficulty’ because it was ‘strongly emphasised that the state of mind of the [pregnant] woman would have a direct and certain effect on the child’. See Reiger, Disenchantment of the Home, p. 85. As Damousi observes, in the early twentieth century ‘the question of “nervousness” and “worry” figured prominently’ in women’s magazines and advertisements as “mental conditions to be resisted.”’ By the interwar years the concern over ‘nerves’ was intensified particularly in relation to women’s relationship with their children. An ‘over-anxious’ mother, it was believed, would cause irreparable damage to her child. See J. Damousi, Freud in the Antipodes: A Cultural History of Psychoanalysis in Australia, Sydney: UNSW Press, 2005, pp. 100- 101. 274 Because men were believed to be rational, fathers were cast as important agents in the maintenance of healthy nerves. The ‘various nervy reactions which may occur during pregnancy’ could, if left unchecked, have disastrous consequences – unless they were they to be soothed by the attention and comfort of the husband. ‘If … with the aid of good humour, a little common sense and a great deal of loving-kindness, he will play the peacemaker, his wife’s nerves will receive the rest for which they are really crying out … by the gentle taking over of morning tasks, so that the dressing operations can be undertaken very slowly; and the bringing of a hot drink to the bedside … the mother experiences such a sense of being cared for that subconscious fears are banished’. Husbands, however, were warned not to ‘indulge’ women’s neuroses: ‘the young husband can prevent the wife, if she is at all neurotic, from indulging her whims unnecessarily, or becoming, or making others, a martyr to her nerves’. See Mother’s Handbook, pp. 31-33.

94 motherhood, rejecting the foetus within: There is a proneness for a young wife to miscarry, and woe betide her if she once establish the habit, for it, unfortunately, becomes a habit. A miscarriage is a serious calamity, and should be considered in that light; not only to the mother herself, whose constitution frequent miscarriages might seriously injure and eventually ruin, but it might rob the wife of one of her greatest earthly privileges, the inestimable pleasure and delight of being a mother.275

The ideas of American psychoanalyst Helene Deutsch, who claimed that a miscarriage often occurred because women fled from motherhood and renounced the foetus within, causing its death,276 refined the notion that miscarriage and the subconscious were linked; this was an influential attitude shared by some in the medical profession.277 In a medical textbook, for example, Abraham Stone argued that whilst all women ‘instinctively’ craved motherhood, the subconscious rejection of this role could have disastrous consequences: For conception to take place a woman must be a woman. Not only must she have the physical structure and hormones of a woman but she must feel she is a woman and accept it … Being a woman means acceptance of her primary role, that of conceiving and bearing a child. Every woman has a basic urge and need to produce a child.278

Medical language itself cast the female body as inherently flawed and held the female body as culpable in many instances of pregnancy loss. Where the male reproductive organs were described as ‘robust’, the female body was couched in terms of its tendency towards

275 Allen and McGregor, The Glory of Woman, p. 186. 276 Deutsch constructed some cases of miscarriage as the ‘earl[y] renunciation of the child’; she argued that this ‘mother conflict’ occurred when a woman’s ‘psychic motive’ wished the unborn child to die. Deutsch argued that she had ‘observed several miscarriages provoked by the sharpening of such a mother conflict … “I shall have no child, I have no right to have one, I shall lose it, I shall pay for it with my death.’’’ Deutsch cited the case of ‘Mrs Smith’, whose subconscious fear of her inability to become a mother led to several miscarriages, and Deutsch argued that ‘I have not been able to establish psychologic types of women more predisposed to abortion than others. But I have gained the impression that, particularly in cases of recurrent abortion, destructive tendencies directed against the self or against others are involved’. See H. Deutsch, The Psychology of Women: A Psychoanalytic Interpretation, New York: Grune and Stratton, 1944, pp. 143-145; 189. 277 The ideas of psychoanalysis in general had gained popularity in Australia; Damousi, for example, argues that Freudian notions had gained credence - even if Freud’s methods had not - in Australia. See Damousi, Freud in the Antipodes, p. 100; Helene Deutsch’s ideas in particular were influential in the Australian context; her work was included in a 1950s text used in Australia. See Deutsch, ‘Psychology of pregnancy, labour and the puerperium’, in J. de Lee and J.P. Greenhill (eds.) Principles and Practice of Obstetrics, W.B Saunders and Co., Philadelphia and London, 10th ed., 1951, ch. xxiii. For more on this see Reiger, Our Bodies, Our Babies, p. 40. 278 Abraham Stone cited in Elaine Tyler May, ‘Nonmothers as Bad Mothers: Infertility and the “Maternal Instinct”’, in Ladd-Taylor and Umansky, ‘Bad’ mothers, p. 198.

95 incompetency.279 The lecture notes of Mary de Garis, for example, illustrate how maternal causes were understood to be the primary factor behind recurrent miscarriages. Not only were ‘diseases of the mother’ considered to be a primary factor behind many deaths but the uterus was particularly vulnerable, prone to imbalances which could be caused by ‘nervous influences’.280 In analysing the language of reproduction in early twentieth century medical textbooks, Martin argues that women’s reproductive processes were overwhelmingly constructed as degenerative and prone to deficiencies: Ovaries ‘shed’ eggs but testicles ‘produce’ sperm, unfertilized eggs ‘degenerate’ and are ‘wasted’, and ‘menstruation is the uterus crying for lack of a baby’. In contrast, although millions of sperm that do not fertilize eggs die within a few hours, the textbooks never called them ‘wasted’, ‘failed’, or ‘degenerating’; rather they described the male reproductive physiology as a ‘remarkable cellular transformation … [the] amazing characteristic of spermatogenesis is its sheer magnitude.281

Reinforcing the apportioning of culpability was the lack of recognition for those women whose babies were stillborn. Mothers of stillborn babies were not regarded as mothers, since their babies themselves were disregarded as ‘failed’ human lives. For example, the 1912 Maternity Allowance, although ostensibly designed to assist women in the discomforts of pregnancy, made the distinction between ‘appropriate’ and ‘inappropriate’ motherhood, ‘successful’ and ‘failed’ motherhood. Not only were indigenous mothers and Asiatic and Pacific Islander mothers excluded from this bonus, the Allowance was not extended to include those women whose children were born dead.

Remaining childless was seen as the sign of the ultimate social failing for a woman, and the language of many medical writers in the early twentieth century employs this rhetoric. Live born children were termed ‘successful issue’ whereas miscarried or stillborn babies were referred to as ‘foetal wastage’ and ‘pregnancy failure’.282 The language of medical textbooks explicitly affirmed the notion that a woman could only be properly regarded as a mother until she had produced a living child. A medical textbook authored by Lance Townsend, professor in obstetrics at the University of Melbourne, defined the medical terms for ‘gravity’ – the number of ‘successful issue’. Amongst the list provided by

279 May, ‘Nonmothers as Bad Mothers’, pp. 200-201. 280 de Garis, ‘Lecture notes’, Lecture XXXI 1 July 1903. 281 Emily Martin in May, ‘Nonmothers as Bad Mothers’, p. 201. 282 See for example Lance Townsend, Obstetrics and Gynaecology for Medical Students in the University of Melbourne, Carlton, Vic.: Melbourne University Press, 1959, p. 576.

96 Townsend, there is no definition for a pregnant woman who has not yet been delivered of a ‘viable’ child, that is, a pregnancy that had proceeded past twenty eight weeks gestation. 283

Notions of viability and the ‘failed’ foetus

The yearly clinical and medical reports of Victoria’s principal maternity hospital, RWH Melbourne, are a useful source for detailed analysis of the medical discourse of failure in the middle of the twentieth century. These reports, most often published yearly although in the case of several reports, every eighteen months, contain detailed information as to the number of booked patients at RWH, the number of live births, the perinatal and maternal mortality rates, as well as information from the gynaecological wards. Most of the reports contain brief information, with often only the increasingly uncommon maternal deaths being recorded with any great detail.

The idea that certain women were not suitable to bear children persisted well into the 1950s, and the increasing supervision over women’s pregnant bodies meant that these women whose childbearing may have previously escaped attention now fell under the gaze of medical authority, with the result of such surveillance ranging from a forced relinquishing of the child at birth to the termination of pregnancies considered to be too ‘undesirable’ to continue. For example, within the context of the discourse of ‘mental hygiene’ in 1956 three women were delivered of live babies at the RWH Melbourne, which were then removed from their custody, presumably to be adopted, whilst the mothers were either transferred to asylums or returned back to the asylum.284 Other women’s pregnancies were considered to be ‘unviable’ by the medical profession, within the

283 Townsend, Obstetrics and Gynaecology for Medical Students in the University of Melbourne, p. 57. In a society that appeared silent towards pregnancy loss, it is interesting to conjecture how many women were labelled and stigmatised as ‘barren’ and childless, but who had, in reality, suffered the loss of a baby through miscarriages or stillbirths that were subsequently not recognised. 284 RWH Clinical Report 1956, p. 10. Contained in Box 602, A1999/02/1974, RWH Archives.

97 apparent greater focus on psychological illness and childbearing in the postwar years, and these pregnancies were terminated at various stages of pregnancy.285

The 1947 Clinical Report, for example, gives brief details about the five terminations done at the hospital on women under twenty eight weeks pregnant. Two of the cases were described as being due to ‘maternal immaturity’ whilst the remaining three cases were, variously, psychopathic personality; anxiety and neurosis; and psychosis. The former case was terminated of her pregnancy, as well as sterilised to prevent the possibility of any future ‘undesirable’ pregnancies occurring.286 In 1955, also, thirty one women were terminated of their pregnancies before they reached twenty eight weeks gestation; five were due to an unspecified ‘psychiatric problem’ and all these women were sterilised to prevent further pregnancies, whilst one woman’s pregnancy was terminated because she had a ‘difficult obstetrical history’, having previously given birth to several babies with ‘foetal abnormalities’ and babies who died in the neonatal period.287 Ten years later, such terminations of pregnancy were still being done – in 1965 five pregnancies were terminated in women who were variously classed as ‘schizophrenic’ or ‘psychotic’, with three of the former group of four also being sterilised.288 These women were not categorised as mothers, because their pregnancies were classed merely as ‘products of conception’.289

From the brevity of the Clinical Reports, it is not known whether these women consented to or requested the terminations of their respective pregnancies, but the 1940 lecture notes of Professor R. Marshall Allan at the University of Melbourne indicate that this was unlikely; rather, evidence suggests that the doctor in charge of the woman’s pregnancy made such a decision. Although Allan was cautious in declaring that all women displaying signs of

285 For example in 1955 and 1956 thirty one pregnancies under twenty eight weeks gestation – the cut off for ‘viability’ at this time – were terminated. Five patients were terminated of their pregnancies due to maternal ‘psychiatric problems’, and all of these women were sterilised. One woman was terminated of her pregnancy and sterilised because of her ‘bad obstetrical history’ of ‘recurrent foetal abnormalities’, and one patient was terminated of her pregnancy because of ‘heredity deafness in all [living] children’. See RWH Clinical Report 1955-1956, pp. 25 & 81. In 1957, the pregnancies of five patients were terminated past 28 weeks – the gestational cut-off for ‘viability’ at this time - for ‘psychotic disorders’, and two of these patients were sterilised to prevent further pregnancies. One patient’s pregnancy was terminated before the foetus reached the viable gestation of twenty eight weeks, due to the woman’s ‘insanity’; she was also sterilised. See RWH Clinical Report 1957, p. 23 & 36. 286 RWH Clinical Report 1947, p. 57. 287 RWH Clinical Report 1955, p. 81. 288 RWH Clinical Report 1965, p. 30. 289 RWH Clinical Report 1955, p. 14.

98 ‘insanity’ or ‘psychosis’ – which included ‘anxiety’ - should be terminated of their pregnancies, he did note that regarding the offspring of such women, ‘the broad view is that such children be better off unborn’.290 While Allan asserted that ‘true insanity’ in pregnancy was a rare occurrence, he did believe that pregnancy itself was a period of ‘mental instability’, arguing that this, in itself, provided a compelling reason for medical supervision during the antenatal period with a particular focus on the mental state of the mother.291

Allan’s lecture notes also reveal that women suffering from other diseases were regarded as unfit to continue their pregnancy. Although he noted that ‘termination of pregnancy at any period is a serious surgical procedure and therefore not without risk’, Allan advocated for the decision to terminate in cases of serious illness to rest solely with the medical team: ‘The decision to terminate the pregnancy should be based on the unfettered opinion of obstetrician and physician given after a full review of all the circumstances of the case’. At no point did Allan raise a consideration of the wishes of the mother-to-be, nor do her wishes come into play in his further argument for the sterilisation of women with an ‘undesirable’ ‘permanent disability’ that would hinder their ‘success’ in producing healthy children.292

Indeed within medical discourse the inscribing of the classifications of ‘successful’ or ‘failed’, ‘viable’ or unviable’ on the foetal body can be seen in the use of the terminology in medical texts, evident increasingly from the turn of the century as the medicalisation of childbirth confined obstetrics to the authority of the medical profession. For example, whilst the 1904 lecture notes of Mary de Garis record the use of the term ‘habit of abortion’ in the 1940s Clinical Reports this had become interchangeable with the phrase ‘habitual aborter’, a subtle shift in terminology implying that the responsibility for the action of miscarrying lay within an inherent ‘deficiency’ of the mother, rather than an action of nature itself. Women’s bodies, which had long been seen as inherently ‘defective’ or ‘inferior’ to the masculine body, were bestowed with a scientific-based inferiority: with the

290 Allan, Obstetrics and Gynaecology, p. 111. 291 Allan, Obstetrics and Gynaecology, p. 111. 292 Allan, Obstetrics and Gynaecology, p. 117.

99 medicalisation of childbirth, the reproductive system was subject to such accusatory terms as ‘incompetent cervix’ and ‘ineffective uterine contractions’.293

A variety of sources, including the RWH Clinical Reports, the case notes of the NSW Bush Nursing Association, and various medical textbooks and lecture notes also demonstrate that the foetal body was also subject to a wide variety of inscriptions, some of which indicate the belief that some foetuses had ‘failed’ at being born healthy, whilst other meanings give rise to the notion that some foetuses were ‘meant’ to die, having transgressed or fallen short of the bounds of humanity. Certainly there abounded the idea that some babies were not strong enough to develop in the womb; for example, in his explanation of the phenomenon known as ‘super-foetation’ – a normal delivery of a healthy child, followed by a small, dead one – Australian physician F. Milford argued that ‘the explanation of this is that there were originally twins, and under the law of ‘survival of the fittest’, the healthier has lived, while the other has died’.294

For most of the early twentieth century until relatively recently, certain babies were regarded as possessing little humanity, or a ‘failed’ kind of humanity which rendered them worthless. Babies with a ‘deformity’ such as anencephaly or hydrocephaly were often termed ‘monsters’ and in the medical literature, at least, were afforded little humanity. For example, the lecture notes of Mary de Garis at the turn of the century record the telling statement that ‘[i]f there is enough enlargement of the head to completely obstruct labour the child’s life is of no value’.295 Milford, writing in a text intended for assistants to doctors, gave a detailed analysis of a so-called ‘monstrous birth’ that he had attended in 1861. As part of his recounting of this incident he notes that ‘the monster respired twice, but did not cry, and then ceased to breathe’.296 In later years, the Clinical Reports of RWH, along with medical texts from the 1940s up to the 1980s, continued to refer to foetuses affected by the congenital disorder of anencephaly as ‘monsters’,297 and before caesarean

293 See for example RWH Clinical Report 1957, p. 2; RWH Clinical Report 1954, p. 97. The latter report recorded the case histories of three patients who had had previous caesarean sections but whose subsequent deliveries were vaginal, the women having ‘failed to deliver themselves’ of a live baby. See p. ix. 294 F. Milford, Australian Midwife’s and Nurse’s Handbook, Melbourne: E.W. Cole, 1916, p. 203. 295 de Garis, ‘Lecture notes’, Lecture XXI 22 April 1903. 296 Milford, Australian Midwife’s and Nurse’s Handbook, p. 191. 297 The Clinical Report for 1954, for example, made particular mention of a case involving twins who were both stillborn. The first twin was described as a ‘headless monster’ and its sex unrecorded. The second twin, presumably not a ‘monster’, was recorded as a ‘macerated female’. See RWH Clinical Report 1954, p. 62.

100 section techniques were refined, such foetuses were not infrequently delivered by way of destructive operation such as embryotomy or craniotomy, some operations occurring whilst the foetus was still alive.298

At the turn of the century, in particular, caesarean section posed enormous risk to the mother’s life so craniotomy or embryotomy were preferred even if the child was still alive, not surprisingly given the low regard in which ‘monsters’ were held. As maternal morbidity in caesarean sections declined, destructive operations were still used so that that the woman concerned would be able to potentially have a caesarean section in the future for ‘successful’ pregnancies.299 In 1944, for example, nine destructive operations were performed, with the Clinical Report noting that although all babies were, obviously, born dead, not all had been deceased when the operation took place.300 This significant statement highlights how, within medical discourse, such babies were not regarded as valuable or worthy of humane treatment even whilst in utero; the repeated referring to such foetuses as ‘monsters’ can perhaps also be seen as a deliberate measure to reduce the humanity of the foetus involved, exonerating the hospital for performing a destructive operation on a living foetus.301

Of course, not all medical professionals were satisfied with destructive operations on live children; Milford, for example, in a handbook for nurses and midwives, advocated that it was best to take such measures only if the child was dead, arguing that the instruments used were ‘barbarous’ if used upon a living child. Nonetheless, he did concede that the hydrocephalic or anencephalic child’s life had little value and therefore, if the mother’s life

298 For example the Clinical Report of 1963 noted that ‘in face presentation five of the seven stillbirths were unavoidable. In four there was an anencephalic monster and the other was dead before labour began. Prolapse of the cord caused one stillbirth and there was one neonatal death in an anencephalic. Thus the high [perinatal mortality] was nearly unavoidable’. See RWH Clinical Report 1963, p. 10. 299 Destructive operations on ‘monsters’ were preferred to caesarean section because, as Lance Townsend argued, the latter operation should be reserved for ‘successful’ pregnancies. He argued that ‘unless the patient objects, sterilisation is often performed after three caesarean sections, the reason being that the lower segment is fairly weak after three incisions … This is a factor to be remembered when the first caesarean section is being contemplated; namely, that it will limit the family to three’. Contraindications for caesarean section included ‘known foetal death, monster is present, eclampsia’. See Lance Townsend, Obstetrics for Students, Carlton, Vic.: Melbourne University Press, 1969, pp. 566 & 576. 300 RWH Clinical Report 1944, p. 31. 301 The Clinical Report for 1965 noted that ‘three hydrocephalic monsters had their heads perforated’. See RWH Clinical Report 1965, p. 26.

101 was in danger, it would be necessary to ‘destroy’ the living child to assist in its delivery.302 Craniotomy and embryotomy were also denounced roundly by Roman Catholic physicians and priests at the Second Australasian Catholic Congress, held in Melbourne in 1903.303 The speakers at the Congress regarded the practice as sufficiently widespread that almost half the speakers focused their attention towards what was understood to be the unjustified destruction of the unborn child. Whilst obstetrics students at the University of Melbourne had been taught that their first priority lay in ensuring the health of the mother, speakers at the Congress expounded the belief that the foetus had as much claim to the obstetrician’s attention as did the mother. Although some considered the foetus to be a creature that had not yet attained full status of human, sanctioned Roman Catholic doctrine as preached in Australian churches dictated the sanctity of human life at conception; therefore, procedures such as craniotomy devalued the worth of the unborn child by privileging the life of the mother.

For example, Dr Michael O’Sullivan proclaimed that ‘all true Catholics accept the right of the unborn child to live, both on the authority of Divine revelation and Church pronouncement’.304 Furthermore, according to O’Sullivan, obstetric situations that demanded a choice between the life of mother or child were not morally ambiguous: that is, the Bible clearly taught that ‘Thou shalt not kill’ and that this command included the foetus. He remarked that ‘the life of the foetus in utero is as valuable in the eyes of the creator as the child just born … [and] that we cannot do evil that good may follow – Non sunt facienda mala ut eveniant bona’.305

Nonetheless, the medical profession was a more authoritative voice than the Catholic Church in determining which life held value and medical knowledge largely superseded other forms of knowledge in the hospital setting. In medical literature, the foetus was classified into ‘nonviable’ and ‘viable’, an inscription which gives insight into the ways in which such foetuses were treated in the clinical setting, which shall be discussed further in later chapters. ‘Non-viable’ foetuses were not regarded within medical discourse as having

302 Milford, Australian Midwife’s and Nurse’s Handbook, pp. 113 & 115. 303 Proceedings of the Second Australasian Catholic Congress Held in the Cathedral Hall, Melbourne October 24 to 31, 1904, Melbourne: The Advocate Office, 1905. 304 Dr M.U. O’Sullivan, ‘Part II: The Catholic Physician in regard to craniotomy’, in Proceedings of the Second Australasian Catholic Congress, p. 13. 305 O’Sullivan, ‘Part II: The Catholic Physician’, p. 13.

102 fulfilled the criteria to attain full humanity. Significantly, it appears that at times, the classification of ‘non-viability’ was less about the gestation reached than the weight of the individual foetus. For example, in the Clinical Report of 1955-56, the report’s introduction notes that ‘deliveries of previable infants (less than two pounds twelve ounces) have not been included in the totals,’ even though the report later briefly mentioned that several of these so-called ‘previable’ infants had actually survived.306

Pippa, who was a nurse in the 1950s and who also suffered the miscarriage of her first pregnancy at the same hospital in which she worked, remembers that the definition of ‘viability’ was an important demarcation in terms of how women were treated as patients. After her own miscarriage, Pippa was asked if she would like to see the remains, but she refused because ‘it would have been a shock’ – even though, as a nurse she had seen foetal remains and was firmly of the opinion that because her pregnancy had not been in the advanced stages, the foetus itself was not viable.307 However, despite her reticence in seeing the foetal remains, it was precisely because Pippa was a nurse at that hospital that she was given this opportunity, unlike many other women for whom the decision to withhold the baby was made for them. Recalling her work in the gynaecology and obstetrics wards at a major Perth hospital, Pippa observed that women often asked if they could view their baby’s body and even have them baptised, but these requests were, as a rule, refused: I can remember when I worked in the ward myself, and the people would ask to have the children baptised, and we would say, well, they’re not viable … In those days … under a certain time – they just disposed of them in the hospital. But that didn’t worry me, really, because we were taught that under a certain time they weren’t viable.308

Furthermore, as Pippa’s experience illustrates, with the medicalisation of childbirth most women delivered their babies in hospitals after World War II; a significant cultural shift which afforded doctors a greater degree of surveillance over their patients during childbirth. Although criminal abortion had been deplored since the turn of the century, as demonstrated in the concerns of the RCDB, women delivering miscarried or stillborn

306 RWH Clinical Report 1955-1956, p. ix. 307 Pippa, interview with researcher, 3 May 2005. Tapes and transcript in possession of researcher. 308 Pippa, interview with researcher.

103 babies within the hospital were sometimes subjected to suspicion by the staff.309 Pippa remembers caring for many women who had suffered either spontaneous miscarriage and induced abortion; both cases were treated in the same ward and if a woman was unfortunate enough to exhibit signs of infection, she was often suspected of having ‘introduced an instrument’ to procure a criminal abortion, although this was not necessarily the case.310 The lecture notes used by medical students at the University of Melbourne also advises practitioners to err on the side of caution when a woman presents with a ‘septic abortion’, noting that a miscarriage may have occurred for a variety of reasons, including the ‘passage of an instrument’ or ‘excessive sexual intercourse’; the notes warned students that ‘it must always be borne in mind’ that criminal abortion may be the underlying factor.311

Conclusion

The medicalisation of childbirth had positioned medical knowledge as a powerful way of describing the female body and, as pregnancy was pathologised the perceived necessity for medical supervision became considered a routine part of an Australian woman’s pregnancy. Supervision of the pregnant body was a significant factor in the construction of the duality of ‘successful’ or ‘failed’ pregnancy. Medical terminology and notions of ‘imperfection’ and ‘abnormality’ shaped the understanding that a miscarriage, stillbirth or neonatal death was an instance of ‘failed’ pregnancy. Reinforcing the authority of the medical profession in the management of perinatal death was the shift away from birth and death at home; most Australians became separated from the processes of death and dying, and the deceased body became viewed with disquiet and uneasiness. In Chapter Three I consider the impact of the culture of ‘death avoidance’ on understandings of perinatal loss, wrought by the medicalisation of death and reinforced by social change which eschewed the public expression of grief, replacing in its stead an expectation of stoicism and ‘spartan control’.

309 May, whose first pregnancy ended in miscarriage in 1959, recalled that she was asked by a doctor in the hospital what she had ‘done’ to end the pregnancy – ‘Had I stuck a knitting needle in myself?’ She said that she ‘demanded an apology, but the doctors just sneered at me’. May was then placed on what was commonly referred to as ‘the dirty side’ of the ward, along with other women who were suspected of inducing miscarriage. May, conversation with researcher, 25 April 2005. 310 Pippa, interview with researcher. 311 de Garis, Lecture Notes, Lecture XXXI 1 July 1903.

104 CHAPTER THREE

‘It was as if she had never existed’: the invisibility of perinatal loss, 1940-1970

Sitting in her lounge room in an inner city suburb of Perth, Margaret recounted to me her memories of the stillbirth of her first child over fifty years ago; throughout the interview she repeated her understanding that the stillbirth of her first child was ‘for the best’. That is, nearly sixty years later, Margaret articulated her experience of losing a baby in the language of stoicism and controlled grief which characterised the dominant attitudes towards death and grief for much of the twentieth century, and was critical of more recent ideas of grieving as healing and appropriate: ‘I think people think they’ve got to be helped. Instead of being made to say, well get over it’.312 Margaret finished the interview with the decisive statement that ‘I’m glad I never saw the baby, because I don’t feel it’s as if I had a baby, and I don’t like the way women nurse their babies now, and take photographs of them and people say, you must mourn that baby. I don’t. I feel as if you’ve got to get over it, and get on with life’.313

Margaret’s baby, a boy, was stillborn after a protracted and agonising labour, and during the interview she recalled her deep sadness at not seeing her child after he was delivered, and the frustration she felt at the time in not being able to participate in the organisation of her son’s burial. Margaret remembered that she was told whilst in hospital that the best antidote to her grief was to have another baby: ‘It was a terrible trauma … my sisters came, my dear husband cried, but the nurse, the sister at St Anne’s said to me afterwards … ‘now now dear, you’ve got a little baby in heaven, you’ve got a little angel in heaven. Go home and put all the things away and start having another baby’. That was all, there was no sympathy, no nothing [sic]’.314

Margaret’s experience of losing a baby gives insight into the ways which women were expected to grieve the loss of a baby in the era of medical dominance over pregnancy and childbirth. These ways were largely dependent upon the prevailing cultural constructions as

312 Margaret, interview with researcher, 31 March 2005. Tapes and transcript in possession of researcher. 313 Margaret, interview with researcher. 314 Margaret, interview with researcher.

105 to what constituted ‘appropriate’ responses to the death of a loved one; a prescription of bereavement which had been transformed after the great losses of the two world wars into an expectation of suppressed sorrow. The silence and stoicism expected of bereaved mothers in the postwar years was framed within the context of what the French philosopher Philippe Ariès has termed ‘the great twentieth century refusal of death’.315

In this chapter I continue to explore the interaction between the experience of perinatal death and the medical construction of pregnancy loss as ‘pregnancy failure,’ an incongruity in an environment which measured reproductive ‘achievement’ based on live births. Within medical discourse and the cultural expectation of suppressed sorrow, it was widely presumed that women needed to be shielded from the bodies of their deceased babies in order to prevent emotional disturbance and to increase the likelihood of women continuing on to have other children. Furthermore, the prevailing view that pregnancy loss was but the ‘nonfulfilment of a ‘wish fantasy’, led to the belief that a subsequent pregnancy would resolve any grief. The impact of this expectation can also be seen in the experience of most women who were denied any information as to why their baby had died, and who rarely were told where the body had been buried. In this chapter, then, I again return to the theme of medical authority and explore how women’s bodies were interpreted by medical knowledge, which led to the women’s loss of agency as actors in the drama of childbirth, and the silence which ensued in the hospital setting after the death of a baby.

‘The great refusal of death’: transforming attitudes towards grief and mourning

The late nineteenth century would see a transformation in attitudes towards death in general in Australia. The turn of the nineteenth and twentieth centuries saw the widespread cultural distancing from matters of death and dying in many Western societies; this rejection of the Christian ideal of the ‘good death’ was originally motivated by the steady increase in secularism. That is, even before the socially destabilising impact of the two World Wars,

315 Philippe Ariès, Western Attitudes Towards Death: From the Middle Ages to the Present, trans. P. Ranum, London: M Boyars, 1976, pp. 81-82.

106 most of the Western world was already moving away from the dominant Christian ideas of death and the afterlife.316

The emerging ideas of modernity wrought a more widespread rejection of the Christian notion of a ‘good death’; as Jalland argues, ‘scientific’ ideas of the body rendered the Christian ideal of the immortality of the soul as a seemingly implausible concept. Rather, the physical suffering wrought by death became the focus and the ‘good death’ therefore became more difficult to obtain, leading to an intolerance of death and its reminders.317 Ariès observes that this led in the early twentieth century to the notion of ‘the interdiction of death in order to preserve happiness [of those surviving]’.318 British anthropologist Geoffrey Gorer observes that there were several components to the culture of death avoidance; a central element being ‘the generous wish not to make others unhappy in one’s misery … Frequently coupled with this is what might be described as psychological hypochondria, a belief that giving way to grief and mourning is ‘morbid’ and ‘unhealthy’.319

In Australia the unprecedented and wholly unexpected trauma of the Great War served to precipitate the ‘swifter march in the direction of denial [of death]’.320 Jalland argues that the overwhelming death toll of the Great War led to a widespread belief that the individual’s grief must be ‘restrained’ as a sign of respect and recognition of the enormity of the nation’s loss of young men’s lives.321 The impact of two world wars in little less than thirty years was the formation of, to borrow Ken Inglis’ term, an expectation that Australians would exhibit ‘spartan control’ in matters of death and bereavement; several writers also argue that the sights and sounds imprinted on the returned servicemen’s memories were so horrific that they defied description – ghastly experiences that were

316 British anthropologist Geoffrey Gorer suggested in 1965 that ‘all versions of Christianity contain dogmatic statements about the reality of a life after death and its nature, because, traditionally, religion is held to offer consolations for the grief of bereavement’. See G. Gorer, Death, Grief and Mourning in Contemporary Britain, London: The Cresset Press, 1965, p. 30. 317 P. Jalland, ‘A private and secular grief: Katharine Susannah Pritchard confronts death and bereavement’, History Australia, vol. 2, no. 2, 2005. http://publications.epress.monash.edu/doi/full/10.2104/ha050042. Accessed 10 August 2006. 318 Ariès, Western Attitudes Towards Death, p. 94. 319 Gorer, Death, Grief and Mourning, p. 69. 320 Jalland, Changing Ways of Death, p. 19. 321 Jalland, Changing Ways of Death, pp. 55-56.

107 untranslatable into language that could be understood by civilians.322 Therefore by the 1950s the effect of the two world wars had, in Damousi’s words, ‘transformed the ways in which white Australians mourned their dead. Because such huge numbers of men perished in war, there were no longer the elaborate public processions for the dead. The impact on communities like Australia was to make mourning a simpler practice and a more private matter’.323

Intensifying the expectation of ‘spartan control’ after bereavement was the medicalisation of death. Early in the twentieth century hospitals increasingly became, as Ariès argues, ‘the designated spot for dying’.324 This shift reinforced the medical profession’s authority over the management of death; as the hospital became the site for dying, individuals lost the right to control the rituals of the death.325 Whilst death at home was the norm in the late nineteenth century with perhaps only one out of ten deaths – usually of paupers – occurring in a hospital, this number had risen to four out of ten by the interwar years; as Inglis argues, this had the effect of most Australians being ‘less comfortable than their parents had been at the prospect of having a dead body in the house: the less people saw of death, the more uneasy it made them’.326

‘You must not give way’: death avoidance and perinatal loss

As the shift from home to hospital as the site of death became more entrenched, this expectation of controlled sorrow grew to encompass any death, not just those brought about by war. The ways in which many Australians responded to the staggering losses of World War One and later, World War Two, would have a great impact on the way that other

322 Despite many Australians’ loss of the relative naïveté enjoyed before the First World War, the Second World War served to confirm the necessity of this restrained grief, especially as the horrors of Auschwitz and Hiroshima emerged – what Adrian Gregory has described as ‘a silence in which nothing meaningful could be said’. See Damousi, Living with the Aftermath, pp. 99-100. 323 Damousi, The Labour of Loss, p. 163. 324 Ariès, Western Attitudes Towards Death, pp. 87-88. 325 Jalland, Australian Ways of Death, pp. 326-327. 326 Inglis, ‘Passing Away’, p. 235. For example, because her family knew the matron at the small private hospital where she delivered her son, Mrs Mead was offered the chance to view her baby’s body after he was stillborn at the end of the Second World War, but she declined, saying later that she felt uncomfortable with the idea of viewing a deceased body, particularly the body of her own child. She recalls that she was ‘asked by the Sister if I wanted to see him and I said, no, no I don’t think so! I had this awful … it was because he was dead. I didn’t want to be anywhere near him. It was the biggest mistake I’ve made in my life’. Mrs Mead, interview with researcher, 29 August 2005. Tapes and transcript in possession of researcher.

108 deaths were mourned – at least in public – with the construction of culturally appropriate responses to loss and a restriction of avenues available to those who would previously have been expected and permitted to openly mourn their dead.327 This ‘cultural prescription of grieving’ - which, according to Jalland, began after the First World War as a kind of ‘suppressed, privatised sorrow’, and which evolved after World War Two into the ‘rejection of expressive sorrow’328 - would impact those who suffered the death of a loved one in the thirty or so years after the end of the Second World War.329 In Australia, the widespread rejection of Christian ideas of death and eternity, reinforced by the massive losses of the Great War, and later, the Second World War, led to a silencing of death and dying: as Gorer notes, ‘death had superseded sex as a taboo subject’.330

In her oral history of midwives who had worked in hospitals in the immediate postwar era, Penny Curtis argues that both the cultural expectation of suppressed sorrow and the medical discourse of supervision and control over the pregnant body led to the prevailing view that women should be shielded from the experience of perinatal loss. As Curtis observes: Midwives whose practice predates such contemporary norms [of collecting mementoes], indicate that they were influenced by, and helped to maintain, what can be characterised as a myth of ‘healing-distance’, both during and after the birth. Professionals assumed that women needed to be protected from the experience of giving birth to a stillborn baby, and in their practice they sought to construct both emotional and spatial distance between mother and child.331

The experiences of women who lost babies during the Second World War and in the twenty or so years afterwards give credence to Curtis’ observation that the prevailing belief held that women needed to be ‘shielded’ from the experience of delivering a stillborn or

327 Australian psychologist Beverley Raphael argues that the language of bereavement in postwar Australia was characterised by an expectation that to exhibit emotion was to be considered ‘weak’; one must remain in control of their emotions following bereavement, an expectation that, unlike the nineteenth century responses to grief, came to encompass women as well as men. See Jalland, Australian Ways of Death, p. 30. As Luckins has demonstrated in her study of post-Great War grief, to flout this cultural directive was to risk stigmatisation and, in some cases, institutionalisation, indicating how strictly Australians, and in particular, women, were governed by this cultural prescription of mourning. See Luckins, The Gates of Memory, p. 111. David Walker notes that the ‘fear of sick nerves’ was strong in Australia in the 1930s and beyond. In 1888 the rural labourer was most likely to be admitted to an asylum; by 1938 the ‘troubled suburban housewife’ had displaced him. See D. Walker, ‘Mind and Body’, in Spearritt and Gammage, Australians 1938, p. 223. 328 Jalland, Changing Ways of Death, p. 171. 329 It is also apparent that whilst some individuals still continued to respond to grief in different ways, by the 1940s the language of repressed grief had spread to the middle and ‘respectable’ working classes. See Jalland, Changing Ways of Death, p. 35. 330 Gorer, Death, Grief and Mourning, p. 23. 331 Penny Curtis, ‘Midwives’ Attendances at Stillbirths: an oral history account’, Midwifery Digest, December 2000, p. 528.

109 seriously ill baby. Overwhelmingly the older women interviewed for this project recalled that they were often sedated after the death of their baby; their babies were either ‘whisked away’ after delivery without the mother catching a glimpse of the body, and they were usually excluded from any burial arrangements and rarely were given any detailed information as to why their baby had died. In describing the attitude of the nurses at the hospital where she delivered her first child, Barbara commented that after her daughter was stillborn at term, ‘it was as though she never existed, really, to me. Because I had nothing’.332

In her history of the RWH in Melbourne, McCalman argues that the practice of shielding women from the experience of perinatal loss was borne out of a paternalistic sense of concern; she suggests that whilst ‘there were also unacceptable lapses of empathy and sensitivity, these were sins of omission more often than of commission by busy professionals simply not aware that a patient was … grieving’.333 As I discuss further in the chapter, the memories of some of the interviewees support this claim to an extent; some mothers found that they were treated gently and kindly, even if the circumstances surrounding the event itself were not mentioned. Certainly it must be acknowledged that doctors and nurses are themselves individuals with the means to internalise or resist certain attitudes towards perinatal loss. However, the medicalisation of childbirth had, as I argue in the previous chapter, positioned pregnancy and childbirth within the dualities of ‘successful’ versus ‘failed’ and accorded the obstetrician an important role in ensuring a ‘successful’ birth. Furthermore, the foetus was understood within medical discourse as essentially unknowable and ultimately replaceable; therefore the motives behind the avoidance of stillbirth and neonatal death invite a more nuanced analysis.

The practice of shielding women from their babies was not borne merely out of a desire to ‘protect’ women but was an intersection of several significant understandings of the impact of perinatal loss and the inscriptions of the deceased foetal body, as well as the prevailing construction of perinatal loss as ‘repugnant’ – as an incident which reflected badly on the objectives of obstetrics. Douglas J. Peddicord argues that the silence after a perinatal loss

332 Barbara, interview with researcher, 10 June 2005. Tapes and transcript in researcher’s possession. 333 McCalman, Sex and Suffering, p. 313.

110 was to an extent an extension of the inscribed on the foetus in medical discourse: In trying to ‘protect’ parents from the reality of their experiences caregivers at times [made] stunningly incorrect assumptions. For instance, a nurse commented to an unmarried, teenage mother that her loss, a stillbirth, must have been in some way a relief … another assumption [was] that a stillbirth was somehow less real, less painful than the loss of a liveborn infant.334

The desire to ‘protect’ women from ‘emotional imbalance’ after a stillbirth or neonatal death was also borne out of dominant medical constructions of women as fixed to nature and prone to emotional instability - notions which were reinforced by and reproduced within the cultural shifts towards repressed sorrow after death. In general terms, the medical profession advocated a distant and aloof approach to obstetrics and gynaecology.335 For example, in the 1920s, those women who delivered their babies at home but were attended to by visiting practitioners from the RWH in Melbourne were often treated with little empathy - indeed, ‘empathy’ was scorned as being an emotional response best left to the womenfolk.336 As McCalman notes, ‘some patients were hysterical and received careful reassurance by women medical students who were most likely to attend to the feelings of the patient and her family than were men, who left that ‘women’s business’ to the nurse’.337 After a perinatal loss, the understanding that stillbirth or neonatal death would not lead to any long-term impact led to women’s grief being minimised within the understanding that women would be able to bear other children which would ‘replace’ her deceased baby.338 Lorna Lloyd Green, a resident at RWH Carlton in the 1940s, recalled feeling distressed by the brisk and detached response of male obstetricians who dismissed the possibility of any

334 Douglas J. Petticord, ‘Perinatal Death’, in George Stricker and Martin Fisher (eds.) Self-disclosure in the Therapeutic Relationship, Plenum, NY: Springer, 1990, p. 270. 335 As McCalman notes, particularly in the early years of the RWH in Melbourne the daily lives of the doctors and their patients were often sharply at odds with each other. Although students at this time were taught by their lecturer in obstetrics, Arthur Wilson, that all patients should receive the same care afforded to their wife, mother, or sister, there were distinct class-based assumptions at work which impacted the way that medical students treated their patients. In particular, as McCalman argues ‘the working woman was a tougher breed than the lady: she felt less pain and she popped out babies like shelling peas from the pod. Alongside “savages” she had not yet partaken of the moral benefits and reproductive deficits of modern civilisation’. See McCalman, Sex and Suffering, p. 193. 336 McCalman, Sex and Suffering, p. 192. 337 McCalman, Sex and Suffering, p. 192. 338 The prevailing view that another pregnancy would replace a perinatal loss was largely at odds with how many women viewed the death of a baby. Although she notes the decline in women recording details of their intimate lives in the 1920s and 1930s, Holmes observes that for many women, a healthy baby was cause for ‘great rejoicing’. See Holmes, Spaces in her Day, p. 74.

111

emotional ramifications after a stillbirth or neonatal death: What used to worry me no end … especially one obstetrician was: I would say – ‘it’s just terrible that she’s lost that baby, we should have been able to do something about it’. And he’d reply, ‘She’ll have another’. And I would get mad – ‘How do you know that she’ll have another? We have no idea that she will have another’. Psychologically and physically there was everything against her.339

Treating the physiological condition: aloofness and distance in general perspective

Reinforcing the distant approach to obstetrics and gynaecology were the sheer logistical problems facing many maternity wards around Australia during the postwar ‘baby boom’; whilst individual doctors and nurses may have sought to pay more attention to pregnant mothers and bereaved mothers alike, the nature of working in a maternity hospital during this period was likely to be a significant obstacle. Margaret, for example, recalls being left to her ‘own devices’ whilst she waited in hospital for her labour to begin. The nurses were busy preparing for the hospital fête, and, according to Margaret, ‘they just sort of didn’t take much notice of me, and I can remember walking all the way down from the hospital right down to the river, having a lovely walk down’.340 Reiger also paints a vivid picture of the busyness of the postwar maternity wards in Australia during this time. Labour wards were crowded, noisy, and understaffed and these constraints meant ‘little time for individual attention and the general authoritarianism of hospital routine was unquestioned’.341 It was, as one doctor, Percy Rogers, observed, akin to prison: ‘the sisters in charge, I’m certain, had been recruited from the concentration camps’.342 Midwife Thelma Matson described the delivery suite at the RWH in Melbourne in equally grim terms: If I could just describe the actual delivery suite and the archaic and barbaric conditions under which women, I believe, had their babies … It was a great big Florence Nightingale ward. On one side there were four beds, and we had screens round it. At least it wasn’t like Crown Street [Sydney]. As late as 1959 when I went to Crown Street to have a look, you still had calico-type screens, and ones that you lifted around … We would have anything up to – well I remember eighteen deliveries on one shift. And that was really going. You could have anything up to

339 Lorna Lloyd Green quoted in McCalman, Sex and Suffering, p. 200. 340 Margaret, interview with researcher. 341 Reiger, Our Bodies, Our Babies, pp. 22-25. 342 Percy Rogers quoted in Reiger, Our Bodies, Our Babies, p. 20.

112 six, seven women in the prep. room. Oh well, they just sat wherever they could find a seat. There was very little room.343

As Reiger observes, the conditions under which many staff were working meant that maintaining a humane approach was an enormous challenge, which concerned some staff ‘but on the whole most were too busy to think about patient needs’.344 Particularly in the busy maternity hospital, geared towards the production of live babies, bereaved women could be treated dismissively by both doctors and nurses. For example, Barbara recalled that the nursing staff caring for her after her stillbirth were generally kind but brisk: Oh, they were kind, but nothing was mentioned, really. It was … more or less, you know, it’s happened. Especially with, I know one of the old nuns, even when I lost the first baby, she was pretty tough. And going back, I had to have an operation in the very beginning, I had to have an operation so I could have children at all, so when I lost the first one at sixteen weeks I was devastated, because I thought, oh, maybe I won’t ever, seeing as I had had the problem. And I remember her coming in to see me after I’d lost [the next] one and she said, ‘oh well! You’ve lost your baby,’ and that was sort of it.345

Certainly some women were treated with kindness and gentleness despite the hustle and bustle of the postwar maternity ward; Iris, for example was granted an unusual request because of, she believes, her friendship with the sister of one of the nurses. Although she had not been permitted to view her daughter’s body, Iris requested that she be able to hold someone else’s baby for a while ‘because everything in you just wants to do that’. The request was met with some consternation, but it was eventually granted, to Iris’ pleasure. Iris recalled that: There was a bit of a turmoil amongst the staff, because I’d asked, and whose baby would it be, that sort of thing. And anyway somehow they agreed, went to the women and asked for a volunteer, I don’t know how it happened but the next thing someone brought in – not the mother, a nurse, brought in a little baby, and I just had a hold and a little cuddle and then handed it back, of course. But if felt, sort of, expressed something from within me [but] of course it couldn’t go on and on.346

Several women who experienced less than compassionate care in hospital also found other doctors who had not been involved in the delivery to be more concerned about their

343 Thelma Matson quoted in Reiger, Our Bodies, Our Babies, pp. 20-21. 344 Reiger, Our Bodies, Our Babies, p. 25. 345 Barbara, interview with researcher. 346 Iris, interview with researcher, 12 October 2005. Tapes and transcript in possession of researcher.

113 wellbeing. Barbara, who felt that she was avoided while in hospital having been told nothing as to why her baby had died, remembers the effort her family doctor took to relay the news to Barbara’s family. She recalled that: My [general practitioner] was wonderful. Because it was about nine o’ clock at night when I had the baby, and she went all the way out to my mother’s house, and had to climb up this very steep hill, clamber over a barricade that they’d put up to stop my eldest little girl, who was two, from falling down the steps, and this middle aged doctor climbed over to tell my husband and my mum and dad, that the baby had died.347

Iris was also greatly relieved to find a specialist who was keenly interested in her previous stillbirth and who encouraged Iris to talk about her experience. After being treated dismissively at her postnatal checkup eight weeks after her baby’s death – the doctor brushed off Iris’ insistence that she was still ‘terribly sore’ – her husband suggested she see another obstetrician: So I made the appointment, it was with one of the ones that my friend had used, and she’d talked well of him, so I made an appointment with him, and the day I arrived I went into his office first, and said, ‘I’m not pregnant, I know that, but about eight or nine weeks ago I had a stillborn’ - and do you know, he was the first person, other than my husband, he sat in that big office chair and said, ‘a stillborn? Tell me all about it’. And he just let me unfold it all, and he was interested too, that people had these things. At any rate, he was lovely, and sent me off, and said, ‘you have another baby when you want it’.348

The practice of ‘protection’: rendering perinatal loss as invisible

However, amongst the women interviewed for this project these experiences appear to be exceptional. In the late 1960s the British obstetrician, Stanford Bourne, argued that most doctors had little recollection of their patients who had delivered stillborn babies and tended to distance themselves from such cases.349 Although the emotional consequences of

347 Barbara, interview with researcher. 348 Iris, interview with researcher. 349 Bourne conducted his study by sending out questionnaires to a random sample of 100 doctors who had delivered live babies and 100 doctors who had delivered stillborn babies. He concluded that ‘the [stillbirth] doctors know less, remember less, and appear to be able to think less about their patients than the [livebirth] doctors … The [stillbirth] doctors return fewer questionnaires and two wrote especially [long letters] to refuse to participate [on the grounds of limited time]. Of the questionnaires returned, fewer [stillbirth doctors] contained any usable information … tend[ing] repeatedly to ‘not to know’, they confine themselves with impoverished answers in comparison with the [livebirth] doctors who manage to provide more spontaneous

114 stillbirth and neonatal death were rarely, if ever, discussed in medical literature, it was believed by some medical professionals that perinatal death was an event that had customarily been repressed by the obstetrician because of its ‘extremely distasteful’ nature. Emanuel Lewis argued that stillbirth was viewed by the medical profession as ‘extraordinarily chilling’ and ‘repulsive’: an anomaly in an environment which heralded a live birth as a ‘success’ on the behalf of the medical practitioner.350 Bourne also suggested that much of the silence after a perinatal loss was borne out of medical professionals’ own ‘revulsion’ of the event particularly because, in an environment where livebirths were the norm, ‘we have insufficiently prepared ourselves’. Reflecting on his long career as a doctor Bourne concluded in the early 1980s, for many decades, obstetricians had reacted with ‘aversion’ to stillbirth because by nature it was a ‘stupefying non-event, defiling, one of nature’s obscenities’.351

As reminders of a ‘failed delivery’, women who miscarried or suffered perinatal loss were often regarded as somewhat of an anomaly within the busy environment of the maternity hospital, and inevitably, many women slipped through the system and were virtually ignored or neglected in terms of their postnatal care. Whilst Mrs Mead felt she was not treated badly in hospital, she remembers that the staff seemed somewhat puzzled as to their role in caring for her. After she was given a tablet to stop her milk from ‘coming in’, she was left alone except for intermittent observation; she recalled that ‘there was nothing much to do for me. I don’t really remember there being anything untoward there, but they didn’t talk about the baby. I think it was taboo to talk about it’.352 So taboo was the topic of stillbirth that Mrs Mead was actually brought a baby by a nurse, as she was preparing to leave the hospital to return home. In the busyness of the hospital Mrs Mead’s situation was not clearly communicated to all staff members, and so both she and a nurse were unwittingly faced with an embarrassing and awkward scenario. She recalled that: One of the awful things that happened the day that I was leaving hospital … one of the nurses brought me a baby. She felt terrible, because I said, ‘ooh no, no, no, it’s not mine’. She’d made a mistake, she’d brought the baby to the wrong room, but I

comment’. See Stanford Bourne, ‘The Psychological Effects of Stillbirth on the Doctor,’ Journal of the Royal College of General Practitioners, vol. 16, 1968, pp. 103-112. 350 Emanuel Lewis, ‘The Management of Stillbirth: Coping with an unreality’, Lancet, September 18 1976, pp. 619-620; Emanuel Lewis, ‘The Abhorrence of Stillbirth’, Lancet, June 4 1977, p. 1188. 351 S. Bourne, ‘The Psychological Management of Stillbirth’, The Practitioner, no. 227, Jan 1983, p. 54. 352 Mrs Mead, interview with researcher.

115 was packed up ready to go home. And I don’t know which one of us felt worse, the nurse or me.353

The common practice of placing of bereaved women back onto shared wards is also indicative of the stoicism expected of women after perinatal loss. Rayma, for example, was placed back on a general postnatal ward after her twin sons were stillborn: ‘afterwards they put me into a ward with nursing mothers. That was hard’.354 Iris remembered that upon her admission to hospital she was initially accommodated in the labour ward in a four-bed room with a woman who was waiting to deliver her deceased baby, whilst Iris – whose baby was still alive at this point - herself waited for labour to begin: ‘I sort of said, ‘when’s yours due?’ Because mine was still to come, but the others had had theirs – it was a four- bed, I think. And she just sat there and said, “I’ve got to wait till it comes. It’s dead now.”’355

Removing women as active players in the drama of childbirth

The practice of ‘protecting’ women from their experience, which manifested itself in distant and aloof care, was part of a wider removal of women’s existential agency in childbirth which had taken root as medicine assumed authority over obstetrics and gynaecology. The medicalisation of childbirth served to distance women from their bodies – and their babies – during pregnancy and childbirth, in both bodily and psychological terms. In the previous chapter I argue that the maternal body was reconstructed under the banner of ‘science’ in the early twentieth century; significantly, the dominance of the medical language of pregnancy and perinatal death largely rendered silent the ‘language of the flesh’ from the vocabulary of ordinary Australian women.356 Murray notes that women’s knowledge of their bodies was ‘replaced by the authority of the medical understandings of the body … Medical scientists claimed the right to speak about the

353 Mrs Mead, interview with researcher. 354 Rayma, interview with researcher, 3 October 2005. Tapes and transcript in possession of researcher. 355 Iris, interview with researcher. 356 In her study of Australian women’s diaries in the early twentieth century, Holmes notes both the decline in women keeping personal diaries, and amongst those who did continue the practice, the silence imposed upon women with regard to pregnancy and childbirth. Her analysis suggests that the medical discourse of maternity largely rendered these topics off-limits to most Australian women, even in the intimacy of a personal diary. See Holmes, Spaces in her Day, p. 71.

116 body’.357 The physician F. Milford, for example, warned that a medical professional should never accept a woman’s claim that she was pregnant, but rather should examine the patient themselves, because, he argued ‘women often deceive themselves and fancy they are pregnant when they are not’.358 Women of childbearing age in the 1920s attest to the authority of medical language in silencing women’s understandings of sex and pregnancy. Kathleen Baxendale, for example, remembers that after her marriage her employer used to leave books about sex and reproduction written by the famous author, Dr Marie Stopes, ‘lying around the office’ for her to read, and that this was her only means of gaining knowledge in this area. Talking about sex and reproduction, ‘the facts of life’, was considered to be ‘dirty talk … hush hush. Mothers [never] talked about those sorts of things’.359

By the postwar years, women were not made privy to either the changes occurring in their pregnant bodies, nor to the processes of labour and birth.360 This was further reinforced by the growing shift away from birth at home to birth in hospital under the supervision of the medical profession. An oral history participant observed that she had been ‘so naïve’ that she had not even known how the baby would be actually born – and that finding out during the actual labour was, to say the least, a great shock.361 The medical discourse of pregnancy and childbirth restricted maternal participation by limiting access to knowledge about their bodies; Holmes argues that the silence towards matters of intimacy in women’s diaries in the 1920s and 1930s is reflective of the power of the medical profession in removing the language of sex from women.362

The medicalisation of childbirth also served to remove women’s autonomy over pregnancy; in describing the medical assumption of control over childbirth, Helen Woolcock et al note that mothers were ‘often the least regarded players in the childbirth drama’.363 A significant

357 Murray, ‘Being Unwell’, pp. 137-138. 358 Milford, Australian Midwife’s and Nurse’s Handbook, p. 46. 359 It was not until she reflected on this that Baxendale realised that her employer had been done deliberately so that she could become informed about reproduction and childbirth. Still, she felt that sex and reproduction were not topics to be discussed, so she knew very little. Kathleen Baxendale, interviewed by Josie Castle in the NSW BOHP, 31 August 1987, ORAL TRC 2301/22, NLA. 360 Reiger, Disenchantment of the Home, p. 85. 361 Ivy, interview with researcher, 6 May 2005. Tapes and transcript in possession of researcher. 362 Holmes, Spaces in her Day, p. 71. 363 Helen R. Woolcock, M. John Thearle and Kay Saunders, ‘My Beloved Chloroform: Attitudes to Childbearing in Colonial Queensland: A Case Study’, Social History of Medicine, vol. 10, no. 3, 1997, p. 437.

117 demonstration of the medical profession’s authority over reproduction was the increasingly routine use of analgesia during childbirth. Whilst the nineteenth century was host to the idea that pain in childbirth was part of woman’s fate and nature’s plan,364 in the early twentieth century medical discourse constructed pain relief as a blessing - a way to remove women from this suffering.365 Although the use of anaesthesia had had a rocky beginning in the mid nineteenth century, with many suspicious medical practitioners believing that it ‘meddled’ with the ‘natural’ course of childbirth and contradicted the Biblical notion of pain in childbirth, it began to be increasingly accepted as techniques of administration improved with an ensuing decline in problems with its use in childbirth.366 As Woolcock et al observe, the use of chloroform and other anaesthesia was another justification for the banishing of midwives and other birth attendants: medical professionals proclaimed that it was ‘too powerful an agent to be entrusted to nurses or other unprofessional individuals’.367 Therefore sedation, whilst explicitly serving to provide very practical relief for women, also implicitly reinforced the authority of the practitioner in matters of pregnancy and childbirth, and ultimately, removed women as active performers in the corporeality of childbirth.

In particular, the use of the so-called sedative ‘twilight sleep’, a mixture of scopolamine and morphine administered to dull the pain of childbirth and to produce a form of amnesia, was viewed as beneficial for use in the labour of those women who were considered of ‘nervous temperament’. Within medical and psychiatric discourse, the management of nerves was considered to play a significant role in reducing any problems in pregnancy and childbirth. Milford, for example, instructed readers of his midwifery manual to pay particular attention to a labouring woman’s mental state; arguing that ‘the senses of a parturient woman are in a most exalted state … in this state it does not take very much excitement to overthrow the ordinary mental equilibrium’.368 Furthermore, he noted that anaesthesia would serve to ‘rob [labour] of its terrors’.369 A prevailing view amongst obstetricians who advocated anaesthesia was that middle-class women were not ‘empowered’ like their ‘primitive sisters’ and were unused to the rigours of physical labour

364 Woolcock et al, ‘My Beloved Chloroform’, p. 450. 365 Hanna Rion, Painless Childbirth and Twilight Sleep: A Complete History of Twilight Sleep from its Beginning in 1903 to its Present Development in 1915, T. Werner Laurie Ltd, London, 1915, p. 20. 366 Woolcock et al, ‘My Beloved Chloroform’, p. 451. 367 Woolcock et al, ‘My Beloved Chloroform’, p. 452. 368 Milford, Australian Midwife’s and Nurse’s Handbook, p. 222. 369 Milford, Australian Midwife’s and Nurse’s Handbook, p. 150.

118 and pain. A proponent of twilight sleep, Dr Kronig, argued that sedation would remove such a ‘highly strung’ woman from the experience and render childbirth as painless and therefore manageable for the obstetrician.370 Another advocate, Hanna Rion, argued that the irrational fear of pain in many modern women ‘germinated in the coming child’, leading in many cases to foetal malformations and birth difficulties; Rion postulated that if twilight sleep was made readily available to all childbearing women then the fear of pain would disappear, along with many problems in labour.371 Several decades later, Australian obstetrician Lance Townsend advocated the use of anaesthesia during labour to ‘abolish [the] memory of suffering’.372

Women delivering babies up until the end of the Second World War recalled being given sedatives during their labour. Mrs Mead, for example, was sedated during labour with twilight sleep; in her interview, she remarked that she was given this as a matter of course, although she was unaware of what this sedative actually contained: ‘Everybody had twilight sleep … depending on how much fuss you were making. Don’t ask me what it actually was, but that was what it was called’.373 Similarly, Margaret had also been sedated with what she believes was chloroform, ‘the heavy stuff’, during labour – she remarked that this may have been because she had ‘caused a fuss’ because her legs had been ‘aching and aching’ after a traumatic long labour.374

The recollections of oral history interviewees suggests that many women who delivered stillborn babies or very ill newborns were also sedated after the birth, as a way of diminishing their memories of the experience. That is, just as sedation had been conceptualised as providing the means to reduce a woman’s physical pain in childbirth, the sedation of women after perinatal death was a way to suppress any emotional ramifications of a ‘failed’ birth. Although Reiger observes that the practice of ‘total sedation’ during childbirth was gradually phased out in labour wards in Australia by the 1950s,375 there is

370 Dr Kronig quoted in Rion, Painless Childbirth and Twilight Sleep, pp. 17-18. 371 Rion, Painless Childbirth and Twilight Sleep, p. 20. 372 Townsend, Obstetrics for Students, p. 153. 373 Mrs Mead, interview with researcher. 374 Margaret, interview with researcher. 375 Reiger observes that after the practice of rendering women unconscious for the birth was phased out after World War II, heroin became a popular method of sedation for a time, as was the predecessor of the contemporary epidural, the spinal anaesthetic. See Reiger, Our Bodies, Our Babies, pp. 29-30.

119 evidence demonstrating that sedation after perinatal loss remained a common practice until at least the late 1970s.376 Where sedation during labour was viewed as means to avoid women’s hysteria, sedation after birth in cases of perinatal loss was a way to suppress the possibility of an ‘excessively’ emotional response.377

For example, Dorothy recalled that she was sedated after delivering her second baby at a small Catholic maternity hospital in Perth; the infant was born prematurely and died two days later. She was told little as to why her baby had died; in her recollection, she ‘got a glimpse’ of the child immediately after the delivery before he was ‘whisked away’, presumably to the nursery, where he died after two days. Dorothy was put into a shared room and during these two days, she was not informed as to her son’s progress; after he died the nuns came into the four-bed verandah ward, pulled the curtain around Dorothy’s bed, and informed her that her baby had passed away. Remembering her response, Dorothy recalled that she had cried and when the nun had asked if she was ‘alright,’ she had replied ‘no, I’m just going to cry all day’. After this, Dorothy was sedated, quite possibly because she indicated to the nurses that she wished instead to be ‘left alone to cry’. However, she commented that she still allowed herself to be sedated, because, in terms of her experience with pregnancy and childbirth, ‘of course, I always did what I was told’.378 Similarly, Margaret was sedated after her baby was stillborn because she had become highly emotional after the experience of losing her baby, quite likely exacerbated by the physical strain of a week-long labour. She recalled that ‘I must have had a few bad nights, and I remember a lovely nurse, I must have been having a crying fit, sobbing, and this lovely

376 Writing in 1985, Raphael claimed that ‘many women are heavily sedated throughout the stillbirth experience and afterward’ in order to ‘suppress the grieving response’. See Raphael, The Anatomy of Bereavement: A Handbook for the Caring Professions, New York: Basic Books Inc., 1985, p. 244. Western Australian obstetrician Patrick Giles, whose work I discuss in greater detail in the next chapter, urged colleagues in 1970 to avoid sedation after pregnancy loss ‘as was customary’. See P. Giles, ‘Reactions of Women to Perinatal Death’, Australia and New Zealand Journal of Obstetrics and Gynaecology [ANZJOG], vol. 10, 1970, p. 209. 377 The midwives interviewed by Curtis framed their own understanding of the benefit of sedation in terms of the ‘protection’ of bereaved mothers, with one midwife remarking that ‘sedation was used to dull the experience and distance her from the tragedy’. See Curtis, ‘Midwives’ Attendance at Stillbirths’, p. 528. 378 Dorothy, interview with researcher, 1 August 2005. Tapes and transcript in possession of researcher.

120 nurse that wasn’t a nun, she made me a cup of tea and she made me feel so good … she gave me some … pills.379

The widespread use of sedation after perinatal loss gives greater insight into the underlying motivations behind the ‘protection’ of mothers from the experience of losing a baby. The presumption that women were fixed to nature, essentially driven by emotion and prone to irrationality led to the belief that women’s inherently unstable minds needed to be safeguarded in order to produce a live birth or avoid problems during labour. The belief that miscarriage and stillbirth could be caused by a woman’s psychological ‘irrationality’ was, therefore, arguably an underlying factor in the practice of protecting women from the experience of losing a baby. As I have argued in the previous chapter, medical discourse understood some instances of pregnancy loss to be the result of women’s subconscious desire to be rid of the foetus, and this idea persisted well into the 1960s. Dr Heiman, for example, claimed in 1965 that ‘a woman can never escape her ultimate biologic destiny, reproduction, and a goodly number of psychologic problems encountered in the course of pregnancy are the result of conflicts concerning this biologic destiny’.380 Oakley argues that women who showed signs of ‘emotional disturbance’ during pregnancy and early motherhood were treated with suspicion; to be ‘ridden with conflicts about the desirability of a feminine destiny’ was often presumed to be the cause of problems during pregnancy and childbirth.381

The care of women’s minds therefore became a central focus in the management of a perinatal death. If the subconscious could affect the outcome of pregnancy, then it was necessary to remove any signs of the ‘failed’ pregnancy in order to ensure a healthy mind for the subsequent pregnancy. Grantly Dick-Read, for example, argued in his 1942 book Childbirth Without Fear that many problems in obstetrics could be overcome if more attention was paid to women’s minds during pregnancy and childbirth. He commented that ‘the mother is the factory, and by education and care she can be made more efficient in the

379 Margaret was also given sleeping pills to take home, but her husband objected to this measure, and requested that she throw them down the toilet ‘because he didn’t like anything like that’. Margaret, interview with researcher. 380 Dr Heiman quoted in Oakley, Women Confined, pp. 38-39. 381 Oakley, Women Confined, p. 39.

121 art of motherhood. Her mind is of even greater importance than her physical state, for motherhood is of the mind’.382

It was also believed that in order to safeguard against ‘inappropriate’ displays of emotion after perinatal loss, women should be shielded from the bodies of their deceased babies. The opportunity to hold their stillborn or seriously ill baby was not an option for most of the older women interviewed for this research. Ivy, for example, was sedated during the birth and when she regained full consciousness, was told by a nurse that her baby had died. The baby’s swaddled body was briefly shown to Ivy, but she was not permitted to either touch or unwrap the body: When I really came to, the nurse said, ‘your baby is dead’. And I said, ‘whose baby?’ And she said, ‘your baby’. And she did bring the baby to me. He was wrapped in cotton wool, ‘cause he had instruments, you know, they had to use instruments to get it out I suppose, and she just brought him, and showed me to him, and I just touched him, pulled it back so I could see his face, and she pushed my hand away and covered him up again. Maybe there were a lot of marks which I didn’t see… and that was the last I saw of him … The last I heard of him. There was no birth certificate, no death certificate, it was as if he wasn’t there. A non-entity.383

Other women experienced a similar situation after the death of their babies. When Margaret, for example, regained consciousness after her labour, she was told that her baby had not survived the birth; she was not permitted to view her baby as her obstetrician deemed this ‘inadvisable’ because it would be ‘too upsetting’.384 Daphne was also not given the opportunity to view her baby, her third child, who was delivered after a very traumatic birth. Daphne indicated that she would like to see the baby, but she recalled that she was ‘crying, I was almost hysterical’ and her request was refused. She recalled that ‘the nun said – there were two nuns – no, they weren’t nuns, they were ordinary nurses, one said, ‘well what do we do with it now?’ And the other said, ‘just put it in that drawer’. So that was it. The baby was taken away, we never saw it, they said, ‘she’s a beautiful little girl with dark hair, and quite a decent size for the circumstances’.385

‘Undesirable’ and ‘desirable’ knowledge

382 Grantly Dick-Read quoted in Oakley, Women Confined, p. 36. 383 Ivy, interview with researcher. 384 Margaret, interview with researcher. 385 Daphne, interview with researcher, 9 May 2005. Tapes and transcript in possession of researcher.

122 A crucial factor in the practice of shielding women from the experience of perinatal death was the construction of what was deemed to be ‘desirable’ or ‘undesirable’ knowledge. The shift from home birth to birth in hospital had served to further reinforce the notion that only medicine could interpret women’s bodies, an antagonism between medical knowledge and women’s knowledge.386 Both the expectation that women should submit to the rightful authority of the doctor and the dominance of medical language can be seen clearly in Ivy’s experience. Recalling the loss of her son over sixty years previously, Ivy remarked that in her recollection, her doctor, an eminent Perth obstetrician, was seemingly brusque and unsympathetic to her loss. Instead, he reprimanded Ivy for not coming to the hospital soon enough after her waters broke; because she was a self-confessed ‘naïve’ first time mother who was loathe to discuss her pregnancy because ‘we didn’t talk about those things,’ Ivy regarded the doctor’s rebuke as implicating her in the death of her baby. Furthermore, when she tentatively inquired as to why her baby had died during delivery, his answer was incomprehensible to her, couched as it was in the language of medical authority: ‘the doctor told me … I don’t know, cause they speak in their own language, and he said that something or other happened …but they talk – they understand what they’re saying but you don’t, do you’.387 That short exchange was also the last encounter between Ivy and the obstetrician, and she was never to find out why her baby, a ten pound ‘beautiful boy’, died before delivery.388

Because she could demonstrate an understanding of the masculinist scientific knowledge of the body, Rayma’s experience was different from most of the other women who had experienced a perinatal loss in this period, as she was allowed to see her babies after delivery. She recalled that: When I began to get my brain back together again, I was sitting up, so I asked the next nurse who was coming by, ‘Can I see the twins please?’ And she was horrified. You could see all these distasteful expressions crossing her face – you know, ‘this is

386 See Oakley, Women Confined, p. 285. Reiger also argues that women’s knowledge of their bodies was held as untrustworthy in comparison to medical knowledge; breastfeeding rates in the postwar period, for example, significantly declined because of the appeal to ‘scientific’ knowledge, as opposed to ‘nature’. Reiger quotes Dr James Smibert, an early advocate of the Nursing Mothers’ Association of Australia, who commented that: ‘I think it’s a bit of a question of an ego trip … The obstetrician or the paediatrician is a bit inclined to control the feeding if it’s artificial. If it’s breastfeeding, he’s not controlling it at all’. James Smibert quoted in Reiger, Our Bodies, Our Babies, p. 34. 387 Ivy, interview with researcher. 388 Ivy, interview with researcher.

123 disgusting! This request is disgusting!’ She said, ‘But! But they’re dead, they’re going to the incinerator’.389

Although the nurse initially found this request to be repugnant, she eventually brought the babies in, provided Rayma promised that she ‘wouldn’t tell anybody’; in Rayma’s opinion, she was granted this request because she managed to convince the nurse that she would not become ‘emotional’, having seen foetal remains as part of her training in biology. She recalled that she said ‘I know what they’ll look like, I have seen foetuses in bottles, I know what they’ll look like, I won’t be distressed’. So [the nurse] said, “well, alright, but don’t tell anyone.”’390

However, despite Rayma’s assurances that she would not find viewing her babies to be distressing, the reality was quite different than what she had expected, because she had imagined the bodies would be presented to as ‘babies,’ not foetal remains. I don’t know what I was expecting, in retrospect I was expecting that they would be swaddled in little towels or something, but in fact they came in in a kidney bowl, a stainless steel kidney bowl. Anyway, I knew that I wasn’t going to let [the nurse] see that she’d made the wrong decision. So I looked at them, and I checked them out, and they were perfect, ears, nose, five fingers, five toes … little penises, the eyes were closed, but they had eyebrows … About ten inches long each, something like that. So I sort of stroked them, I didn’t think to pick them up so I stroked them.391

Based on other women’s experiences of perinatal loss during this period it appears that Rayma’s experience was exceptional; the belief that women could not understand their bodies and that female biology could only be understood through a scientific framework meant that many women were denied any information as to why their babies had died. Women who delivered stillborn or seriously ill babies during this period usually acquiesced to medical authority and generally did not question medical authority or demand

389 Rayma, interview with researcher. 390 Rayma, interview with researcher. 391 Rayma’s experience of being allowed to view her twins also gives insight into the notion of ‘appropriate’ knowledge. Because Rayma was able to demonstrate that she would be able to view the bodies with an objective eye, having trained in biology at university, she was permitted to see the babies, presented as foetal remains in sterile receptacles. Although women were generally not permitted to see their babies because it was considered to be inappropriate and likely to cause an emotional disturbance, the medical profession regarded the foetal body as a site for exploration and the deformed foetus in particular was viewed as a medical curiosity. Medical textbooks from this period showed explicit photographs of deceased babies with anencephaly, described in one as ‘a stillborn anencephalic monster’. See Townsend, Obstetrics for Students, p. 432.

124 information as to why their infants had died. After her own baby was stillborn after a very long labour, Iris was not permitted to see her baby, and was told little as to why her baby had died, until she was seen by a nurse who was the sister of a friend. In Iris’ opinion, she was only told that her daughter had died because of a knot in the umbilical cord because of this connection, otherwise she believes, she would have been told little. You just sort of don’t jump up and down in those days, because nobody did jump up and down. You just took these authorities, like hospital and doctors, as though they knew best and you didn’t demand anything, like people would do today, if anything happened. So meekly you go back to your room without your baby and your husband– and I remember Brian, of course, he was rung up to come – they didn’t have husbands with wives in those days either, through the delivery, and he came, evidently rushed down, and all I remember … I was being pushed back to the room, along the passage, and I saw him … I always remembered seeing him looking so alarmed, no one made it easy, you couldn’t come to your wife till they got back to the room.392

Similarly, after Ivy’s son was delivered, she accepted that she would not be told any possible reasons for her child’s death because in those days ‘I wouldn’t ask questions, I wouldn’t answer back or anything’.393

Percy Rogers, an obstetrician during this period recalled with vivid horror his first day as a medical student at the RWH Melbourne; an incident which gives insight into both the hierarchy of a hospital and the use of medical knowledge: I recall going on a ward round with a consultant and there was a full entourage of the lord, his faithful retainer, his third in command and a rag taggle of students with bum freezers on. And we were standing around the bed of a woman whose baby had died. It had died and the cervix had clamped around the neck … And the method of extracting this was to put weights on the end of the baby’s leg, hang them over the end of the bed, then adjust the weights and let the cervix dilate up slowly. He described this in graphic detail standing around the bed – the poor woman sobbing her heart out.394

Some women were told that their babies had died because of ‘deformity’; it is likely that this was meant to reassure women that the loss had been ‘for the best’ whilst also

392 Iris, interview with researcher. 393 Ivy, interview with researcher. 394 Rogers’ account lends weight to the argument that individual doctors often disagreed with the way women were treated after perinatal loss. The experience, he felt, was ‘brutal … And us standing there unable to express sympathy with the patient’. Percy Rogers quoted in McCalman, Sex and Suffering, p. 313.

125 preventing any further discussion on the issue. Audrey recalled that she was told that her baby was ‘defective’; a reason which effectively put an end to the conversation: ‘I remember saying, ‘Why did it happen, doctor?’ And she sort of looked at me and she said, ‘well dear, I can’t tell you this. It’s nature’s way, sometimes, if things aren’t right’. And they were her words. And I didn’t question her any more’.395

For those women who were reassured that their babies would not have survived because of the medical inscription of ‘deformed’, the attitude that the loss was ‘for the best’ was a reassurance. The idea of giving birth to a ‘deformed’ baby was a horrifying thought for Margaret, for example, who commented that ‘I’m glad [my baby] wasn’t deformed and my family saw it, because if it was deformed I would say, ‘I’m glad it died’ ... I think you’ve got to count your blessings that you didn’t have a deformed baby’. Although Margaret was not permitted to see her baby’s body, staff allowed her husband to view the baby; afterwards, Margaret said, he ‘cried, and told me he was a dear little fellow …but he had a crooked nose, it must have been as he was squashed out’. Although her son was not visibly ‘deformed’, Margaret and her husband took comfort in the fact that if the child had lived, he may have had physical disabilities which would have prevented a ‘normal’ life: But this way, it wasn’t deformed in any way, except for the nose twisted, but [my husband] said to me, ‘it’s better this way, how do we know, having been forced out, if he didn’t have a weak chest’. Imagine going to school, and he couldn’t play sport, and they’d say, ‘oh you know, he’s not allowed out’. It made me feel better. I thought, it must have been God’s will.396

Medical records also give further insight into the extent of the notion of ‘desirable’ and ‘undesirable’ knowledge. Whilst women were often not told why their babies had died, or were told that the cause was ‘unknown’, the bodies of many deceased babies underwent autopsy, although any knowledge gleaned from post-mortem was clearly not intended for the parents, but for medical use. In 1957, for example, over three hundred stillborn babies were given post-mortem examinations.397 Furthermore, women had no legal claim over their non-viable foetuses; ‘non-viable foetal tissue’ was not considered to be a body or a

395 Audrey, interview with researcher. 396 Margaret, interview with researcher. 397 RWH Clinical Report 1957, p. 23.

126 corpse – it was, in essence, a non-being. The ‘non-viable’ foetal body therefore was generally considered to be the possession of the hospital, which had the authority to dispose of the body or use it for scientific or medical purposes without consent of the parents.398 For women whose babies were considered to be ‘viable’, sometimes the options offered for burial were equally limiting. Many of the women interviewed for this research were not given a choice as to how their babies were buried, and some surmised that their infants were buried anonymously in mass graves.399 Liz, for example, was a single woman who had been sent by her parents to Brisbane from Sydney to have her baby; after her baby was stillborn at twenty four weeks gestation the matron told Liz that ‘they were going to bury the baby in a paupers’ grave, and I didn’t know I had any rights, and I got a bill for the burial, which was thirty pounds in those days.400 Daphne’s baby, on the other hand, was given a private funeral, but was told by the undertaker that no one should attend, ‘because babies like that are buried in someone else’s coffin’. In her interview, Daphne said ‘and that really ate at me, till just recently really’.401

Gendered expectations of perinatal loss

The exclusion of men from the domain of ‘domesticity’ – of which childbearing and rearing was an integral part – reinforced the cultural expectation of ‘appropriate’ masculine responses to grief. Although some men were permitted to be in the room during early labour, such as Margaret’s husband who rebuked her for continually apologising for ‘making a fuss’,402 after this initial stage of labour men were customarily banned from the

398 John Archer argues that the foetal body – alive or deceased – was considered valuable fodder for the ‘pioneering’ research work of the medical and scientific communities in the postwar years; the maternal and foetal body were ‘sites of exploration’, often with disastrous results for both mother and child, such as the original contraceptive pill testing and the testing of thalidomide. See J. Archer, Bad Medicine: Is the Health Care System Letting You Down?, East Roseville, NSW: Simon and Schuster, 1995, pp. 22-25. 399 The acceptability of the mass burial was based on the presumption that the foetus was not regarded as a member of the family; a presumption that was rarely tested by actually asking women if this was the burial option they desired. Because the foetal body was conceived of in physiological terms the hospital burial was ostensibly to ‘spare’ women the trauma of organising a funeral but also give insight into the social inscription of the foetus as not being worthy of a proper burial. 400 Liz, interview with researcher, 18 May 2005. Tapes and transcript in possession of researcher. At Liz’s request, this is a pseudonym. 401 Daphne, interview with researcher. 402 Margaret recalled that, in the early stages of what would prove to be a long and protracted labour, she kept ‘jumping [up], and saying, oh, sorry! Sorry!’ to the nurse who came periodically to check on her progress. She continued that she kept ‘making excuses to her, and afterwards my husband saying, “oh, we’re paying for this” – [because] we had a lovely private room – and saying, “don’t ever go on like that.”’ Margaret, interview with researcher.

127 delivery room, whether the child was expected to be born alive or not, a practice which endured well until the 1970s.403 Pregnancy, childbirth and the early life of a newborn – and beyond - were largely presumed to be the responsibility of the mother, and whilst some fathers ‘paced outside the corridor, smoking cigarettes,’ as Audrey observed,404 others accepted their exclusion from this domain and returned home or to the pub to wait for the news, like Barbara’s husband. She recalled that ‘he’d gone home [during labour]. In those days [husbands] just delivered you to the door and that was it’.405

In her research into attitudes towards death in nineteenth century Australia, Jalland argues that men were not expected to feel the loss of a baby as keenly as their wives; this view led to the exclusion of men from ‘an important part of the process of mourning’ – the sharing of sympathies and consolations through letter-writing.406 This idea was perpetuated in the mid twentieth century; the cultural exclusion of men from the realm of childbirth, both bodily and psychologically, was driven by the idea that men had no attachment to the unborn child and served to reinforce the idea that ‘manliness’ in the face of bereavement was characterised by silent stoicism and a deep-rooted fortitude, coupled with a physical distancing from the event itself. Most of the husbands of the women interviewed for this research were given the responsibility of organizing the funeral, and were often requested to view the deceased baby’s body in order to exonerate the hospital of any responsibility.407

In recalling their experiences of the loss of a baby many of the women interviewed who had lost babies in the postwar period articulated their experiences through the lens of gendered expression of grief, expressing the belief that their intensity of loss was far greater than

403 Reiger observes that because maternity wards of the 1950s and 1960s were typically busy and overcrowded with little privacy, women also faced the stress of separation from their family. She notes that ‘even husbands’ presence was only tolerated in the early stages of labour, after which time they were either banished to a special waiting room, or advised to go home’. As Reiger argues, women themselves generally accepted the exclusion of men from the realm of childbirth; one mother, who was herself a nurse, commented that her experience of childbirth was ‘terrible. I thought it was awful. It’s not a thing I would want my husband there for, and he would never want to be there, I’m quite certain … I think it’s something that you do quite on your own because I think it can be quite distressing and unpleasant’. ‘Paula Molloy’ quoted in Reiger, Our Bodies, Our Babies, p. 32. 404 Audrey, interview with researcher. 405 Barbara, interview with researcher. 406 Jalland quotes Ellie Le Soeuf’s articulation of this idea in a letter to a bereaved mother. Le Souef wrote that ‘[y]ou have this terrible lonely heartache into which not even your husband can enter – (only a mother who has given a precious baby back to God can enter into your heartache)’. Ellie Le Souef quoted in Jalland, Australian Ways of Death, p. 142. 407 Margaret, interview with researcher; Dorothy, interview with researcher.

128 their respective husbands’ bereavement. For Audrey, the fact that her husband rarely spoke about the baby to his wife was framed within Audrey’s own expectation that, as the man of the family, he had to ‘just get on with it’ with the ‘stiff upper lip and all that’.408 Daphne, who had given birth to a stillborn daughter in 1959, commented that whilst her marriage was a happy one, her husband ‘was very upset about it, but nothing like I was. Nothing like I was’.409 Most of the women interviewed who had lost babies during the postwar years echoed Audrey and Daphne’s sentiments and strongly believed that, for their respective husbands, the event could not have been as significant as it had been for them. Daphne went on to say that ‘I had a wonderful husband, but he didn’t want to call her anything. But I always did – I called her Barbara Therese, and he said, I don’t want to perpetuate her memory. And that was difficult, that was difficult for me’.410 Many women who were interviewed for this research recalled that, even amongst the intimacy of a husband and wife relationship, there was little discussion of the baby and what did occur was usually spoken about in euphemistic terms, and what was articulated was brief. Ivy, for instance, recalled that she used to remember her son with sadness every time she took the train from Fremantle to Perth to visit her mother, and as they passed Karrakatta Cemetery, located adjacent to the train line, her husband would say ‘it’s my baby too, you know’ – [because] I’d get upset’ - but on the whole, ‘it was if he never existed’.411

No words to say: avoiding grief in public

The practice of ‘shielding’ women from the experience of perinatal loss was not restricted to the hospital setting. Some women who lost babies in the postwar period experienced the active involvement of their relatives or friends in removing any tangible reminders of the impending arrival before they were discharged from hospital. In the immediate postwar period, this was often exacerbated by the living situation of many newly married couples who were forced to live with their parents due to the severe housing shortages. Iris, for example, returned home to discover that her mother had already dismantled the baby furniture and removed the layette; in hindsight, she said, she realised that ‘my poor mum, she thought she was doing the right thing I suppose, and she put everything out of sight’.

408 Audrey, interview with researcher. 409 Daphne, interview with researcher. 410 Daphne, interview with researcher. 411 Ivy, interview with researcher.

129 Iris never felt able to ask her mother where the baby’s furniture had gone, and surmised that it had been given to charity; it was a source of pain to her, however, that she had to return home to an empty nursery: ‘once you come home, all you want to find is all the little things you had for them, to look at them’.412

Despite the expectation that the expression of grief should remain private some women did attempt to share their grief with family and friends, but found that their loss was rejected – reinforcing to them that they had been unwise to share their feelings, and that their grief should be internalised and remain a private affair. Ivy, for example left the hospital feeling as though her baby had never existed. She did venture to tell some close friends that she and her husband had named the child, but was deeply hurt when the couple openly articulated their opinion that ‘oh they’ve named the baby – that’s a bit stupid!’ After hearing this callous remark, Ivy determined that she ‘wouldn’t talk about it anymore’ – acknowledging that this was how she perceived what was expected of her anyway: ‘We never discussed it. Now, everything is discussed, but then we never discussed anything. You never asked - well I didn’t’.413

Jalland suggests that silence after death was, following the two world wars, perhaps also borne out of ‘a true lack of words to say’, given the decline in religious belief in Australian society and the customary solace that such faith had traditionally, if not privately, brought to many people.414 This idea had begun to take shape some years before the turn of the nineteenth and twentieth centuries and was further defined and reinforced by the impact of the two world wars. For example, the book Australian Etiquette: or the Rules and Usages of Best Society in the Australasian Colonies, first published in 1885, extolled the virtues of controlled sorrow and welcomed the diminishing of ‘elaborate’ mourning rituals as a mark of a progressive, civilised society. The authors of this tome advised readers to avoid discussing death and other ‘distasteful’ topics in polite company: ‘Avoid all exhibitions of temper before others, if you find it impossible to suppress them entirely. All emotions, whether of grief or joy, should be subdued in public, and only allowed full play in the

412 Iris, interview with researcher. Iris eventually retrieved the clothes from her mother and recalled that she felt great pleasure in being able to pass the clothing on to a missionary organisation working with mothers in India; she later received a letter from the recipient of the clothing which she said helped ease some of her sadness. 413 Ivy, interview with researcher. 414 Jalland, Changing Ways of Death, p.173.

130 privacy of your own apartments … Never introduce unpleasant topics, nor describe revolting scenes in general company’.415

Dorothy, for example, remembers that she ‘didn’t talk about it at all. I think we were embarrassed. I think that was like anything, you don’t know what to say’.416 Similarly, Lynette did not talk about her experience of losing her first baby in 1960 because of what she perceived to be people’s desire to avoid talking about such a painful subject: ‘I think in those days people just didn't want to trespass on your grief. And people always [felt it was] difficult, doing that. And I guess if I had broached the subject maybe it would have opened it up, but I didn't either, and I don't think that I even talked about it with my husband much - if at all. It was just something that happened, and I had to get over it’.417

Audrey recalled clearly her mother’s exhortation that she should keep the death of the baby as a private matter: ‘I remember my mother coming in the door of the hospital room, and her first words were to me, ‘I hope you’re not going to put it in the paper’ … I’m nearly seventy, she’s still alive at ninety six – and I remember that’.418 When her extended family came to visit her in hospital, Audrey remembers that they were ‘very kind’ but that ‘nobody talked to me about it … [they] all tiptoed around it’. Upon leaving hospital, Audrey was greeted with the same sort of attitude towards her loss: ‘You went home, and you got on with it, and my friends around the district … were supportive, I suppose, but it wasn’t something – the first time they’d see you, they’d ask, and say, ‘oh I’m sorry’ – but they didn’t really talk about it, and I didn’t really talk about it. I didn’t talk about it to a lot of people’.419

After Barbara was discharged from hospital, she returned to her parents’ home, where she and her husband were living temporarily while her husband looked for work, and Barbara found that the silence after the baby’s death was only challenged by her little daughter, who

415 Anon., Australian Etiquette: or the Rules and Usages of Best Society in the Australasian Colonies 1886, London: J.M. Dent, 1980, pp. 103 & 109. 416 Dorothy, interview with researcher. 417 Lynette, interview with researcher, 30 May 2005. Tapes and transcript in possession of researcher .At Lynette’s request, this is a pseudonym. 418 Audrey, interview with researcher. 419 Audrey, interview with researcher.

131 was two at the time: We really didn’t discuss it a lot. It was just something that had happened. The hardest part was my little 2 year old – ‘where’s the baby, mummy?’ [Because] I’d been telling her that I was going to bring her back a little baby, and of course I came home without a little baby. And she kept asking, where’s the baby, which was a bit hard, especially as she couldn’t understand.420

However, the ‘refusal of death’ and the expectation of a repressed sorrow did not necessarily mean individuals lacked compassion or the desire to engage with people’s pain following bereavement; rather, the cultural expectation of ‘spartan control’ largely removed the language of bereavement from the vocabulary of many Australians in the postwar period. Iris, for example, remembers being told about her employer’s reaction to her loss: I went and worked for a man after I got married, for a really short time - eight months - because I was having a baby, and he didn’t see me again, I didn’t go to work once I was pregnant, you’d say you were and would leave, but the girls in the office, I got to know them when I was working there, and they were all waiting for the date in the paper – this is what one little lass told me, much later – and she said ‘I grabbed the paper, on what might have been the date after, and it was in there,’ because of course I’d had it right on the date, on the Monday I think, and she said, ‘I saw it, and oh! Stillborn!’ And she was so upset, she raced into work – she told me all this later – and the boss absolutely went to pieces, and he went home. That’s what she said to me. He couldn’t understand why, I suppose, and he had to go home.421

Long before the formal support group would come into existence, some women would draw strength, even if it was mainly unspoken, through shared experience, the comfort of being with those who had ‘been there’. Like the women described by Joy Damousi in her research into wartime bereavement,422 a collective identity was sometimes formed between bereaved mothers: Mrs Mead, for example, remembers feeling ‘at home’ with some of her mother’s friends who had suffered similar losses: There were women in my mother’s circle, who had had the same experience, and I can remember they were the sort of people … that I was always comfortable with. [Because] I didn’t have to pretend … and if mum had friends there – they used to play cards on Saturday afternoon, when the men went to golf … I always felt comfortable with them. It was only vocalised once, and then after that I felt at ease with them.423

420 Barbara, interview with researcher. 421 Iris, interview with researcher. 422 Damousi observes that women waiting for news of their husbands, brothers or lovers, fighting overseas in the Great War, bonded as part of their identification as ‘potential mourners’. See Damousi, Labour of Loss, pp. 21–25. 423 Mrs Mead, interview with researcher.

132

Iris also recalled that she received letters from women who had also lost babies in infancy or at birth, and she found the idea of a shared experience to be a comfort. For Iris, though, her solace lay principally in her Christian faith, and during the interview she spoke several times of the supportive relationship she and her husband shared, although she echoed the sentiment that she felt isolated and alone amongst her wider family and community. She recalled that: We just staggered along together, and neighbours were very supportive, and you just slowly accept that it happened, and just hope that another time it won’t … Brian and I began to query a lot of things, ‘why?’, get a bit bitter, ‘why me?’ … all this type of attitude, but you do feel sorry for yourself. And because I’m a believer in God, in Christ, I made it a matter of prayer, took it in prayer, to help me to try and not be so nasty, bitter and nasty. So that helped a lot, we got a better attitude. But nobody really wanted to talk about it in those days … They all sort of wanted to not think it ever happened, like girlfriends who had their children, they didn’t know what to do.424

‘Moving on’: having another baby

The expectation that another child would resolve any feelings of sadness was particularly strong in the postwar years. McCalman observes that infertility was a hard burden to bear in the years of the so-called ‘baby boom’ after the end of the Second World War.425 Furthermore, the cumulative loss of many young men’s lives reinforced the naturalised assumption of women-as-mothers; as Philippa Mein-Smith observes, the widespread grief after the two world wars ‘furrowed landscapes … as death renewed the importance of birth and life – and hence put the spotlight on mothers and babies’.426 As I argue in the previous chapter, to ‘fail’ to fulfil one’s femininity by remaining childless was to risk social stigma; under such pressure to become a mother, some women whose babies died internalised the attitude that the best prescription to grief following perinatal loss was to repress the experience and to ‘try again’ in the quest to attain the status of mother.

Having more children signified the bereaved mother’s willingness to reassume and resume her ‘rightful’ and ‘natural’ role as mother and to wallow in grief was regarded as selfish and

424 Iris, interview with researcher. 425 McCalman, Sex and Suffering, p. 309. 426 Mein-Smith, ‘Maternity and Eugenics’, p. 148.

133 self-indulgent. Caught between the two taboos of death and sex, women who bore a deceased or sickly baby bore a particular burden: that is, not only were they denied any form of expressive sorrow, but their loss itself was invalidated. As ‘failed’ mothers – a theme which is discussed in more detail in Chapter Two – women were expected to repress their grief and ‘get on with it’. In postwar Australia, the public demonstration of one’s stoicism following the death of a baby often entailed the heavy responsibility of producing another (live) child as soon as possible in order to avoid the stigma of having ‘failed’ to fulfil one’s ‘rightful’ role as a woman. Because the unborn child was also viewed as essentially unknowable and replaceable, the possibility of subsequent pregnancies was regarded as assisting women ‘achieve’ the true fulfillment of their femininity. Mrs Mead, whose baby was stillborn at term just after the end of World War II, articulated this prescription for loss after a stillbirth, in her interview, recalling that ‘I was very anxious to have another [baby] straight away, [because] people said to me, there’s only one cure for this, and that’s to have another baby straight away. Women said that [to me]’.427

Lynette received a letter from her mother after her first daughter was stillborn; the letter is full of sadness and warmth as her mother wrote of her ‘grief, and disappointment over the loss of our little girl’ She continued to write that ‘I was waiting to welcome her joyfully, and looking forward to the end of the year, to see her for myself’. Lynette was encouraged to take heart because ‘you are young, and there is plenty of time for you to have another little daughter to take her place … All the grieving in the world won’t do any good, as I know you realise without me telling’.428

Iris recalls that her community did not regard her as a mother until her next baby was born alive: to be viewed as a mother, she remarked, ‘you had to have your baby [alive]’. Indeed, whilst she was still in the hospital recovering after the delivery of her first child, she remembers her doctor – who was not actually present at the birth - ‘bouncing in … and her first greeting was a big grin, I can still remember, and she said, ‘oh have another baby!’ And I felt like saying, no, I’d like that one’.429

427 Mrs Mead, interview with researcher. 428 Lynette, private letter from her mother. Copy held by researcher. 429 Iris, interview with researcher.

134 For Margaret, having another baby did ease the sadness she felt after her son was stillborn. In her interview, she recalled that she fell pregnant shortly after her first baby died and was delighted to ‘become a mother’. The contrast between Margaret’s first labour and her second is striking: Her birth was so easy, and I couldn’t believe it, when [the doctor] came in, he was saying, ‘good girl!’ I think they gave me a mask, no chloroform, no heavy stuff. I knew everything that was going on, and then … all of a sudden, I wanted to push, naturally! This was like a most beautiful feeling, this beautiful feeling. And they said, ‘look, there’s your baby!’ And I looked down and this little dark head was there … And I didn’t feel a thing, and I was so happy! I said, ‘I could help everybody in the world have a baby!’ And she was so beautiful, and when my husband came in, all I could say to him was, ‘thankyou! Thankyou for giving me this!’ And that was it, she was the most beautiful joy that I’ve ever had.430

Conclusion

Many women who lost babies in the postwar period were considerably restricted in the ways they could mourn a perinatal loss. Australia – along with most of the Western world – had experienced a cultural shift in attitudes towards grief and bereavement after the atrocities of the two world wars; individual grief and the public expression of sorrow became seen as self-indulgent in the light of the massive loss of young lives. In its stead, stoic forbearance became the culturally acceptable response to grief and loss. Within this context many women who suffered some form of perinatal loss were expected to repress their grief and to ‘get on’ with their lives as wives and mothers to subsequent children, despite the heartbreak they were often suffering in private. The medical discourse of perinatal loss reinforced and intersected with the expectation of ‘spartan control’; because the medicalisation of childbirth had seen a shift away from birth and death at home, for many years the dominant medical inscriptions of perinatal death governed the way that women were treated within the clinical setting.

As I mention in the previous chapter, medical inscriptions of the unborn child held that stillbirth and neonatal death were incomparable to the death of a living child; rather, they were the more abstract ‘nonfulfilment of a wish fantasy’. Because stillborn children were viewed as essentially ‘unknowable’ and therefore replaceable, many in the medical profession and the wider community believed that having a live baby would restore a

430 Margaret, interview with researcher.

135 woman’s health by fulfilling this ‘imagined’ child. Many women who suffered the loss of a pregnancy or a baby through miscarriage or perinatal death were not expected to grieve for the child and it was assumed that withholding the deceased infant from the mother was the best possible measure to ensure a speedy resolution to a rather distasteful affair. The radical shift in attitudes towards grief, women’s healthcare and women’s bodies which occurred in the 1970s and early 1980s in Australia wrought significant challenge to the dominant understandings of perinatal loss; these challenges had considerable impact not only for women delivering live babies but for those whose pregnancies ended in stillbirth or neonatal death.

136 CHAPTER FOUR

Emerging change: the impact of theories of grief and loss on constructions of perinatal death in the l970s and 1980s

In describing her early experience as a midwife at KEMH, Belinda Jennings recalled the unspoken rules for midwives caring for a patient whose baby had died: ‘It was seen to be a midwife’s responsibility to separate a baby from the mother, to protect the mother and their family from what was basically a sad event, but something that they would get over as soon as they walked out the door’.431 In previous chapters, I have argued that this attitude was prevalent amongst the medical fraternity and the wider community, and that many women whose pregnancies ended in miscarriage or perinatal death were expected to resume their lives and to repress any grief they may have felt after the event.

However, the late 1960s and 1970s were a period of great social upheaval in Australia and other Western nations; this social change prompted a shift in attitudes towards grief and loss and drove the concerns of the consumer health movement and second wave feminism. These wider shifts in social attitudes carried over into bereavement and loss, health care and women’s bodies, and hence wrought a challenge to the dominant construction of perinatal death, which have been discussed in previous chapters. Recalling this impact of these changing attitudes on the management of perinatal death in the hospital context, Belinda recalled that: I think the literature started to hit us, we as midwives, started to learn more about it … Certainly with experience [also] comes some exposure to the degree of emotional response that parents had. Not all midwives allowed that exposure to impact on them personally, but I think with lots and lots of experience I think that you can’t deny the impact it has on you as a person.432

In this chapter, I discuss emerging ideas of grief and loss and consider the impact of these ideas which, coupled with the growing dissatisfaction towards the medical management of pregnancy and childbirth in the 1970s and early 1980s, gradually enlarged understandings of pregnancy loss and baby death within the hospital setting. The practice of rendering

431 Belinda Jennings, interview with researcher, 18 November 2004. Tapes and transcript in possession of researcher. 432 Jennings, interview with researcher.

137 stillbirth and neonatal death as invisible was increasingly challenged during this period, initially inspired by research which legitimised a more complex range of responses to grief and loss. Supporting this challenge to the medical management of childbirth was a growing dissatisfaction amongst members of the midwifery profession, coupled with the burgeoning ‘consumer rights’ movement. Growing from this social change was the construction of perinatal loss as a potentially traumatic experience, and some professionals working with bereaved women began to explore other possibilities in caring for women whose babies had died. In this chapter I consider some of these ways in which some social workers and midwives sought to change the way they cared for women who had suffered a miscarriage or perinatal death at two major maternity hospitals in Australia, KEMH in Perth and the RWH in Melbourne.

Grief as healing and appropriate: emerging theories of grief and loss

In 1972, Kaye was delivered of her first child, a girl, who was stillborn at twenty five weeks gestation. Remembering her experience, Kaye recalled that although some of the staff treated her kindly and gently, she felt that her child’s existence, and by extension her own experience, were ‘trivialised’. During her stay in hospital, Kaye had requested to see the baby’s body ‘out of curiosity’: ‘it was our first child, and naturally I was interested to see what an offspring of ours would look like’. This request was refused, and she was also told that there would also be no need to hold a funeral because of her baby’s prematurity: The baby was a bit small for twenty five weeks gestation, but the nurses and doctor said she was perfectly formed. I asked to see the body… [but] I was told that it would be too upsetting because she was "black and blue" and that it was best not to see her. I would have loved to see and hold her. I think having not seen her made it harder because I couldn't visualise what I was grieving over. I felt quite emotional and upset and asked if we needed to hold a funeral. I was told that because the baby hadn't reached twenty eight weeks gestation that a funeral wouldn't be necessary. That upset me because I felt not being able to see the baby or have a funeral somehow trivialised her existence, as if she just hadn't ‘mattered’. I guess if we had insisted, the body would have been released, but we were given the impression that we should just let the matter drop.433

As I have argued in previous chapters, Kaye’s experience was not extraordinary. For several decades, many women who suffered the ending of a pregnancy or the death of a

433 Kaye, personal correspondence with the researcher, 27 July 2005. Letter in possession of researcher.

138 baby were most likely to be faced with silence, both within the hospital and amongst their families and friends. The dominant construction of pregnancy loss and baby death held that this experience would have little lasting impact on a woman; indeed, no writing existed in Australian medical and psychological literature specifically on the subject on the potential impact of perinatal death. The ideas of psychoanalyst Helene Deutsch, for example, still carried influence, and stillbirth and neonatal death were constructed as incomparable to the death of a living child; rather, were the more abstract ‘nonfulfilment of a wish fantasy’.434 Many women who suffered the loss of a pregnancy or a baby through miscarriage or perinatal death were not expected to grieve for their child, and it was assumed that withholding the deceased infant from the mother was the best possible measure to ensure a speedy resolution to a rather distasteful affair.

The late 1960s however had seen a growing recognition that perhaps the stoic response of former generations was not necessarily beneficial; the expression of grief, it was argued, could be healing and appropriate. In the international arena, the Swiss-American psychiatrist Elisabeth Kübler-Ross had published a seminal work on the stages of grief exhibited by terminally ill cancer patients, which had received wide acclaim.435 British psychologist John Bowlby had also postulated the influential attachment theory, which explored the nature of human affectional bonds, particularly the mother-infant bond, and what possible psychological sequelae could occur if these bonds were broken.436 These seminal theories, however, were largely concerned with the death of older children and adults; although revelatory by nature, at no point were miscarriage, stillbirth and neonatal death mentioned as potentially traumatic events.

In 1970 the head of obstetrics and gynaecology at KEMH, Patrick Giles, became interested in the possible emotional impact of perinatal death, which he suspected would show similarities to the psychosomatic reactions often seen after the death of an older child or an adult. Stillbirth and perinatal death, Giles concluded, were major life events that would

434 Deutsch’s ideas were still being cited until at least the 1990s; Irving Leon, for example, referenced her construction of pregnancy as the ‘self-aggrandizement’ of the woman’s subconscious. See I. Leon, When a Baby Dies, Psychotherapy for pregnancy and newborn loss, New Haven, London: Yale University Press, 1990, pp. 18 & 24. 435 Elisabeth Kübler-Ross, On Death and Dying, New York: Macmillan, 1970. 436 For more discussion of both Kübler-Ross and Bowlby and the development of popular ideas of grief and loss in the twentieth century, see Beverley Raphael, ‘Grief and Loss in Australian Society’, in A. Kellehear (ed.) Death and Dying in Australia, South Melbourne: Oxford University Press, 2000, pp. 116–130.

139 almost certainly have a profound effect on a woman, physically, mentally and emotionally. He argued that ‘besides feeling empty, sad and physically exhausted, the woman who has lost a baby in the perinatal period may feel that she is to blame, that she is a failure, and that it may recur in future pregnancies’.437 However, although Giles noted that these women’s grief reactions were similar to those of a recently bereaved widow, he was understated in his conclusions, arguing that the grief reactions of the bereaved mothers were similar but not as severe as those of the widows, and made no mention of the likely reasons behind a woman’s feelings of responsibility for the death of her baby.438

Nonetheless, Giles’ relatively small study with its cautious findings challenged the prevailing understanding of pregnancy loss. For the first time in twentieth-century Australia, the idea emerged that perinatal death could potentially be a highly stressful event in the life of a woman. In making this claim, Giles argued for greater understanding on the part of the physician and stressed that the doctor had the ability to play a crucial role in helping the mother reach a resolution of her grief and to once again reach a state of psychological wellbeing.439 In an article discussing his research, Giles suggested that instead of sedating the mother to avoid confrontation as was customary, the doctor should, in the first instance, tell the parents immediately that their baby had died and then, when results of the post mortem came to light, provide a ‘simple, rational explanation of the cause of the death [to] relieve fear, misconception and guilt’. Giles echoed the traditional sentiments that the hope of future pregnancies would ease any sadness: ‘When the post- mortem report and results of any special investigations are available, the prognosis for a future pregnancy should be discussed factually. The patient should be left in no doubt as to when she may start another pregnancy if she wishes’.440

In the same year, American physicians Marshall Klaus, John Kennell and Harold Slyter began to take an interest in the bereavement patterns of parents who had lost a child in the early neonatal period. Klaus et al concluded that bereavement following neonatal death

437 Giles, ‘Reactions of Women to Perinatal Death’, p. 209. 438 Giles, ‘Reactions of Women to Perinatal Death’, pp. 208-210 439 Giles, ‘Reactions of Women to Perinatal Death’, p. 209. 440 Giles, ‘Reactions of Women to Perinatal Death’, p. 210.

140 showed similarities to possible grief reactions following the death of an adult loved one.441 A later study in 1976 led Klaus and Kennell to suggest that attachment most likely began before birth, usually when the child ‘quickened’ in utero – not after birth, an idea which had long driven the appeal to detachment in the clinical setting and which lay behind the view that the unborn child was essentially replaceable. In a radical step, the authors suggested that, because many women had begun to give their foetuses ‘human attributes’ prior to birth, perhaps allowing mothers to hold their dying or dead babies would not have the disastrous consequences that most supposed would occur, and may actually help a woman resolve her grief, rather than heighten it.442

Several years later in the early 1980s a clinical psychologist in Western Australia undertook research which produced a radically different construction of perinatal death. Margaret Nicol, along with Dr Jeffrey Tompkin, a neonatal expert at KEMH, sought to explore the possible extent of maternal grief following the death of a baby either in utero or shortly after birth. Adopting Madison and Walker’s 1967 general health questionnaire - used to assess the wellbeing of recent widows - into the Mother-Infant questionnaire, Nicol and a small team of KEMH staff interviewed 110 women who had experienced some form of perinatal loss in various hospitals around the Perth metropolitan area in the three years preceding the study.443 Based on these interviews, Nicol came to the conclusion that ‘the pattern of health deterioration in bereaved mothers is very similar to the two major studies on the effects of bereavement in women after the death of their husband. It may therefore be concluded that the loss of a baby can have as severe effects on the mental and physical health of a woman as the loss of a husband’.444

In her influential book Loss of a Baby: Understanding Maternal Grief, Nicol argued that

441 J. Kennell, M. Klaus and H. Slyter, ‘The Mourning Responses of Parents to the Death of a Newborn Infant’, New England Journal of Medicine, no. 283, pp. 344-49. See also J.R. Wolff, B.E. Nielson and P. Schiller, The Emotional Reaction to a Stillbirth, American Journal of Obstetrics and Gynecology, September 1970, no. 108, pp. 73-77. 442 Kennell and Klaus postulated that the length of pregnancy was directly related to the length of bereavement if a loss occurred. Miscarriage, then, was downplayed as an important experience in some women’s lives, with most writers not even mentioning this form of pregnancy loss. The authors cited anecdotal evidence to support this idea: ‘One mother commented [to me] “if I had to lose any of my children, it would be better to lose one I hadn’t become attached to. If anything was to have happened to her, I would have preferred it in the first three months.”’ See J. Kennell and M. Klaus, Maternal Infant Bonding, St Louis: Mosby, 1976, p. 210. 443 Nicol, Loss of a Baby, pp. 13-15. 444 Nicol, Loss of a Baby, p. 15.

141 miscarriage and perinatal loss were extremely complex life events – not, as was previously thought, a ‘sad event’ that could be resolved by simply having another child. She argued that many women faced multiple ‘losses’ following such an experience, including the death of their own dreams and hopes for that particular child, and their own preparations for impending motherhood which had been cruelly interrupted. Relationships with the baby’s father, Nicol argued, were often complicated following loss. However, she was at pains to point out that, for many women, their grief was often intensely focused towards the loss of the individual baby, even though society was reluctant to acknowledge a baby that was ‘unknown’: ‘to others, this baby may be only an unknown child. To the mother, her baby is deeply known and loved. The mother has many links to the baby’s past and through the future. She often intuitively knows her baby well, through all the memories and daydreams she has had of her child’.445

Nicol’s study was a watershed in many ways, not least for the construction of the unborn child as potentially holding many meanings for the mother.446 Significantly, she also refuted the idea that attachment began only when foetal movement is felt. Whilst previous writers made distinction between perinatal loss as a significant life event and miscarriage as a potentially distressing event, Nicol argued that it was unwise indeed to treat women who had miscarried merely as gynaecological patients, and deplored the inadequacy of medical terms in fully explaining the meaning that that pregnancy may have held for the mother: The loss of a baby up to the twelfth week of pregnancy is termed a ‘spontaneous abortion’. Neither the terms ‘spontaneous abortion’ nor ‘miscarriage’ convey the reality that a mother has lost a baby … Emotionally the first trimester seems to be the period when the mother begins to experience the baby as an integral part of herself. For this reason, if the baby dies during this term, the woman may feel that she has lost a part of her own self. Grieving over the loss of one’s self can be as painful as grieving for the loss of the real baby inside the mother.447

Nicol’s research and conclusions were fundamentally radical in challenging the dominant construction of perinatal death and its potential impact on women’s health. For decades

445 Nicol, Loss of a Baby, p. 9. 446 Some writers continued to view the loss of a baby in abstract terms, as the shattering of dreams or the loss of ‘what could have been’. For example, British doctors Lewis and Page claimed that stillborn babies are ‘idealised’ in the mother’s imagination and are individually indistinguishable whilst in utero: ‘If the mother has little or no experience of her newborn, it will only have been really known to her as a foetus. And like identical twins until you know them, one foetus is much like another’. See E. Lewis and A. Page, ‘Failure to Mourn a Stillbirth: An Overlooked Catastrophe’, British Journal of Medical Psychology, no. 51, 1978, p. 240. 447 Nicol, Loss of a Baby, p. 61.

142 women had been deprived of their baby’s body, protected or constrained in their mourning, and the babies constructed as essentially ‘unknowable beings’ held in scant regard by many in the hospital and community.448

‘Full of feminist zeal’: the professionalising of allied health and challenges to the management of perinatal death

Simultaneous to the emerging ideas of prenatal attachment and the potential grief response after miscarriage or perinatal death was a more general cultural shift within the community against the positioning of the medical profession as authority in women’s health; in the decades to follow, this challenge would serve to transform the way that perinatal loss was managed and understood even within the hospital. As Reiger has argued, the late 1950s saw the emergence of a social climate that increasingly grew ‘conducive to what we now call ‘consumer rights’ ’, particularly in the sphere of women organising themselves to ‘assert their desire for more control over birth and lactation’.449 The evolution of ‘activist mothers’ who lobbied for greater control over their pregnant and lactating bodies resulted in the formation of the Association for the Advancement of Painless Childbirth [AAPC] in 1961, which evolved to become the Childbirth Education Association [CEA] in 1965. The 1970s would prove to be fertile years for the CEA, fuelled by the newly elected Whitlam Labor government coming to power in late 1972450 and what Reiger describes as the feminist and consumer movements’ ‘wider mood for social critique’.451

448 The suggestions for change still could astound even those who promulgated them. Eminent British paediatrician, Hugh Jolly, spoke passionately on an ABC radio programme in 1977 about the issue of stillbirth, concerned that many women were attended by unsympathetic staff, who either wilfully or through well-meaning ignorance, came across as ‘callous’. Dr Jolly claimed that ‘the Western world in general has failed to study the needs of … parents [of stillborn babies]’, and recounted several incidences of shocking coldness, such as the man who was customarily banned from the labour ward only to walk past the sluice and find his dead baby ‘lying amongst the dirty tea cups’. His astonishment at the depth of grief after loss, however, was evident as he recalled that ‘what really did amaze me was that in many instances the loss of a baby many years previously was still so acute that the mother burst into tears when telling me of the event. Clearly, she had not been able to work through her grief and the baby was still unmourned’. See Dr Hugh Jolly, ‘Loss of a Baby: Transcript from ABC Radio Programme “Guest of Honour”’, Australian Nursing Journal [ANJ], vol. 7, no. 4, 1977, p. 40. 449 Reiger, Our Bodies, Our Babies, p. 37. 450 For a more detailed analysis of the social and political changes wrought by the reformist Whitlam Labor government – the first Labor government since 1949 – see J. Faulkner and S. MacIntyre, True Believers: The Story of the Federal Parliamentary Labor Party, Sydney: Allen and Unwin, 2001; R. McMullin, The Light on the Hill: The Australian Labor Party, 1891-1991, Melbourne: Oxford University Press, 1991. 451 Reiger, Our Bodies, Our Babies, p. 65.

143 By the 1970s the conservative trust in the medical profession’s authority that so marked many prior decades was being questioned, particularly with regard to the surveillance and supervision of women’s bodies during pregnancy and childbirth. The growing homebirth movement was testament to this dissatisfaction, as more and more women demanded that their needs and desires in labour and childbirth be considered. Women began to choose homebirth in order to ‘reclaim’ control over their bodies; to demand that they be able to give birth to their children without routine use of analgesia and other interventions such as episiotomy; and for the opportunity to be close to their child immediately after birth and for their partner to be able to play a significant role in the birth – features which were not likely to be a part of the experience of giving birth before this period.

Behind this challenge to conservative ideas of the treatment of labour and childbirth was a growing dissatisfaction amongst members of the midwifery profession. Many midwives had begun to resent their unenviable status compared to that of the obstetrician and by the mid 1970s had begun to openly deplore this and to call for a strengthening of the profession as a whole. In an impassioned plea to her colleagues in 1979, Jane Shoebridge, for example, claimed that the midwifery profession was ‘transfixed by bureaucracy and between occupation boundaries dominated from above by obstetricians and gynaecologists’.452 By the 1980s, many midwives, it seemed, were no longer content to occupy the lowly role bestowed on them by the medical profession. As I argue in previous chapters, nurses and midwives had been positioned as completely subservient to obstetricians and gynaecologists since the medicalisation of childbirth in the early twentieth century. Australian registered nurses Patty Brandner and Mary Bayer noted that nurses and midwives were treated as second – class citizens in the medical world and had no agency in terms of decision making: ‘medicine says ‘frog’ and nursing jumps’.453 Liz, a bereaved mother who also worked as a midwife in the 1970s, recalls that a woman in her position would never dare challenge the obstetrician, nor act above his head; even although she might privately disagree with their actions: I’ve seen [stillbirths] happen … I remember delivering a baby, and thinking, oh, it doesn’t look too good. And that was a girl that I knew … and she’s saying to me, ‘Liz, what’s wrong, what’s wrong’. ‘Ohhh, it’s not up to me … the doctor’s just

452 Jane Shoebridge, ‘Questioning Current Attitudes in Nursing and Midwifery’, ANJ, vol. 9, no. 3, 1979, p. 47. 453 Mary Bayer & Patty Brandner, ‘Feminism and Nursing’, ANJ, vol. 4, no. 8, 1978, p. 33.

144 over there examining the baby, he’ll be over soon’ – and then the coward wouldn’t say anything to her. I mean, it was obvious [the baby had died].454

Shoebridge was one midwife who petitioned those in her profession to challenge the absolute faith in medical science and technology and to return to what she perceived to be their original vocation – ‘patient-focused’ care rather than clinical management motivated by scientific understandings of the body. Instead of acting as the subservient assistant to the aloof medico, Shoebridge argued that midwives should carefully consider the psychosocial needs of mother and baby, aiming to care for women and their babies in a holistic manner: Do midwives feel deprived of the role they know they are trained to do? They are trained to give advice to clients on pregnancy, to monitor the normal physiological process of pregnancy and to refer complications, to help support women in labour and their families, to help women deliver their babies and to guide the mother, baby and family through the puerperium and indeed, if needed, beyond it.455

This shift from institution-based care to patient–focused care was doubtless driven in part by ideals of feminism. In seeking to care for pregnant women in what was understood to be a more holistic approach, midwives and other allied-health professionals, such as social workers, challenged the masculinist medical discourse which constructed the body in purely physiological terms, and they sought to raise awareness of the fact that women, as important consumers of hospital services, were not being served well.456 Bayer and Brandner urged nurses to think of their fellow nursing colleagues and their female patients as part of the ‘sisterhood’ and encouraged the feminist ideal of co-operation: ‘[Feminists’] game is, ‘give your sister a hand’’.457 Writing in the early 1980s, social workers influenced by second-wave feminism echoed these sentiments, arguing that women patients’ needs were not being met and that hospital services pertaining to women were often delivered insensitively and with little regard for the individual patient. Other social workers and midwives wrote of ways in which feminist theory could contribute to the psychosocial care

454 Liz, interview with researcher. 455 Shoebridge, ‘Questioning Current Attitudes’, p. 47. 456 See for example Janet George, ‘Women, Health Policy and Social Work: Dilemmas of Theory and Practice’, in H. Marchant and B. Wearing (eds) Gender Reclaimed: Women in Social Work, Sydney: Hale & Iremonger, c1986, p. 172. 457 Bayer & Brandner, ‘Feminism and Nursing’, p. 33.

145 of women in the health care system, focusing particularly on the need to educate women as to the ways in which they could support each other.458

In an effort to unite Australian midwives, the National Body of Midwives was formed in July 1978. Perhaps responding to the call of Bayer and Brandner four years earlier to ‘interact directly with the patriarchal system, engage it in dialogue or combat, teach it, change it’459 there were efforts to educate nurses and midwives of the need to treat all patients with compassion and dignity – to treat the ‘whole person’, not just the physical condition. Nursing education in the past had emphasised an aloof approach to patients and had placed little, if any, emphasis on individuality, but the late 1970s and early 1980s marked a new trend in nursing and midwifery care. Filling a ‘most necessary gap in the educative process within [the community]’, the late 1970s heralded a new course at Gippsland Institute of Advanced Education, headed by well-respected Melbourne undertaker Des Tobin, which aimed to educate health professionals as to ‘the necessary background and functional understanding of the social and psychological aspects of death, dying and bereavement in Australia today’.460 At the Second National Midwives’ Congress held in Melbourne in early 1981, Lady Cowen, wife of the incumbent Governor – General, noted the recent changes in midwifery care and urged attendees to fully accept a ‘more caring and less authoritarian approach to midwifery – one which [takes] account of Australia’s diversity’.461

Almost immediately after the national body was formed, some midwives began to take an interest in the emerging ideas of grief and loss – for instance, study days and seminars were held at both national and state levels to help educate those who were involved in the care of dying patients, including babies. The ‘Death and Dying Workshop’ at Monash University in September 1980, was intended for ‘professional staff and others whose work involves

458 See, for example S. Speedy, ‘Feminism and the Profession of Nursing’, Australian Journal of Advanced Nursing [AJAN], vol. 4, no. 2, pp. 20-27; Deborah Saltman, Women and Health: An Introduction to Issues, Sydney: Harcourt Brace Jovanovich, 1991; Dorothy Broom, Unfinished Business: Social Justice for Women in Australia, Sydney: George Allen and Unwin, 1984, p. 54; H. Marchant and B. Wearing, ‘The Gender Dimension of Social Work Education, Past Present and Future’, in Edna Chamberlain (ed.) Change and Continuity in Australian Social Work, Melbourne: Longman Cheshire, 1988; H. Marchant and B. Wearing (eds) Gender Reclaimed: Women in Social Work, Sydney: Hale & Iremonger, c1986, passim. 459 Bayer & Brandner, ‘Feminism and Nursing’, p. 33. 460 Des Tobin, quoted in an advertisement for the course in ANJ, vol. 7, no. 8, 1978, p. 6. 461 Lady Cowen, ‘Report of Second National Midwives Congress, Melbourne February 1981’, ANJ, vol. 10, no. 9, 1981, p. 13.

146 them with the dying and bereaved and those coping with loss’, and speakers included Des Tobin and Patricia Harrison, a lecturer in obstetrics and gynaecology at University of Melbourne.462 Similarly, the Midwives Annual City Seminar for 1981 focused solely on perinatal death and the midwife’s role and involvement in this event.463

At the RWH in Melbourne and KEMH in Perth, some social workers and midwives, along with a few obstetricians, spearheaded the push to change the way that women were treated when they came to hospital to give birth. Coupled with the emerging literature on the psychosocial needs of pregnant women, as well as the embracing of feminism, was the fact that the late 1970s and early 1980s heralded a major shift in community attitudes towards exnuptial birth. In the decades prior to the 1970s, most social workers were preoccupied with adoption issues, but as single motherhood became more socially acceptable and financially viable, social workers were able to turn their focus to other needs within the hospital.464 Although allied health professionals were no doubt affected by theorists of grief and loss,465 many were keen to find ways to actually implement theory and a crucial part of this became listening to parents themselves. This was of course a radical step, moving from the authoritative voice of the medical profession, who held themselves responsible for disseminating medical knowledge and information, towards a parent–focused approach that

462 Advertisement for one-day workshop on ‘Death and Dying’ on the 15th September 1980 at Monash University, ANJ, vol. 10, no. 2, 1980, p. 80. 463 Change also occurred with staff educating each other within the hospital itself and through nursing journals such as the ANJ. Experienced neonatal midwives also encouraged other midwives to treat each patient with respect and dignity, stressing the importance of treating the family as a whole, in order to obtain the best possible outcome for a tiny, often sick, baby in the nursery. For example, Kaye Eddy outlined several ‘daily responsibilities’ that were essential duties for the busy neonatal intensive care nurse: ‘Our daily responsibility should include such questions as, has mother telephoned or visited? If not, we should ask why! If parents have not seen their babe, have we sent a photo? Has doctor spoken to parents regarding any change of condition? Is mother wishing to breastfeed her babe and has she been instructed on how to express her milk? Have we involved the social worker with any family problems? If at all possible has mother been brought to visit and encouraged to touch or hold her baby even if he or she is attached to numerous bags and tubes?’ See Kaye Eddy, ‘Aspects of Neonatal Nursing’, ANJ, vol. 7, no. 1, July 1977, p. 32. 464 McCalman, Sex and Suffering, p. 342. 465 Libby Lloyd, interview with 17 November 2004; Robert Anderson, interview with researcher, 16 November 2004. Tapes and transcripts of both interviews in possession of researcher.

147 sought to value the needs and desires of the patient, and privileged patients’ dignity.466 Libby Lloyd, who started her career at KEMH in 1977, recalls that ‘the main thing I think we were interested in [during] those days at King Edward in the late seventies, early eighties was how to learn from parents and how to support parents supporting each other. We were more interested in that than the theory per se’.467

This was a revelation in terms of constructions of pregnancy loss. For perhaps the first time, health professionals sought the wisdom of bereaved parents in seeking to understand what parents felt they wanted and needed after the death of their baby. Other writers, such as Peter Barr, an obstetrician, and his wife, social worker Deborah de Wilde, echoed the importance of recognising the individual nature of grief saying that ‘each person experiences of expresses his or her grief differently according to a number of different factors including past childhood and adolescent experiences and the meaning and significance attached to the person who died’.468

Changing practice: the special care nursery and parent support groups

In the area of perinatal death, most early practical change grew out of the intensive care nursery, and was later extended to the care of women whose babies were stillborn or miscarried. The work of prominent American physicians Klaus, Slyter and Kennell had opened the door for women to be granted contact with their dying or critically ill newborns and it was increasingly understood that this could produce beneficial results rather than irrevocably harm the woman, as had been believed for many years.469 For example at KEMH half of the tiny department - two social workers out of a complete staff of four -

466 In a general sense, the notion of ‘patient rights’ was garnering support in hospitals such as RWH in Melbourne. McCalman, for example, recounts the story of an immigrant mother whose baby was in the neonatal intensive care unit; the mother ‘lashed out’ at a nurse who was subsequently badly beaten in the attack. After the mother was declared to be ‘psychotic’ she was transferred to a psychiatric hospital, where a psychiatrist, with the help of a translator, found that the mother was ‘perfectly sane’; she had believed that staff had taken her baby away from her and, understandably, had reacted violently. From this point onwards, nursing staff increasingly exerted their energies into better ways to care for staff from different cultural backgrounds. See McCalman, Sex and Suffering, p. 332. 467 Lloyd, interview with researcher. 468 Peter Barr and Deborah de Wilde, Stillbirth and newborn death: Death and life are the same mysteries, Camperdown, NSW, 1987, p. 46. 469 Responding to Klaus and Kennell’s groundbreaking research, psychologists advocated that mothers be allowed to hold their infants, as recognition of the bond that had formed prenatally and to help complete the grieving process. See for example Thomas A. Helmrath. & Elaine M. Steinitz, ‘Death of an Infant: Parental Grieving and the Failure of Social Support’, Journal of Family Practice, vol. 6, no. 4, 1978, p. 790.

148 was responsible for psychosocial care in the Neonatal Intensive Care Unit [NICU] in the late 1970s. Although Libby Lloyd recalls that most of the nursing staff in NICU were receptive to any change in the care of patients and their family, in the late 1970s and early 1980s social workers were often responsible for addressing any psychosocial issues that arose. Although developing into the multi-professional model that would emerge only a decade or so later, Lloyd recollects that the early days of bereavement support in the NICU was a very hefty responsibility of the social work department: If I think about the nursery, social work was probably the more prominent resource in terms of bereavement support. The nurses were obviously involved around the deaths and in basic support for the parents but weren’t as prominent or confident as they became … The paediatricians were of course central from the parents’ point of view, in the process of decision making, giving news, making agonising decisions, and the obstetricians similarly, but the obstetricians were always a bit more in the background. I think if they had private patients, they would follow them up but the public patients, there was an expectation that GPs would follow them up and that happened in a very variable way, I think. And certainly delivery midwives were certainly always very engaged in the whole process, but it was only for the time that they had business with it. So I think there became … I certainly noticed when I came back a decade later … that [in] the special care nursery, the nurses were much more involved with the managing of the dying, as it were, so whereas in the late 70s, I would have been present for every death, in working hours anyway, you know, orchestrating it a little bit if you like, as in, go to a quiet room, sit with the people, help the relatives, what are we going to do with the children, with grandma, bring cups of tea, tissues, all that sort of stuff.470

Lloyd also recalls that, many years before these actions were formalised into policy, she and two other staff members in the hospital – the midwife in charge of delivery ward and the head nurse of the special nursery – would have ‘conversations’ to plan for a more cohesive programme to help support parents;471 however a significant agent for change at this time were the parents themselves. Recent trends in the community had meant that hospital care was gradually growing more patient–focused and listening to parents’ needs was a significant step towards changing ways of supporting women who had lost a baby.472 The manifestation of listening to parents, at KEMH at least, coupled with the enthusiasm of

470 Lloyd, interview with researcher. 471 Lloyd, interview with researcher. 472 For discussions on this topic, see for example, D. Milliken, ‘Changes in the Neonatal Nurse’s Role,’ ANJ, vol. 8, no. 4, 1978, pp. 30-33 & 40.

149 some staff for the ideals of a supportive ‘sisterhood’, was the birth of several support groups. At KEMH in 1980, recalled Libby Lloyd: One of the things that I did was to establish a self-help group called PIPA - Preterm Infant Parents’ Association - and after a little while of those gatherings, we made a video of people talking about their experiences and so on, [and] there came a parent who said, ‘well I had a prem., but it died and I need help now for its dying’, and then another who said ‘I had a prem., but it was to do with IVF’, so we started Concern for the Infertile, and then we started off SANDS. So in one glorious year there were three of these groups running.473

All but Support After Neonatal Death [SANDS] faded over time, but, according to Lloyd, it had become obvious to social workers at the hospital that women would most likely need support after the death of a baby - and that women could draw great support from each other.474 In a wider sense, the birth of the support group for bereaved parents grew out of a more general trend towards an acceptance of grief; culturally, the medical profession had begun to lose its grip on the management of birth and death. Alternative services developed out of a broader cultural shift of women agitating for more sensitive and ‘appropriate’ care. Feminist health workers in the 1970s and 1980s decried the medical model of health services that positioned women as dependent upon the medical practitioner who was the sole means of a ‘cure’. Feminist sociologist Dorothy Broom, for example, claimed that doctors were placed by the profession and society in general as ‘important actors’ in women’s lives; although pregnancy and childbirth were such significant life events for many Australian women, Broom noted that women played correspondingly minor roles in the obstetrical arena.475

Reflecting on this era, Wendy Weeks noted that the women’s movement was instrumental in exposing the medical profession’s lack of awareness, or interest, in women’s experiences, which was combined with the prevailing medical view that effective care meant divorcing oneself from the patient, ‘not noticing that their race, ethnicity, gender and personal experience must have an enormous impact on what they see and hear, how they think, what they consider evidence and what are the range of possible solutions they might

473 Lloyd, interview with researcher. 474 Lloyd, interview with researcher. 475 Broom, Unfinished Business, p. 54.

150 propose’.476 The feminist movement had already begun to promote the vitality of supportive relationships between women and the 1970s had seen the establishment of the first women’s refuge centres, rape crisis centres and women’s referral centres in Australia.477 Within this environment, some health professionals had begun to realise that healthy and useful partnerships could be formed with parents who had suffered the loss of a baby, and worked to form relationships that would help address their needs better and promote a what was perceived to be healthier grieving process.478

For example, SANDS (WA) had an inauspicious beginning in 1979 at KEMH, with the fledgling group’s first meeting convened by Libby Lloyd, who had herself recently suffered a miscarriage, and held in the office of the part time psychiatrist who fortuitously happened to be away that particular day. Although the meeting was not without its problems – Lloyd remembers that the psychiatrist was none too pleased that his office was used by a ‘bunch of women’ without his explicit permission – the concept was well received and, according to Lloyd the women who attended found this first informal meeting a great encouragement.479 It was in fact a meeting rooted quite deeply in the particular cultural and social changes that were occurring both outside the microcosm of the hospital – a time when more women were demanding that their needs and desires be heard – and within the clinical setting, with many social workers embracing the feminist ideal of ‘women validating other women’s experience’ and recognising the significance of supportive relationships amongst women.480 Lloyd, attending the meeting as part-participant and part- social worker, said that the ten or so women who met that day ‘just as women shared our experiences. It was a very strong time of the women’s movement, I was full of feminist zeal and all the rest of it’.481 On the face of it an informal meeting of ten or so women in a small isolated city in Australia is hardly extraordinary; in the light of years of silence surrounding miscarriage and perinatal death, this small gathering gives insight into the reinscribing of

476 Wendy Weeks, Women Working Together: Lessons From Feminist Women’s Services, Melbourne: Longman Cheshire, 1994, p. 63. 477 Weeks, Women Working Together, pp. 63-65. See also Murray, More than a Refuge, passim. 478 For more on the development of parent-focused or patient-focused care see Barbara Downe-Wamboldt & Mary-Lou Ellerton, ‘The Parent Connection: Self-help for Families of Chronically Ill Children’, ANJ, vol. 13, no. 11, 1984, pp. 50-2; A. Katz, ‘Self-help Organisations and Volunteer Participation in Social Welfare’, Social Work, vol 15, 1970, pp. 51-60; D. Robinson, ‘The Self-help Component of Primary Health Care’, Social Science and Medicine, vol. 14A, 1980, pp. 415 – 421. 479 Lloyd, interview with researcher. 480 See for example Marchant and Wearing (eds.) Gender Reclaimed, p. 59. 481 Lloyd, interview with researcher.

151 the foetal body and a significant challenge to the construction of pregnancy loss which underscored the practice of ‘protection’.

After this first informal event a public meeting was held and the SANDS (WA) Committee was formed, consisting mainly of parents but still with welcome involvement from health professionals and those involved in caring for bereaved parents.482 Alongside the research that Margaret Nicol was undertaking at KEMH at the same time, SANDS (WA) would prove to have a great influence on the way hospital practice changed to meet the needs of parents who had suffered the loss of a baby. Volunteers, mostly bereaved parents, acted at the grassroots level to help promote better understanding of the impact of perinatal death on a family.483 For example, social workers from KEMH and bereaved parents spoke at many seminars from the mid 1980s, to audiences consisting of high school early education students, social work students, nursing and midwifery students, and, astonishingly, to final year medical students and experienced paediatricians and neonatal nurses.484

This was astonishing simply because, for decades, the medical profession had positioned itself as the authority on matters concerning pregnancy and childbirth, and the birth of the parents’ support group signified both the relinquishing of some of this control to the bereaved parents themselves and a reinscribing of foetus as valuable and irreplaceable child. Not only did this offer bereaved parents a sense of agency that they had previously

482 In a report of the activities of SANDS (WA) at KEMH, the comments of the Charge Sister of the Labour Ward were recorded: ‘I would like a regular commitment from SANDS to participate in our In-Service Education’. See ‘Evaluation of SANDS Teaching Programmes’, c1987. Unpublished document held in KEMH Social Work archives. See also SANDS (WA) ‘Submission to the Centre for Women’s Health funding’, c1996. Unpublished document held in KEMH Social Work archives. 483 At a meeting of the SANDS Advisory Council in March 1987, the Chairperson Jane Gillon spoke of the reciprocal relationship between SANDS and KEMH; the minutes record that the Advisory Council, which was composed of obstetricians, nursing and midwifery staff alongside members of the SANDS (WA) Committee, was established with the express purpose of extending the activities of SANDS in the hospital: ‘SANDS has grown in the past few years, as has our recognition in Health Care (SANDS very aware that we could be felt as a threat to people in the Health Care area). The Advisory Council provides recognition for us in the eyes of other professionals. It is also hoped that through the Advisory Council we will have access if problems arise. It gives the group someone to turn to; also, if there is any way SANDS could be of assistance to Advisory Council members, the channels are open’. See SANDS Advisory Council, Minutes, 31 March 1987. Unpublished document held in KEMH Social Work archives. 484 For example over the course of a three month period in 1987, SANDS (WA) volunteers spoke to various groups including KEMH social work students; St John of God Hospital nursing staff; LaSalle College Year 11 Early Childhood students; Churchlands campus Western Australian College of Advanced Education nursing students; Curtin University postgraduate midwives; Bentley Hospital nursing staff; Franciscan Group Lesmurdie, WA. See SANDS (WA) newsletters, September-November 1987. Unpublished documents held in KEMH Social Work archives.

152 been denied, it was a radical about-face for many in the medical profession. Most of the twentieth century was characterised by a widely accepted belief that medicine held the answers for society’s ills, particularly in the areas of maternity, which had become pathologised with the medicalisation of childbirth. Even those obstetricians and doctors who had begun to accept the early ideas of the psychological impact of stillbirth and neonatal death in the 1970s had characteristically assumed any responsibility for parental grief by believing that they would be able to ‘fix’ this tragedy, by helping the woman deliver a live child.485

Practical change

Although support groups such as SANDS still valued the input of supportive health professionals they were predicated on the value of the experience of the bereaved parents themselves. Parents also sat on committees in various hospitals that were formed during the 1980s, such as the Perinatal Death Multidisciplinary Committee [PDMC] at Royal Women’s Hospital in Melbourne,486 and their opinion and experience was generally held in high regard – a significant step from previous decades where the medical profession’s understandings of perinatal death were given sole recognition. The PDMC was formed at the RWH in Melbourne initially as a temporary means of investigating ways to better support parents after infant death, and consisted of representatives from the social work department, obstetrics, paediatrics, gynaecology, nursing and administration. It would prove to be a more long-lasting committee than was originally thought, as the challenges to complete medical authority exposed bereaved parents’ needs.487

485 Writing in 1970, Giles had come to the conclusion that the obstetrician remained the major player in the drama of a stillbirth, with his primary role being to reassure the woman as to the prognosis of any future pregnancy. See Giles, ‘Reactions of Women to Perinatal Death’, pp. 208-210. British obstetrician Emanuel Lewis echoed this sentiment, noting that although a stillbirth presented a ‘challenge’ to the obstetrician, their role was to then to deliver the woman of a (subsequent) live child, despite the practitioner’s own fears, citing the example of a woman who was encouraged to stay in a particular hospital to give birth: ‘In encouraging her to stay the obstetricians were able to help her bear the anxiety about the pregnancy by demonstrating that they themselves could tolerate it’. See Lewis, ‘The Abhorrence of Stillbirth’, p. 324 486 See Marilyn Kenny, memorandum to members of the Perinatal Death Multidisciplinary Committee [PDMC], 12 January 1987. Unpublished document held in RWH Archives. 487 For example, social workers at RWH wrote to the founder of the Stillbirth Association in the UK, Hazel Wood - herself a bereaved mother - requesting information to ‘[improve] our care for the mothers of stillborn babies’. See Bethia Stevenson, letter to Hazel Wood, November 1978. Unpublished document held in RWH Archives.

153 The primary aim of the various SANDS groups around the country was, of course, to provide understanding and support for women and their families who had experienced a loss of some kind.488 Initially SANDS (WA), at least, was principally concerned with stillbirth and neonatal death, but increasingly found that women who had had miscarriages felt that their losses were invalidated, having found little support and understanding both within the hospital and amongst their relatives and friends. Pregnancy loss under twenty weeks was usually dealt with by gynaecology, rather than obstetrics, and whilst many midwives were becoming increasingly familiar and accepting of changes to hospital practice, nursing staff in gynaecology wards and theatre were often not familiar with recent understandings of pregnancy loss and tended to still view miscarriage in a somewhat offhand manner.489

Maureen, for example, whose fourth pregnancy ended in miscarriage just after twelve weeks gestation in 1984, remembers her experience in hospital in terms of a ‘procedure’ – that is, the routine procedure of dilation and curettage or ‘D&C’ – and she returned home the next day. Upon returning to daily life, she felt that most people responded dismissively to her experience, or avoided talking about it entirely. Still, it stayed in her memory as a difficult time, because she had already inscribed her twelve-week foetus as a baby: I found it quite hard, cause what a lot of people say to you … when you have three children [is] ‘why are you worried about losing one?’ Because miscarriages are fairly common, and people don’t sort of understand, I suppose, that that was still a baby that you wanted, even though you had three. So I found that quite hard – and people would say, ‘oh you’ll be fine, you’ve got three children’ … but I think it probably took me a good six months to get over it and come to terms with the fact… another thing that people would always say as well was ‘it wasn’t meant to be’.490

Although Maureen was not told the sex of her baby and did not harbour any prolonged desire to know what had happened to the foetus after the D&C, other women at this time were starting to push for the right to find out the sex of their miscarried baby and for the

488 Branches of SANDS groups were formed in all states and territories of Australia in the late 1970s, however by the end of the twentieth century SANDS groups only remained in Victoria, Queensland and South Australia. In other states and both territories, SANDS had become part of SIDS and Kids, an amalgamation of the Sudden Infant Death Syndrome support group and SANDS. Libby Lloyd recalled that the decision to merge the two groups was a pragmatic one; SANDS urgently required funding which the SIDS group could provide. It was, she said, a marriage of ‘the men in suits at one organisation and boxes of tissues at another’. Lloyd, interview with researcher. 489 This view was expressed by Jennings, who specialises in the area of perinatal death. Jennings, interview with researcher. 490 Maureen, interview with researcher, 16 May 2005. Tapes and transcript in possession of researcher.

154 chance to bury the so-called ‘non-viable foetal material’ with dignity and a degree of ceremony.491 Legally, such foetuses belonged to the hospital and parents had no right of ownership over foetal remains, and no death certificate was issued until the pregnancy had reached twenty weeks gestation or four hundred grammes in weight.492 Without a death certificate, then, cemeteries were legally unable to accept miscarried babies for burial. It was the opinion of the Crown Solicitor of Victoria in 1982 that, in accordance with the Victoria Registration of Births, Deaths and Marriages Act 1959, ‘non-viable foetal tissue’ could not be buried in cemeteries because it was not a body or a corpse – it was, in essence, a non-being. Pointing out that ‘viable’ foetuses should be disposed of ‘any way which does not constitute a nuisance or an affront to public decency’, he did concede that parents of foetuses under twenty weeks gestation could negotiate with the hospital to bury this material in a similar manner to a foetus over twenty weeks gestation. The final authority lay with the hospital however, as the Crown Solicitor confirmed the supervisory role of the doctors – ‘parents have no enforceable rights to possession’- and he recommended that hospitals thoroughly investigate parents’ psychological state before deciding to release the foetal remains.493

The Crown Solicitor’s comments brought into sharp relief the contrast between the legal status of a miscarried foetus and the inscribing of the foetal body as unknowable and many parents’ own inscriptions of their deceased foetuses. SANDS (Victoria) had been concerned with the nature of hospital burials since its formation and, together with the social workers at RWH, had begun an extensive campaign to completely overhaul the accepted practice of hospital-organised burials, as well as the issue of disposal of ‘non-viable’ foetuses.494 In the past, miscarried babies were usually disposed of in the hospital incinerator and babies of a

491 See Marilyn Kenny, memorandum to members of PMDC, 12 January 1987. 492 The Minutes of the SANDS Advisory Council meeting on the 31st March 1987 at KEMH note that this was increasingly becoming a concern of many parents. The Chairperson, Jane Gillon, remarked that some women whose babies fell under the twenty week gestational classification had requested a funeral, but as Committee member, Anne Donaldson noted ‘there would currently be an ‘ownership’ problem, as under twenty weeks, the baby is the property of the hospital!’ See SANDS Advisory Council, Minutes, 31 March 1987. 493 The Crown Solicitor’s opinion was expressed within a letter from H.V. Feehan, Secretary, Hospitals Division, Health Department of Victoria, to the Chief Executive Officer of RWH Melbourne, Dr Yeatman, on 31st October 1982. Mr Feehan was responding to an earlier letter from Dr Yeatman, dated 15 November 1982, in which he raised the issue of burial of ‘non-viable’ foetuses, after several requests from RWH patients. Unpublished documents held in RWH Archives. 494 Marilyn Kenny, ‘RWH Management Course Task Administrative Project, Hospital Burials for babies dying in the perinatal period – alternatives’. No date (circa 1980s). Unpublished document held in RWH Archives.

155 ‘viable’ gestation were either buried through private arrangements or, more commonly, through a hospital-arranged burial.495 At RWH at least, which as the major teaching hospital in Victoria dealt with most perinatal deaths, over 100 babies per year were interred through this method; miscarried foetuses were also transferred to RWH from smaller hospitals for hospital burial. The burial process was described in a manual for social workers in 1982: Babies awaiting a hospital funeral are left in mortuary refrigeration in the pathology department. When a sufficient number have accumulated (usually ten) the Mortuary Attendant contacts the funeral director who usually comes within a day or two to collect the caskets. The caskets are very plain, wooden containers made by the hospital carpenters. Each baby has an individual container and these are sealed. In a hospital burial the baby is buried in a common grave usually containing some hundreds of bodies. There is no religious service with this type of burial. The burial is done quietly and with dignity by the undertakers and the cemetery attendants with the caskets being handed down into the grave.496

Prior to the mid 1980s, many involved with the care of bereaved parents genuinely believed hospital burial to be a viable choice, reasoning that the cost of a private burial was often prohibitive to many families. An extract of the discussion paper of the Mortuary and Cemeteries Administration Committees Review of Cemetery Legislation in Victoria stated that ‘many stillbirths are buried in groups in public graves, either due to the parents’ wish for this cheap form of disposal, or as a result of their ignorance of the other options’.497 Many hospital staff also assumed that hospital burials would be beneficial to the parents, believing that by removing them from funeral arrangements, their distress would be minimised. Libby Lloyd remembered with some embarrassment offering this service to parents in the 1980s, believing at the time that it was a reasonable option, even though she

495 The Secretary of the Hospitals Division, Health Department of Victoria, Mr Feehan, stated his opinion to the CEO of RWH that ‘the public generally accept disposal through the hospital incinerator’. H.V. Feehan, Letter to Dr Yeatman, 31 October 1983. Unpublished document held in RWH Archives. 496 The manual reminded staff that parents were not to be encouraged to attend the burial and that no markers or memorialisation of any sort was allowed at the cemetery. See Social Work Department, RWH Melbourne, ‘Procedure Statement: Baby Death and the Social Work Department’, 1982. 497 Social Work Department, RWH Melbourne, ‘Memorialisation of stillbirths buried in public graves, Royal Women’s Hospital Extracts of Discussion Paper: Extracts from Mortuary and Cemeteries Administration Committee Review of Cemetery Legislation – Discussion Paper’, November 1986. Unpublished document held in RWH Archives.

156 recalls that the grave for hospital burials was ‘essentially a giant grave … [filled] in gradually’ without ceremony or individualisation.498

In reality, however, with the emerging ideas of prenatal attachment came the understanding that the choice of burial was not as simple as disposing of the foetal body. Within the construction of perinatal loss as a significant experience in women’s lives, the funeral was viewed as part of the complex process of resolution of grief, and it was argued that the opportunity to play an active role in the funeral arrangements would help parents in dealing with their loss as well as gain some sense of agency in an otherwise hopeless situation.499 Some health professionals also feared that the great number of bad debts each year for hospital burials would leave parents with a sense of unresolved guilt and could even prevent them from returning to the hospital for subsequent deliveries.500 For some women, the sense of economic disenfranchisement and lack of viable choice did lead to a great deal of guilt. As young parents in Sydney in 1976, Nancye and her husband had chosen the hospital burial, which had been strongly presented to them as the best option on both economic grounds and by virtue of their doctor’s opinion that their baby was essentially ‘unknown’. After several weeks, Nancye had rung the cemetery to find out where her baby was buried only to be told words to the effect of ‘you can’t ask where the baby is buried, it’s not something we can tell you’. After some persistence, she was then told that her child was buried with six other babies; she said ‘boy, that bit of news really broke my heart’.501

Some staff who felt it important to listen to the expectations of parents found that many felt rushed and ill-informed by other staff members and overbearing family members, misguidedly hoping to suppress the reality of the event.502 In a memorandum to other members of the PMDC, Marilyn Kenny noted that, whilst RWH hospital regulations

498 Lloyd, interview with researcher. 499 The minutes of the Advisory Council meeting on the 19 April 1988 note the Council’s concern that the high cost of private burials restricted the choice of burial for some parents: ‘As some parents don’t have a choice purely because they can’t afford most options, [Council member] Robyn Shine suggested that in addition to producing a leaflet [on funeral/burial alternatives] we need to set about lobbying for some changes to the present system; the Cemetery Board should be presented with information from the point of view of resolution of grief’. See SANDS Advisory Council, Minutes, 19 April 1988. Unpublished document in KEMH Social Work archives. 500 Kenny, ‘RWH Management Course Task Administrative Project, Hospital Burials’. 501 Nancye, personal correspondence researcher, 12 May 2005. Email in possession of researcher. 502 Bethia Stevenson, memorandum to Assistant Director of Medical Services, Dr Flower, 10 April 1980. Unpublished document held in RWH Archives.

157 required written consent for hospital disposal, consent was often not obtained in smaller hospitals. Approximately ten percent of RWH hospital burials were babies from other Melbourne hospitals, and Kenny observed that case records made reference to ‘distressed parents in labour wards making certain statements, taken as sufficient authority or taking lack of parents making other arrangements of speaking of them, as permission’.503

Many parents also complained about the lack of individuality of a hospital burial, which was increasingly becoming at odds with other practices designed to help parents bond with their deceased infants.504 At RWH grieving parents were given just one week to advise the hospital of their decision for burial, and if the mortuary had not received this advice then the infant was disposed of by hospital burial. The difference in funeral expenses was enormous and gives great insight as to why so many parents chose such an arrangement. A burial arranged through RWH would cost parents $65 to $80 in 1984, compared to over $450 which would cover the undertaker’s fee for a service and burial in a separate small gravesite, and would allow for a small memorial such as a headstone.505 A hospital burial also meant that family members were usually unable to attend the funeral and publicly mourn the child, and growing awareness of cultural differences in the practice of mourning contributed to community pressure to change the availability and access to reasonably- priced burials.506

Social workers during this period argued that cost, not a lack of desire to publicly memorialise their child, was the real reason behind most parents choosing a hospital burial

503 Furthermore, Marilyn Kenny noted that smaller hospitals often did not send accurate records to RWH: ‘It [is] difficult/impossible to obtain names, addresses and telephone numbers of parents. Medical records do not appear to have access to any of this information. It is wondered whether parents can or are therefore informed after the burial has taken place and if an account is issued. There can be no reason for treating these parents more or less favourably than RWH patients in the matter of notification and account’. See Marilyn Kenny, memorandum to PDMC, 12 January 1987. 504 For example, a bereaved father whose baby had died at RWH after being born prematurely wrote to the Assistant Medical Director in 1980 that, in his opinion, the hospital-arranged burial ‘detracts from the dignity of human life and relegates the baby to a non-entity status. On both religious and humanitarian grounds it is a shocking indictment of the value that your hospital places on human life’. Excerpt from letter from Mr A. to Dr C. Flower, 13 February 1980. Unpublished document held in RWH Archives. 505 Australian Funeral Directors’ Association set this fee for hospital arranged burials in 1984. See Kenny, ‘RWH Management Course Task Administrative Project, Hospital Burials’. 506 Many parents were increasingly dissatisfied with communal burials. For example in September 1985 SANDS (Victoria) made a submission about this issue to the Mortuary Industry and Cemeteries Administration Committee, which was, according to Marilyn Kenny, ‘extremely interested and concerned to hear of the problems with hospital burials’. See Kenny, ‘Hospital burials for babies dying in the perinatal period – alternatives’.

158 and feared that this economic division would only serve to further marginalise bereaved parents and enforce their feelings of isolation and powerlessness.507 In some hospitals special committees were formed which recognised the need to help parents individualise their child’s memory. In the early 1980s social workers around the country visited major cemeteries and met with members of cemetery boards to discuss ways to rectify this situation.508 Tours of several cemeteries in Melbourne led social workers at RWH to overwhelmingly reject communal burials, believing that the shared grave was a poor option for parents, both in terms of memorialisation – it was usually prohibited by the cemetery board – aesthetics, and lack of parental involvement.509 Communal graves were often left open until full, and were situated in the least attractive part of the cemetery with little maintenance, undoubtedly making the gravesite a difficult place for parents and family to visit.510 In Victoria, there had already been a government inquiry into cemeteries and crematoria, which had raised doubts as to the existing practice of hospital burials, and the board of directors at Springvale Necropolis, for example, were keen to provide a more personalised service for parents, although, as social workers at RWH noted,

507 Kenny, ‘RWH Management Course Task Project, Hospital Burials’. 508 Social workers in Melbourne visited Melbourne General Cemetery in Carlton, Fawkner Cemetery and Springvale Necropolis. See Bethia Stevenson, ‘Inspection of proposed infant burial sites at Springvale Necropolis: Report’, 7 March 1984. Unpublished document held in RWH archives. Social workers from KEMH in Perth met with cemetery board members at Karrakatta Cemetery to raise concerns held by the department and SANDS as to the nature of communal burials. Lloyd, interview with researcher. 509 Dr Lambert wrote to RWH social workers in 1985 that ‘you will undoubtedly be interested to know that the organisation, Family Involvement Funerals, has decided to cease providing a service for baby funerals until further notice. The reasons for this are of particular relevance to this Hospital. The first is that the Firm has had a number of problems with such funerals, particularly from in laws and especially in the area of viewing of the baby’. See R. Lambert, Deputy Director of Medical Services RWH, memorandum to Bethia Stevenson, 30 August 1985. Unpublished document held in RWH archives. 510 Marilyn Kenny was given the task of assessing the current system of hospital-arranged burials in communal gravesites, the results of which she discussed in the report ‘Hospital Burials for babies dying in the perinatal period – alternatives’. Oral history testimonies of two former employees of the Karrakatta Cemetery in Perth give insight into the nature of the mass burial. Bill Manners, a gravedigger in the postwar period, recalled that ‘the stillborn babies’ [grave], of course, would be just a hole in the ground virtually. The size of the grave would never vary. The area was eight foot by four foot’. See William (Bill) Manners, Interview with Gail O’Hanlon, 10th May – 10th June 1993, OH 2549/1 Battye Library. Victor Carpene, the Head Gardener at Karrakatta from 1963 to 1989, recounted his memories of the burial of stillborn babies during this period: ‘When a stillborn came down to the cemetery … it was placed underneath a hedge adjacent to the office. The [paperwork] pertaining to that particular stillborn was submitted to the office, and the grave was allocated. It was then picked up by the truck driver … and buried in a community grave, a stillborn grave, with quite a number of other stillborns … There was a steel ladder getting down to the bottom of the grave. The truck driver would take the stillborn casket, put it down at the bottom of the grave, get out and then cover it over with a couple of foot of soil. This would happen time and time again until such times there might be about twenty, thirty stillborn babies in the one grave’. See Victor (Vic) Carpene, interview with Gail O’Hanlon, 29th October and 12th November 1993, OH 2549/3, Battye Library.

159 individualisation and financial accessibility were often factors that worked against each other.511

It was to be some years before these competing variables could be resolved and personalised funeral options became more readily accessible; in the meantime, at least at RWH and KEMH, social workers had begun to hold services of remembrance for stillborn babies in the respective hospitals’ chapels, which gave parents the opportunity to memorialise their baby before a hospital burial. The inaugural chaplain at KEMH, the Reverend Robert Anderson, found upon his appointment to the role in 1987 that ‘service for babies’ at KEMH was a quiet, informal way of validating the experience of pregnancy loss: They would have the baby in the chapel with the parents, if the parents wanted that, they would have time with the baby, the parents would do what they wanted to do. They may have brought someone in [from the church] to take the service or not, but often I think I observed that it was the social workers who were doing things that created memory and space and so on.512

The shift towards creating ‘memory and space’ for stillborn infants was a significant shift in the construction of the impact of perinatal loss; this quiet informal practice would be further refined and extended towards the end of the twentieth century.

Conclusion

Despite the entrenched appeal to stoicism and silence which had characterised the experience of perinatal death for much of the twentieth century, the cultural shifts of the 1970s and 1980s underscored a reinscribing of the foetal body and the experience of perinatal loss - a period which would herald a more widespread acceptance of the psychosocial significance of stillbirth and neonatal death and lead to the refining of policies and practices concerned with the care of bereaved parents. The work of Margaret Nicol, amongst others, was grounded within the more general cultural shift away from the traditionally authoritative role of the medical profession in women’s health; a shift that, in the decades to follow, would significantly change the way that perinatal loss was managed and understood within the hospital. However, as I argue in the next chapter, whilst these

511 Stevenson, ‘Inspection of proposed infant burial sites at Springvale Necropolis’. 512 Anderson, interview with researcher.

160 localised changes did pave the way toward the more complex construction of perinatal death as a life event that could potentially have great psychosocial significance for bereaved parents, the taboos surrounding perinatal death were well entrenched and change in actual practice and hospital policy was minimal during this period, and it would be some years before the efforts of midwives and social workers bore fruit in the hospital setting.

161 CHAPTER FIVE

‘I consider as much has been done as can be done’: opposition and resistance to emerging understandings of perinatal loss in the 1970s and 1980s

In a letter recounting her memories of the stillbirth of her first child at small hospital in Hobart, Tasmania in 1983, Sally noted that, when she requested a funeral for her child, she was informed by her father-in-law that he had taken responsibility for the burial, ostensibly so that Sally and her husband ‘wouldn’t have to worry’. She was then told that the baby had been put in with a stranger’s coffin and cremated; her father-in-law had been reassured that ‘that was the way stillbirths were dealt with’.513

As I argue in the previous chapter, the 1970s would see an emergence of international and local research that would prove pivotal in challenging accepted constructions of pregnancy loss and baby death. In Australia, the 1970s and 1980s would mark a paradigm shift in the way that psychologists and later, some of the medical fraternity, viewed the impact of perinatal death on a woman and her family. However, although understandings of pregnancy loss and baby death during this period became more complex and. despite some health workers rejection the practice of ‘shielding’ women from the experience of losing a baby, change in hospitals was slow and localised and some shifts in practice were often met with resistance and opposition. As McCalman shows, hospitals are sites of complex relationships and change in policy or tradition is often a gradual process.514

In this chapter I argue that this period was still discernible by the silence and avoidance reminiscent of earlier years despite the changing attitudes amongst some staff caring for women after pregnancy loss or baby death. Furthermore, it was still widely believed amongst the medical profession that the deceased baby was the product of a ‘failed’ pregnancy’. This attitude led to some deceased or dying babies being treated with a certain disregard and perpetuated the idea that women would naturally feel shame and guilt at having ‘failed as women’. Women’s narratives of loss during these years give insight into

513 Sally, personal correspondence with researcher 31 May 2005. Email in possession of researcher. At Sally’s request, this is a pseudonym. 514 McCalman, Sex and Suffering, passim.

162 the gradual and ad hoc process of changing an entrenched tradition of shielding women from their deceased infants. The fairly lonely voices of some of those involved in caring for bereaved women were not heeded for many years, and it would be some years before the efforts of social workers and midwives would bear fruit within the hospital environment.

Continuing the practice of aloofness and distance

Sally’s experience described previously gives insight into the gradual nature of changing the accepted management of perinatal death. The emerging ideas of the 1970s and 1980s were in such opposition to the accepted construction of perinatal death and its management within the hospital setting that it would take some years for any changes in practice to become widely accepted within the medical fraternity. Reiger and McCalman both observe that second-wave feminism and the consumer health movement had wrought significant change in the ways pregnant women were treated in the hospital; for example, it was now increasingly common to see husbands in the labour room and for babies to be ‘roomed-in’ with their mothers, instead of being taken immediately to a separate nursery.515

However, notwithstanding the progress and success of childbirth reformers – who, as Reiger argues, were not without their own detractors516 - the incidence of perinatal loss was

515 Reiger notes that the admission of fathers into labour wards was a ‘prime objective of the childbirth organisations: like dispensing with routine ‘prepping’ it was of symbolic as well as of practical importance’. Furthermore, she observes, ‘[f]rom a later vantage point, it is hard to recognise just what a challenge it presented’. See Reiger, Our Bodies, Our Babies, p. 215. See also See McCalman, Sex and Suffering, pp. 329- 350. 516 Reiger, Our Bodies, Our Babies, pp. 212-214. Not surprisingly, many obstetricians were quick to voice their concerns over the burgeoning home birth movement, warning ominously that the rate of stillbirths would surely rise if home births were allowed to continue. Some members of the nursing profession were also reluctant to embrace the move to less intervention in childbirth. Writing for the ANJ, Australian nurse Patricia Whaley found the home birth phenomenon ‘inexplicable’. Upon observing two homebirths she was ‘impressed’ - albeit surprised - that the mothers were well–educated and widely read on the subject, but concluded that ‘many [women] turn to homebirths after reading the literature which is flooding the bookshelves at this time, much of which is slanted to appeal to the emotions, not to hard headed practicality’. However, both Whaley and Professor Norman Beischer conceded that the homebirth movement could be a learning experience for the medical profession. Although still resistant to many women’s demands for greater psychosocial care during pregnancy and labour, Beischer proclaimed in 1978 that ‘it is relatively easy for us to satisfy most of the new requirements without lowering the standard of patient care’. In the early 1980s many hospitals reached a compromise which certainly heralded a significant change in the way the birth experience was treated in a clinical setting. For instance, the Alternative Birth Centre was opened at KEMH in 1980, which aimed to give women and their families greater control in labour and birth, whilst maintaining a degree of supervision over the mother and baby’s health during childbirth. See Patricia Whaley, ‘Two Home Births’, ANJ, vol. 8, no. 1, 1978, p. 44; Norman A. Beischer, ‘Projected Developments in Midwifery’, ANJ, vol. 8, no. 2, 1978, p. 55.

163 often still treated in accordance with practices of years past. Despite the increasing debate within medical and nursing journals as to the psychological effects of perinatal death, the level of empathy and compassion showed to women during this period depended largely on the individual staff member’s awareness of and response to the emerging trends both overseas and at home. The recollections of some Australian women’s experiences of perinatal death in the 1970s and 1980s are indicative of the persistence of a general misunderstanding and ignorance towards the complexities of meanings of perinatal death; sources from the social work departments of RWH and KEMH also give insight into the opposition some staff faced as they worked to implement changes which better reflected current theories of grief after perinatal loss.

As I discussed in Chapter Three, nursing and medicine had long advocated an aloof approach towards patients and warned against ‘emotional involvement’, which in reality could translate into abrupt care that dealt only with the physical condition of the patient. Judith Harrison, an Australian registered nurse, lamented in the ANJ that many nurses’ avoidance of ‘difficult’ patients often reflected a general lack of empathy in many hospitals. The word ‘care’, she noted, was derived from the Greek word kara ‘which means “to lament, to grieve, to experience sorrow, to cry out with”. In nursing, the word has lost much of its meaning’. Harrison argued that ‘nurses frequently do not respond to people, just to their condition. They often do not care about the person … their concern rests with the patient’s illness and the expected outcome … Empathy is sadly lacking and understanding and acceptance is all too infrequent’.517

Although some women were treated with care and compassion during this period, resistance to changing understandings of perinatal death was strong, and at times, vocal. Despite the growing number of studies which viewed the death of a baby as a complex and significant event, perinatal death was still constructed in medical discourse as ‘basically a sad event’, and inscriptions of the foetal body held that the unborn child was essentially ‘unknowable’. Like women in decades past, many women interviewed for this research who lost babies in the 1970s and early 1980s felt that their experiences were invalidated and their babies denied recognition, even if their lives were short or solely in utero.

517 Judith Harrison, ‘Caring in Nursing: Are We Being Sidetracked?’ ANJ, vol. 9, no. 11, June 1980, p. 43.

164 Attitudes of some health professionals ranged from contempt, to indifference to a clumsy, awkward sorrow. In letters and interviews many women recounted hurtful or gauche comments made by people misinformed as to the reinscribing of perinatal loss and perhaps too confronted by the enormity of the woman’s grief to appreciate the complexity of the experience.

For example, Nancye’s doctor attempted to placate her after the death of her daughter, her third child, by saying words to the effect of ‘you’ll be able to get on with your life now, Nancye, you won’t be tied down with three children’.518 Other women felt that their grief was minimised – both within the hospital and their communities - by an avoidance of the subject: for example, in recalling her discharge from the hospital, and the ensuing grief and pain she felt over the death of her first child, Robin commented that ‘nobody said anything … nobody warned me of what would happen – I didn’t know that [I would] feel that depressed’.519 Pam, whose first baby died ten minutes after delivery, recalled that ‘whenever I tried to sit and talk to my mother and other relatives [or] friends, they would inevitably change the subject - it was as though they didn't want to know but as the years went by, I came to realise that maybe they were embarrassed’.520

Julie, who suffered multiple losses including a miscarriage, stillborn twins and the death of an infant daughter, articulated her belief that the prevailing view amongst her friends at the time was that a foetus was ‘purely considered as this lump of cells, it wasn't a baby until it had gone full term’.521 As I mentioned previously, Nancye was told by her doctor not to have a ‘proper’ burial and ‘don’t pay all that money out for a baby you didn’t even know’.522 The use of language in the clinical setting often reflected this prevailing view; some doctors did not consider the impact that referring to the unborn child as a ‘foetus’ could likely have on the mother. Although not all women would have regarded their foetuses as a ‘baby’, in interviews some women articulated great dissatisfaction with how

518 Nancye, personal correspondence with researcher. 519 Robin, interview with researcher, 11 August 2005. Tapes and transcript in possession of researcher. 520 Pam, personal correspondence with researcher. 521 Julie, interview with researcher, 31 May 2005. Tapes and transcript in possession of researcher. 522 Nancye, personal correspondence with researcher.

165 their babies were described by medical staff at the time.523 For example, Coralie’s baby was stillborn at a late gestation in a small town in the north of Western Australia in 1974. Not only did her doctor request that her husband leave while he examined Coralie, but he repeatedly referred to what she believed to be her precious ‘baby’ as ‘the foetus’: ‘He then informed me that the foetus was dead and would be stillborn. What a way to tell me, I felt like he was talking gibberish, but I guess there is no easy way to tell that sort of news. But I hated my baby being referred to as a foetus’.524

Women who delivered a stillborn baby in the 1970s and early 1980s were still regarded as anomalies in an environment which was geared towards the production of live babies. Some staff in busy maternity wards still felt that their time was better spent caring for women who were delivering live babies and paid little attention to the cases of miscarriage and stillbirth. Alice Lovell observed of the British context in the early 1980s that ‘maternity units are geared to the production of live babies. When this goes wrong, there is the … problem of what do with the maternity patient – is she a patient?’525 It can be assumed that this was often the case in Australian hospitals. For example, after the stillbirth of her daughter Kaye was aware that her baby had died before labour started, and remembers feeling that she did not quite ‘fit’ as a maternity patient: ‘One nurse … made a few heartless comments during labour. I'm sure she was busy but made a comment to another nurse that it was a ‘waste of time’ bringing a crib into the delivery suite as it wouldn't be needed. I didn't need to hear this - it was the reality of the situation but a little tactless I felt’.526

In a similar vein, Jennifer’s memory of her miscarriage evokes the lonely isolation that some women suffered while experiencing a miscarriage. After the tiny body was delivered and whisked away in a bedpan, Jennifer spent a miserable day recovering in hospital with little attention from staff and with no visitors. She recalled that ‘I lay in my bed all day,

523 Medical terminology used to describe pregnancy loss was also reflected in the way data was collected by government agencies. SANDS (WA) members, for example, expressed great dissatisfaction over the wording of the 1986 Census. Under the question ‘For each female, how many babies has she ever had?’ the Census form explicitly excluded stillbirths, requesting that census participants ‘do not include stillbirths’. See SANDS (WA) newsletter, March-May 1988. Unpublished document held in KEMH Social Work archives. 524 Coralie, personal correspondence with researcher. 525 Alice Lovell, ‘Some questions of identity: late miscarriage, stillbirth and perinatal loss’, Social Science and Medicine, vol. 17, no. 11, 1983, p. 757. 526 Kaye, personal correspondence with researcher.

166 nobody came to visit, cause my husband was at work and probably my mum was working and my dad definitely would have been, and none of my friends knew I was there, so I was really really sad all that day’.527 Upon returning home she was expected to ‘press it down’ and found that none of her friends mentioned the incident and there was no follow up from either the hospital or her local doctor.

Apparently some staff felt hesitant or ill-equipped to deal with bereaved parents and were unable to properly deal with the psychosocial needs of patients when for years the physiological health of the patient had been their only concern. With such avoidance and little awareness amongst staff of the emotional impact of perinatal loss, it was often left to the least skilled staff to deal with women who were delivering a miscarried or stillborn child. According to Belinda Jennings, ‘the least experienced midwife was given these women to look after, regardless of their own experience, training, what they wanted to do, didn’t want to do. So [the women] were actually neglected in their care, because it was thought that [the inexperienced midwife] couldn’t do any damage, because the baby was already dead’.528

This often meant that women were attended to by staff that were simply out of their depth when faced with such a confronting and challenging situation. Some were simply inexperienced in dealing with stillbirth and neonatal death – despite its relative regularity, some doctors, particularly in country hospitals, would have rarely had to deal with such an event. For example, Marie’s first baby was born prematurely in a country town in NSW in 1973. She was attended by her local general practitioner, who had refused Marie’s husband’s request that his wife be referred to a specialist. When Marie went into early labour the doctor put her on an alcohol drip which rendered her unconscious for the entire birth and left her feeling sick and dazed; as she said, ‘the whole experience was quite bizarre’. The doctor seemed unable to cope with the situation, and as Marie recalls, seemed ‘staggered’ by what was happening: ‘He couldn’t function – my husband actually had to work out how much of the alcohol to put in the drip’. Marie delivered her daughter, who was not expected to live and, was according to her husband’s recollection, left to succumb

527 Jennifer, interview with researcher, 24 May 2005. Tapes and transcript in possession of researcher. At Jennifer’s request, this is a pseudonym. 528 Jennings, interview with researcher.

167 alone in a humidicrib. She lived for an hour, yet Marie had only seen a glimpse of her straight after delivery. Despite his awkwardness the doctor still clearly felt sorrow for the couple: ‘He obviously felt, well I think he felt guilty [because] he came out and said, ‘I’m sorry for what has happened,’ and he put his arm around me and gave me a hug’. Other staff caring for Marie were, she said, ‘gentle, but they sort of just went about doing their own business – they never said a lot’. The doctor also insisted on naming the baby, because Marie was in too ‘dazed’ a state to complete the required forms.529

Often women were met with different responses from individual staff members. Julie experienced more empathetic, skilled care from her doctor, who was greatly respected in the small Wheatbelt farming community – ‘we always felt very secure’, she recalled - but was treated callously by the midwife, who Julie said ‘gave me a really hard time – I found out later her nickname was “the witch.”’ Although in her mid twenties at the time, Julie felt that she was treated like a disobedient child by this particular nurse, who refused to believe that Julie was having labour contractions and accused her of ‘looking for attention’ from the nursing staff. Eventually after she complained that the pains were getting much worse, the nurse, apparently intending to frighten Julie, scolded her saying ‘well that's it. It's the coldest night of the year, and I'm going to get [the] doctor down now just to see how you're behaving and how you're carrying on’. When the doctor arrived Julie’s cervix was dilated enough that the doctor could see one baby’s head already emerging. The nurse’s attitude changed rather quickly, Julie remembered in the interview: ‘from then on she turned into this smolchy [sic] nice… she was so slimy, it was awful, [because] it was all in front of the doctor, [she was] probably really worried that I was going to say something’.530

Particularly in busy general hospitals in rural areas, few staff were aware of the challenges to the dominant construction of perinatal loss and continued to operate under the custom of that particular hospital which had become entrenched over the course of several decades. As a young woman in a small town in Far North Queensland in 1974, Vicki’s first pregnancy was attended to by a young and inexperienced general practitioner. She

529 Marie, interview with researcher, 19 May 2005. Tapes and transcript in possession of researcher. At Marie’s request, this is a pseudonym. 530 Julie, interview with researcher. Echoing the sentiments of many other women, Julie acknowledged that the matron’s performance for the doctor was quite unnecessary – as a young woman in the 1970s, she would never have seriously considered complaining about her mistreatment.

168 recollects that the experience of being pregnant was ‘a bit like falling in love all over again. I had all sorts of dreams and plans and hopes for this baby I was carrying’, but her hopes were dashed when her baby was stillborn a week before term. After a protracted and agonising labour the child was delivered into ‘total stillness and silence’ before the young trainee nurse, thoroughly unprepared for the ordeal, burst into tears and ran out of the room. Vicki remembers that ‘after a minute or so the doctor spoke – ‘it isn’t alive’. The baby was hastily wrapped in a sheet by the midwife without Vicki even catching a glimpse of her child. It was at this moment I realised that I had no idea if I had had a boy or a girl. I said to the doctor, ‘is it a boy or a girl?’ He looked at me absolutely flabbergasted and said, ‘To tell you the truth, I didn’t notice. I was too busy looking for other things’. He then despatched the midwife to find out. She returned to the room with her hands on her hips, walked up to me and barked “FEMALE!” … She then squeezed my hand and said possibly the most ludicrous words I have ever heard - ‘never mind dear, there’ll be others’.531

The midwife’s words were understandably ‘ludicrous’ to a young woman who was lying in bed ‘utterly exhausted and devastated’ and who remembers desperately hoping for some emotional support – her husband had been long banned from the delivery room and was away from the hospital – but these sentiments were echoed many times by many midwives. Julie, for example, recalled the indifference of the nurse who ‘came in, sort of lifted the paper on the bedpan and said, “oh well! There's plenty more where they came from!” And I think I burst into tears and she just shrugged her shoulders and walked off, and that was it’.532

After the delivery of her baby, Robin was returned to the postnatal ward; she was ‘totally sedated’ with a mixture of Valium and sleeping pills and wheeled up to gynaecology – a trip she remembers as being heartbreaking, ‘all the little baby noises…that was horrible’. It was upon waking in the morning once the heavy sedation had worn off that Robin began to realise the enormity of what had happened, but instead of answers to her queries was sent home without any advice for postnatal care. Once home, Robin discovered to her great shock that her milk had come in ‘with a vengeance’, and when she rang her doctor for advice he not only refused to give her any medication to dry up the milk but also neglected

531 Vicki, personal correspondence with researcher, June 8 2005. Letter in possession of researcher. 532 Julie, interview with researcher.

169 to tell her to bind her breasts or to stop expressing milk to ease the situation. It was a traumatising realisation, said Robin: ‘I [was] standing in the shower with this milk spurting – and that’s when it hit me. I thought, what a waste. I’ve got all this milk, and no baby’.533

Janice also experienced this kind of avoidance in 1970, when her second child was stillborn at 6 months. In her memory of the experience, the hospital staff ignored her repeated questions – she only found out the baby’s sex by surreptitiously reading the nurse’s notes – and she was sent home bruised and with infected stitches. When Janice’s milk came in, her mother rang her doctor to ask for some medication to dry it up but, she recalled, ‘he seemed to forget the baby had died, and asked me why I wasn’t feeding the baby’.534 Coralie, too, was seemingly forgotten by the doctor who had delivered her baby. Upon returning for her six week check up, he asked Coralie where the baby was and if everything was going well.535

Melanie’s baby was stillborn at twenty four weeks gestation at a hospital in Perth, and after the baby was delivered there was no mention made of the incident again. Although she recalled that she had initially felt ambivalent about this pregnancy – her second child was only several weeks old when she fell pregnant again – by the time she was seventeen weeks pregnant, Melanie had well and truly accepted her pregnancy and had begun to prepare for the baby’s impending arrival. At twenty four weeks gestation, however Melanie began to bleed at home, haemorrhaging massively, before delivering the stillborn baby in hospital. Although she was attended by her obstetrician throughout the whole labour, he had told Melanie words to the effect that ‘there’s no way that this baby will survive and no way that you can have it. You’ve just got to go through this’. Because of the huge amount of blood loss the whole experience was more akin to a medical emergency than a labour, and Melanie does not remember the baby actually being delivered. She surmises that the baby was most likely swept up with all the soiled linen; at any rate, she never saw the child. She said that ‘in amongst all the haemorrhaging, the baby was born. But it all got taken away with all the blood, and the blood clots, and I actually didn’t even know that it had happened’.536

533 Robin, interview with researcher. 534 Janice, personal correspondence with researcher, 23 May 2005. Email in possession of researcher. 535 Coralie, personal correspondence with researcher. 536 Melanie, interview with researcher, 24 May 2005. tapes and transcript in possession of researcher.

170

Melanie left the hospital the next day, despite having experienced a life–threatening loss of blood, and remembers that none of the medical staff or her family mentioned the baby. She recalled that it was as if the incident had never happened, although she acknowledges that, brought up in a family that typically responded to tragedy with stoic silence, she herself did not ask about any details such as the baby’s sex. Her obstetrician did not volunteer any information to Melanie about the baby, even though she later returned to him when pregnant with her next child. It was fifteen years before Melanie found out the sex of the deceased baby, although she never was able to find out what had happened to the baby’s body. She surmised that it was likely that, after being removed as part of the hospital waste, the baby was disposed of in the hospital incinerator.537

Continuing the practice of protection

This period was also still marked by the hospital acting as ‘protector’, with many mothers still shielded from their dead babies and denied the opportunity to have an active participation in their child’s burial. Coralie, for instance, was not permitted to see or hold her baby because attending staff felt that it would be ‘too upsetting’. Her husband and parents, however, were given permission to see the baby if they had wished, although they declined because they felt it would be ‘unfair’ to Coralie.538 With regard to Coralie’s experience, it is also useful to briefly consider how the literature at this time was primarily preoccupied with women’s response to grief following perinatal loss and how emerging theories of grief and loss were still structured around assumptions of sex role stereotypes.539 The early studies of grief responses to perinatal death were focused primarily on women’s experience; indeed, attachment theory held that the maternal-infant attachment was the primary bond and it was widely assumed that men were unlikely to

537 Melanie, interview with researcher. 538 Coralie, personal correspondence with researcher. 539 See for example M. Clarke and A.J. Williams, ‘Depression in Women After Perinatal Death’, Lancet, vol. 8122, no. 28, 1979, pp. 916-917; P.M. Seitz and L.H. Warrick, ‘Perinatal Death: The Grieving Mother’, American Journal of Nursing, vol. 74, no. 11, 1974, pp. 2028-2030; L.G. Peppers and R.J. Knapp, ‘Maternal Reactions to Involuntary Fetal/infant Death’, Psychiatry, vol. 43, 1980, pp. 155-159; Margaret T. Nicol, Jeffrey R. Tompkins, Norman A. Campbell and Geoffrey J. Syme, ‘Maternal Grieving Response After Perinatal Death’, MJA, vol. 144, March 1986, p. 289.

171 form attachments to their unborn babies.540 Interestingly, many of the husbands of women involved in the oral history project had been offered the chance to see their deceased infant, suggesting that men were assumed to rely less on emotion and more on rationality, whereas women were usually not allowed to see their infants on the presumption that they would be ‘too upset’.541

Although some women had been allowed to view their babies after the emergence of research which suggested that it may be beneficial,542 the suggestion that mothers should be allowed to hold their deceased infants proved to be a complex issue. Whilst Robin, for example, was left alone with her deceased son for nearly an hour after delivery, where she ‘marveled in his perfection,’543 most women were still not given the opportunity to hold their babies during this period. When Lena’s twin daughters were delivered prematurely in 1988 in a private hospital in Perth, she had a strong feeling of being avoided by staff. Having known since she was eighteen weeks pregnant that one twin would not survive birth, Lena remembers arriving at theatre on the gurney and thinking that: ‘“This is it, this is time to face this.” Because while I was pregnant with [the deceased twin] I knew that I could keep her alive, and I knew that things would be okay, and then all of a sudden … “okay, now I’ve got to face this.” I remember thinking that, and it was pretty scary stuff’.544 The postnatal period was complicated by the surviving twin’s prematurity and the necessity for her to spend several weeks in the special care nursery, and Lena said that staff ‘didn’t really know how to deal with me’.545 Although staff had dressed the baby in readiness for

540 Peter Barr and Deborah de Wilde, whilst overwhelmingly supportive of the emerging changes in the care of bereaved parents, argued that ‘grief usually lasts longer in mothers than in fathers. Many mothers grieve for a year or longer after the death of their baby whereas most fathers have recovered within three months. The mother suffers the double loss: the death of the child within her which she experiences as a part of herself and the death of her son or daughter’. See Barr and de Wilde, Stillbirth and Newborn Death, p. 46. 541 Until the late 1980s, the responsibility for arranging the funeral, if it was privately arranged, and dealing with any paperwork fell to the husband; perhaps most likely a double edged sword that gave men some sense of control over the situation whilst forcing them into the masculine role of protector of the vulnerable woman and precluding them from any kind of emotional response, at least publicly. In a situation similar to many other men, the burden of organising a funeral in a tiny mining town in North West Australia fell to Coralie’s husband, who was faced with the prospect of having to drive the tiny coffin 40 kilometres to the next town where the only available minister lived. Supportive friends of the family offered to relieve him of this task, but he was still faced with attending the funeral without his wife, whom the doctors would not discharge from hospital, having decided that the funeral would be too difficult emotionally for Coralie to attend. Coralie, personal correspondence with researcher. 542 As a result of Margaret Nicol’s research at KEMH, some staff at the hospital advocated this move in an article in the MJA. See Nicol et al, ‘Maternal Grieving Response’, p. 289. 543 Robin, interview with researcher. 544 Lena, interview with researcher, 2 June 2005. Tapes and transcript in possession of researcher. 545 Lena, interview with researcher.

172 the family to view the body and to prepare for the funeral – which Lena did not attend - perhaps they privately agreed with many of Lena’s acquaintances who felt that she should be glad that she had had one baby survive, or perhaps the stark intersection of birth and death was too overwhelming. In any case, Lena was not encouraged to see the deceased twin and she recollects that no mention was made of her after the delivery.546

Particularly if their baby was ‘deformed’ in any way, women were usually not offered the chance to view the body. Nicol argued in The Loss of a Baby that this was borne not only out of the perceived need to ‘protect’ women but was also because of the persistent idea that touching a dead body was ‘repugnant. She observed that ‘in our society, there is a taboo about touching a dead person and yet, it is one of the most natural acts we can do’.547 Culturally, the death of a baby was a baffling and mysterious death; as I argue in Chapter Three, it certainly fell outside the socially acceptable concept of a ‘good death’ and perhaps, particularly for many obstetricians and midwives – so used to dealing with life – was too difficult to confront.

Furthermore, ‘deformity’ was sometimes still offered as the sole reason for a perinatal loss with the implicit reassurance that a perinatal death had been ‘for the best’. For example, Robin’s obstetrician told the couple that the baby had most certainly been ‘deformed,’ which had led to his death. Although Robin was skeptical – as I mentioned earlier, she had seen the baby, and to her eyes he had looked perfectly formed – she did not question her doctor. Robin implicitly trusted this man, who was, in her words, ‘such a busy and important doctor … a real stalwart of the community’.548 Despite his dismissive attitude and her own misgivings, Robin chose to return to this specialist with her next child, yet felt she did not receive the ‘high priority’ care she had been promised. When she began to display the same symptoms, at exactly the same point in her pregnancy with her first child, Robin’s doctor ordered her two weeks bed rest. Robin’s misgivings eventually took precedence over her culturally–acceptable submission to her doctor’s authority, and she went straight from her clinic appointment to the emergency department of KEMH Perth.

546 Lena, interview with researcher. 547 Nicol, Loss of a Baby, p. 88. 548 Robin, interview with researcher. Other women involved in the oral history project expressed a similar view. For example, Coralie, whose baby was stillborn in 1973, expressed that ‘of course, thirty two years ago one did just what the doctor told you to do and that was it, I certainly wouldn’t take all that now and no one should’. Coralie, personal correspondence with the researcher.

173 There, she was to realise the full extent of her doctor’s neglectful care, when she inadvertently was able to read her baby’s autopsy report – the results of which had previously not been made known to her or her husband.

Even over twenty years later, Robin marvelled at the coincidence which led to her being able to view this post mortem report: ‘I don’t know how this happened, but I’m sitting in admissions, and they plonked down my admissions file, and it flipped open to the autopsy report of the baby … And I’m looking, and of course, being the curious person that I am, I decided to read it’.549 The autopsy had revealed that there was nothing congenitally or chromosomally ‘abnormal’ about the baby, except for the fact that by a certain gestation, Robin’s body was unable to support further foetal growth; the baby therefore had died because of ‘placental insufficiency’. For her first baby, that point was thirty five weeks gestation, the exact point she was at with her next pregnancy as she sat in the admissions area of the hospital. It was at this point that Robin began to feel that she had been deceived by her doctor. She recalled feeling that: Here I am, thirty five weeks pregnant again, obviously – I now know what could be happening [because] I’m looking here and thinking, two and two doesn’t make five here, because I shouldn’t be sitting here in this position, the doctor telling me to lie on my side for two weeks. I don’t want this baby to starve to death again.550

Despite this, the hospital and the obstetrician still decided to wait until the morning to deliver the baby. Remembering their experience with their first baby – who had died in the short space of time it took to prepare Robin for a caesarean section – it was only through her husband’s persistence that their baby, a daughter, was delivered that evening. Looking back, Robin believes that perhaps the doctor had kept the results of the autopsy to himself to ‘cover himself’ and to plant seeds of justification for the baby’s death in the couple’s minds. Although she felt that she had been treated ‘appallingly’ and had nearly ‘run the same track twice’ she still outwardly maintained the cultural faith in the medical profession, and at the time was never openly critical about her treatment. As a young woman in the late 1970s and early 1980s, Robin was fairly typical in her trust in the medical profession; as she said, ‘I honestly believe I was naïve, I was easily led, and I take some of the blame for that, because I was so confident [because] … he’d delivered 18 000 babies by then, he said

549 Robin, interview with researcher. 550 Robin, interview with researcher.

174 he knew what he was doing. So I was totally confident that he knew what he was doing’. She did, however, change doctors for her next two children and, in her perception, received excellent, compassionate care from an obstetrician who took her obstetrical history very seriously and acted accordingly.551

Robin’s experience is significant in many regards, not least because her obstetrician felt that because her baby had been ‘deformed’, the sense of loss would be minimal. In the British context, Lovell argued that many health care professionals still clung to a deep- rooted ideology as to ‘what constituted a baby and what babies “ought to be like’’’ – noting that some doctors referred to stillborns as ‘bad babies’. A miscarried or stillborn baby was not regarded as a ‘proper’ baby, therefore did not warrant ‘proper’ care.552 The object of greatest distaste in this system of classification was the ‘deformed’ child; although by the mid 1980s, for many health care professionals, in Australia and internationally, the idea of holding a well-formed stillborn child was gaining acceptance, many mothers were still shielded from ‘deformed’ infants.553 Sally, whose baby’s deformities had been detected via ultrasound, was told that she might be able to hold her child provided it was not ‘too deformed’. The doctor and matron, however, took Sally’s choice away from her after the birth by deciding that the child was, indeed, ‘too deformed’ for her to view.554 ‘Grossly deformed’ babies, such as those affected by anencephaly and hydrocephaly, were still referred to as ‘monsters’ in textbooks and clinical notes,555 and it was not an uncommon opinion amongst the medical profession that such ‘creatures’ should never have been conceived: one junior doctor in Lovell’s study held the view that ‘monsters [are] disgusting. They should be destroyed, wiped off the face of the earth,’ whilst a nurse told the parents of a hydrocephalic stillborn baby that it would be better not to see the baby because it was ‘an ugly little thing’.556

551 Robin, interview with researcher. 552 Lovell, ‘Some questions of identity’, p. 756. 553 This issue had been raised in 1980 by social workers at RWH, who noted that ‘some patients in the hospital have experienced bad reactions from staff with stillbirths and in particular physically deformed babies … following delivery of children with gross physical abnormalities there was a tendency of some staff not to talk to the mother until the paediatrician had seen the child and then often the mother was not shown the stillborn child. This led to the mother imagining unrealistic abnormalities present’. See PDMC, Minutes, 4 March 1980. Unpublished document held in RWH archives. 554 Sally, personal correspondence with researcher. 555 J.W. Williams, J. Pritchard and P. Mac Donald, Williams Obstetrics, New York: Appleton Century Crofts, c1980, 16th ed., p. 998. 556 Lovell, ‘Some questions of identity’, p. 756.

175

There is also evidence that some doctors made decisions as to which babies should be resuscitated. In many states legislation had changed in 1978, lowering the gestational age for mandatory reporting of stillbirths from twenty eight weeks gestation to twenty weeks, yet many hospital staff still based their care on medical distinctions of ‘viability’ and often babies under twenty eight weeks gestation were accorded less dignity than those babies of more advanced gestation. These distinctions meant that doctors, and by association, nursing staff, sometimes vicariously judged which babies would be regarded as human beings and which would not, resulting in vastly different standards of care. Jennings recalls that: These little babies were not considered an identity in their own right. I remember babies being put into kidney dishes – alive babies being put into kidney dishes – and being put into a pan room to succumb, without any respect for their bodily function or their bodily being … And that was for babies up to twenty-four, twenty- five weeks gestation.557

Women’s experiences reflect Jennings’s observation; for example when Nancye asked her doctor what efforts had been made to save her daughter – who had been born prematurely but alive - she was told bluntly: ‘nothing. If she was strong enough to fight then she would [have] lived, if she didn’t then she would die’. After Nancye accused the doctor of treating her child heartlessly, the doctor justified his actions by telling Nancye that ‘the baby was so tiny, she may have been blind or mongoloid [sic] … and I couldn’t do that to you, because you are alone in Sydney with no immediate help’.558 The terminology used in the clinical setting continued to use language which reinforced medical inscriptions of ‘non-viability’ on certain foetal bodies. For example, the Midwifery for Student Midwives textbook, written by staff at RWH, referred several times to late-term stillbirth as ‘foetal wastage’ and miscarriage as the expulsion of ‘products of conception’.559 The RWH Clinical Reports measured infant mortality in terms of ‘perinatal wastage’ and ‘foetal wastage’ whilst miscarriage was the ‘expulsion of the products of conception’.560

Thus miscarried or stillborn babies under a certain gestation were sometimes still treated with a fair amount of indifference, and until the late 1980s parents often had little say as to

557 Jennings, interview with researcher. 558 Nancye, personal correspondence with researcher. 559 Anon., The Royal Women’s Hospital Melbourne: Midwifery for Student Midwives, Melbourne, Vic., 1975, p. 101 & 102. 560 See for example RWH Clinical Report 1954, p. vii; RWH Clinical Report 1957, p. 5.

176 what happened to the body. Astrid’s second stillborn baby, for example, was flown from Karratha in the North of Western Australia to KEMH Perth for an autopsy; despite recent legislation which specified that the next of kin must give consent in order for an autopsy be performed,561 she had not been asked permission. Six weeks later, she unexpectedly received a bill in the mail for services rendered by a funeral home in Perth. The terse epistle informed Astrid and her husband that if they would require the ashes sent to Karratha, it would cost a further $270. Otherwise, the ashes would be spread at KEMH. Astrid had had no idea that her baby would be cremated in Perth, having been given no information at the time the baby was delivered except that he would be flown down to Perth for testing. At that point, Astrid recalls, she ‘really lost it, when I got that [letter], because I hadn’t heard whether he’d been cremated, or anything like that, what the procedure was …’ Despite going on to have a baby at KEMH, who lived, Astrid has never visited the site reserved for the scattering of ashes at KEMH because of her continuing guilt borne out of her lack of control.562

Hostility Some members of the medical and nursing professions were openly hostile and rejected any moves towards a more empathetic approach towards the care of bereaved women. On a general level, the movement toward less medical intervention and more maternal control was dismissed by some as a highly risky experiment that could only end in an increase in maternal and infant mortality. Midwives were cautioned to resist any community pressure to participate in home birthing, warned that the ‘allure’ of increased status and recognition would be a poor trade for ‘unacceptable or unwise risks’.563 The tragic case of a Melbourne woman, Françoise S. was trumpeted as a case in point – adamant that she wanted a ‘natural’ birth, Ms S. laboured for 3 days in 1977 in a deserted spot in a national park, before being taken to hospital by police where she gave birth to a baby who later died in hospital. The tabloid newspaper, the Melbourne Sun, gave sensational coverage of this tragedy, with the

561 See Victoria Human Tissue Act 1982, Part V ‘Post-mortem examinations’, Section 28: ‘Authority for Post- Mortem’. According to Section Five, this only applied to stillborn babies over 20 weeks gestation; tissue removed from a foetus under twenty weeks gestation was exempt from the Act and therefore did not require consent. For other states’ respective legislation relating to these issues see Western Australia Human Tissue and Transplant Act 1982; New South Wales Human Tissue Act 1983; Queensland Transplantation and Anatomy Act 1979; South AustraliaTransplant and Anatomy Act 1983; Tasmania Human Tissue Act 1985; Australian Capital Territory Transplantation and Anatomy Act 1978. 562 Astrid, interview with researcher, 3 June 2005. Tapes and transcript in possession of researcher. 563 Lesley Barclay, ‘Report on Overseas Midwifery Practices’, ANJ, vol. 8, no. 7, 1979, pp. 18-22

177 direct implication that the baby died as a direct result of the birth – even though Ms S. had previously been rejected as a candidate for home birthing by the National Homebirthing Movement, and had been referred instead to her local hospital because of the potential for complications. Edith Gosling, a midwife who was called to attend on the mother while she laboured in the national park, furiously rejected the newspaper’s claims that the homebirth movement had contributed to the baby’s death, and declared that the media coverage had been used to ‘promulgate distortions and thus feed the powerful [Australian Medical Association] anti-homebirth league with [the] ammunition it was seeking to thoroughly discredit domiciliary midwifery’.564 The case of Françoise S. was also tinged with blame and scapegoating, and provided a perfect opportunity for a kind of moral fable for those women who chose to take their childbirth into their own hands instead of relying on the established ‘scientific’ wisdom of the medical profession.

Sometimes staff who believed that they should provide care which better reflected current theories of grief and loss also faced opposition from both medical and ancillary staff. Having obtained a ‘viewing room’ in the perinatal pathology department and introduced the practice of small memorial services in the hospital’s chapel, the social workers at RWH Melbourne found some staff resistant to their efforts. Whilst social workers were concerned that the procedure of viewing babies after autopsy was an imperfect one, the director of pathology at RWH, Dr Fortune, strongly disagreed. After the Director of Medical Services, Dr Cliff Flower, requested an improvement in viewings on the behalf of the pathology department, Fortune replied in a letter that ‘I cannot think what there is to discuss about storage of infant bodies …With regard to the aesthetics of the viewing area, I consider as much has been done as can be done. Do you want an organ to be played quietly in the background during viewings? – I can recommend someone for the job’.565

Some parents complained to the hospital that they were treated with insensitivity by some staff in the hospital. In an intra-department memorandum in 1981, social worker Marilyn Kenny raised the possibility of providing training for all staff who came into contact with bereaved parents, such as the birth registrar clerk, noting with some degree of

564 Edith Gosling, ‘Letter to the Editor’, ANJ, no. 6, vol. 8, 1978, pp. 6-8. 565 See C. Flower, letter to D.W. Fortune, 7 December 1987; D.W. Fortune, letter to C. Flower, 14 December 1987. Unpublished documents held in RWH archives.

178 understatement that in the absence of formal protocols many staff ‘could probably benefit by discussion of how to approach patients after stillbirth’.566 Social work documents reveal that it would take great effort to break down entrenched practices; in 1987, for example, a bereaved mother was with her deceased baby in the viewing room adjacent to the mortuary, when a hospital porter entered the room without knocking, carrying another deceased baby in a box. In a memorandum to the Director of Medical Services, senior social worker M. van Laar wrote that the mother had been distressed and disgusted by being confronted with the sight of a deceased baby on its way to the mortuary for post-mortem; van Laar noted that, although she had taken some ‘action on the matter’ she doubted that this would be sufficient to prevent a recurrence of such an ‘unfortunate incident’.567

In some hospitals it appears that several staff reacted to efforts to break down the taboos of infant death with a certain degree of disgusted indignation and insisted that handling dead babies for reasons other than autopsy or disposal was not in their job description. In 1981 mortuary attendants at RWH Melbourne complained that it was ‘not part of their duties’ to transport dead infants to the Hall of Worship for memorial services, and on more than one occasion, the stillborn baby was ill–presented, still wrapped in preserving plastic and laid in the cradle carelessly,568 whilst on another separate occasion some years later the wrong baby was presented for viewing by the parents.569 Two years later the same battles were still being fought between departments – for instance, a mortuary worker refused to transport a stillborn baby to the Hall of Worship for a memorial service and co - workers threatened to resign if this was added to their list of duties.570 Social workers and midwives were thus left to carry out these tasks, even though at this early stage they had not received specific counselling or training, and hospital memoranda indicates that many staff in the social work department found these distressing duties – but many were still willing to perform them in order to better support bereaved parents.571

566 Marilyn Kenny, memorandum to Bethia Stevenson, 13 July 1981. Unpublished document held in RWH archives. 567 M. van Laar, memorandum to C. Flower, Director of Medical Services, 7 December 1987. Unpublished document held in RWH archives. 568 Marilyn Kenny, memorandum to Bethia Stevenson, 13 July 1981. Unpublished document held in RWH archives. 569 See Marilyn Kenny, memorandum to Dr C. Wellington and Dr I. Horacek, 15 May 1990. Unpublished document held in RWH archives. 570 Kenny, memorandum to Stevenson, 13 July 1981. 571 Kenny, memorandum to Stevenson, 13 July 1981.

179 Despite the hostility evoked by these changes, it is nonetheless significant that during this period a dialogue had emerged between those involved in the care of bereaved mothers. Both women’s experiences of loss and the activities of social workers and midwives give insight into this emerging dialogue between the medical and allied health professions about the complex nature of such a loss. Certainly not all women experienced indifferent or callous care. Like Margaret’s doctor, some staff were clumsily well-meaning whilst others treated bereaved mothers with extreme sensitivity and understanding. Of course, given the numbers of women affected by such an event, it is highly likely that some women were cared for staff who themselves had experienced the death of an infant. Although Coralie’s doctor’s behaviour exemplified the chasm that often existed between medical and parental understandings of unborn children, other staff caring for Coralie treated her with remarkable compassion. Unlike many other women who were often left to let the labour ‘run its course’, Coralie was attended to by the hospital matron and a nurse throughout the entire labour. The nurse stayed on despite her shift ending in order to hold Coralie’s hand during the labour and when asked why she did this, Coralie recalled that ‘she told me she had had a stillbirth herself and wanted to be there with me’.572 Although Kaye, mentioned earlier, had felt that some of the nurses had been ‘tactless’ during labour she nevertheless praised her doctor for his commitment to her care, recalling that ‘our daughter was delivered around 8pm on a Saturday night and my doctor was there at my bedside at 9am the following morning (Sunday) – I felt this was above and beyond the call of duty. His sensitivity and understanding was fantastic’.573

Conclusion

The emerging theories of grief and loss significantly undermined the dominant understanding of pregnancy loss as a sad, but easily forgotten, event in a woman’s life. However, although understandings of pregnancy loss and baby death in the 1970s and 1980s became more complex it would be many years before these changes were formalised and accepted as hospital policy. Medical discourse continued to construct perinatal loss as an instance of ‘failed pregnancy’ and some deceased or dying babies were treated with a certain disregard; furthermore, women’s narratives of loss during these years give insight

572 Coralie, personal correspondence with researcher. 573 Kaye, personal correspondence with researcher.

180 into the gradual and ad hoc process of changing an entrenched and widespread tradition of shielding women from their dead and dying infants. In retrospect, the fairly lonely voices of some of those involved in caring for bereaved women were not heeded for many years, and it would be some years before the efforts of social workers and midwives would be formalised into hospital policy. As I discuss in the next chapter, despite any hostility towards changing practices in the hospital context, a dialogue between parents, medical staff, and social workers had begun which displaced the confidence in the practice of protecting women from their deceased babies. In years to come the small beginnings of the bereaved parents’ groups would wrought widespread changes to the inscription of perinatal loss that would, ironically see the hospital become, to an extent, a haven of sorts for those women who had suffered the loss of a baby.

181 CHAPTER SIX

‘Awakened by angels’: re-inscribing the foetal body in the late twentieth century

In the early 1990s, the inaugural chaplain at KEMH in Perth, the Reverend Robert Anderson, took possession of the first foetal cremator in Australia. This unique creation was the culmination of a lengthy design collaboration between Anderson and a firm in London, an expensive shipping fee and an equally costly customs charge. It was with a sense of bittersweet satisfaction that Anderson recalled that he was present to oversee the first cremation of an individual stillborn baby; from this point onwards, Anderson believed that he was able to answer parents’ queries as to the whereabouts of their baby’s body with sincerity and credibility.574 Prior to this significant event, the bodies of deceased ‘non viable’ foetuses were often cremated as part of hospital waste in the general incinerator, leaving no distinguishable remains for parents to take home to dispose of as they wished. These two methods of cremation exemplify the radical shift in the way that the miscarried and stillborn foetal body was inscribed within the clinical environment, as well as indicating a wider cultural shift away from the avoidance of grief toward a greater openness in times of bereavement towards the end of the twentieth century.

In the late 1980s, contemporary attachment and grief theories were increasingly accepted by healthcare professionals, leading to a greater recognition that women would form bonds with their infants in the prenatal period and therefore, would potentially grieve intensely after perinatal loss. This acknowledgement in turn led to a number of changes within the hospital environment - it became accepted practice within some special care nurseries that women should be encouraged to hold their critically ill infants, and at KEMH at least, social workers had begun to hold small ceremonies for miscarried babies in the hospital’s chapel, although some staff remember that this was sometimes met with disapproval or outright hostility by other staff members.575 As I argued in the previous chapter, despite the emergence of studies which gave insight into the potential significance of perinatal death, the level of empathy and compassion showed to women in the late 1970s and 1980s depended largely on the individual staff member’s awareness of and response to the

574 Anderson, interview with researcher. 575 Lloyd, interview with researcher.

182 emerging trends both overseas and at home. By the last decade of the twentieth century, however, as more women began to occupy positions of influence and power within hospitals, women’s needs began to take greater priority and pregnancy loss became part of the discourse of ‘consumer rights’. The growth of so-called ‘consumer agency’ at this time was borne out of the demand for consumer rights in the health care setting – such as patient advocacy and access to one’s patient notes and information. This agitation for ‘consumer agency’ would eventually lead to the formation of specific groups to help support bereaved parents, as well as foster an appreciation for the value of parents’ opinions within the clinical setting.

In this chapter I consider the practical impact of the changing construction of perinatal death discussed in the previous chapter– meanings which moved away from the inscription of the foetus as ‘unknowable’ toward the reinscription of the deceased baby as ‘knowable’ and thus able to be bonded with - while examining the role of the hospital, and in particular KEMH in Perth and RWH in Melbourne, in creating a more supportive and protective environment for bereaved women.

Validating the individual experience

By the 1990s it was progressively more accepted by many health care professionals, and particularly social workers and midwives, that many parents understood their stillborn baby or deceased infant to be human:576 a precious member of the family despite having not lived outside the womb, or for just a short time, and some hospitals around the country, including KEMH and RWH, had begun to respond to this knowledge by implementing routines that were geared towards caring for bereaved women and their families. At KEMH, for example, in response to the need to educate all staff who came into contact with bereaved parents, the late 1980s had seen the introduction of the ‘teardrop programme’ at maternity hospitals in Western Australia. An initiative of SANDS (WA) this involved the placing of small teardrop shaped stickers on the doors of rooms accommodating bereaved

576 ‘RWH Extracts of Discussion Paper: Extracts from Mortuary and Cemeteries Administration Committee’s Review of Cemetery Legislation – Discussion Paper’, November 1986. Unpublished document held in RWH archives.

183 women, a move designed to alert all staff from gynaecologists to ward stewards as to the need for sensitivity and diplomacy.577

The Grief Kit was also a significant creation at KEMH, developed by SANDS and KEMH social workers, and which would later be used complete or modified by most major hospitals around the country.578 The Grief Kits were designed to help parents create a tangible record of their baby: a way of honouring the memory of the stillborn or deceased baby where little tangible evidence existed.579 Underpinning the kit’s development was the belief that each stillborn or deceased newborn child was, most often, perceived to be a valued member of a family and worthy of such validation. The kits also contained several leaflets on the grieving process and, some time later, physiological issues such as milk suppression and how to cope with ‘after pains’.580

For some time nurses and midwives had been taking photographs of deceased babies for the parents to take home and keep, but the Grief Kit was a more formal and intentional means for parents to gather mementoes, illustrating the gradual shift away from shielding parents from their babies. Tiny footprints and handprints were inked onto cards, midwives took several photos of the baby – dressed often in clothing made by older women, volunteers who perhaps had suffered such a loss themselves – which were then placed inside a small album in the kit and there was space for the cot card and identity bracelet.581 Libby Lloyd, who was part of the committee that developed the Grief Kit template, remembered that a key objective was that the kit could form a focus for parents’ memories of their children, resembling a baby book or newborn photo album: I was always keen that it was paperback size, that people could put in their handbag, or put in their bookshelf, or store in an easy way, because it would be something that they would refer to as years went by and also their children would be able to

577 SANDS (WA) newsletter, Feb-March 1986. Unpublished document held in the KEMH Social Work archives. The Teardrop Symbol had been adapted from the triangle sticker which had been used in the 1960s and 1970s to alert staff of the rooms which accommodated women who were relinquishing their babies for adoption. 578 Lloyd, interview with researcher. 579 For a comprehensive anthropological discussion of the role of ‘making memories’ after pregnancy loss see Layne, Motherhood Lost, pp. 103-144 580 See SANDS (WA) Advisory Council Meeting, Minutes, 4 March 1993. Unpublished document held in KEMH Social Work archives. 581 Lloyd, interview with researcher.

184 look at as they grew older and they were able to understand what happened to their dead sibling.582

The Grief Kits, and in particular photographs, were still an experimental process; most midwives had received little or no training on appropriate methods of photographing deceased babies and sometimes the results were confronting, but it was significant that many were willing to undertake the task, even when the child’s appearance was rather overwhelming.583 For example, Claire’s daughter was stillborn at KEMH in 1991 and the baby’s tiny body was macerated, having died in utero some time before delivery. Claire was given a Polaroid photograph of her baby as part of the Grief Kit, taken by a midwife and, in her interview Claire remembered the picture, which she had long destroyed, as ‘awful. They dressed her up in these clothes and it looked really macabre … like some Catholic evil christening ceremony gone wrong’.584 However, Claire was able to return some time later to take her own photographs, and staff were willing to assist her in this endeavour to obtain more aesthetically pleasing memories of her daughter: ‘I went back a few days later and said, ‘I want to see her again’. So they … made her look nice in a bassinette and everything … cause I thought, I’m not having [the Polaroid photograph] as my only memento of her’.585

As time went on more staff became skilled in the complex art of taking photographs of deceased newborns. Brenda, for example, remembers a nurse who encouraged the parents to relax and cherish the time with their baby while she took photographs with Brenda’s camera: ‘she was making us laugh, and brush his hair, and she was just fantastic. And I have so many photos it’s not funny. And photos of us laughing with him. It was a real [sic] precious time’.586

It had also become apparent that there was a need for specialised staff to deal specifically with bereaved parents, as well as the necessity for the provision of training for those who

582 Lloyd, interview with researcher. 583 Lloyd, interview with researcher. 584 Claire, interview with researcher, 9 June 2005. Tapes and transcript in possession of researcher. 585 Claire, interview with researcher. 586 Brenda, interview with researcher, 4 April 2005. Tapes and transcript in possession of researcher.

185 came into contact with bereaved women and their families during their stay in hospital, from doctors to hospital orderlies.587 At KEMH, the first hospital chaplain was appointed in 1987 in an agreement between the hospital and the Perth Diocese of the Anglican Church. The Reverend Robert Anderson started his chaplaincy in December 1987; he had come to the position assuming that most of his time would be spent counseling patients on the oncology and gynaecology wards. He was, however, astonished to discover the frequency of baby death and miscarriage and the depth of grief that many women felt after such a loss, and in his recollection, he found that his ministry became focused around the care of bereaved women and their families - although he remembers that he felt it a great challenge to discover what he could bring to the role: I didn’t come to the position with an idea of what I wanted to do … The first dimension was gradually realising almost overwhelmingly the extent of pregnancy or baby loss. And wondering what did I, as a white male Anglican priest would ever have to offer in that context. And that was disconcerting in some ways and very very quickly I realised that I had no resources, and limited knowledge about that.588

Shortly after his appointment as chaplain Anderson found he was principally occupied in taking small ceremonies for babies in the chapel – particularly for babies under twenty weeks gestation, who were still labelled by the hospital as ‘non-viable foetuses’ and who legally required no formal burial. This caused some censure amongst some other staff working at the hospital, who had begun to accept the practice of parents viewing so-called ‘viable’ foetuses but who felt that memorial services for miscarried babies was perhaps going ‘too far’.589 Libby Lloyd, Belinda Jennings and Anderson all recalled that it was becoming increasingly clear to those in charge at the hospital that policies needed to be formalised, and although Anderson stressed in his interview that he was not principally responsible for such changes, his appointment did act as a catalyst for the formalising of these changes that individual staff members had been working quietly to achieve for some years. 590

587 SANDS (WA) conducted a survey in the Labour Ward of KEMH in 1987 to ascertain whether or not staff felt prepared in dealing with a perinatal death. They found that whilst ‘all staff had sufficient knowledge and previous experience dealing with stillbirths and neonatal deaths,’ more than seventy percent felt that they knew ‘what to say to parents, but feel that they lack the skills to communicate effectively with the parents and families’. According to the evaluation, ‘all staff felt [that] the talks [by SANDS members] were beneficial for information and ideas’. See ‘Evaluation of SANDS Teaching Programmes’, c1987. 588 Anderson, interview with researcher. 589 Lloyd, interview with researcher. 590 Anderson, interview with researcher.

186 At the heart of these shifts in the care of bereaved women was the concept of holistic care. Whilst midwives since the mid 1970s had been suggesting that members of the profession should extend their care to the emotional needs of the patient, the 1990s saw several studies which affirmed the anecdotal evidence, suggesting that this type of care, with the core value of the individualised approach, would produce the best outcome for the patient, whether the pregnancy had ended with a live baby or a stillborn baby.591 The work of chaplains at both KEMH and RWH Melbourne was motivated by these values; for example, the chaplain at RWH, Mary Sila-Mato wrote in a staff manual that chaplaincy at the hospital aimed to ‘liaise within the hospital as well as the wider community’, using skills obtained from ‘training in psychology and human life cycle processes … formal theological study, clinical pastoral education and rigorous reflection on life experience’ to help ‘guide persons through the spiritual aspects of crisis in personal and life issues’. Furthermore, Sila-Mato observed, it was crucial that chaplaincy work recognised the ‘individual diversity’ of bereaved parents at the hospital.592

The individualised approach in caring for pregnant women had particular relevance in the event of pregnancy loss. A crucial part of this paradigm of care was what Belinda Jennings termed ‘professional friendship’ – the allowing of a relationship to form between midwife and patient whilst the latter was in hospital – and the concept of ‘continuity of care’ which ensured that women were cared for by a small team of midwives who had detailed knowledge of the patient’s history.593 There was also a growing awareness of the need for women to be cared for by the more experienced midwives, and at KEMH, for example, it became important to introduce a student gradually to the more complex obstetrics cases, both for the sake of the student and importantly, the wellbeing of the mother.594 It became less common for the least experienced midwife to be given the most clinically or psychosocially difficult cases to handle, and although it was to take some years to develop, the 1990s saw the emergence of the mentor-relationship between student midwife and

591 See for example L.E. Radwin, ‘Knowing the Patient: A Review of Research on an Emerging Concept’, Journal of Advanced Nursing [JAN], no. 23, 1996, pp. 1142-1146; K. Caelli, J. Downie and A. Letendre, ‘Parents’ Experience of Midwife-Managed Care Following the Loss of a Baby in a Previous Pregnancy’, JAN, vol. 39, no. 2, pp. 127-136; Victor J. Callan and Judith Murray, ‘The Role of Therapists in Helping Couples Cope with Stillbirth and Newborn Death’, Family Relations, vol. 38, no. 3, 1989, pp. 248-253. 592 Mary Sila-Mato, ‘Statement of Definition of the Distinctive Role of Chaplaincy at the RWH’, in The Royal Women’s Hospital Perinatal Death Procedure Manual, Box 454 A1999/09/3.1, RWH Archives. 593 Jennings, interview with researcher. 594 Jennings, interview with researcher.

187 professional which aimed to better educate the novice midwife as to how to adapt their care in situations of loss.595

This formalised response to perinatal death greatly altered how women were cared for in several Western Australian hospitals – and in particular KEMH - in the late twentieth century. Whilst the experience was still highly traumatic for many women – Michelle, for example, described the death of her first child as ‘just tremendous sorrow, shocking. The worst experience … people can go through’596 – many bereaved mothers in the 1990s were increasingly cared for within the confines of the hospital with compassion and empathy carefully modeled on recommendations by psychologists researching the psychological impact of perinatal loss. For example, when Christine’s first baby was stillborn near term in the late 1990s, she experienced the model of ‘continuity of care’ from a small group of midwives, and she remembers that although the doctors were, in her perception, somewhat ‘aloof’ and uninvolved, several individual midwives in particular were willing to involve themselves in the personal tragedy that Christine and her partner were experiencing. She recalled that ‘there was one particular nurse … and she’d come in every day and give me a kiss and a cuddle, and she’d say, ‘you had any sleep?’ I’d say, no, not real keen on that. ‘That’s alright’ [she’d say] ‘but you need to get some sleep’’.597

The midwives dressed Christine’s baby son, took photographs and footprints for the Grief Kit and strongly encouraged Christine to hold her baby over a period of several days, even though he had multiple congenital disorders and was, in Christine’s words, ‘a pretty sick baby’.598 Similarly, Brenda remembers one particular midwife who ‘sat up all night, hour after hour, [because] I couldn’t sleep, and she just sat there and talked to me’.599 Her experience was not isolated; many hospital staff that had direct contact with bereaved parents went out of their way to show their care and concern. According to Libby Lloyd, midwives and social workers would often attend funerals held in the hospital chapel and

595 In her interview, Jennings expressed her belief that, prior to the early 1990s, the most inexperienced midwives were assigned to care for those whose babies had died or been stillborn, because of the belief that they could do ‘no further harm’. See Jennings, interview with researcher. 596 Michelle, interview with researcher, 3 August 2005. Tapes and transcript in possession of researcher. 597 Christine, interview with researcher, 7 June 2005. Tapes and transcript in possession of researcher. 598 Christine, interview with researcher. 599 Brenda, interview with researcher.

188 would sometimes share with mothers their own stories of loss.600 In her interview Claire recalled ‘one nurse coming in the morning after when they’d moved me off the labour ward, down to this other ward in my own room, and she’d experienced the same thing herself and she came and gave me a big hug and was crying with me’.601

Because parents were often keeping their deceased babies in their rooms for longer it was becoming rarer for mistakes to be made, as described in the previous chapter, such as presenting the wrong baby for a viewing, but when such did incidents occur through miscommunication or negligence, some staff went out of their way to alleviate any pain caused. An incident at RWH in 1990, for example, illustrates the dedication of the social work department in providing individualised care. Late one afternoon a bereaved father had complained to social work staff that his son, stillborn at the hospital and later transported to a private funeral home, had been left by the parents dressed in clothing knitted by the mother, as they wished the baby to be buried in this outfit. When the father had requested to see his child at the funeral home one last time, he had discovered that the infant was naked, much to his distress. It transpired that mortuary workers had undressed the child, mistakenly assuming that the clothing belonged to the hospital, and sent the clothing to a central linen service. With the funeral for the baby scheduled for the next morning, several social workers stayed past normal working hours in order to find the clothes, launder them, and to take a taxi to the parents’ home in order that the baby could be buried in the special outfit.602

Despite some of their colleagues’ reticence, some obstetricians and gynaecologists also increasingly embraced the notion that bereaved parents should be treated with empathy and sensitivity, and some doctors confessed that their training had left them unprepared for caring for a patient whose baby had died. A survey of junior medical officers found that whilst sixty five percent felt suitably confident to physically examine a patient, only thirty five percent were sure of their abilities to break bad news, such as poor foetal diagnosis or

600 Lloyd, interview with researcher. 601 Claire, interview with researcher. 602 Case of Mr B, as reported by Sue Dower, memorandum to the Director of Medical Services, Dr Wellington, 10 May 1990. Unpublished document held in RWH archives.

189 intrauterine death, to a patient.603 Accordingly, in 1995 the Royal Australian College of Obstetrics and Gynaecology introduced a unit in behavioural medicine into the programme for membership into the College.604 Some hospitals began to educate postgraduate medical students about the likely impact of perinatal death on the lives of affected women. Members of SANDS (WA) addressed a group of postgraduate students in February 1990, for example, with a lecture titled ‘What I would like my doctor to be if I lost my baby’. This lecture dealt with such revelatory concepts as ‘breaking bad news gently’ and with empathy in a quiet environment, ensuring that the mother be well supported by a family member or friend, and stressed that some parents may need information repeated several times over in language they could understand.605

For those obstetricians who had been trained in decades past and who had begun to accept the changing understandings of the possible meanings of perinatal death, it was perhaps more likely that compassionate care was a lesson learnt after witnessing the tragedy many times. Although the wider community believed that stillbirths and neonatal deaths rarely occurred, most practising obstetricians would have still have had contact with bereaved parents. For example, Michelle’s baby was stillborn at thirty five weeks after an otherwise uneventful pregnancy. Although she had been a nurse herself, Michelle had had little professional experience of miscarriage and stillbirth, and was shocked to find that her obstetrician faced a similar ordeal with other patients ‘at least once a month’. Throughout Michelle’s labour, the obstetrician was clearly emotionally involved and Michelle found out some time later that he was visibly affected at work the following day.606 Some doctors openly rejected the attitude of aloofness and distance of the past; the Melbourne obstetrician Norman Morris, for example, was quoted in a front-page article in the Victorian daily newspaper The Age as confessing that his profession had, in the past, mishandled incidents of perinatal loss out of professional pride: ‘I think obstetricians have, until recent times, handled it pretty badly … People come to us expecting a live baby. When they deliver a dead baby, we as a group feel we've let them down’. Morris went on to

603 Jill Cockburn and William A.W. Walters, ‘Communication between doctors and patients’, Current Obstetrics/Gynaecology, 1999, vol. 9, p. 36. 604 Cockburn and Walters, ‘Communication between doctors and patients’, p. 36. 605 SANDS address to postgraduate students, ‘What would I like my doctor to be if I lost my baby’, February 1990. Unpublished document held in KEMH Social Work archives. 606 Michelle, interview with researcher.

190 say that Australians in general ‘handled death badly’; in the past, he argued, Australians were part of a community ‘that denies death’. 607

From shielding to embracing

Within the context of the formalising of hospital policies it was now accepted practice that women were not only allowed to hold their babies but that they be encouraged to do so.608 Whereas in the 1980s some women were allowed to briefly hold their babies – often provided the child was not ‘too deformed’ - by the 1990s the emphasis had largely shifted to helping women form emotional attachments to their deceased or dying infants, even if such deformities were present.609 Women who had delivered stillborn babies were now, at least in the hospital context, considered to be mothers, and it was now regarded as part of the hospital’s responsibility to help bereaved women bond with their children.610 The ‘unknowable’ stillborn baby was now regarded as eminently ‘knowable’ through the enactment of rituals that were similar to those following a live birth. This often involved keeping the baby in the mother’s room for at least some of her stay in hospital, measuring and weighing the child, and bathing, dressing and naming the baby. For all the women interviewed, the time spent with their baby was a precious time, and they used the opportunity to cram in what should have been years’ worth of parenting.

Both Christine and Kelly had witnessed their respective sisters’ experience of stillbirth so

607 Norman Morris quoted in Jennifer Alexander, ‘When a Baby Dies’, Age, 9 December 1992, p. 1. 608 Marilyn Kenny observed that ‘over the last decade there has been marked improvement at the Royal Women’s Hospital in addressing the needs of bereaved parents. This has come about by encouraging parents to express their sense of loss and listening to how they perceive we can help them. We have acknowledged that the death of an infant is an important event for parents and that parents should, if their grieving is to run its normal course, be encouraged to acknowledge the event in appropriate ways. It is now routine practice in this hospital for parents to see and hold their stillborn infant, or one who dies in the neonatal period, for photographs to be taken of the infant with or without parents, by hospital staff; for parents, family and friends to view the baby dressed, or have the baby dressed in clothes that they provide, and for baptism, memorial, commemoration and other religious services to be held’. See Kenny, Management Course Task – Administrative Project, Hospital Burials’. 609 For example, Australian midwife Jane Warland suggested that ‘fear may well be the driving force in parents deciding not to see their baby, particularly if there is abnormality or maceration involved. Midwives need to acknowledge the parents’ fear but work through it to produce an acceptance of the baby as a person, entitled to acknowledgment irrespective of how he looks’. See J. Warland, The Midwife and the Bereaved Family, Melbourne: AUSMED Publications, 2000, p. 56. 610 See Jennings, interview with researcher; Lloyd, interview with researcher.

191 knew what to expect in terms of seeing the deceased infant.611 Christine’s sister had delivered a stillborn baby a few years earlier and her insistence that Christine hold the baby would, ironically, stand Christine in good stead for when her own child was stillborn. She recalled that she ‘just looked [at the baby]. I was horrified. Absolutely horrified. She said, “are you going to hold him?” I said, “I can’t”. And she said, “hold him”. So I picked him up and it just changed everything. My fear, everything, went away. And I remembered from that experience, how important it was to hold [my son]’.612

With the introduction of formal policies designed to oversee the management of perinatal death came the danger that all women were treated the same, and that the unique nature of the event – which would be influenced be cultural background, relationship status and a myriad of other variables – would be homogenised. This danger was recognised by staff on the Advisory Council at KEMH, and formal policies were given a degree of flexibility – a recognition which gave women agency to decide, within limits, how they wished to be responded to by staff in the hospital.613 For example, where Kelly was able to discharge herself from hospital the day after the delivery, returning to the hospital every day to visit her deceased daughter, Christine was encouraged by midwives to stay in hospital as long as she needed before facing her empty house.614 As a single mother with a limited support network, Claire was also treated with care appropriate to her particular situation. Although she was put in a private room, she was fairly close to the nursery and remembers going to the nursery to see the babies, and having ‘a mini breakdown’. Despite one older nurse scolding her for being near the babies, another midwife later took her back to the nursery with the express purpose of allowing Claire to cuddle one of the babies, recognising her deep need to embrace a baby.615

Whereas in the past parents’ questions about reasons why their infants had died were deflected or ignored, deemed as ‘undesirable’ knowledge, some staff began to believe that parents had every right to have these questions answered satisfactorily and truthfully. The

611 Kelly, interview with researcher, 24 May 2005. Tapes and transcript in possession of researcher; Christine, interview with researcher. 612 Christine, interview with researcher. 613 See the Stillbirth and Neonatal Death Support (SANDS) Submission to Centre for Women’s Health, c1996. Unpublished document held in KEMH Social Work archives. 614 Kelly, interview with researcher; Christine, interview with researcher. 615 Claire, interview with researcher.

192 manifestation of a culture of silence from decades past was a fear of procedures such as autopsy, and it was a matter of concern to many hospital directors that many parents refused a post mortem, afraid as to what would be done to their child. The various Human Tissue Acts in respective state legislation meant that autopsies could only be performed on the deceased with the consent of the next of kin, and many parents chose not to give their consent.616 Some perinatal pathologists and social workers felt it was important to demystify the concept of the autopsy and so the idea of plain language reports was born.617

Increasingly patients were demanding that they be treated with respect and dignity and there was a growing expectation amongst the community that the medical profession had a responsibility to inform patients of their condition in understandable language and terms. The plain language report was driven largely at KEMH by the conviction that parents deserved to be informed in an understandable manner as to any reasons – if known – why their baby had died. Simon Knowles, a perinatal pathologist at KEMH in the 1990s, believed that autopsy was vital in acknowledging the value of that individual child: A post-mortem is worthwhile both for the caregivers and for the parents, quite apart from the amount of medical help it provides. It reinforces the existence of the infant as an individual in his or her own right and helps to underline the fact that the medical attendants consider the baby (and the family) sufficiently important to deserve a full and caring investigation.618

Parents also began to embrace the funeral service believing it to be an empowering ritual that would help them properly say farewell to their baby. As discussed in Chapter Four, some major hospitals had begun to offer more formalised memorial services for babies under twenty eight weeks gestation, which provided parents with the economically accessible option of hospital cremation and burial, but also afforded them the dignity of a memorial service that validated and recognised their child’s existence. For Claire, the

616 The Director of Pathology at RWH strongly opposed what he believed to be social workers unduly discouraging parents from consenting to autopsy; it was his opinion that, in a misguided attempt to help parents grieve, many social workers were discouraging parents from consenting to autopsy. See Fortune, letter to Flower, 14 December 1987. 617 For example the SANDS (Vic.) checklist was circulated in mid 1986, informally through the hospital and to Dr Flower & Head of Nursing Mrs McArthur and Sr L Wilson. See SANDS (Vic.) Perinatal Death Nursing Checklist. Unpublished document held in RWH archives. The Minutes of a 1993 SANDS Advisory Council meeting also recorded that Simon Knowles, perinatal pathologist at KEMH, had attended a public meeting about perinatal autopsies and noted that there were ‘big issues [of] dignity and empowerment. Relatives upset, very little control over [coronial] autopsies’. See SANDS (WA) Advisory Council, Minutes, 4 March 1993. Unpublished document held in KEMH Social Work archives. 618 Simon Knowles, ‘Perinatal Pathology: Working with and for the family – the hospital team’, SANDS Conference Presentation, 1990. Unpublished document held in KEMH Social Work archives.

193 decision was a significant one; although she had initially wanted to have her daughter cremated and interred in a cemetery, the cost was prohibitive and the idea of a tiny coffin was difficult to bear. The memorial garden at KEMH was an attractive option, particularly the idea that her baby would be interred with other infants – ‘like a little baby heaven’. The garden also provided a reflective space for those women and their families who chose hospital cremation. Claire visited the garden each year for several years, just to sit in the gazebo and reflect on her baby’s death.619

Many cemeteries around the country had responded to pressure – usually through groups such as SANDS – and the advice of hospital social workers to provide an area appropriate for the interment of stillborn children or neonatal deaths. For example, after nearly a decade of discussion and planning, the Metropolitan Cemetery Board of Western Australia [MCB] had opened the Infants Butterfly Garden in the early 1990s which was a private area within Karrakatta Cemetery dedicated to babies dying before birth or shortly afterwards, and provided for the interment of ashes with a range of memorial options such as butterfly plaques and wind sculptures symbolising ‘the spirit of the child’. Pinnaroo Valley Memorial Park, also operated by the MCB, also became a popular choice for bereaved parents from the 1990s. In a bushland setting, with native wildlife and flora, the park is particularly serene and beautiful. Michelle and her husband chose to bury their infant son at Pinnaroo because of the peaceful nature of the park and the fact that other babies and young children were buried there: ‘he overlooks a lake, and it’s very peaceful. And a lot of babies are up there. And children. Some of it is upsetting [but]… I go up there when I need some peace, I find it peaceful’.620

With more parents able to actively participate in their baby’s funeral, it was now more likely that friends and relatives were able to attend the service and share to some degree in the couple’s loss. Before her son was interred at Pinnaroo, Michelle and her family held a funeral service in the chapel of the private hospital where the baby was delivered, to enable friends from the labour ward to attend. In the past, women were often discouraged or even disallowed from attending their child’s funeral, for fear that it would unduly ‘upset’ them. Most women in the 1990s were sufficiently empowered to not only attend the service but to

619 Claire, interview with researcher. 620 Michelle, interview with researcher.

194 make significant decisions regarding the arrangements. Brenda, whose son was also interred at Pinnaroo, was very sick following delivery and it was some time before she was well enough to participate in funeral arrangements. However, her husband insisted that Brenda be present at all meetings as he felt strongly that a meaningful service could only be organised taking her bond with the baby into account: [My husband] was really the one that wanted me there too, ‘cause he said, I don’t know a lot about [the baby] - you see he missed out, I feel so bad for him because he missed out on so much, but then he really drew on me for information …he liked certain music, he loved the 4WD, he was going to be a boys boy! (laughs). And [my husband] was really good, he said to the funeral director that he wasn’t going to make any decisions without [Brenda], so they didn’t push for anything … They were good on the day as well.621

For Christine and her partner, the funeral service was significant in that it enabled them to actively acknowledge that their baby had been a vital part of their lives even in utero, and also gave them the opportunity to perform parenting rituals that they would never be able to enact for that child again. Christine wrote a letter to her son that was then placed with his ashes: ‘it just told him that he would be looked after by the kangaroos and the ducks [at Pinnaroo Valley] and that we would come to visit’.622 At the funeral service, Christine and her partner chose the words from a song by popular Australian band, Hunters and Collectors, to symbolise their feelings for their child, which the chaplain from KEMH read: I dreamed of you at nighttime And I watched you in your sleep I met you in high places I touched your head and touched your feet So if you disappear out of view You know I will never say goodbye And though I try to forget it You will make me call your name And I'll shout it to the blue summer sky And we may never meet again. So shed your skin and let's get started And you will throw your arms around me.623

At an official level the major faiths in Australia prior to 1990 – specifically, Roman Catholicism and Protestantism – had also treated perinatal death as a taboo event and several women interviewed had found little comfort from the church following the death of

621 Brenda, interview with researcher. 622 Christine, interview with researcher. 623 Mark Seymour, ‘Throw Your Arms Around Me’, from ‘Human Frailty’, Hunters and Collectors, Mushroom Records: 1986.

195 their babies. For example, although she was visited in hospital each day by an elderly priest for a blessing, Lena, whose baby was stillborn in 1988, found the priest to be ‘an old man really’ who simply could not understand her circumstances. As previously discussed, some women had also been subject to blame by members of the clergy, such as Liz, who was told that her babies had died because she had been sexually active before marriage.624 Both Roman Catholics and Protestants had been active for several decades in the abortion debate,625 and it was accepted in the late 1990s that recognition of the loss of an infant before birth was corollary to the belief that human life began at conception and was sanctified and created by God.626 Similarly, both the Uniting and Lutheran churches introduced a service specifically for babies dying in utero or shortly after birth, changes that reflected a more widespread understanding of how pregnancy loss and perinatal death could potentially devastate a family.627

Through his work at KEMH Anderson was one who recognised a gaping void in the Anglican liturgy.628 The last revision of the Anglican Church’s prayer book was in 1978 and the funeral services did not provide for stillborn children or those dying within a few weeks of life. This is of course unsurprising, considering that many parents would have opted for a hospital arranged burial without a religious service; for those rarer instances where the parents requested a religious service, it is most likely that the individual clergyman involved adapted the existing funeral services for older children and adults. One Anglican minister, for example, broke with tradition to add to the existing funeral service a prayer for those who mourn, asking that God would ‘deal graciously … with those who mourn, that casting every care on you, they may know the consolation of your love’.629 The changes to the liturgy of the major Protestant churches signified a more formal recognition of the emotional devastation caused by a stillbirth or neonatal death. Although some in the Anglican tradition rejected the new prayer book in its entirety on principle, on the basis of

624 Liz, interview with researcher. 625 Since the 1970s, the issue of legal abortion had been fiercely contested in Australia. For more on the concerns of both the so-called ‘pro-choice’ and ‘pro-life’ groups, see Siedlecky and Wyndham, Populate and Perish, p. 60; Stephanie Grayston, ‘Changing Attitudes and Services: Abortion in Western Australia, 1970- 1990’, in P. Hetherington and P. Maddern (eds.) Sexuality and Gender in History: Selected Essays, Nedlands, WA: University of Western Australia Press, 1993, pp. 242-254. 626 See for example Grant, Richard, ‘Remembrance Services: Letter’, AD2000, vol. 13, no. 11, p. 15 627 See Tobin and Griffin, In the Midst of Life, p. 140. 628 Anderson, interview with researcher. 629 Right Reverend Peter Brain, personal correspondence with researcher, 27 October 2005. Letter in possession of researcher.

196 theological revisions and a more ‘inclusive’ liturgy,630 the provision of a service specifically for an infant provided a much needed resource for those who came to the church for support following the death of a baby and it was widely accepted by the Church as such.631

The formal funeral service ‘for an infant dying near the time of birth’ in the revised A Prayer Book for Australians was prepared specifically for the ‘burial or cremation of a baby who dies in the womb, or is still-born, or who dies shortly after birth’, and constructed perinatal loss as a unique and complex event, with the introduction to the service noting that services for babies were usually small affairs but ‘powerfully intimate’.632 The liturgy for the funeral of a baby was founded on the belief that God had created that child for a purpose, quoting Psalm 139 as evidence of this: You created my inmost parts; You knit me together in my mother’s womb. You know my soul, and my bones were not hidden from you: While I was being made in secret, and woven in the depths of the earth. Your eyes saw my limbs when they were still unfinished: All of them were written in your book.633

Prayers used in the service urged parents to trust that He had their child safe in His care, for example the prayer ‘Remembrance of a baby who has died at or before birth’: Heavenly Father Your love for all your children is strong and enduring. We were not able to know [baby] as we hoped. Yet you knew her/him growing in her/his mother’s womb. In the midst of our sadness, We thank you that [baby] is with you now.634

630 John G. Mason, ‘A prayer book for Australia?’ ACL Online, July 1995. http://acl.asn.au/old/mason_pbrk.html. Accessed 15 January 2008. 631 Although the Sydney Diocese of the Anglican Church of Australia had rejected the new prayer book on the basis of its ‘non-Biblical inclusiveness’ and theological revision, most pastors used the funeral service for a baby when necessary. See Brain, personal correspondence with researcher; Mason, ‘A prayer book for Australia?’ 632 Anglican Church of Australia, A Prayer Book for Australia [APBA], Sydney: Broughton Books, 1995, p. 754. 633 Psalm 139 (New International Version) quoted in Anglican Church of Australia, APBA, p. 754. 634 Prayer ‘Remembrance of a baby who has died at or before birth’ in Anglican Church of Australia, APBA, p. 758.

197 Filling in the gaps: educating about diverse needs in Western Australia

The disparity between services in the metropolitan area and rural areas was no more obvious than in the massive state of Western Australia. Although many women were flown to Perth after ultrasound or other tests detected a potential problem with the pregnancy, many Western Australian women were still delivering stillborn children or suffering the death of a newborn in country areas and it had become apparent to some staff at KEMH that some areas lagged behind their city counterparts in terms of the knowledge and skills to best manage perinatal death in these areas. To further compound the problem, rural communities were often unable to comprehend the depth of loss for those women who did deliver their child in a city hospital, many kilometres away from home. For example, Brenda and her husband were living in a small south-west town when she became pregnant with their first child, and as high-profile members of the community,635 Brenda felt that the community in general shared in the couple’s excitement and anticipation. However, because the baby was delivered at KEMH, Brenda returned to her home feeling like she was ‘in a bubble’. The reason for her absence from the town went generally unmentioned, although people obviously knew what had happened and Brenda felt like she was on display when she did venture out in public: ‘[people] wouldn’t go anywhere near me but they were … about twenty five metres away from [me] just staring’.636

The Western Australian Rural Pregnancy Loss Team, or the Roadshow, as it was affectionately known, was formed in the early 1990s, and was funded in part by a grant from Healthway, a state government agency in Western Australia established in 1991 to promote and fund health projects637 for the purpose of travelling to country areas to provide support and education for local caregivers, as well as to promote local support groups in the area.638 The Roadshow’s beginnings were grounded in the findings of Margaret Nicol and the notion that women suffering some form of perinatal death often had ‘moderate to severe

635 Brenda’s husband was a policeman in this small town at this time. They later requested, and were granted a transfer on compassionate grounds because Brenda felt that she ‘needed to leave’ such a small community. Brenda, interview with researcher. 636 Brenda, interview with researcher. 637For more information on Healthway and its role see http://www.healthway.wa.gov.au/internal.aspx?MenuID=454. Accessed 15th December 2007. 638 Simon Knowles, ‘A Passage Through Grief – the Western Australian Rural Pregnancy Loss Team’, British Medical Journal, vol. 309, p. 1705.

198 deterioration in their health following the loss,’639 which was further compounded by the isolation and lack of knowledge in rural areas. Particularly in the transient north of the state, morbidity following pregnancy loss was substantial, and as Knowles observed, ‘largely unrecognised’ within the community.640 Growing out of the presentation to the SANDS Conference, the Rural Pregnancy Loss Programme was remarkable in its multidisciplinary approach to sharing knowledge and marked a more cohesive attitude between departments at KEMH. Libby Lloyd was part of the project, and remembers it as: A very comprehensive programme, very well thought through and designed. It comprised of chaplaincy, social work, midwifery, SANDS and pathology, and we went to a country town on invitation, that was important, we did sessions for all the professionals in town, we usually had lunch with the GPs who were too busy to come to the session, and downloaded some of the information for them, and in the course of the one day workshop we would at some point break up into our professional sub groups and have mini workshops there, and in the evening we would have an open session for the public, to promote SANDS and so on, and … of course we would leave behind good written material and offer to be ongoing consultants - so that whole sequence was really designed to strengthen to local awareness and support networks.641

Staff working with women in the clinical setting had begun to construct perinatal loss as a complex experience, and articulated the belief that cultural diversity would lead to a great variety of needs. Particularly in the major teaching hospitals, there existed a wide range of cultural backgrounds and it became clear that the management of perinatal death could not be followed with a ‘checklist’ approach.642 Lloyd recalls that ‘in the early days a presumption was that everyone was the same and that meant that everybody was an educated Caucasian’.643 However, particularly at major maternity hospitals such as KEMH and RWH, staff had begun to request training in cultural diversity.644 For example, different religions have vastly different requirements in terms of burial, and Lloyd

639 Knowles, ‘A Passage Through Grief’, p. 1705. 640 Knowles, ‘A Passage Through Grief’, p. 1705. 641 Lloyd, interview with researcher. 642 Lloyd noted that ‘[KEMH] is the state centre, so we certainly get indigenous people, refugee people from a variety of cultures, any faith you’d like to mention, we have forty different language groups and umpteen different cultural groups so when you’re setting up professional development these days a very common request from staff is, tell us all about the different cultural groups, so they’re keen to do the right thing. So again, you’re still trying to help people practice … mature practitioners in whatever their profession in a way that is attentive to the individual and not be routine about it, because there’s nothing routine about death’. Lloyd, interview with researcher. 643 Lloyd, interview with researcher. 644 See Margaret Peters, Deputy Director of Nursing, memorandum to PDMC, 28 October 1983. Unpublished document held in RWH archives.

199 remembers that most staff increasingly ‘bent over backwards’ to accommodate diverse cultural and religious customs: Of course there is universals involved in death, but certainly at King Edward my observation is that people bend over backwards to adapt to individual needs so that parents who want to take home the dead body, parents who want to show the baby to people, to have the baby in their room for long periods of time, come back and see the baby afterwards, have this ritual, that ritual, have the funeral the same day for Islamic people, anything you like, take the body to some remote area, take the ashes somewhere, have just their baby’s ashes for the very young ones, not mixed in with all the other ashes, almost anything, produce some unusual clothing for the baby to wear, anything you like, we’ll adapt to.645

Quite separate from the issue of cultural diversity was the breaking down of gender stereotypes. For many decades men were either absent – by custom, choice or otherwise – when their partner actually delivered the baby, and the only role they were given to play in the drama was the strong, decisive partner who would ‘take care’ of all arrangements, ostensibly to ‘protect’ the woman from the tragedy but often serving to rob her of any sense of agency in the experience. Whereas any change in the 1970s and 1980s had affirmed the cultural assumptions of masculine absence in perinatal death by focusing solely on the woman’s needs and experience, writers in the mid 1990s began to explore the impact of perinatal death on the father of the child, and what their specific needs were in terms of postnatal support and care.646 Of course, not all women experiencing perinatal death were supported by the baby’s father, but many women were and those interviewed felt keenly for their partner, aware that of the pressure they were facing to be ‘strong’ for their wives; Brenda, for example, recalled that her husband ‘would go and cry in the shower, quietly, so I didn’t have to hear him crying, so he could be strong for me. He didn’t want me to see that he actually had trouble’.647

Several Australian studies began to question the role that men were typecast to play when their wives or partners gave birth to a stillborn child. Simon Knowles, for example, had argued that the health care system had traditionally imposed upon fathers the role of

645 Lloyd, interview with researcher. 646 See for example Diane McGreal, Barry J. Evans, Graham D. Burrows, ‘Gender Differences in Coping Following Loss of a Child Through Miscarriage or Stillbirth: A Pilot Study’, Stress Medicine, vol. 13, no. 3, 1997, pp. 159-165; Brett O’Neill, ‘Stories: A Father’s Grief, Dealing with Stillbirth’, Nursing Forum, vol. 33, no. 4, pp. 33-37, F.M. Boyle, J.C. Vance, J.M. Najman, M.J. Thearle, ‘The Mental Health Impact of Stillbirth, Neonatal Death or SIDS: Prevalence and Patterns of Distress’, Social Science & Medicine, vol. 43, no. 8, 1996, pp. 1273-1282. 647 Brenda, interview with researcher.

200 ‘protector and organiser’.648 Kate Caelli et al argued that men and women did indeed grieve differently, particularly that men grieved less intensely and for a shorter duration, but stressed that men did often grieve the death of their child and also needed support and care after the event.649 Miro, for example, remembers that after his son died during labour in 1995 the baby was bathed and dressed by the midwives, after which Miro sat with him in an armchair, just as father and son: ‘the cricket was on the TV in the room, and I sat with him close to the bed and watched the match, speaking to him that all I wanted to do was to be a dad and play cricket with him like other dads do, and I probably said a million other things too’.650

Without appropriate care for men, the writers warned, the loss of the baby could be compounded by marital stress leading to breakdown of the relationship. To prevent this, it was the responsibility of the nurses and midwives caring for the family to ‘ensure that patients in this situation are prepared for gender differences in grieving’.651 Importantly, the management of perinatal death within the clinical setting became gradually more geared towards the family rather than focused solely on the woman. SANDS (WA) for example, sought funding to assist Margaret Nicol to produce three videos which would cover the issues of grief from the perspective of fathers and siblings, as well as the impact of grief on any subsequent pregnancy.652 SANDS (WA) also produced a pamphlet for inclusion in the Grief Kit that specifically addressed the different grieving patterns of men and women, designed to ease any tension between the parents.

Gendered expectations of grief after perinatal loss: women’s experiences

Whether or not perinatal death does significantly contribute to marriage breakdown remains a matter of conjecture but it is clear that the different expectations of men and women sometimes led to great stress within a relationship. After the death of her son, Brenda became active in SANDS and remembers many support meetings where women would share their stories of tension and stress between themselves and their partner which

648 Simon Knowles, ‘A Passage Through Grief’, p. 1708. 649 Caelli et al, ‘Parents’ Experience of Midwife-managed care’, pp. 127-136. 650 Miro, personal correspondence with researcher, 7 August 2005. Letter in possession of researcher. 651 Caelli et al, ‘Parents’ Experience of Midwife-Managed Care’, pp. 127-136. 652 SANDS (WA) Advisory Council, Minutes, 3 March 1994. Unpublished document held in KEMH Social Work archives.

201 inevitably led to the breakdown of the relationship.653 Although the information supplied to parents often naturalised the differences in gender responses to perinatal death, most women found that this knowledge helped them to understand their partner better. In Kelly’s experience, her husband was her ‘rock’, but she soon realised that they grieved their daughter’s death in different ways: He was really supportive and he was just there. He would just listen, and he would do a lot in that regard. He explained to me [as] the anniversaries have come and they’ve obviously had more impact on me each year, where it’s still an impact on him, but because he didn’t carry her, he didn’t deliver her, he didn’t get to bond with her in that regard before she was born – he feels a lot but it’s obviously nowhere near as great as what I feel, in that regard. Which I understand, but at the time [it was hard].654

Some families did experience loving, supportive care after their baby’s death that would continue long after the immediate shock had worn off, although many soon found people becoming impatient with the intensity and duration of their grief. Indeed, whilst acknowledging the support of close friends and relatives, Brenda admitted that ‘I think we jagged it’.655 For some women who were not so fortunate, the support group became a kind of haven where they could share their pain with people who knew, to some degree, what they were experiencing.656 The value of such self help groups was their ability to give a parent ‘permission’ to grieve, particularly when others refused to acknowledge the depth of the loss.657

Conclusion

The impact of second wave feminism and the consumer rights’ movements of the 1970s and early 1980s in Australia reached those caring for bereaved parents within the hospital environment towards the last fifteen years of the twentieth century. The transformation of

653 Brenda, interview with researcher. Another interviewee commented that her husband used to refer to SANDS as ‘Death Women’; her participation in SANDS was a source of tension for the couple. Janet, interview with researcher, 3 August 2005. Tapes and transcript in possession of researcher. At Janet’s request, this is a pseudonym. 654 Kelly, interview with researcher. 655 Brenda, interview with researcher. 656 Jennifer, interview with researcher. 657 Layne notes that the contemporary support group for bereaved parents is ‘fundamentally designed to break [cultural] silence. Through their meetings they carve out a space in which it is permissible to speak, and with the claim that pregnancy loss is a legitimate source of grief, they define loss as an acceptable topic of conversation outside of support-group meetings’. See Layne, Motherhood Lost, pp. 74-75.

202 attitudes towards the likely impact of a perinatal death wrought radical changes in the way that women, and by extension their families, were treated by health care professionals: where women were shielded from their deceased infants in the past, the last decade of the twentieth century was characterised by the belief that women did form attachments with their unborn baby, and that these attachments should be fostered and respected even if the pregnancy ended in death. Parent-driven groups, most notably SANDS, worked with health care professionals to implement ways of encouraging parents to bond with their deceased or dying infants, such as the Grief Kits at KEMH, and establishing of dedicated spaces for reflection and memorialisation in cemeteries and hospital grounds around Australia. Although the construction of perinatal loss as a significant event was challenged towards the end of the twentieth century - as I argue in the final chapter - the changes in hospital policy had enormous impact on the way that some Western Australian women were able to memorialise and publicly express their sorrow for the death of their infants.

203 CHAPTER SEVEN

‘I’d just like to die with a bit of peace’: renegotiating and reinscribing perinatal loss

As she considered the changing ways in caring for women whose babies were stillborn or who died shortly after birth towards the end of the twentieth century, Libby Lloyd observed that these changes did not only affect those women who suffered a perinatal loss towards the end of the twentieth century: We get older women and sometimes their daughters contact the hospital requesting information about a previous death of a baby or loss of a pregnancy where they were left in the dark. They didn’t see the baby, didn’t hear what sex it was, didn’t have any ritual, weren’t told where it ended up, and so often later in their life, they’re starting to revisit those painful little nooks and crannies of their life and wanting to get some closure by way of at least information about what happened.658

As I have explored in more detail in previous chapters, women who lost a baby in the post- World War II period were most likely never able to see or hold their infant, and many were not told even basic information such as the child’s sex or any possible explanation for what had contributed to the infant’s death. Oral history suggests that very few women left hospital knowing how and where their infant was buried, having had little or no input into these important decisions. It was, as British obstetrician Stanford Bourne observed in the late 1960s, as if the event had never existed at all, a ‘non-event’.659

However, the greater openness towards death and the shift away from the inscription of the foetus as replaceable and unknowable had seen dramatic changes in how many women were cared for within the clinical setting: for some women, the contemporary public interest in stillbirth and its increased visibility within the community led to their memories being reshaped and recast within a different framework. The public repression of stillbirth and neonatal death was re-framed, to a degree, within a culture of greater openness towards death and bereavement by the late 1990s.660 The expectation of ‘spartan control’ which had characterised the interview years was displaced by the construction of grief as a liminal and

658 Lloyd, interview with researcher. 659 Bourne, ‘The Psychological Effects of Stillbirth on the Doctor’, pp. 103-112. 660 Jalland argues that the cultural shift away from ‘emotional and expressive dying and grieving’ was challenged in the late twentieth century: ‘death and bereavement [have] again become topics of intense public concern and discussion, stimulated by the AIDS epidemic, by debates about euthanasia, and by reaction against the medicalisation of death’. See Jalland, ‘A Private and Secular Grief’.

204 highly individual experience; instead of the repression of expressive grief was, as Damousi notes, the encouraging of a ‘more open and frank expression of grief’.661 In the late twentieth century the cultural avoidance of grief and loss has gradually been recast to an emphasis on the ‘need to grieve’ particularly for older Australians who were once encouraged to repress their painful experiences with stoicism and to ‘move on’ from a bereavement.

In this chapter, then, I consider some of the ways in which a group of older women renegotiated their often traumatic and repressed memories of babies who had died within the context of a culture dominated by silence and avoidance; experiences which were reinterpreted within the contemporary context of greater acknowledgement of perinatal death. In doing so I further explore the impact of the radical changes to the clinical management of perinatal death, discussed in Chapter Six, which would affect not only those women experiencing the death of a baby towards the end of the century, but also opened a space for some older women to revisit and re-negotiate their experiences of a long-ago perinatal loss. I also explore the ways in which some older women have remembered their past experiences as interpreted through changing cultural context. Whilst some women welcomed the opportunities wrought by changing understandings of perinatal death, other older women continued to express their memories of perinatal loss with an appeal to the ‘spartan control’ of the postwar period; their personal narratives give insight into the complexity of memory and the diversity of meanings given to perinatal loss by individual women.

Raising awareness: community interest in perinatal loss

Towards the end of the twentieth century the work of support groups such as SANDS had played a significant role in re-inscribing understandings of the foetal body and perinatal death within the community, with some sectors of the popular media in particular beginning to demonstrate a willingness to explore the issue of emotional impact after a stillbirth or

661 The model of a ‘grieving process’ or series of ‘stages’, proposed initially by Kubler-Ross, was challenged towards the end of the twentieth century. Damousi argues that ‘interviews with war widows reflect what Littlewood characterises as ‘wave after wave of violently contradictory impulses’’. Over time, continues Damousi, there is a ‘reviewing process’ of the event which precipitated the grief response, ‘where the meaning of each memory is dissected and considered’. See Damousi, Living with the Aftermath, pp. 166-167.

205 neonatal death.662 Major metropolitan newspapers began to run stories about the activities of parent support groups in the late 1990s that would have been considered in poor taste and morbid only ten years previously;663 similarly, letters to the editor from bereaved parents were significant in their unheard-of openness and honesty about the personal cost of perinatal death. Susan Pain, for example, whose son died in utero only hours before birth, wrote a moving and frank letter to the editor of the Victorian daily newspaper, The Age following the paper’s reporting of funding cuts that threatened the survival of the Victorian branch of SANDS. In this letter Mrs Pain wrote of the emotional turmoil she and her husband went through after her baby’s death, paying tribute to SANDS for ‘allowing [her] to remember while helping [her] to move on’.664

Although testimonies from women involved in the oral history project of this thesis suggest that the contemporary support group held limited appeal for many older women, its role in the latter years of the twentieth century was not limited to the support of women who had recently lost a baby or experienced a miscarriage.665 By raising public awareness of many women’s desire for the validation and memorialisation of their baby, the work of the support group helped to directly and indirectly open up previously forbidden ways for many older women to recast their memories of a long-ago perinatal loss.666

For some women, the renewed public interest in stillbirth and its increased visibility within the community led to their memories being reshaped and recast within a different

662 Linda Callaghan, ‘What do you tell a mum who has lost her baby?’, Subiaco Post, 31 January 1998, p. 11. 663 See for example Alexander, ‘When a baby dies’, p. 1; Jane Cafarella, ‘A Long Journey Without Arrival’, Age, 10 January 1996, p. 16. 664 Susan Pain, Letter to Editor, Age, 7 July 1994, p. 12. 665 Victoria Button, ‘Grief, And How To Come To Terms With It’, Age, 16 September 1995, p. 8. In this article, the incumbent Patron of SANDS (Vic.) and former Prime Minister’s first wife, Hazel Hawke, was quoted as describing the four days' life of her son, Robert James, in August 1963 as a ‘conspiracy of denial’. She commented that ‘it was as if I had never borne and lost this child … It was just not spoken of or acknowledged in any way [and] I never saw the child’. 666 For example, at Rookwood Cemetery in Sydney in 1999, a memorial service was held to recognise the lives of stillborn babies who had died in the past; journalist Evie Gelastapoulous wrote that ‘they cried not only for lives lost, but for lives never realised. Parents who lost children before, during or just after birth gathered at Rookwood Cemetery yesterday for a memorial service which acknowledged those unrealised lives’. See E. Gelastapoulous, ‘Tears for lives which never had a chance’, Daily Telegraph, 19 March 1999, p. 21. 669 Audrey, interview with researcher. 670 Inglis argues that the cultural trend towards cremation in the interwar years, as opposed to burial, ‘recognised and encouraged, as funeral directors were doing, a modern distaste for the physical facts of mortality and a modern aversion to the darkness of mourning’. See Inglis, ‘Passing Away’, p. 246.

206 framework. The public memory of repression was re-framed, to a degree, within a culture of openness and a greater discussion of the issues surrounding perinatal loss was culturally acceptable by the late 1990s. Audrey, for example, began to revisit her past experience of loss when she heard a news bulletin revealing improper use of the bodies of stillborn babies in the 1950s and 1960s;667 prompted by this challenge to her idealised perception of her baby being buried peacefully, she sought to resettle and resolve her memory of stillbirth by searching for the baby’s gravesite and beginning to refer to her stillborn son in conversation.668

The need to find the actual burial site was shared by many older women. Whilst cremation had gained popularity in the minimalistic middle decades of the twentieth century,669 a return to more elaborate and public bereavement rituals, especially those associated with the graveside, took on new importance towards the end of the century. As I argued in Chapters Four and Six, the importance of the gravesite had been increasingly adopted in contemporary memorial services for stillborn babies with several hospitals organising memorial gardens for the interment of ashes, and hospital disposal rapidly lost favour for its perceived devaluing of the infant as an individual human being. Rituals which reinscribed the deceased infant as an individual worthy of recognition were gradually reclaimed by older women who, like many of their contemporary counterparts, felt that the individual gravesite or memorial plaque appropriately signified their child’s individual value. For these older bereaved mothers the opportunity to locate their baby’s grave was constructed as a significant act and would finally reassure them of their baby’s existence.

Lynette, for example, had had no role in the burial of her stillborn daughter in 1962; in her interview Lynette surmised that the baby had ‘just been taken away’ and disposed of by the hospital. As the years passed, she had often wondered where her baby had been buried, but had been preoccupied with, as she said, ‘three kids, I was on my own, I had a career, I was really really busy’. It was over forty years later before Lynette was able to begin searching

667 It was revealed in 2001 that the bodies of stillborn babies had been sent to the United States of America for nuclear tests, whilst other reports exposed the activities of several Australian hospitals which had kept body parts and bodies of stillborn babies from the 1950s and 1960s for testing, without parental consent or knowledge. For the newspaper coverage of this, see for example Mark Steene, ‘Body parts: doctors defend practice, we did it all for science’, Adelaide Advertiser, 28 June 2001, p. 1; Susie O’Brien, Colin James and Rebecca Holmes, ‘Corridors of Shame’, Adelaide Advertiser, 27 June 2001, p. 1.

207 for her child’s grave. She recalled that ‘it was when [the children] were off my hands, and I thought, well now I'm going to find out what I can about the child. It's not nice to think it's just been thrown in a pit with two thousand other little darlings. It's not nice at all’.670 Lynette traveled from her home in Perth to Melbourne, where she discovered that her baby had been buried in a communal grave; the knowledge of exactly where her baby had been buried gave her, she recalled, a degree of resolution. That particular gravesite had been made into a memorial for the many stillborn infants buried there in the 1960s, and some parents had placed plaques on a slab of granite covering the site. During the interview, she remarked that she felt that she was ‘ready’ to memorialise her daughter by placing a plaque at the site: ‘I'm going to do it [now] … I [always] thought, how am I going to word it, what am I going to say? … And that's why I've been putting it off for so long. But I think I can do it now, I can word it now. And I will do it, I will go back [to Melbourne]. And that might be a closure for me’.671

In popular constructions of perinatal loss, the search for the gravesite was cast as an act of reunification between mother and child and had the potential to prompt deep emotion from observers - a realisation that the invisibility of perinatal death, and the passing of many years, did not render a loss meaningless. In an article in The Age, journalist John Lahey movingly described one older woman’s search to find the gravesite of her ‘lost child’: No matter what words you used, nobody could ever depict the anguish of Mrs Veronica Rose, 81, as she stood this week at the gravesite of her baby, David, whom she had never seen. When David was stillborn 47 years ago, someone at the hospital simply took him away’.672 Observed by Lahey, Mrs Rose, described as a ‘vivacious woman’, returned to that day in 1947 when her baby son was swiftly removed from her body and her sight: Not knowing what part of the mass grave held her baby, Mrs Rose walked slowly over it, studying the ground and murmuring: “Where are you, darling? Where are you? Where will I find you?”.... Mrs Rose was calling to her lost child, and it was the most natural act in the world. It was heartbreaking. “Where are you?” When she was told that David could be anywhere in the site, she scooped some earth into a little jar because this had as much chance as anything of being a part of him. She held the jar to her cheek and softly talked to the earth. Everything about this gesture evoked the word purity. It was a pure act of indescribable love.673

670 Lynette, interview with researcher. 671 Lynette, interview with researcher. 672 John Lahey, ‘At Last, The Touch Of The Child She Never Saw’, Age, 11 June 1994, p. 3. 673 Lahey, ‘At Last, The Touch Of The Child She Never Saw’, p. 3.

208 Cemetery staff became increasingly accustomed to the numbers of women who were starting to approach the cemetery with the intention of exploring the possibility of memorialising their stillborn child who had died many years previously. David McGowan, who was appointed manager of the West Terrace Cemetery in Adelaide in 1995, soon became aware of older women seeking to find their deceased babies’ burial site. Initially, McGowan said that he and his staff responded to such requests by saying ‘we have no idea – goodbye’; however, as the requests increased he began to believe that ‘the mothers deserved to know – warts and all’. With the use of burial registers and hospital records, McGowan was able to satisfy some women’s search for their child’s grave.674

After forty years, Daphne finally felt able to seek out her daughter’s gravesite and, in her recollection, she approached the cemetery staff with some trepidation. To her surprise, the staff at Karrakatta did not greet her with bewilderment, as she had expected, rather, they treated her with gentle compassion: ‘I went down there [to see] the man at the cemetery and once again just about cried my way through it. I said, “I’m terribly sorry”, and he said, “[Daphne], you would have no idea the number of women who have sat in that chair and cried, just like you’re crying, because they haven’t even realised that the little baby that they had can be honoured.”’ 675

The nature of specialised infants’ gardens created a socially acceptable space for older women to finally memorialise their stillborn babies.676 The more general trend away from burial to cremation had also led to greater flexibility in terms of the choice of memorialisation; this proved particularly significant for those women whose babies had been disposed of in the hospital incinerator or whose baby was buried in a mass grave. For example, because the Butterfly Garden at Karrakatta Cemetery was designed to give newly bereaved parents the choice of placing a memorial with or without the actual ashes of the infant, older women who had no access to their baby’s remains were able to participate in the contemporary trend of grieving rituals. Amongst the Butterfly Garden are plaques and stones dedicated to children stillborn only recently, as well as babies born over fifty years ago.

674 Louisa Hatfield, ‘The Lost Children’, Sydney Morning Herald [SMH], 31 January 1996, p. 11. 675 Daphne, interview with researcher. 676 See for example Hatfield, ‘The Lost Children’, p. 11; Heather Bird, ‘Love And Loss Come Full Circle’, SMH, 3 June 1996, p. 15; Gelastapoulous, ‘Tears for lives which never had a chance’, p. 21; Cherie Critchley, ‘The taboo of lost babies’, Herald-Sun, 24 February 1999, p. 19

209 Individual diversity and differing degrees of acceptance of the shift towards the culture of embracing death and bereavement led to some older women choosing to validate their child’s brief but vital existence in different ways. Registering for a birth certificate, for example, was understood to be a symbolic act for women whose losses had been invalidated in the past. Heather Bird, whose twin pregnancy had ended in the over thirty years ago with the live birth of one daughter, Frances, and the stillbirth of the other twin, Jessica, wrote in a feature piece in the Sydney Morning Herald [SMH] of her efforts to register her deceased daughter’s death. Bird recalled that the surviving twin had provided the motivation for her to do this; her daughter had queried why her own birth certificate contained the paradox that she was ‘elder born of twins’, but which then stated that her parents had no deceased children. Initially inspired to give her surviving daughter ‘some sort of proof that she'd been one of two’, Bird discovered that the birth certificate provided her with resolution. She wrote in the article ‘today I received a birth certificate for “Jessica Ann Bird (Stillborn). Female younger of Twins”. I feel that I've completed some sort of cycle, not only for myself but for Frances’.677

The SMH also reported in 1996 the story of Jan Stoker of Sydney who sought to locate her twin daughters’ burial place. Mrs Stoker’s babies had been born prematurely in 1962; like other women during this period she was not allowed to see her infants and found that her community responded in silence to her loss.678 Over forty years after her daughters died, Mrs Stoker rang SANDS in NSW and discovered that she was able to apply for birth certificates for her babies. After receiving the certificates, she discovered that her twins had been buried in a communal grave at the Field of Mars cemetery in Ryde, where she later placed a plaque in their memory. In the article, Mrs Stoker articulated her motivations for finding the gravesite in terms of closure: ‘Every time you think about that episode in your life you go back to the nightmare ... My other kids are growing up, but there was still a part of my life that wasn't settled.’ 679

677 Bird, ‘Love and Loss Come Full Circle’, p. 15. 678 Jan Stoker recalled that "everybody had the same attitude: 'Oh well, it is over now, get on with it’. So you couldn't talk to anyone. "I was absolutely totally neurotic. I used to get up in the middle of the night and walk around the streets. "I went back to work four weeks after the birth. Some people said it was good, but I wasn't coping with what had happened, let alone trying to work and be normal with people’. Jan Stoker quoted in Hatfield, ‘The Lost Children’, p. 11 679 Hatfield, ‘The Lost Children’, p. 11

210 Barbara had chosen a hospital burial because of the family’s economic circumstances; her husband had been on strike for five months and ‘things were a bit tight money-wise’. She was offered a private funeral but had to refuse: ‘When they asked me what I wanted done about the baby, I was suppose I was governed mostly by the cost involved, and they said to me, we can have her buried with all the other little babies. And at the time I thought that was the way to go’. Like other older women, Barbara recalled that she would often wonder about her baby’s gravesite, but it was only with older age that she felt it important to discover where her child had been buried. Although she remarked that she had never placed importance on visiting graves and did not wish to physically visit her baby’s grave, Barbara noted that she treasured a piece of paper that confirmed that her baby daughter had been buried in an unmarked grave in Karrakatta, because it ‘showed that I had had her … it’s the most precious piece of paper that I have had’.680

Iris was content to place a plaque in another significant spot with other valued family members instead of searching for the physical location of her baby’s burial site; in her interview she recalled that she had grappled with the silence after her daughter’s stillbirth for a long time, particularly after giving birth to two subsequent children: ‘it was a long while after, when I really got peace, because you’re all the time, in your mind, groping, because you haven’t seen her, you don’t know if the next one looked like her, and [my next child], he’s a redhead, and I wondered if the [first] little one would have been like either one. But it took a long while’.681 Forty years after her daughter was stillborn, Iris created a space of familial significance, placing plaques for her mother and father as well as the baby. For Iris and her husband, the simple act of engraving their daughter’s name on a plaque gave legitimacy to that individual child’s existence and provided them with a sense of having resolved a problematic part of the experience. She recalled that ‘my real peace was when I did that little plaque, just acknowledging that we’d had a little baby and the world should know. When I did the plaque, I think I felt I’d done something to publicly acknowledge her, and from then on I’ve been quite at peace about it all’.682

680 Barbara, interview with researcher. 681 Iris, interview with researcher. 682 Iris, interview with researcher.

211 ‘Reshaping the memory’

Damousi observes that ‘in oral testimonies we make meaning from our experiences, but that meaning is under constant revision’.683 Revisiting one’s memories, then, is a complex process of revisiting, reshaping, forgetting and remembering the past. The popularity of grief therapy and the insistence from some quarters that repressed memories needed to be ‘released’ were the impetus for some older women to sort through painful memories and to recast them through the lens of ‘healing’ memories.684 For example, Denise’s recollection of her experience of delivering a stillborn child in the early 1970s was recounted in terms of her discovery of gestalt therapy. A contemporary trend, the routine therapy group, was the catalyst for Denise to begin to reconstruct her experience and what she saw as years of buried hurt and resentment towards hospital staff who had insisted that she not name her son and who placed her back on the antenatal ward with expectant mothers after she delivered her stillborn baby. Denise then began a conscious effort to transform a highly negative experience into what she hoped would become a positive memory, which involved amongst other things, confronting the gynaecologist who told her over twenty years ago to go and get pregnant again and to learn to ‘put it all behind’ her. To the doctor’s credit, Denise recalled that ‘he was great, accepted the rightfulness [sic] of my anger and distress and reassured me and reassured me that such a situation had come to be handled very differently. That was a very important step for me to take.’ 685

For some women who had felt restricted by the confines of their roles as wives and mothers in the twenty five years or so after the end of the Second World War, older age provided an opportunity to revisit and reinterpret their memories of a perinatal loss. Melanie, for example, noted in her interview that she felt able to be introspective, over twenty five years later, because she now had the time and the emotional energy after her children had left home. She claimed that this was a phenomenon not uncommon to women of her age, noting that grief relating to childbearing, be it abortions, adoptions or stillbirths or otherwise, was

683 Damousi, Living with the Aftermath, p. 3. 684 See Damousi, Freud in the Antipodes, p. 257; Layne, Motherhood Lost, p. 13. As Layne notes, bereaved parents’ support groups grew out of a widespread acceptance of the ‘talking cure’ – once treated with suspicion by the medical community – and psychoanalysis in general towards the end of the twentieth century. 685 Denise, personal correspondence with researcher, 11 May 2005. Email in possession of researcher.

212 a common topic of conversation amongst her friends: I’ve been stunned with what has happened to me since I turned fifty. I speak to a lot of my friends who are fifty, and all the things that happened to them – they had babies that they gave away cause that was very common, you got pregnant and didn’t keep your baby, and terminations, at fifty it all comes bubbling up, because you’ve got time. And it’s happened to hundreds and hundreds of thousands of women. More women than its not happened to, in my generation. Certainly unplanned pregnancies, terminations, giving babies away – I’ve haven’t got a friend that it hasn’t happened to. All not dealt with then, couldn’t be dealt with then, life went on, met partners, got married, but now there’s this, because there’s so many of us, there’s this really huge issue for women of that age.686

Melanie’s self-reflection then was part of the wider process amongst her peers of reshaping a collective memory – a challenge to the public memory of childbearing and motherhood as a secure and happy time in Australia’s history. As Darian-Smith observes: It is through memory that we frame our sense of individual, group and national identities, give meaning to our own life history, and understand our social past. Our individual memories, however, are constantly supplemented, altered and mediated by the circulation of representations and articulations of the past that constitutes collective memory.687

Ageing and the death of one’s life partner were also the means by which some women were able to gain an unexpected space for reflection. Psychologist Beverley Raphael argues that widowhood can result in a drastic reinterpretation of all the meanings of that partnership: ‘All meanings of the marriage, all its memories, will be thrown into relief’.688 In her study of the reinterpretation of war widows' memories, Damousi suggests that whilst some memories of the relationship are sentimentalised and become idealised, other meanings of the marriage are radically recast and reinterpreted after the death of the husband.689 The personal narratives of older women interviewed for this thesis suggests a similar theme: that is, for bereaved women, the death of a husband – albeit often a much-loved partner – was the catalyst some older women being able to view their memories of the loss of a baby through an entirely different and liberating lens. After Audrey’s husband died, she was already in a position of self-reflection and adjustment to her new role as widow and for the first time, she said, she felt able to begin to think about properly memorialising her baby. During the interview, she articulated her belief that, although her marriage had been happy,

686 Melanie, interview with researcher. 687 Darian-Smith, ‘War Stories’, p. 137. 688 Raphael quoted in Damousi, Living With the Aftermath, p. 169. 689 Damousi, Living With the Aftermath, pp. 164-166.

213 it was only upon her husband’s death that she felt able to revisit the memory of her stillborn son and to begin to identify herself in conversation as a mother of three.690

Similarly, Daphne recalled that even though her marriage had been happy, it was only after her husband’s death that she felt able to erect a small plaque in the children’s memorial garden at Karrakatta Cemetery. Daphne had long avoided mentioning her stillborn daughter’s name because her husband had not wanted to ‘perpetuate [their daughter’s] memory’ by treating the child as a member of the family. When her husband died however Daphne was encouraged by her daughter to explore the possibility of placing a plaque in memory of the baby in the Butterfly Garden at Karrakatta. She also publicly articulated her inscription of that child as a valued member of the family when placing the death notice for her husband in the local newspaper; by including the child by name along with her other living children.691 For Daphne, the act of creating an individual memorial to this long- deceased baby served to challenge not only the cultural invalidation of the baby herself but also the construction of the death of her baby as a ‘failure’.692

Complex pasts: revisiting memories

Not all women interviewed for this thesis have sought ways to memorialise a long-deceased infant. Indeed, several older women railed against such ideas in their interviews, suggesting that the idea that they needed to ‘find’ their baby was an unnecessary gesture and claiming that the experience had had no lasting impact on their life and expressing distaste at the contemporary trend towards naming and including miscarried babies as members of the family.693 Their reasons for participating in the oral history project, however, give insight into the varied ways that we tend to constantly reshape and recast our experiences. Importantly, their willingness to participate in such a project also gives credence to the argument that changing constructions of perinatal death tacitly provided some older women with a space to revisit their experiences, even if they did not wholly agree with changing attitudes towards perinatal death.

690 Audrey, interview with researcher. 691 Daphne, interview with researcher. 692 Daphne, interview with researcher. 693 Mrs Mead, interview with researcher; Dorothy, interview with researcher.

214 Several older women were eager to be part of the project because of their desire to ‘tell it as it [was]’. Taking their cue from the Birmingham Popular Memory Group, some oral historians have claimed that the oral history interview is an opportunity for apologies; Jean Peneff for example argues that ‘most people let themselves off lightly in telling their life story, so that shameful behaviour is seldom recalled … The life story can be a way of excusing ourselves in public, an effective means of building an enhanced self image’.694 Paula Hamilton argues that the oral history interview is ‘contested terrain’ whereby the subject renegotiates, excuses and redefines an event; the experiences recorded for this project give insight into the ways in which an individual simultaneously desires to excuse oneself; contest; and explore one’s memory of the past.695

Rayma, for example, was adamant in the interview that she preferred to focus on the positive aspects of her life, such as the fact that she had had a daughter subsequent to her stillborn twins who would not have been born had the twins survived. She was dismissive of the repression of her sons’ memories by her family and her community as being hurtful, saying that ‘it was the accepted thing that it was one of the things that happened, sometimes, and you just got over it and carried on. Which [I did]’.696 As the interview progressed however, Rayma said that she had recently begun to wonder whether or not there had been autopsies done on the twins, and this had resulted in her contacting the hospital to try and locate her medical records from this time.697 Thus, whether consciously or otherwise, some older women seized the opportunity to participate in a formalised oral history project that was specifically concerned with their experience of perinatal loss, seeking to affirm that their responses to the death of their babies had been appropriate and understandable.

Many of the older women interviewed for this project were born in the interwar period and grew up in the Depression, marrying and having children shortly after World War II. As I have argued in Chapter Three, this was a formative period in terms of attitudes towards grief and loss; Jalland points out that ‘attitudes to death and grieving were moulded not by

694 Jean Peneff quoted in Raphael Samuel and Paul Thompson (eds.), The Myths We Live By, New York: Routledge, 1990, p. 39. 695 Paula Hamilton, ‘The Knife Edge: Debates About Memory and History’, in Darian-Smith and Hamilton (eds.) Memory and history in Twentieth Century Australia, p. 15. 696 Rayma, interview with researcher. 697 Rayma, interview with researcher.

215 one terrible war, but the cumulative impact of two, during little more than thirty years. There was a massive overload of death and sorrow in just two generations’.698 Some of the interviewees continued to frame their narratives in terms of the widespread response to this ‘overload of death’ – that is, the private nature of grief and the importance of ‘getting on’ with life. Whilst it was increasingly important for some women to seek resolution to their grief, particularly within an environment of therapy and self-renewal, several older women whose attitudes towards therapy and counselling were tremendously and subconsciously shaped by their experiences in the Depression and by war continued to find the idea of therapy and resolution unnecessary and indulgent.

For example, Mrs Mead did not share other women’s desire to find her baby’s grave, and avoided the enacting of any rituals that had become so popular in the last two decades of the twentieth century. She continued to find comfort in the trenchant appeal for the sober moderation in grief that had so characterised most of the twentieth century, particularly following the two world wars. Whilst Mrs Mead, whose first baby was stillborn shortly after the end of World War II, harboured deep regrets about not seeing her baby she was nevertheless highly skeptical of the rise of counselling after bereavement, which in her perception was a selfish and self-indulgent trend: ‘in those days, things like counselling, they were unheard of! We wouldn’t have been bothered anyway … My generation, we had to rise above our own problems and sort them out ourselves, and we still do. We still do. None of this talking it over with a psychiatrist or somebody’.699 Growing up in the context of the Depression and two World Wars, Mrs Mead was shaped by and continued to accept the cultural restrictions placed on the expression of grief in Australia in the immediate postwar years. She said in her interview that the whole experience was a ‘tragedy’ for her entire family, with whom she was living whilst her husband completed his naval posting in Singapore, but repeatedly used phrases like ‘for the best’ and ‘meant to be’ when describing the loss of her baby.700 Similarly, when asked how the experience of losing her first baby at two days old had affected her, Dorothy reflected that after forty eight years ‘it hasn’t, actually. We’ve got our faith, and you know, it hasn’t affected us at all’.701

698 Jalland, Changing Ways of Death, p. 171. 699 Mrs Mead, interview with researcher. 700 Mrs Mead, interview with researcher. 701 Dorothy, interview with researcher.

216 In recalling their experiences, Dorothy and Mrs Mead’s memories highlight the interaction between their adherence to the context in which their babies died – such as maintaining that the experience had had little impact on their life, as was culturally acceptable at the time of their respective losses– and their making sense of the experience in their later years. Although both women maintained that the experience had had little effect on their lives over time, they were both, to some degree, in favour of changes that had occurred since their own babies had died. Although both Mrs Mead and Dorothy neither held nor saw their respective babies, both articulated a sense of regret, and both were in favour of women being able to hold their babies. Not holding her son was, according to Mrs Mead, the ‘biggest mistake I’ve made in my life. I should have held him, and let him know that his mother was there.702 Whilst Dorothy accepted her exclusion from the organisation of her son’s burial, she recounted that she was pleased that, fifty years later, her granddaughter was able to see her own stillborn baby and to have her husband spend the night in the hospital with her – a vastly different situation to Dorothy’s memory of her own experience.703

Although Mrs Mead, for example, had rarely spoken about her baby in the fifty years since his death, her ability to communicate her sadness in the interview was part of the complex process of the intertwining of the past and the present. Accordingly, a persistent theme in the interviews with older women was a vacillation between stoicism and regret – a simultaneous clinging to the context in which their experiences occurred, and a re-enacting of the event that allowed for greater personal control. Elizabeth Coleman has argued that ‘between the collection of an oral testimony and the events it purports to describe, many presents have intervened’.704 This is strikingly evident in this oral history project, perhaps because the events being recalled were surrounded by high emotion and were subsequently invalidated by others. As I discussed in Chapter Three, Audrey complied with her mother’s request not to put a death notice in the paper for the baby, and outwardly accepted the ways in which her friends reacted to the baby’s death; in her testimony however, Audrey said that she ‘still resented’ her mother for not allowing her to place a death notice and recalled her relief that as an older woman she finally felt able to tell people that she had had three sons,

702 Mrs Mead, interview with researcher. 703 Dorothy, interview with researcher. 704 Elizabeth Coleman, Narrating our Pasts: The Social Construction of Oral History, Cambridge: Cambridge University Press, 1992, p. 116.

217 not two. However, despite the vastly different cultural reactions to stillbirth that have occurred since Audrey’s baby died and the interview, some of her actions were seemingly still governed by the context of the past - most notably she felt that asking her mother why she had forbidden Audrey to put a notice in the paper, despite Audrey’s continuing resentment about this incident, would be ‘unkind’ : ‘I’ve never asked [her] ... I suppose I should, but she is ninety six and … [although] she’s got all her faculties it wouldn’t be kind’.705

Revisiting the past: a negative experience

Attempts to recast one’s painful memories within a more positive light were at times problematised by restricted access to medical records or lost records; for example, although Denise has since named her son, who is now discussed at times by her other children and is regarded as a sibling; planted a tree in the baby’s memory; and has included the child in her own funeral plans, she is still to find the baby’s actual burial site. She had attempted to find the site, thinking in her self-described naïveté that the hospital would have ‘had a nice little ceremony’ but was told instead that her child was most likely buried in a shoebox in a mass grave. This knowledge led her to believe that finding the gravesite would be ‘very difficult’; she wrote that ‘now … I realise I have anger still in relation to this aspect of that occurrence thirty four years ago’.706

Cultural restrictions still bound some older women who consciously attempted to reconstruct their experiences within a more positive light. Although many older women were becoming gradually more aware of the changes in the way that perinatal death was managed and the re-inscribing of the foetal body in the hospital context, the taboo of silence was still so strong in some families that many women approached the possibility of locating their baby’s grave with some trepidation; still others remained unaware that it was even a possibility. The same barriers that had prevented women from playing an active role in the funeral arrangements sometimes still existed, such as overbearing family members and financial restrictions. Choosing to memorialise a stillborn baby was a decision that potentially overstepped many boundaries that exist as part of the social expectations of

705 Audrey, interview with researcher. 706 Denise, personal correspondence with researcher.

218 older women. Accordingly, some women found their babies in secret, whilst for others it remained an unfulfilled desire.

For example, because she had overheard the nuns in the hospital mention that her baby had drawn breath and therefore required burial rather than hospital disposal, Liz was haunted by her lack of knowledge as to where her baby was buried and articulated a deep desire to find out and to gain some sense of closure: ‘As I’m getting older I think … I’d just like to die with a bit of peace, to find out these things’. The baby had been conceived when Liz was a young single woman in the 1960s and she had only recently revealed this secret to her husband, who was not the father of the baby. Because she still considered this experience to be shameful – her daughter had not been told about her mother’s previous loss, for example - Liz admitted that it was unlikely that she would ever be able to find out where the baby was buried, let alone travel interstate to visit the burial site. She commented that ‘often now I think, I’d just love to go and see [the grave] … I mean, I got a letter, surely there’d be records. And I could maybe find out. But how would I explain that I’m going to Brisbane, to find out? I don’t know’.707

Some women approached the interview with an acknowledged desire to begin to consciously sort through painful repressed memories, prompted by the increasing public visibility of perinatal death. Whilst the interview provided the space for the ‘interactive cycle of recovery and burial’, these women were nonetheless dissimilar to Darian-Smith’s subjects in her study of wartime memory, who constructed their wartime experiences as an ‘anomalous, adolescent and dateable time … ‘the war’ was a neatly boxed section of their life stories’.708 Rather, these oral histories of stillbirth and neonatal death were clearly unresolved stages of women’s lives that had been carried under the surface for many years and the interview itself was but one occasion for revisiting an unresolved and painful experience. Further to this, Peneff’s argument that the personal narrative lends itself to self- censorship holds only limited weight with these interviewees who were more prone to self- censuring their behaviours in the past. Rather than using the interview as a space in which their responses to the death of a baby could be justified and rationalised, several interviewees maintained that their experience of stillbirth had shaped and defined their

707 Liz, interview with researcher. 708 Darian-Smith, ‘War Stories’, p. 146.

219 behaviour in other areas of their adult life, leaving them - and to a degree, their relationships with their spouses - emotionally damaged. Several older women claimed that they themselves had handled their grief badly and that their behaviour had caused irreparable damage to their families. Although her recollection of the past is necessarily viewed through the distorted lens of the present, Liz was adamant as to her role in the negative consequences of her past experiences, saying in her interview that ‘I drink too much … much too much. And just sometimes I think it blocks out the pain’.709

Similarly, Robin viewed her memory of the stillbirth of her first baby through a lens of self- blame. Although she had earlier said that she felt that she had been treated ‘appallingly’ by her obstetrician, she later attributed a ‘wedge’ in her marriage to what she believed was a poor emotional response on her behalf. After months of hesitation, Robin decided to visit what she believed was her baby’s grave on the twenty fifth anniversary, consciously articulating this as a symbolic ritual of reunification by getting dressed up and buying flowers to place on the grave. Upon arrival at the cemetery however she was shocked to find out that her baby, at her husband’s request, had been cremated and his ashes scattered to the wind – a member of the Karrakatta Cemetery staff informed Robin that there was no actual grave to visit. She had not discussed her intentions with her husband – indeed, the couple had not discussed the baby since he had died. In her interview she recalled this incident: I’m thinking, I don’t believe this. This is where it’s gone terribly, terribly wrong. That we as a couple – as parents … he made that decision, but hadn’t told me. And I’m standing there, all dressed up, flowers … and I just went to another grave and put them on it. And I went home, but I still didn’t tell him what I’d done, and I thought, it’s actually put a wedge in our relationship. This is something that is a very important issue that people shouldn’t have – I shouldn’t be doing those things – it’s too important.710

Conclusion

A life history is never straightforward or unproblematic; rather, it tells the story of the constant cycle of reinterpretation of one’s memories, particularly in the case of a traumatic experience like perinatal death. For some Australian women, the growing contemporary

709 Liz, interview with researcher. 710 Robin, interview with researcher.

220 cultural openness towards perinatal death has provided a space in which they are finally able to begin a journey of revisiting their experiences of stillbirth and neonatal death. For many women interviewed as part of this research, this has been a positive process which has given them some agency in renegotiating or reinscribing their baby’s identity from unnamed entity to precious offspring. For other women however, the process of remembering such a painful event as a stillbirth or neonatal death has been complicated by the cultural context in which their babies died – a context which advocated stoicism and a suppression of grief over open expression of mourning. Personal narratives of perinatal death highlight the individuality of lived experience of losing a baby, illustrating the variety of ‘spaces’ which help different women to be able to revisit their memories of loss from long ago, and in doing so, illuminate an area of women’s history which has long remained hidden and silent.

221 CHAPTER EIGHT

The ‘pointless pregnancy’: reinforcing the inscription of ‘defectiveness’ at the end of the twentieth century

In Chapter Six, I mentioned Brenda’s belief that, in terms of family support after the death of her first child, she thought that she and her husband had been incredibly fortunate in terms of their friends’ support after loss: ‘I think we jagged it’. As the interview progressed, however, she recalled that although her immediate family and a small group of friends had supported her after her son died, as time went on many around her found it difficult to comprehend that depth of her grief.711 [Some] of the family don’t deal with grief, and … he’s not even spoken of now. He wasn’t spoken of back then and he’s not spoken of now. So I’ve had to go through a whole range of emotions, dealing with my anger towards them, I even had one of them say to me, well it’s not like you even knew your child, so I just told that family member that I wouldn’t be speaking to her for the next six months. I just had to shut off [because] I wasn’t dealing with it, you know.712

Although Brenda had been able to hold her son, enact significant mourning rituals whilst in the hospital, and had felt overwhelmed by the support of her close friends who visited and spent time holding her baby, she found that her grief became problematic when she returned home to the country town where she and her husband were living at the time. Some people … even looked at me like I was a leper … and I felt very much on display, so I didn’t go to church much. Shopping? I wanted to run through the shopping centre and yell out, ‘I’ve just had a baby! Just do something. I look like this, I’ve got all this extra weight [because] I’ve just had a baby and it’s not feeding off me!’ And unfortunately I had a chest that would put Dolly Parton to disgrace, [because] they wouldn’t let me express [breastmilk].713

The complexity of Brenda’s experience gives insight into the competing constructions of perinatal death which were evident at the end of the twentieth century. In the previous chapters I argue that the emerging theories of grief and loss were the motivation for the formalising of hospital policies which sought to assist women in forming attachments with

711 Layne observes that memory serves a social function; the absence of tangible reminders of a deceased baby’s existence and the fact that so few knew the one being remembered mean that pregnancy loss ‘poses a number of challenges in terms of memory…difficulty in finding empathetic listeners and social pressure to forget, appear to be widely shared by those who suffer trauma’. See Layne, Motherhood Lost, p. 202. 712 Brenda, interview with researcher. 713 Brenda, interview with researcher.

222 their deceased infants; a greater openness towards death and loss in general had also meant that some older women were able to revisit the memory of a long-ago perinatal loss and to seek to renegotiate their experiences. These shifts in constructions of perinatal death, however, were challenged in the late twentieth century by the rise of prenatal testing and the growing belief that medical science had conquered the incidence of perinatal death. Therefore, the late twentieth century was host to competing understandings of pregnancy loss and baby death and at times, contradictory and paradoxical inscriptions on the foetal body which problematised changes in the clinical management of stillbirth and neonatal death.

Layne notes that the rise of ‘in utero’ technology towards the end of the twentieth century has caught women who experience a pregnancy loss in the middle of ‘two contradictory sets of powerful cultural forces’. According to Layne, the rise of ultrasound imaging and so-called ‘at home’ pregnancy tests, combined with the strategies of the pro-life movement to inscribe the foetal body as fully human, have served to ‘move up the time and the pace with which many … women begin to socially construct the personhood of a wished-for child’. However, as Layne observes, pregnancy loss remains a deeply entrenched cultural taboo, exacerbated by the increasing expectation that medical technology can, and should, combat the death of a baby.714 She notes that after a perinatal loss ‘the incipient personhood of the wished-for child is revoked’.715

In this chapter, then, I consider the impact of these contradictory constructions of perinatal death and how these constructions have problematised the meanings wrought by the more open approach to pregnancy loss. I argue that the rise of perinatal medicine as a specialised discipline served to both reinforce and shift the inscriptions on the foetal body; where perinatal death, and most particularly miscarriage, were once viewed fatalistically due to

714 Layne notes that reproductive technologies have contributed to changing understandings of perinatal death at the end of the twentieth century; she argues that ‘the silence surrounding pregnancy loss has resulted in extensive ignorance concerning the frequency of pregnancy loss … compounded by the media hype surrounding the advances in reproductive and neonatal technologies’. Furthermore, this faith in science plays a significant role: ‘A central aspect of this faith stems from our ideas about the nature of science and technology, namely, that they inevitably, cumulatively, and almost automatically by definition, progress’. See Layne, Motherhood Lost, pp. 93-94. Likewise, Reiger cites a senior midwifery educator who observes that young women of childbearing age are used to controlling their bodies through reliable and accessible contraception, and many expect that childbirth should be ‘regulated [and] standardised’. Margery Priestly quoted in Reiger, Our Bodies, Our Babies, p. 230. 715 Layne, Motherhood Lost, pp. 16-17.

223 the ‘mystery’ of development in utero, the last decades of the twentieth century saw the medical profession shift their attention towards the unborn child, constructing the foetus as an individual patient within the context of rapid developments in prenatal diagnostic testing. This shift further entrenched the notion that women’s bodies are merely hosts to the developing foetus, revitalising ideas of maternal responsibility and the linking of maternal behaviour to foetal outcome.

‘If at first you don’t succeed, try, try, try again!’: understanding pregnancy loss as failure

The greater openness towards stillbirth and neonatal death in the late twentieth century saw a shift in the way many women were able to grieve for their deceased babies. However, at times these ways were problematised by the developments in perinatal medicine towards the end of the twentieth century, which renewed the construction of pregnancy loss as an instance of ‘failed production’;716 the medical scrutiny of the maternal body was renewed, but with a twist. Where the medical gaze primarily rested on the female body in the past, advances in the medical ability to view development in utero shifted the focus to the foetal body.717 By the latter decades of the century, the causes of perinatal death became a focused area of research in the scientific community; whilst foetal medicine had been virtually ignored in favour of neonatology in the 1960s and 1970s, the development of ultrasound technology and in utero diagnosis saw the prioritising of foetal medicine in many major research hospitals. Within this context, argue Crouch and Manderson, obstetricians became increasingly better able to assess ‘foetal outcome’ precisely because of these advances in medical technology, bringing with it a change in attitude: ‘formerly the focus was on the mother and delivery, now it is centred on foetal outcome’.718

716 As I have argued in earlier chapters the medicalisation of childbirth at the turn of the twentieth century constructed pregnancy as potentially pathological, and perinatal loss was viewed within medical discourse as ‘pregnancy failure’. The pregnant body in medical discourse has been constructed as inherently unstable and susceptible to disease and abnormality; furthermore, medical terminology explicitly links biology to some women’s apparent failure to give birth to a healthy child. Medical terminology has cast women’s bodies as inherently defective: the terms ‘habitual aborter’ and ‘incompetent cervix’ illustrate how the female physiology is held culpable for perinatal loss, whilst the common usage of ‘pregnancy wastage’ and ‘pregnancy failure’ indicate that medical discourse understood miscarriage and perinatal loss to be instances of ‘unsuccessful’ reproduction. 717 McCalman, Sex and Suffering, p. 244. 718 Crouch and Manderson, New Motherhood, pp. 31 & 33.

224 The unveiling of what was once deemed to be mysterious – the development of the foetus in utero – has both strengthened and subtly shifted the categories of successful or failed pregnancy in the late twentieth century in contemporary Australia. On the one hand, the acceptability of ultrasound as a ‘routine’ part of antenatal care in the last two decades has greatly increased expectations of a healthy birth; furthermore, ultrasound technology has elevated the notion of ‘foetal personhood’, and has been lauded for its ability to help women form attachments to their unborn babies earlier. However, ultrasound and other prenatal screening and diagnostic tests have also strengthened notions of achievement, of manipulating the environment in order to produce a ‘successful outcome’ – or its corollary, avoiding an ‘unsuccessful’ outcome by way of screening for ‘imperfection’. The rise of ultrasound and other diagnostic tools has given the medical profession an increased surveillance over women’s bodies and the products of their wombs during pregnancy and childbirth.719

Where antenatal care was hailed in the early twentieth century for its role in dramatically decreasing the maternal mortality rate through medically-controlled supervision of the maternal body, prenatal screening has shifted the focus to the foetal body; developments in foetal medicine and assisted reproductive technologies have become synonymous with notions of achievement, and are valued for their role in assisting women who would have otherwise ‘failed’ to achieve a healthy pregnancy and birth. For example, the editorial of the MJA in 1996 lauded technology for its role in ‘achieving a significant drop in infant mortality rates’,720 whilst reproductive technologies such as in vitro fertilisation have been widely understood as a means by which infertile women (including those who have experienced numerous miscarriages) could ‘achieve pregnancy’.721

As I have argued previously in the thesis, the foetus has always been inscribed with a diverse range of meanings; the last decades of the twentieth century however saw the foetus embedded with values which were simultaneously competing and seemingly paradoxical.

719 See for example K. Salvesen and S. Eik-Nes, ‘The routine fetal examination’, in Asim Kurjak and Frank Chervenak (eds.) The Fetus as a Patient: Advances in diagnosis and therapy, New York: Partheon Publishing Group, c1995, p. 87. 720 Editorial, ‘The health of Australia's mothers and babies’, MJA 1996; no. 164, pp. 198-199. 721 See for example Gabor Kovacs and Donna Howlett, ‘If at first you don't succeed, try, try, try again: A successful birth after 37 cycles of assisted reproductive technology over 11 years’, ANZJOG, vol. 44, no. 6, pp. 580-582.

225 In the previous chapters I have considered the construction of perinatal loss as an event of great significance for a woman and her family, an inscription of individual value on the foetal body which would greatly shape how women were allowed to grieve their deceased babies. However medical constructions of the unborn child have often been at odds with the meanings that women themselves have inscribed to their babies. The last years of the twentieth century had seen the medical profession also shift their attention towards the unborn child, constructing the foetus as an individual patient worthy of medical attention and scientific research. For example, in the 1980 edition of Williams Obstetrics the authors enthused ‘who would have dreamed that we could serve the fetus as physician?’722

Feminist critics of medical interventions into pregnancy in the late twentieth century have focused their attentions on the renewed supervision of the maternal body, arguing that the rise of perinatal medicine privileged the foetus and created expectations on pregnant women to self-monitor and self-sacrifice for their ‘baby’s sake’.723 Ironically, however, as the health of the unborn child became a matter of medical concern, the foetal body itself became subject to greater scrutiny and was imbued with often contradictory meanings which were often espoused by the same groups who privileged the foetus over the maternal body. Towards the end of the twentieth century, the rise of prenatal diagnosis and its construction as an ‘essential’ part of pregnancy, with particular focus on the expectations of women after a positive prenatal diagnosis is made, meant that the foetal body was classified according to levels of viability and perfection. The values upon which prenatal testing is predicated – that a healthy baby is a ‘successful’ birth - have also, in turn, reinforced the discourse of maternal responsibility to strive for reproductive perfection.

Renewing the discourse of maternal responsibility

Women are not uninformed and unreflective social actors, and it would be unwise indeed to assume that pregnant women have always been wholly restricted by the medical discourse

722 Williams et al, Williams Obstetrics, p. vii. 723 See for example Pollitt, ‘Fetal Rights’, pp. 285-298; Hubbard, ‘The Politics of Fetal-Maternal Conflict’, pp. 311-324; Rebecca M. Albury, The Politics of Reproduction, St Leonards, NSW: Allen and Unwin, 1999, pp. 130-155.

226 of maternal responsibility and the burden for producing a successful outcome.724 Neither have all of those involved in medical management of pregnancy and childbirth always been in support of the exhortation to pregnant women to take responsibility for the birth of a healthy baby. For example, the multi-disciplinary authored book A Guide to Effective Care in Pregnancy and Childbirth critiqued the growing assumption that women were the primary agents in producing a healthy baby, arguing that ‘with the implied promise that it will help her have a perfect birth, a perfect baby, and become a perfect mother, a pregnant woman is exhorted to lead a selfless healthy life, uncontaminated by sex, cigarettes, alcohol, employment or anxiety. The evidence for most of these exhortations are slight. Where the evidence is stronger, the flaw has been in the way that research and prescription fail to take into account the real lives and responsibilities of women’.725

Nevertheless, towards the end of the twentieth century, both medical and popular sources have overwhelmingly espoused the view that pregnant women’s lifestyles are intrinsic to a successful birth. This has been made problematic, as Murphy-Lawless argues, because the foetal body has become split from the maternal body; with the rise of the ‘foetus as patient’, obstetrics has cast itself as ‘the advocate for the foetus’ pitted against the selfish irresponsible mother-to-be.726 Where the discourse of maternal responsibility in the first half of the twentieth century was focused around the expectation that ‘responsible’ women would submit their bodies to the supervision and authoritative knowledge of the medical profession, women in the late twentieth century and beyond have been cast as the primary agents in producing a ‘successful’ outcome. The expectation that women should pay heed

724 Women since the 1970s have sought to challenge the medical model of pregnancy and childbirth, seen most powerfully in the ‘natural birth’ movements discussed in the previous chapter. Reiger’s study of the childbirth reform movement gives great insight into Australian women’s efforts to change the medical paradigm of childbirth in the 1970s and beyond. The establishment of the Nursing Mothers Association, for example, was a powerful example of women challenging the taboo of breastfeeding; the combination of ‘excessive hygiene, regimented feeding and scientific measurement of artificial formulae … shaped by a context which valued the “modern” and “scientific” had seen breastfeeding rates decline sharply in the postwar years. The objectives of Nursing Mothers were firmly predicated upon changing popular attitudes towards breastfeeding and encouraging women to harness the uniqueness of their lactating bodies’. See Reiger, Our Bodies, Our Babies, pp. 34, 49-61. See also the chapter ‘Tackling the System from Inside and Out’, pp. 187-284. 725 Murray Enkin, Marc J.N.C. Keirse, Mary Renfrew and James Neilson, A Guide to Effective Care in Pregnancy and Childbirth, Oxford: Oxford University Press, 1995, p. 25. 726 Murphy-Lawless, Reading Birth and Death, p. 199.

227 to their medical practitioner is still an ever-present part of pregnancy in Australia;727 with medical research increasingly weighted towards the investigation of maternal behaviour and its impact on foetal wellbeing, coupled with the values of self-responsibility and individual determination, women have increasingly borne the burden of responsibility for producing a healthy baby; the prevailing view held that if women tried hard enough, they would be able to achieve the birth of a live, healthy child.728

As I have argued in Chapter Two, the notion of maternal responsibility is not original to the late twentieth century; rather, it was a fundamental premise of the 1904 NSW RCDB. By the 1950s, as Hubbard argues, mothers were increasingly portrayed as ‘being bad for their children’.729 In the latter years of the twentieth century, this portrayal has shifted to the expectant mother, whose actions during pregnancy have become intrinsic to the health and safety of the foetus: ‘In the 1950s and 1960s, mothers damaged their children by being too self-sacrificing … But in the 1970s and 1980s, the smothering mother was replaced by the selfish mother, the woman out of fulfil herself at the expense of her child’.730 From the 1980s, pregnant women in the United States have been subject to both medical and legal surveillance; the pregnant body has been constructed as being pitted against the foetal body, and women who transgress the role of self-sacrificing mother-to-be have faced criminal charges, not to mention public condemnation. 731 In the Australian context, whilst there

727 This expectation may seem paradoxical in light of the challenges to the medicalisation of childbirth discussed in previous chapters; however, as Reiger notes, the model of ‘family or women-centred’ childbirth did not entirely displace the medical model of childbirth; rather, ‘many of the changes [to childbirth practices] desired by reformers were co-opted by [medical] professionals, losing much of their force’. Furthermore, the redefining of the obstetrician’s role as the overseer of the management of “abnormal” and “at risk” pregnancies – with “normal” straightforward births relinquished somewhat to midwives - served to continue medical control over pregnancy in the late twentieth century. See Reiger, Our Bodies, Our Babies, pp. 212 & 220. 728 See for example, Diana Plater, Taking Control: How to Aim For a Successful Pregnancy After Miscarriage, Stillbirth or Neonatal Loss, Moorebank, NSW: Doubleday, 1997. 729 Hubbard, ‘The Politics of Fetal/Maternal Conflict’, p. 311. 730 Hubbard, ‘The Politics of Fetal/Maternal Conflict’, pp. 311-312. 731 Hubbard cites several cases in the USA where women have been charged with endangering their foetuses: for example in 1989 Josephine Pelligrini of Massachussetts gave birth in a public hospital to a healthy newborn, but a routine blood test showed traces of cocaine in her child’s blood. Pelligrini was charged with ‘distributing cocaine to a minor via the umbilical cord and also with possession of an illegal substance’. Atlhough the charge of distribution was dismissed, the possession charge was upheld and the strong implication was that Pelligrini had behaved inappropriately during her pregnancy. According to Hubbard, court-mandated caesarean sections and moves to protect foetuses by barring women from certain employment which is deemed ‘risky’ for foetal wellbeing indicate the rise of the maternal/foetal conflict, and the popular understanding that the foetus must be protected from the actions of selfish mothers. See Hubbard, ‘The Politics of Fetal/Maternal Conflict’, p. 313.

228 have been charges laid in the past for foetal endangerment, those accused have never been convicted of homicide.732 However, as legal academics Sheila McLean and Kerry Petersen observe, although the foetus does not possess ‘rights’ in legal terms, the inscription on the foetus as an individual patient has become entrenched in both medical and lay understandings of pregnancy and has been used to justify the supervision over women’s behaviour during pregnancy. The notion of the foetus as patient is ‘medical fiction’, argue the authors: ‘Effectively the law adopts a very simple approach to the female/foetal relationship and says 'there is no debate' because what we have is one person (who happens to be pregnant) and nobody else’.733

However, despite this, the idea that women’s behaviour must be controlled in order to produce a successful outcome has again gained currency in the later twentieth century.734 As medical researchers began to turn their focus to the development of the foetus, women since the late 1970s have been exhorted to ‘take care of themselves’ during pregnancy in order to ensure a healthy, successful birth. Although the medical profession has often sought to reassure individual women that they most likely did not ‘cause’ a miscarriage or have not ‘failed’ in their quest for motherhood, a variety of medical sources tell a vastly different story. For example, two pieces published in medical journals vividly illustrate the idea that a live birth is a success and that to miscarry or produce a stillborn baby is to have

732 Australian legal academic Judith Fordham argued in 1988 that ‘it has not yet been decided whether a mother can owe a duty of care to her unborn child [however] … theoretically an action in negligence could lie against the mother [if] injury has occurred, arguably as a result of her omission to seek treatment’. Furthermore, Fordham suggested that, in terms of maternal responsibility and informed consent, [i]f the patient is to have an enforceable interest in choice, the patient should also bear the responsibility for those choices. If a doctor could show the patient was fully informed, he should not be liable for undesirable outcomes. In the obstetric context, patient choice or refusal of treatment may have undesirable consequences for the foetus. Without addressing the question of duty owed to the foetus, in principle the patient should bear the consequences in tort or even criminal law of her decision’. See J. Fordham, Doctors’ Orders or Patient Choice? The Law, What it is, and What it Could Be, Melbourne: Leo Cussen Institute, 1988, pp. 13 & 56. Kristin Savell notes that the ‘born alive’ rule does not extend to a foetus which has not drawn breath independently because legally a foetus is not a human being. See Kristin Savell, ‘The Legal Significance of Birth’, UNSW Law Journal, vol. 29, no. 2, 2006, 200-206. 733 Kerry Petersen and Sheila McLean, ‘Patient Status: The foetus and the pregnant woman’, Australian Journal of Human Rights, vol. 6, no. 2, 1996, http://www.austlii.edu.au/au/journals/AJHR/1996/6.html. Accessed 8th December 2007. 734 Expectations of ‘appropriate’ pregnant behaviour are part of the wider disciplinary practices enacted upon the female body. Sandra Lee Bartky argues that ‘the disciplinary techniques through which the “docile bodies” of women are constructed aim at a regulation that is perpetual and exhaustive – a regulation of the body’s size and contours, its appetite, posture, gestures and general comportment in space, and the appearance of each of its visible parts’. See S. Bartky, ‘Foucault, Femininity and Patriarchal Power’, in Irene Diamond and Lee Quinby (eds.) Feminism and Foucault: Reflections on Resistance, Boston, MA.: Northeastern University Press, 1988, p. 80.

229 failed in the quest for the ultimate feminine fulfillment - motherhood. In an article in 1978 entitled ‘Failure to Mourn a Stillbirth: an overlooked catastrophe’, Emanuel Lewis and Anne Page observed that the medical profession had in the past contributed to this catastrophe by neglecting to provide adequate emotional support for women after a stillbirth or neonatal death; however, they argued that this in itself was not the root cause of the widespread failure to mourn a perinatal death. Rather, it was the woman’s own unconscious feelings of guilt and shame at her body’s inability to produce a live child which led to psychological morbidity: because stillbirth was the puzzling death of ‘someone who did not exist’, the authors claimed that women suffering a miscarriage or perinatal loss would naturally feel that they had ‘failed as women’.735

Nearly twenty years later the ANZJOG published a letter to the editor from a long-serving medical practitioner in Melbourne, Max Jotkowitz, who detailed his professional contact with a woman who, after four miscarriages, ‘finally succeeded in achieving a much desired family’. Eight months later, the patient was tragically found dead, having hanged herself in the living room of her family home. In his letter, Jotkowitz concluded that it was the woman’s ‘unconscious shame’ over her troubled obstetrical history that had been her ultimate and tragic undoing, despite her finally ‘achiev[ing] motherhood’. He argued that ‘after all the endeavours on her behalf to achieve a healthy pregnancy this intelligent Grammar school teacher was found dead by her own hand. Presumably this was due to her inability to cope mentally with the various gynaecological procedures over many years on her behalf to achieve motherhood’.736

Although medical discourse has been an authoritative voice in its focus on maternal factors and the level of ‘risk’ given to an individual pregnancy, the medical profession has not been the sole voice in constructing the notion of the self-sacrificing and self-monitoring mother- to-be who is thus charged with the responsibility for producing a healthy baby. In Australia, articles in leading newspapers, preconception and pregnancy handbooks, and, in more recent times, the internet, have perpetuated the notion that pregnancy should be a time for

735 Lewis and Page, ‘Failure to Mourn a Stillbirth’, p. 237. 736 Max W. Jotkowitz, ‘Re: Maternal suicide after pregnancies in a rudimentary horn’, Letter to the Editor, ANZJOG, vol. 45, no. 5, October 2005, p. 465.

230 self-control, for the ‘sake of the unborn child’. 737 The image of the self-sacrificing expectant mother, and her immoral counterpart, the pregnant woman who risks her unborn child’s health and welfare in order to indulge her selfish habits reflect and have emerged from medical discourse but are also produced in a cultural and political context which values self-responsibility, accountability and control; lauds success; and devalues ‘imperfection’.738

In earlier chapters I argued that women were often not informed about the physiology of birth and any complications that may arise; within this context, it is tempting to view the increasing precautions issued to pregnant women in the late twentieth century as merely progressive and responsible behaviour on the behalf of the medical and scientific community. To a degree, this is true; however, as Crouch and Manderson argue, the prescriptions for a normal, healthy birth have cultivated a ‘moral component’ of pregnancy which has led to an expectation that if women manage their pregnancy appropriately, they will be rewarded with a healthy baby.739 The corollary of this expectation is the implication that women have been to blame if their baby died. In the best-selling Australian edition of What to Expect when you’re Expecting, the authors of the comprehensive pregnancy advice manual respond to the question ‘I had the perfect first baby … I can’t shake the fear that I won’t be so lucky this time’ with the reassurance that ‘your chances of hitting the jackpot again are excellent. A mother who has had a perfect baby isn’t only likely to win again, her odds are better than they were before she had a successful pregnancy under her belt’.740 The strong implication is, of course, that women who have had a previously ‘imperfect’ baby have not ‘won’ but have lost in their quest for the perfect baby; furthermore, this loss has been caused in some way by their failure to control their pregnancy adequately.

737 Crouch and Manderson argue that ‘once women are pregnant the self surveillance recommended in many of the popular booklets and pamphlets is extraordinary. They are extolled to “give baby the best start in life” by planning the pregnancy and adhering to a range of dietary, behavioural and psychological prescriptions in line with the idea that a “happy and worry free, healthy pregnancy will add to that joy and lay the ground work for a contented baby.” ’ See Crouch and Manderson, New Motherhood, p. 91. 738 Fore a discussion of the impact of neo-liberalism on contemporary constructions of perinatal loss in the American context, see Layne, Motherhood Lost, pp. 146-147. For a broader analysis of the rise of neo-liberal values across a range of spectrums, see for example Dennis Woodward, Australia Unsettled: The Legacy of Neo-Liberalism, Frenchs Forest, NSW: Pearson Education Australia, c2005. 739 Crouch and Manderson, New Motherhood, p. 91. 740 Arlene Eisenberg, Heidi Eisenberg Murkoff and Sandee Eisenberg Hathaway, What to Expect When You’re Expecting, Sydney: Angus and Robertson, 1996, p. 24.

231 For the past thirty years, women have been constantly reminded that they need to manage their behaviour during pregnancy in order to produce a ‘happy outcome’; to flout these expectations is to invite deleterious consequences including miscarriage, stillbirth or a seriously ill baby. ‘Do your best to avoid risks’, intones Dr Miriam Stoppard in a popular pregnancy-care handbook - and the list of risks is seemingly endless, from leaving childbirth to ‘too late’; eating seafood with a high mercury content; failing to take ‘necessary’ prenatal vitamins; to leaving ‘too little’ space between pregnancies and failing to control one’s emotional equilibrium during pregnancy. The danger of pregnancy loss is explicitly linked to women’s behaviour. Stoppard, for example, advises the pregnant woman that ‘you need to eat properly for your baby’s sake. If you don’t, there is a higher risk you could miscarriage, or have a premature or low birthweight baby who will be more vulnerable at birth and later in life’.741 As pregnancy has also been conceptualised as a time for self-sacrifice, the reward for this sacrifice, argues Stoppard, would be a healthy mother and healthy baby.742

An ironic and paradoxical result of the counter-cultural natural birth movement has been the strengthening of the notion that women can, and should, control their pregnant bodies in order to produce a desired result.743 Homebirthing advocate Rowena Davies, for example, asserted that women need only ‘claim responsibility’ for their pregnancies by wresting the control from ‘the professionals’. To relinquish responsibility, she argued, was to create fear of one’s body, and fear led to complications in childbirth – the corollary of which is the risk of perinatal loss.744 In 1996, Random House published The Natural Way to Better Babies, a preconception handbook for women who had previously been ‘unsuccessful’ in sustaining a pregnancy to the birth of a healthy baby. At the crux of the authors’ message was the idea that, by harnessing their ‘instinctive feminine strength’, women could not only ‘succeed’ in

741 Miriam Stoppard, Conception, Pregnancy and Birth, Ringwood, Vic.: Viking Press, 1993, Rev. ed., p. 138. 742 Stoppard, Conception, Pregnancy and Birth, p. 170. 743 Landsman argues that the counterculture of the so-called ‘natural birth’ movement has contributed to the notion that women can, and should, exert control over their bodies in order to produce a healthy baby. See Landsman, ‘Does God Give Special Kids to Special Parents?’ p. 141. Layne also argues that ‘the fundamental premise of the women’s-health movement, that women must wrest back control of their bodies from physicians, especially during pregnancy and birth, reinforces the notion that positive birth outcomes are something women can control’. See Layne, Motherhood Lost, p. 243. 744 Sally Rowena Davies, Empowerment of Women, Birth: you know how to birth your own baby, Beaconsfield, WA.: Sally R. Davies, 1992; see also Gabrielle Targett, A Labour of Love: An Australian Guide to Natural Childbirth, Fremantle, Fremantle Arts Centre Press, 2006.

232 falling pregnant, but would achieve the birth of a healthy, intelligent, and beautiful baby. Those who did not ‘listen’ to their inner femininity would produce sickly, unattractive and difficult babies – or worse, a baby who was stillborn or died shortly after birth. The authors devoted several pages of the book to introducing two cases to demonstrate their view that, by following the ‘Better Babies’ prescription, women would be ‘rewarded’ with a ‘perfect baby’. Women who did not manage their pregnancy within the ‘Better Babies’ definition – for example those who ate a poor diet; were ‘too stressed’; continued to smoke and drink caffeine; or were in emotional and mental disharmony with themselves and their environment – ran the risk of miscarrying or producing a stillborn or ‘deformed’ baby.745 Furthermore, the authors, both self-described counter-cultural ‘natural birth and fertility experts,’ claimed that ‘certain psychological traits have been noted as being typical of women who have suffered multiple miscarriages. Whether these are causative, or the result

745 In this long but instructive excerpt, the authors wrote that: ‘Just in case you still have a few doubts [about the importance of preconception care] we would like to tell you two short stories which better illustrate what can be achieved with preconception care, and, on the other hand, what you might experience without it. The first couple, who are in their late 30s, conceive at their first attempt after attending to all of the recommendations in Better Babies. This mother-to-be suffers a little tiredness during the early weeks of her pregnancy, but at the end of the first three months she feels like her usual self again. Her pregnancy progresses without a problem, she gains a modest amount of weight, feels well and looks wonderful … She goes into labour shortly after her expected date. Her contractions are strong and effective, and throughout her very short labour she moves and groans instinctively. After her baby is delivered, she has a tiny labial graze, but an intact perineum. Her newborn’s health is rated at the top of the scale. The placenta is delivered, with minimal loss of blood. Breastfeeding is quickly and easily established. In the days that follow the new mother is euphoric. She is confident and at ease in the handling of her new baby. He is particularly handsome, and he has a large perfectly shaped head, with broad and evenly spaced facial features. His skin glows with good health. He is alert, but content … As he grows he reaches all his developmental milestones well ahead of his peers. He suffers from none of the usual ills of infancy. And now we hear of another couple, who also decide they want to start a family. After trying unsuccessfully for three years to conceive (and after suffering two early miscarriages), they are referred to a GIFT program. After four unsuccessful attempts they decide not to try again, but twelve months later the woman discovers to her delight that she is pregnant. During the early weeks of her pregnancy, this mother-to-be suffers badly from nausea and vomiting. Eventually this stage passes, but in the following months, she develops haemorrhoids, varicose veins and stretch marks, though she wears these and her increased skin pigmentation and weird food cravings as a badge of her impending motherhood. She gains a great deal of weight and towards the end of her pregnancy she is unable to eat a meal or sleep with any degree of comfort … Her labour begins spontaneously, although it progresses slowly. After 24 hours with very little progress, she is exhausted, demoralised, and agreeable to some help. This speeds things up, but it also makes her contractions quite unbearable. She has an epidural, an episiotomy and a forceps delivery in quick succession. Her baby, at birth, is limp and a poor colour and is taken to the neonatal ward for observation. When he is returned to her she puts him to the breast, but he has an abnormally shaped palate and does not suckle well … He is a sickly child. His skin is rough and blotchy, his head is rather small, his features are pinched, he has a pot belly … he still has nappy rash, which frequently becomes infected, has cradle cap and is miserable when teething … He is clumsy and accident prone. When he starts school he finds it difficult to sit still, his attention span is short, he is disruptive and is diagnosed as having a learning problem. He has constant colds and develops glue ear. He continues to wet the bed. We could go on, but let us leave the stories here, for it is now probably clear that the first story is about a new family who have a “better baby”, and the second about a family who do not’. See Francesca Naish and Janette Roberts, The Natural Way to Better Babies, Sydney: Random House, 1996, pp. 9-11.

233 of the experiences, is not clear [including] chronic depression and anxiety, loss of self esteem, distorted body image, anger, decreased libido and guilt’.746

In popular understandings of pregnancy, certain behaviours have also been constructed as particularly irresponsible and destructive to the developing foetus and have been positioned as especially selfish on the behalf of the expectant woman, who was constructed as inviting tragedy by pursuing an ‘inappropriate’ pregnant lifestyle. In the mid 1980s studies into the effect of nicotine on the developing foetus took on a new urgency as researchers discovered that smoking during pregnancy would have a harmful impact on the developing foetus and could lead to miscarriage, perinatal death or, for those babies who survived, a lifetime of ongoing health problems.747 Popular understandings of the impact of smoking whilst pregnant were overwhelmingly framed by the idea that expectant women should behave selflessly for the good of their unborn baby. Headlines in major Australian newspapers explicitly constructed women who continued to smoke during pregnancy as transgressing ‘appropriate’ maternal behaviour. ‘We need to put kids first’ proclaimed an article by journalist Sally Morrell in the Sunday Herald-Sun; she argued that selfish parents began inflicting harm in the womb and progressed throughout childhood.748 The editor of an article by Rada Rouse in the NSW daily tabloid, Daily Telegraph, chose the more explicit and unambiguous headline ‘Smoking mums kill their babies’.749

As the results of medical research into the impact of smoking on the foetus became disseminated to the public, women who chose to ignore or flout cultural expectations of ‘appropriate’ behaviour, such as abstaining from smoking during pregnancy, were not only constructed as ‘selfish’, but were also branded as immoral. After the release of a study into nicotine and foetal health in May 1999, the incumbent Australian Medical Association President, David Brand, was quoted in the South Australian newspaper The Advertiser as saying that women who continued to ignore scientific research into the impact of smoking on prenatal health were ‘morally reprehensible’.750 Shaun Brenneke, a doctor at RWH in Melbourne, was quoted in an article in the Herald Sun on this issue; he laid the responsibility for 23,000 baby deaths in Australia squarely at the foot of ‘smoking

746 Naish and Roberts, The Natural Way to Better Babies, p. 152. 747 Susan Vale, ‘How Smoking Puts The Unborn Child At Risk’, Age, 2 June 1993, p. 13. 748 Sally Morrell, ‘We Need to Put Kids First’, Sunday Herald-Sun, 28 May 1999, p. 19. 749 Rada Rouse, ‘Smoking Mums Kill Their Babies’, Daily Telegraph, 5 June 1997, p. 21. 750 Lorna Knowles, ‘Moral Issue’, Advertiser, 26 May 1999, p. 9.

234 mothers’. The journalist, Helen Carter, added that many women who continued to smoke during pregnancy ‘often do not do enough to fight the addiction for the sake of their babies’.751 Pregnant women who did cease smoking were lauded in other newspaper reports for their sense of ‘responsibility’ and appropriate display of selflessness towards their unborn children.752

Towards the end of the twentieth century, there were calls for women whose babies died as a result of ‘preventable’ causes, such as smoking or drug use, to be held criminally liable for their infants’ deaths. Journalist Sally Morrell reported that ‘selfish, indulgent’ women ‘just won’t stop hurting their unborn babies if it gets in the way of their wants’. She added that one ‘would have to be downright dumb’ to not know that smoking can harm a developing foetus, and cited the case of Simone Dagleish, seven months pregnant, who ‘argued weakly’ that ‘she has “tried everything to give up”’, as she lit a cigarette. In her report, women who continue to smoke despite the risks in pregnancy are characterised as weak-willed, selfish and criminal, who need to be forced to stop displaying ‘blatant disregard’ for their unborn children and to ‘act responsibly’. Morrell suggested that these ‘types’ of women should forfeit their rights and be subjected to urine testing to ascertain if they were continuing to smoke cigarettes during pregnancy,753 whilst a later opinion piece by Andrea Burns, published in the Herald-Sun, argued that ‘nicotine-addled’ pregnant women should be subject to a ‘citizen’s arrest’ for continuing to ‘still selfishly indulge a vile habit at the child’s peril’.754

However, smoking during pregnancy was not the only behaviour branded as morally reprehensible and selfish. Towards the end of the twentieth century, women were burdened with a seemingly-endless list of prohibited behaviours which ranged from the mundane to the extraordinary, such as drug use in pregnancy which was branded as ‘child abuse in utero,’ where the unborn child ‘copped a bashing’.755 Newspaper articles from the 1990s stressed the importance of maternal health from conception; for example, women were

751 Helen Carter, ‘Smoke Link to 63 Baby Deaths a Day’, Herald-Sun, May 26 1999, p. 1. My emphasis. 752 See for example Miriyana Alexander, ‘Healthier Mums Lift Live Births’, Sunday Star-Times, 22 June 1997, p. 5. 753 Morrell, ‘We Need to Put Kids First’, p. 19. 754 Andrea Burns, ‘Selfish Mothers-to-be Leave me Fuming’, Sunday Herald-Sun, 25 November 2007, p. 114. 755 Stephen Juan, ‘The Junkie Baby: A Child Development Nightmare’, SMH, 23 June 1988, p. 18.

235 cautioned against using heavy doonas in the third to sixth week of pregnancy, with researchers suggesting the use of a ‘good quality blanket’ instead, to prevent overheating and the risk of miscarriage. Indulging in the so-called ‘peril’ of too much caffeine could also cause miscarriage or premature birth, whilst women who were ‘too stressed’ – particularly if the mother-to-be remained in particularly stressful employment, were warned that they were not only risking miscarriage, but also lifelong negative consequences for their unborn child.756

Women who had been the daughters of the second-wave feminist movement and had grown up with the understanding that they were not limited by their biology were also blamed for reproductive difficulties and ‘pregnancy failure’ because of the growing trend of women ‘waiting too long to start a family’. Medical language explicitly cast the ageing female body as likely to produce ‘defective’ pregnancy; the ova of women over thirty-five, for example, were termed as ‘degenerating eggs’, and popular understandings of pregnancy in older women continued this theme, urging women to reproduce at their ‘biological peak’ or face the prospect of pregnancy loss. An article in the SMH, for example, explicitly linked the rise in ‘unexplained’ stillbirths in the late 1990s with the ‘trend towards women having children later in life’; a curiously definitive claim considering the researcher cited in the article, Associate Professor Paul Lancaster, was reported as saying that this trend may only ‘partly explain the pattern’.757

Those who did not heed the warnings that older age posed great risks to the foetus – whether by choice, circumstance or otherwise – were roundly denounced as both selfish, for ‘wanting it all’, and stupid, for not knowing their own biological limits.758 Journalist Angela Shanahan, for example, argued in The Australian that women who delayed becoming mothers until their late thirties – ‘the principle target group of the feminist message that getting a life is inimical to getting a husband and children’ – were ‘following

756 See for example Sean Parnell, ‘Caffeine Raises Birth Risks’, Courier-Mail, 26 November 1999, p. 16; Angie Kelly, ‘The Baby Making Diet’, Sun-Herald, 25 April 1999, p. 8; John Ellicott, ‘Work Stress Brings on Baby’, Australian, 7 September 1998, p. 1; Julie Robotham, ‘Anxiety May Cause Low Birth Weights’, SMH, 16 January 1999, p. 6. 757 Julie Robotham, ‘Stillbirths Rise: Links to Older Mothers’, SMH, 18 January 1999, p. 3; Kristine Gough, ‘Late Expectations’, Australian, 25 November 1999, p. 14. 758 As May notes, Susan Faludi warned that the new push towards parenthood which took place in the 1980s was explicitly designed to induce guilt in older women, and, she argues ‘took the form of a media blitz aimed at educated career women, warning them that if they delayed childbearing, they were likely to find themselves infertile’. See May, ‘Nonmothers as Bad Mothers’, p. 206.

236 the path previously reserved for young men, of a prolonged period of infantilism, of sexual promiscuity - of wild oat sowing, call it what you will’. To curb the growing ‘selfishness’ of young women, Shanahan continued, there should be a programme of ‘education in sexual morality based on a sense of self-respect that regards fertility as a precious gift, and marriage and parenthood as true vocations, is a valuable grounding for the future’.759

Prenatal testing: avoiding a ‘failed outcome’

Towards the end of the twentieth century prenatal testing became constructed as a routine feature of pregnancy; consenting to prenatal screening and testing increasingly became understood to be part and parcel of ‘responsible’ parenthood.760 Popular understandings of the role of prenatal diagnosis viewed interventions such as ultrasound as providing reassurance that the pregnancy was developing ‘normally’, and towards the end of the twentieth century, and beyond, such tests have become to be regarded as routine and an essential part of pregnancy. Miriam Stoppard, for example, assured her readers that ‘your baby needs scans’ to ensure its ongoing health and vitality,761 whilst a number of newspaper articles decried the withdrawal of public funding to some diagnostic tests, claiming that it robbed women of much-needed reassurance.762

In order for prenatal screening to have become considered routine, Eleanor Milligan argues that in medical and popular discourse testing has been presented as unproblematic and merely a means for reassurance,763 whilst Melinda Tankard-Reist argues that when something becomes routine, fewer questions are asked about the values implicit in such interventions.764 Therefore, whilst couched in such euphemistic and unthreatening terms,

759 Angela Shanahan, ‘Populate or Perish the Thought of a Full Life’, Australian, 18 November 1999, p. 17. 760 Eleanor Milligan argues that ‘once reserved for “high risk” pregnancies, prenatal screening has now become a routine feature of antenatal care in most first world countries with up to 90% of women receiving some form of testing during pregnancy … Widely regarded as a means of increasing reproductive choices through enhanced knowledge and more informed decision making, prenatal screening is seen by parents and doctors alike as unproblematic, even “responsible pregnant behaviour”’. See E. Milligan, ‘Ethical Practice in Prenatal Screening: Can Informed Consent Deliver?’, in C. Bailey, D. Cabrera and L. Buys (eds.) Proceedings Social Change in the Twenty First Century Conference, Brisbane: Centre for Social Change Research, Queensland University of Technology, 2004, p. 3. 761 Stoppard, Conception, Pregnancy and Birth, p. 181. 762 Peta Rasdien, ‘Scans a Loss to Peace of Mind’, West Australian, 11 January 2000, p. 5; Editorial, ‘A Heartless Piece of Cost-Cutting’, Adelaide Advertiser, 11 January 2000, p. 16. 763 Milligan, ‘Ethical Practice in Prenatal Screening’, p. 7. 764 Reist, Defiant Birth, p. 16.

237 women were increasingly urged to submit their pregnant bodies to be screened for ‘abnormal’ foetal development in order to save themselves from the ‘tragedy’ of an ‘unsuccessful’ outcome – the death of a baby or the possibility of a disabled child.765 Whilst prenatal testing and its corollary, termination for genetic ‘abnormality’, was acknowledged as a difficult decision, it was rendered as less problematic because of re- emergence of the medical inscription of ‘unknowable’ on the foetal body; Lachlan de Crespigny, Meg Espie and Sophia Holmes, for example, argued that: Women who have a miscarriage, or a pregnancy termination for a fetus with an abnormality, can experience a grief reaction similar in intensity to that provoked by the death of a partner or child. It is easy to understand how devastating it may be to lose a partner with whom one has long shared experiences, emotions and companionship. It is far less easy to understand how the same depth of grief can be felt for a fetus who has existed for such a short time, and, in reality, has never been a person.766

The rise of ultrasound and associated prenatal diagnostic tests in the late twentieth century has also strengthened notions of achievement, of manipulating the environment in order to produce a ‘successful outcome’ – or avoiding an ‘unsuccessful’ outcome by way of screening for imperfection. On the one hand, prenatal tests have been hailed for their abilities to allow doctors to operate on babies in utero, but have also increasingly been used to detect ‘imperfection’ – a ‘failed’ foetus.767 The increasingly routine use of ultrasound and other diagnostic tools has given the medical profession an increased surveillance over women’s bodies during pregnancy and childbirth – in the medical textbook The Fetus as Patient, the authors argue that ultrasound is a ‘unique opportunity to get in contact with our object, the fetus’, yet another way to ‘organize the surveillance for the mother and her fetus beyond the year 2000’.768

765 Prominent Sydney obstetrician, Lachlan de Crespigny and co-authors Meg Espie and Sophia Holmes recount the experience of one couple who came for a chorionic villius sampling (CVS) test for a subsequent pregnancy after the death of their first child, a girl who had been born with Down Syndrome and who had died five days after birth. According to the authors, the parents were ‘afraid to embark on another pregnancy unless they had the reassurance that the disaster of their previous experience would not be repeated’. Ironically, the authors continued to construct tests such as CVS as a means of ‘reassurance’, even though they acknowledged that in this case the baby had died not because of being affected by Down Syndrome – which can be detected by CVS - but because the vessels of the umbilical cord had ruptured when labour began, which resulted in foetal haemorrhage and severe brain damage which ultimately caused the baby’s death. See Lachlan de Crespigny, Meg Espie and Sophia Holmes, Prenatal Testing: Making Decisions in Pregnancy, Ringwood, Vic.: Penguin, 1998, p. 35. 766 de Crespigny et al, Prenatal Testing, p. 170. 767 See for example Margaret Harris, ‘Breakthrough Test to Save Deformed Babies’, Sun Herald, 29 October 1988, p. 3. 768 Salvesen and Eik-Nes, ‘The Routine Fetal Examination’, p. 87.

238 For example, Michael Bennett, professor of obstetrics and gynaecology at the Royal Women’s Hospital in Sydney, New South Wales, was enthusiastic about pioneering foetal surgery in the late 1990s that would, he argued, help reduce the rate of stillbirths and fatally ill newborns if potential candidates for surgery were selected on the basis of potential to become a ‘productive’ citizen. When asked if such risky surgery was a waste of resources, Bennett argued that it was fiscally beneficial to operate on worthy candidates. The reporter wrote that ‘Professor Bennett says the resources used in such cases justify the results because, if successful, “we've got ourselves a normal member of the human race who, in terms of resources, is going to plough back an awful lot by being a taxpayer.”’ In the same article, Dr Henderson-Smart, director-general of the perinatal medicine department at the King George V hospital in Sydney, agreed that in-utero operations to ‘salvage’ otherwise- ‘useless’ lives would ‘save money’ – but only if foetuses were selected based on their suitability. Foetuses with multiple abnormalities should not be selected, he argued, presumably because they were likely to die before or at birth and would not become ‘productive’ citizens who would therefore justify the expense of such an operation.769

Popular understandings of prenatal testing also viewed the ability to screen for ‘defectiveness’ as a means of reducing the number of babies who would otherwise be unnecessarily and tragically be born ‘deformed’, stillborn, or die shortly after birth. A newspaper report in a 1988 issue of the tabloid Herald-Sun, for example, proclaimed that ‘breakthrough tests save deformed babies’. However, as the ensuing article demonstrated, ‘saving’ deformed babies – in this case, babies with Down Syndrome – was equated not with therapeutic attempts to improve the wellbeing of affected foetuses, but meant the ‘likely’ termination after a positive diagnosis was made using the nuchal fold test, and later, amniocentesis.770 In What to Expect when you’re Expecting, the authors echoed the notion that prenatal testing could ‘save’ both a ‘defective’ foetus and its parents from either a needless stillbirth or the perceived tragedy of a life of disability, proclaiming that ‘in spite of the increased risks in delivering “abnormal babies”, prenatal testing is good news for expectant mums over thirty five … evaluations for birth defects can be done in utero …

769 David McKnight, ‘Australian surgeons not far behind’, SMH, 9 October 1986, p. 19. 770 Harris, ‘Breakthrough Tests Save Deformed Babies’, p. 3.

239 which means that the risk that a mother to be over thirty five will bear an infant with a severe birth defect can be reduced to a level comparable to that for a younger woman’.771

Therefore in the late twentieth century, women were increasingly expected to consent to prenatal screening as part of the rhetoric of ‘responsible’ pregnant behaviour, and having submitted to these interventions, to act in ‘appropriate’ ways. Particularly with the cultural veneration of ‘science’, a number of critics observe that ‘it is extremely difficult, if not impossible for women to choose to reject technologies approved by the obstetrical profession. Once tests are offered, to reject them is a rejection of modern faith in science and also a rejection of modern beliefs that women should do everything possible for the health of the future child’.772 Rothman notes that although ‘non-directive’ genetic counseling is held as the ideal with many counselors professing to hold to this ideal, genetic counselors were given the power to ‘shape the session, and thus the decision-making process, by directing the woman’s attention toward some questions, and away from others’.773

Medical and popular literature from the 1980s on this subject overwhelming subscribed to the idea that women are the agents in choosing interventions and prenatal diagnosis. The authors of the 1980 edition of Williams Obstetrics, for example, argue that genetic counseling allows parents to make ‘intelligent decisions about future childbearing … Amateurish advice, particularly of the unjustifiably optimistic variety, may produce tragic results’.774 In Prenatal Testing the authors argue that, because prenatal testing is at least legally elective, ‘ultimately, it is the pregnant woman who must decide whether or not she wishes to undergo testing. The choice is [hers] alone’.775 Later in the book, they claim that

771 Eisenberg et al, What to Expect When You’re Expecting, pp. 29-30. 772 Leon Kass and Wertz and Fletcher quoted in Reist, Defiant Birth, p. 16. 773 Rothman cites two examples of genetics counsellors in the United States who were part of her study; one counsellor explained why she entered genetic counselling by saying that ‘I’ve had enough freaky kids throw up on me. I want to get it before it happens’. The other articulated her thoughts about children with Down Syndrome by saying that ‘Sure they can be sweet children. And they grow up to be ugly adults’. Whilst acknowledging that these cases are at the extreme end of the spectrum, Rothman argues that ‘if this is how you see it, how can you not influence?’ See Rothman, The Tentative Pregnancy, pp. 46-47. 774 Williams et al, Williams Obstetrics, p. 1003. 775 de Crespigny et al, Prenatal Testing, p. 14. Later in the book the authors continue to stress that parents themselves must choose testing; whilst the authors acknowledge that patients may be ‘subject to paternalistic advice’, they ironically then continue to give ‘positive’ examples of parents who ‘initially had not thought about prenatal testing’ but who did undergo this, after being ‘strongly advised’ from medical professionals. See de Crespigny et al, Prenatal Testing, pp. 43-45.

240 ‘a doctor cannot decide what a woman’s attitude to termination of pregnancy should be. We support the right of the pregnant woman to make an autonomous decision on which if any test to have, and what to do if an abnormality is found’.776

However, like antenatal care, which critics have seen as a ‘coercive measure’ and a means of supervising women’s bodies in the history of obstetrical management,777 the rise of prenatal diagnosis and the emphasis on the development of the foetus and ‘successful’ outcomes in the late twentieth century can be seen as operating within a discourse of authority and coercion.778 As I have argued earlier, prenatal screening and antenatal care are predicated upon similar goals: to ensure a ‘successful’ outcome of pregnancy, yet prenatal screening differs from the latter because, firstly, testing towards the late twentieth century (and beyond) cannot detect all disorders, and secondly, the vast majority of disorders that can be detected are not ‘curable’ – leading to the obvious conclusion that the ‘improved outcome’ is non-continuation of the pregnancy. For example, the authors of What to Expect couched prenatal testing in terms of saving parents the futility of bearing a baby who would be unlikely to survive.779 Milligan observes that the ‘reassurance’ offered by genetic counselling in the late twentieth century has not been focused around assuring parents that their disabled child will be supported in the community, but rather that modern

776 De Crespigny et al, Prenatal Testing, p. 21. 777 Murphy-Lawless, Reading Birth and Death, p. 198. 778 As some geneticists and counsellors themselves have recognised, the consumer-oriented model in prenatal genetic counselling, whereby individuals are left to make their own decisions, often conflicts with broader policy goals which focus on measures of efficiency and define 'successful ' prevention in terms of termination of the pregnancy. Angus Clarke, a medical geneticist, for instance, noted that 'it is impossible to maintain a sincerely non-directive approach to counselling about a disorder whilst simultaneously aiming to prevent that disorder’. He continued that, ‘I contend that an offer of prenatal diagnosis implies a recommendation to accept that offer, which in turn entails a tacit recommendation to terminate a pregnancy if it is found to show any abnormality. I believe that this sequence is present irrespective of the counsellor's wishes, thoughts or feelings, because it arises from the social context rather than from the personalities involved - although naturally the counsellor may reinforce these factors. Thus the Holy Grail of non-directive counselling is unattainable, because the counsellor's conscious or even unconscious motives are irrelevant: the offer and acceptance of genetic counselling has already set up a likely chain of events in everyone's mind’. See A. Clarke, “Is Non-Directive Counselling Possible?”, Lancet, vol. 338, October 19 1991, pp. 998-1001. 778 Furthermore, as some critics observe, not all women understand medical interpretations of ‘risk’, nor are all women aware that ‘co-opting’ out of termination is a viable possibility after a positive prenatal diagnosis for abnormality. Furthermore, the combined factors of the power structure of medicine, the cultural subordination to this authority and the contemporary faith in medical technology have in the past led to women feeling coerced into termination. See Milligan, ‘Ethical Practice in Prenatal Screening’, pp. 1-16. 779 De Crespigny et al, Prenatal Testing, p. 45.

241 medicine can assist in averting the ‘frightening tragedy’ of bearing a ‘defective’ child.780 Reist quotes an Australian obstetrician, Andrew McLennan, who articulates the idea that a ‘successful’ outcome can only be the birth of a live, healthy baby: ‘Now we’ve got a system that allows us to pick up close to 85 per cent or 90 per cent [of foetuses with Down Syndrome]. So that’s a significant improvement in a short space of time’.781

The decision to continue a pregnancy with a foetus that is ‘incompatible with life’ has been made more difficult by the misrepresentation of disability, argues Milligan, and the attitude that to continue would be ‘pointless’.782 Bioethicist Sjef Gevers argues that the continuation of pregnancy in the case of severe foetal abnormality is a ‘pointless pregnancy’ because continuation to term cannot change the outcome of a ‘failed pregnancy’;783 screening, and the option to terminate for ‘defectiveness’, therefore, has been positioned as sparing women the ‘tragedy’ and the ‘futility’ of an unnecessary pregnancy which was likely to end in stillbirth or perinatal death. In Prenatal Testing for example the authors argue that, in the case of a ‘failed pregnancy’784 ‘it is unusual for couples to choose to continue a pregnancy when the fetus has a severe abnormality preventing it surviving long after birth … most women find it intolerable to continue the pregnancy for even a short period’.785

Karen, for example, was told at twenty two weeks pregnant that her unborn child was ‘incompatible with life’ due to a ‘lethal placental chromosomal abnormality’ and she was urged to consider termination. Both the genetic counsellor and her obstetrician told Karen that she needed to ‘think about saving [her] uterus for a healthier baby’ and informed her that she would be approved for a termination, despite being past the cut-off point of twenty weeks gestation, because they were ‘prepared to fake dates up until twenty two weeks’. Karen refused, but was still subject to continual pressure to terminate her supposedly

780 Milligan cites disability advocate Tom Shakespeare as noting that ‘whilst I support a woman’s right to choose, I regret situations where a pregnancy is terminated because of inaccurate or prejudiced information about what it is like to be disabled’. See Milligan, ‘Ethical Practice in Prenatal Screening’, pp. 10-11. 781 Andrew McLennan cited in Reist, Defiant Birth, p. 6. 782 Milligan, ‘Ethical Practice in Prenatal Screening’, pp. 10-11. 783 Sjef Gevers quoted in Reist, Defiant Birth, p. 6. 784 de Crespigny et al, Prenatal Testing, p. 164. 785 de Crespigny et al, Prenatal Testing, p. 143.

242 ‘pointless pregnancy’: she was told at twenty five weeks gestation that ‘we can [still] admit you to hospital today and induce you for medical reasons if you like’.786

Prenatal Testing and Maternal Responsibility

In 2000, bioethicist Henriikka Clarkeburn argued that parents had a duty of care towards their unborn children; these responsibilities fell under the ethical principles of ‘beneficence’ and ‘non-maleficence’ and included the obligation that one must prevent evil and harm. According to Clarkeburn, in the case of a ‘severe genetic abnormality’, this obligation possibly extends to include termination, if the disability renders a life ‘worse than non- existence’.787 Although she noted that genetic conditions usually found in prenatal screening, such as Down Syndrome and cystic fibrosis, did not fulfil the definition of ‘life worse than non-existence’, Clarkeburn suggested that:

If a condition which is worse than nonexistence were identified, the parental duty of beneficence, in a moral sense, would extend even to those parents with only a minimal chance of having a child with such a condition. However, for a society to increase prenatal testing procedures in order to detect all extremely rare conditions is unlikely to be an acceptable use of public funds. Thus the moral duty is more prominent when parents are aware of an increased risk of having a child with a genetic condition which would lead to that child having a life worse than non- existence. Parents in such a situation would have a duty to take all possible precautions to prevent a child with the condition being born. These precautions include terminating an affected pregnancy. Parents who know of such risks and are not willing to use prenatal testing with the possible termination of an affected pregnancy, should refrain from conceiving. Society should allow for the realisation of this moral duty, by providing testing opportunities either prior to conception or during pregnancy. 788

786 Despite the diagnosis of ‘lethal placenta abnormality’ Karen’s baby was born healthy. Karen, personal correspondence with researcher, 15 January 2007. Email in possession of researcher. 787 Clarkeburn argues that ‘if … being born is worse than non-existence, the parental act of carrying to term a child with such a severe impairment can be considered as a harmful act. The parental duty of beneficence to use prenatal testing in conjunction with a possible termination of an affected pregnancy, can therefore only be sustained if it can be proved that it is possible 1) to have a life worse than non-existence, and 2) to detect an affected genetic constitution before conception or birth … If being born inflicts intolerable harm on the child, and there is a form of prevention in relation to financial and technical abilities and opportunities, the parental duty of beneficence requires such preventive measures to be taken’. See H. Clarkeburn, ‘Parental Duties and Untreatable Genetic Conditions’, Journal of Medical Ethics, Oct, 2000, vol. 26, no. 5, pp. 400-405. Clarkeburn’s position on ethics is undoubtedly derivative of the ideas of influential ethicist Peter Singer; see for example P. Singer, Practical Ethics, Cambridge & New York: Cambridge University Press, 1993, rev. ed. 788 Clarkeburn, ‘Parental Duties and Untreatable Genetic Conditions’, pp. 400-405.

243

However, the discourse of maternal responsibility and the notion that women should strive to achieve reproductive perfection serve to create a strong sense of ‘social pressure,’ argues Milligan; at the end of the twentieth century women have been cast as ‘advocates for their child’s health’ beginning in the womb.789 The notion that prenatal screening could ‘reduce’ parents’ suffering by sparing them the inevitability of a perinatal loss, or worse, a lifetime with a disabled child, meant that women in the late twentieth century were increasingly faced with an agonising decision should their child be diagnosed with an abnormality in utero.790

For some women, unwittingly contradicting the cultural expectation of a healthy pregnancy and healthy baby was a heavy burden to bear. Kelly, whose third child was diagnosed during a routine anatomy scan with severe congenital abnormalities ‘incompatible with [post natal] life,’ was given the choice by the team of specialists: to ‘interrupt’ the pregnancy or to continue, knowing that nothing short of a miracle would lead to the birth of a healthy child. Kelly chose to continue the pregnancy and at thirty eight weeks gave birth to a girl who lived briefly and died in Kelly’s arms: I think it was about three and a half hours of start to finish with the labour, it wasn’t very long, and they put her on oxygen for ten minutes, which gave us ten minutes with her, which I’m very thankful for. A lot of women who have babies that are born still don’t have that time, so I value my ten minutes, in that regard’.791 Nonetheless, Kelly did not tell many people that she had had an option to terminate the pregnancy, for fear of being criticised. At the time, with a lot of close friends, I didn’t tell that I had the option to either terminate or continue, because I found they were judging me, and I didn’t want to be judged, I just wanted to be respected for the decision I had made. And even now, I know, when I talk to people, you get to know new people at playgroup or

789 Milligan, ‘Ethical Practice in Prenatal Screening’, p. 11. 790 Towards the end of the twentieth century, this rhetoric was strengthened by the notion that serious disability was not only a burden to parents, but to society. The authors of Prenatal Testing argued that ‘there is a large cost to the community in raising children with Down Syndrome’, de Crespigny et al continued, ‘[and] it would be irresponsible not to consider the cost benefits’. They vigorously rejected the ‘popular’ perception that children with Down Syndrome, for example, were bright, happy children who may enjoy a satisfying, fulfilling life, arguing that the reality was vastly different: ‘Down syndrome babies are a major cost to the community and may cause a family considerable financial and emotional hardship – because of the stresses of raising a child with Down syndrome, the potential for conflict within a family can increase’. Prenatal testing, then, has been positioned as providing parents with reassurance that their unborn babies are ‘normal’, or, in the case of ‘abnormality’, ‘providing the opportunity to reduce the amount of such suffering’. See de Crespigny et al, Prenatal Testing, p. 135. 791 Kelly, interview with researcher.

244 wherever, and they –‘oh, you’ve got just this one?’ ‘No, I’ve got three at school’ – and you do stop and think, no I don’t really want to go into this today, with you.792

For those women who did choose to interrupt a pregnancy on genetic grounds, the view that it was ‘for the best’ was a problematic explanation. While some women accepted this view, others found that their grief was problematised by the misconception that they had not wanted their pregnancy to continue. Support After Foetal Diagnosis of Abnormality [SAFDA], for example, was established to explicitly challenge the notion that the ending of a pregnancy for genetic abnormality was a means of relieving expectant parents of the ‘burden’ of bearing a child with severe abnormalities, noting that within the cultural ideal of ‘healthy pregnancy, perfect baby’, parents were often ill-prepared when this ‘utopic picture’ was shattered.793 Recalling the care of women who terminated pregnancies under twenty weeks gestation for genetic reasons, Belinda Jennings argued that: In some respects, there is a minor degree of this punitive response where [nurses say] ‘you don’t deserve my best care because you don’t want your baby’. And I can give you an example from … gynaecology, where we give out mementoes – in the form of footprints, handprints, photographs - for all women experiencing perinatal loss - on the gynaecology ward, if they’re having a termination, sometimes for social reasons, sometimes for foetal anomalies reasons, they won’t do that, because they say, ‘they don’t want that baby, they don’t deserve it’. So there is a degree of punitive action.794

Transgressing the ideal of the ‘good death’

The discourse of maternal responsibility constructed pregnancy as a process which could be controlled, from daily activities such as managing diet and exercising, to the ‘routine’ use of prenatal testing which was particularly constructed as a means to ‘spare’ parents the trauma of giving birth needlessly to a child that would either die shortly after birth or who would live a severely disabled life. Within this context, perinatal loss was a corollary of what constituted a ‘good death’ in western societies at the end of the twentieth century. In Chapter Six I have argued that the last decade of the twentieth century saw a formalising of hospital policies designed to help women form attachments to their deceased infants; however, the expectation that medical science had conquered perinatal death meant it was

792 Kelly, interview with researcher. 793 See SAFDA, Diagnosis of abnormality in an unborn baby, Sydney: NSW Genetics Education Program, 1995. 794 Jennings, interview with researcher.

245 still a taboo subject, as stillbirth and neonatal death fell outside the idea of what constituted a ‘good death’.795 Anthropologists Bloch and Parry observe that: The notion of a good death may sound oxymoronic to many people living in contemporary Western societies. These societies are infused with cultural assumptions about illness, disease and death; health is beautiful and good, aligned closely to perfection, whereas disease and death are imperfect and implicitly bad. However, throughout history people have attempted to distinguish between “good” and “bad” deaths. From an anthropological perspective, a good death is one which suggests some mastery over the arbitrariness of biological occurrence.796

Despite the shift in hospital practices away from ‘shielding’ women from their deceased infants, stillbirth and neonatal death were still difficult and confrontational topics in Australian society. In seeking to educate the public about the incidence of perinatal death through radio interviews and other media, the perinatal pathologist Simon Knowles noted that some interviewers were open with their distaste for the subject; for example, the radio host who told Knowles that he ‘didn’t want to do the interview in the first place because ‘this is a family show’ and who then proceeded to introduce the subject on air as ‘morbid’.797

Many mothers found that their relatives and friends reacted with horror to their mementoes of the deceased baby. Women often left the relative safety of the hospital, with their only mementoes of their child – some photographs, footprints and handprints, the baby’s clothes, and perhaps a lock of hair, but, unlike the mementoes of a happy birth, found that relatively few were willing to share in these memories, perhaps unable or unwilling to plumb the depths of the loss. Claire, for example, remembers that for several years after her child died, she was eager to join in the inevitable conversations amongst groups of mothers about labour and birth but soon realised that her experience was too difficult for some to hear, or regarded by some as not a valid experience of motherhood. I’d want to say, ‘I’m a mother too!’ I’ve gone through labour, and I would initially talk about it … I’ve always been very open about it, and when people would talk about having their kids, or whatever, I would want to talk about my experiences, and I soon learnt that they weren’t always received as well as you would hope. It

795 Beverley McNamara, Fragile Lives: Death, dying and care, Crows Nest, NSW: Allen and Unwin, 2001, p. 41. 796 Bloch and Parry, cited in McNamara, Fragile Lives, p. 42. 797 Knowles, ‘A Passage Through Grief’, p. 1708.

246 made people uncomfortable, when I would tell them, especially in the initial sort of year or so afterwards.798

Women’s understandings of their miscarriage or perinatal loss were also contradicted by the view that miscarriages and stillbirths due to foetal abnormalities were often ‘for the best’.799 When Christine miscarried her second child only six months after her son was stillborn, an acquaintance tried to console her with an offhand remark. She recalled that ‘I had one woman say to me … third time lucky! … I don’t think it’s anger - it’s frustration, where you just want to push that person, where you want to say, “hang on, hang on. I’ve already lost one baby, and now I’ve lost two”’.800 Upon returning to work after her son died, Christine was faced with the difficulty of telling her colleagues why her child had died in the womb. Very few friends were willing to go into the details of her baby’s death, but Christine still persisted in sharing the story of her child. Oh, I’m a very open person, I tell people – probably people who didn’t want to know (laughs) but I would tell them. And you would always get, ‘well, at least …’ And you’d be, ‘no no no. It’s not ‘at least’. It is what it is’. And I remember telling – I was working on a television commercial shoot, and the last time I had seen this person I was six months pregnant – and I saw this person again, and he yelled across the room, ‘So have you had that baby yet?’ And the guys I was working with just cringed. And I went, ‘do you have a moment? I lost the baby’. ‘Oh. Do you have any idea – can I ask that?’ I said, ‘of course you can. He was really sick’. ‘Oh, well that’s better it happened that way because he was so sick’. And I said, ‘you know what? Either way, I’m dealing with something. Either way, I would be dealing with a really disabled baby that perhaps wouldn’t have survived very long, or doing what I’m doing now, and dealing with the death of my baby. So there’s nothing easy about it’. And people think they’re being helpful by making those sorts of suggestions.801

As Layne argues, the culture of ‘meritocracy’ in the late twentieth century has served to exacerbate the contradiction in understandings that a woman faces after pregnancy loss.802 For instance, Charlotte, whose first baby was stillborn shortly after the turn of the twenty

798 Claire, interview with researcher. 799 Certainly in Australia the idea still persisted that miscarriage and stillbirth were ‘nature’s way’ of getting rid of ‘defective’ foetuses; one popular book aimed at women conceiving after loss, for example reassured readers that miscarriage was ‘nature’s way of abandoning those fertilised eggs that don’t come up to scratch’. See Anne Stonehouse and Bruce Sutherland, After a Miscarriage, Melbourne: Pitman, 1986, p. 18. This sentiment was echoed in a later pregnancy handbook; the authors remarked that ‘nature does a good job of supporting strong, healthy pregnancies – and of abandoning those fertilised eggs that don’t come up to scratch’. See H. Welford, Pregnancy: The Complete Australian Guide to Planning and Birth, Wetherill Park: Gary Allen, 1998, p. 93. 800 Christine, interview with researcher. 801 Christine, interview with researcher. 802 Layne, Motherhood Lost, pp. 146-147.

247 first century, remembers that she felt ‘like a freak’, and that her body had ‘let her down’ by producing a deceased baby; her baby was rarely mentioned by family and friends after the event, despite the baby’s arrival being a much-anticipated and discussed event amongst the family.803

Similarly, after delivering her first child in 1997, Brenda found it difficult to not to blame herself for her baby’s death, even though the autopsy had revealed the cause of death to be ‘inconclusive’ and most likely due to a lack of oxygen. In her interview, she recalled that she was initially reticent to hold her baby because she feared that she had in some way contributed to his death, even though she ‘knew’ that she had done ‘everything right’ by watching her diet, stopping vigorous exercise and abstaining from alcohol. After gentle encouragement from the midwives, she did hold her baby, but she found it difficult. I felt like he was going to … grab a knife and kill me, [because] I’d killed him. Your mind just doesn’t … I don’t know whether other people have really experienced this, I haven’t spoken to others about it, but it was like my mind just … turned it round, like it was my fault and that this baby was going to wreak revenge. Maybe it was because I was responsible for this little one, and it was almost like I’d failed. And yet I know, sort of now, that I did everything right but there still is that ten percent that says, there’s something you did. Something happened, for some reason.804

After Christine’s stillbirth and miscarriage, she felt that her body had failed her in something that was meant to be a natural process. She commented that ‘the thing that was in the back of my mind was, I can’t even get that right! You know, the self-pity, and the blame. You know the medical mechanics of it. You know medically why you’ve lost those babies but you don’t know, spiritually, why’.805 Christine’s feelings of guilt threatened to displace the ways she was able to grieve her baby and, she said in her interview, meant that she and her husband had decided to ‘stop trying’ to fall pregnant again.806 Even though Christine had been reassured that her difficulties in pregnancy were the result of medical issues and not her behaviour during pregnancy, she found this to be scant consolation. She and her husband were told that they should have no problems conceiving again after her stillbirth, except for her body’s ‘inability’ to accept her husband’s sperm: ‘again we were having problems falling pregnant, so … my doctor referred me to [an IVF clinic]. So we

803 Charlotte, personal correspondence with researcher, 12 August 2005. Email in possession of researcher. 804 Brenda, interview with researcher. 805 Christine, interview with researcher. 806 Christine, interview with researcher.

248 went there and had some tests done and … it just turned out that – it sounds so awful – my mucus was hostile. It meant that [my husband’s] sperm wouldn’t – it would have a go, but [for] that angry mucus’.807

Penn, on the other hand, found great reassurance in the advice of a relative who sent her an email shortly after her miscarriage. The relative wrote: ‘how very sad for you both. I want to be really philosophical and give you some wonderful piece of advice that will help you with that but really, there’s nothing that can help at all with such a heartbreak, especially after the euphoria of discovering you were pregnant. I can only believe that sometimes this is a blessing, however badly disguised. It’s nature’s way of selecting only the best and perhaps the miscarriage has saved you from a lifetime of guilt, with a disabled child, which would be an even harder burden to bear. You are one of nature’s beautiful children yourself and you should have only the best’.808 After Penn posted the contents of this email on a public internet forum, she was inundated with replies, many from other women who had suffered miscarriages, who found the construction of miscarriage as ‘nature’s way’ to be offensive and hurtful.809

Conclusion

Earlier in the thesis, I have considered notions of maternal responsibility and the condemnation directed towards ‘selfish’ mothers who put their unborn children’s lives at risk by indulging in ‘dangerous’ behaviours from the early to middle decades of the twentieth century. Towards the end of the twentieth century, pregnant women once again increasingly bore the burden of responsibility in producing a healthy child – or, in the language of obstetrics, a ‘successful’ outcome. At this time the foetal body has also become subject to intense scrutiny; as I have argued in previous chapters, the foetal body was categorised in medical discourse as either ‘viable’ or ‘unviable’, dependent on gestational age and, to an extent, the degree of visible deformity. However, in the latter years of the twentieth century the foetal body was subject to a greater surveillance, and the categories of viable and unviable were widened to include other factors than gestational

807 Christine, interview with researcher. 808 Penn, personal correspondence with researcher, 20th December2007. Email in possession of researcher. 809 Penn, personal correspondence with researcher.

249 maturity and ‘gross abnormality’. Because of the medical profession’s increasing ability to observe the foetus in the womb, due to developments in in utero technologies, the foetal body has become embedded with values of worthiness and merit, which has in turn impacted upon understandings of perinatal death particularly in cases where the foetus was deemed to be ‘deformed’ or ‘unviable’, and thus, inherently ‘failed’. The rise of prenatal diagnosis and its construction as an ‘essential’ part of the supervision of pregnancy served to problematise the emerging understandings of the late twentieth century that pregnancy loss was a significant and traumatic experience for many women.

250 CONCLUSION

Although the incidence of stillbirth and neonatal death has declined significantly over the last one hundred years in Australia, some form of pregnancy loss remains a significant part of many women’s experiences of pregnancy and childbirth. Despite the relative frequency of pregnancy loss, miscarriage and perinatal death have remained relative silent subjects in historiography concerned with women’s lives in Australia. Since the 1970s feminist historians have contributed to a vast, rich and ever-increasing body of scholarship which gives insight into women’s experiences of maternity and motherhood; however, although some of these studies make reference to perinatal loss as part of a broader research focus, this thesis is the first focused study of the changing constructions of miscarriage, stillbirth and neonatal death in Australia and the experiences of some women who have suffered such a loss. In order to enlarge existing scholarship which has challenged the silence of women’s lives in the historical record, this thesis has sought to uncover what has been previously hidden in both women’s lives and the historical record, by privileging women’s voices of the experience of losing a baby.

Oral history has been a vital methodological tool in gaining insight into the ways women have understood their experiences of pregnancy loss. However, the dominant constructions of perinatal loss in twentieth century Australia have often been at odds with the way women themselves have understood the loss of a baby. The twentieth century was host to a number of constructions of miscarriage, stillbirth and neonatal death; although at times in contradiction with each other, these constructions have primarily been, to paraphrase the words of feminist legal academic Jocelynne Scutt, predicated upon the dominant cultural construction of woman’s humanness as dependent on the products of her womb.810 Throughout Australia’s past, the medical profession in particular has claimed the right to speak about perinatal death; whilst this authority has been both challenged and reinforced by the constructions produced by other groups in Australia’s past, medical inscriptions on the foetal and maternal bodies have produced enduring and dominant ways of understanding pregnancy loss.

810 Jocelynne Scutt, ‘Women's bodies, patriarchal principles’, in J. Scutt (ed.) The Baby Machine: Commercialisation of Motherhood, Carlton, Vic.: McCulloch Publishing, 1988, p. 196

251

At the turn of the nineteenth and twentieth centuries, the medicalisation of childbirth heralded a greater scrutiny over the pregnant body and positioned the medical profession as an authoritative voice in describing, naming and classifying the maternal and foetal bodies. Medical discourse constructed pregnancy within the duality of ‘successful’ versus ‘failed’ outcomes; a crucial part of this was the discrediting of women’s knowledge of pregnancy and childbirth, initially focused around the figure of the female birth attendant. The activities of the untrained midwife were dramatically curtailed by the development of obstetrics and gynaecology, and the professionalisation of medicine signaled the end of pregnancy and birth as events to be managed by women themselves.

Furthermore, within the context of the concern over the declining birth rate, the figure of the mother took on greater importance. The ostensible veneration of the (white) mother as vital to the project of nation-building was reinforced by the privileging of medical knowledge over women’s knowledge, and gave rise to the prevailing view that women should take responsibility for ensuring the birth of a healthy baby by submitting to the authority of the medical profession. Those women whose babies died either in utero or during the newborn period were constructed as having transgressed cultural expectations of motherhood. Bereaved mothers were regarded as anomalies and the unwelcome reminder of a ‘failed’ birth within the regimented environment of the postwar maternity hospital, which was principally organised towards the care of live babies and their mothers. Sometimes placed out of sight down a far corridor, at other times, placed back on the maternity ward, those women who miscarried or whose babies died shortly before or after birth presented somewhat of a conundrum for hospital staff. The practice of ‘protecting’ women from a perinatal loss was motivated by the construction of women in medical discourse as prone to ‘emotional instability’ during parturition, and the fear that bereaved mothers would become hysterical was an underlying motivation behind both sedation and the removal of the deceased baby’s body.

Both the medicalisation of death and the cultural rejection of the public expression of grief, wrought by the impact of the two World Wars, meant that perinatal loss was rendered taboo in the postwar period. The inscribing of the unborn baby as essentially ‘unknown’ and therefore replaceable led to the prevailing belief that, whilst perinatal loss was a ‘sad

252 event’, any grief following this event would be resolved by having another baby. This prescription for loss was also part of the cultural expectation that women’s ‘natural’ roles were that of wife and mother, and the act of having subsequent children signified a bereaved woman’s willingness to resume ‘normal’ life by fulfilling her rightful place in Australian society. Furthermore, the inscribing of either ‘abnormal’ or ‘normal’ on the foetal body led to some ‘deformed’ babies being regarded as ‘failed’ babies.

The impact of the wider social upheaval of the 1970s and 1980s in Australia would herald great changes in the way that perinatal death was managed in the clinical setting, due in large measure to the emerging ideas of the psychological impact of stillbirth and neonatal death, and later, miscarriage. Prior to the 1970s, very little writing - if any - existed in medical and psychological literature specifically on the subject of the impact of perinatal death; however, the beginning of the decade marked a focus on this type of loss. The cultural shift within the hospital from shielding women from their dead infants to encouraging them to form attachments with their babies was borne out of the emerging ideas of maternal-infant attachment and the wider cultural reform in matters of pregnancy and childbirth. In some Australian hospitals, this fostered a more supportive atmosphere within the hospital, yet many women still articulated a sense of guilt and failure after their babies were stillborn. The emerging theories of grief and loss were problematised by the continuing dominance of the medical construction of pregnancy loss, and it would be some years before the efforts of social workers, midwives, and some obstetricians to provide care which better reflected current trends in psychology would bear fruit in the hospital environment.

However, by the 1990s it was widely accepted that the practice of ‘protection’ was not an appropriate way of managing perinatal death. Formalised hospital policies at KEMH in WA and RWH in Victoria reflected the construction of perinatal death as an event of great significance in a woman’s life. The rejection of the practice of ‘protection’ in favour of assisting women to form attachments with their deceased babies and the shift away from hospital disposal or mass burial towards individual burial rituals, for example, give insight into the radical changes to the management of perinatal loss and the reinscribing of the deceased baby as eminently ‘knowable’ and irreplaceable.

253 In recent years, growing interest in the psychological impact of stillbirth and neonatal death, and the accompanying openness towards public rituals of mourning and grief, has also provided a space for some older women who suffered the death of a baby in the postwar years to revisit and renegotiate their memories of a long-ago experience. Whilst some older women sought to reinterpret their experience of the loss of a baby through the enactment of memorial practices such as the placing of plaques at unmarked gravesites, others continued to articulate their experiences within the cultural expectation of ‘spartan control’, whilst simultaneously recasting their memories within the greater openness towards grief and bereavement at the end of the twentieth century.

Towards the end of the twentieth century, however, these changing constructions of pregnancy loss were problematised with the medical profession’s increased ability to ‘screen’ the foetal body for ‘imperfection’. The rise of prenatal screening and the expectation that women should strive for reproductive ‘perfection’ has produced a cultural expectation that women can, and should, control their behaviours and bodies to produce trouble-free pregnancies and deliveries; this expectation has led to some women who suffered the death of a baby to question their actions during pregnancy and to feel a deep sense of shame that their bodies had ‘failed’ to produce a healthy baby. In the late twentieth century, the rise of prenatal screening has wrought a re-emergence of ideas of ‘appropriate’ maternal behaviours, potentially leading to stigmatisation for those women whose experiences of expectant and early motherhood fall short of these ideals.

Shane, for example, regarded her first child as precious and valuable despite the prenatal diagnosis that her baby was affected by the chromosomal condition Trisomy 13; the doctors classified her unborn child as ‘incompatible with life’ and Shane was strongly recommended to terminate her pregnancy at twenty weeks gestation. In her interview, she recalled having a meal with her husband on the night before being induced of her pregnancy; the waiter at the restaurant asked Shane when her baby was due, to which she responded that her baby was very sick and would not survive long after birth. The man reassured Shane that this was ‘nature’s way of getting rid’ of ‘defective’ pregnancies; just as racehorses often produce a ‘defective’ foal before producing a ‘good’ specimen, the

254 stranger assured Shane that it was ‘for the best’ that their first, ‘defective’, child was born dead.811

Throughout the twentieth century, medical discourse has sought to classify, surveille and supervise women’s bodies. The rise of prenatal testing and the reinforcing of the inscription of ‘defective’ on certain foetal bodies give insight into the vitality of this research. In recent feminist scholarship there has developed the strong tradition of locating the pregnant body within particular social and historical contexts; feminist sociologists have also been increasingly interested in what has been termed the ‘maternal/foetal conflict’ and the emergence of the notion of the foetus as an individual patient. However, the polemical nature of the abortion debate has led to an avoidance of an analysis of the foetal body by some feminist writers, which has ironically reinforced the medical discourse of ‘successful’ versus ‘failed’ reproduction.

If, as Mary Douglas argues, the body is a ‘powerful symbolic form, a surface on which the central rules, hierarchies, and even metaphysical commitments of a culture are inscribed and thus reinforced through the concrete language of the body,’812 then both the maternal and foetal bodies as surfaces of cultural inscriptions are of great importance to the future direction of feminist scholarship. In this thesis I have argued that the recent shifting of the medical gaze towards the foetal body has further entrenched the notion that women’s bodies are merely hosts to the developing foetus, cementing ideas of maternal responsibility and the linking of maternal behaviour to foetal outcome. It has, however, also meant that the foetal body has become subject to intense scrutiny. Whilst the foetus has long been categorised as ‘viable’ or ‘unviable’, dependent on gestational age and a relatively small litany of congenital deformities, in the latter years of the twentieth century the foetal body has become subject to a greater surveillance, and the inscriptions of ‘viable’ and ‘unviable’ have been widened to include other factors. The foetal body has become embedded with values of worthiness and merit – in a culture where the foetus is considered to be individual patient, this is a seemingly paradoxical shift, yet this shift has in turn impacted upon understandings of perinatal death particularly in cases where the foetus was deemed to be ‘deformed’ or ‘unviable’, and thus, inherently ‘failed’.

811 Shane, interview with researcher, 30 July 2005. Tapes and transcript in possession of researcher. 812 Mary Douglas, cited in Bordo, Unbearable Weight, p. 165

255

It is my hope that this thesis will serve to motivate other historians to continue to engage in the serious and worthy business of challenging the notion that the body is merely natural; rather, it is a site of contestation, power and oppression, simultaneously a site of embodied pleasure and resistance. In particular I am hopeful that many more feminist scholars will recognise the importance of the foetal body as a surface of cultural inscription, a body which is not merely in competition or conflict with the maternal body, but upon which has been inscribed a variety of meanings – some of which, in particular, hold significant challenges for women and women’s struggle for the right to describe and understand their own pregnant bodies. Whilst not all women neither inscribe the products of their womb as a ‘baby’ nor construct pregnancy loss as a tragedy, perinatal loss has been in the past, and remains, a significant event in many women’s lives. As such, this subject is deserving of further feminist scholarship to continue to challenge the hegemonic constructions of pregnancy loss which invalidate or devalue women’s own experiences.

256 BIBLIOGRAPHY

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University of New England and Regional Archives

Cameron, Mrs Christiana, Diary

Cemeteries and Burials New England NSW Database, Department of Archaeology, School of Human and Environmental Studies, the University of New England, Armidale NSW

Dumaresq Shire Council Records for Hillgrove, Kilcoy and Black Mountain area

257

Wyndham family papers, Dalwood Station, 1827-1870 c.1900

BOOKS AND BOOK CHAPTERS

Allan, Marshall, Obstetrics and Gynaecology: Lecture Notes Issued With the Authority of the Professor, Carlton, Vic.: Melbourne University Press, 1943

Anglican Church of Australia, A Prayer Book for Australians, Sydney: Broughton Books, 1995

Anon., Australian Etiquette, Rules and Usages of Best Society in the Australasian Colonies, People’s Publishing Company, 1885, Knoxfield, Vic.: J.M. Dent: 1980

Anon., Support After Fetal Diagnosis of Abnormality: Booklet for parents, NSW Genetics Education program, c1996

Anon., The Motherhood Book: For the Expectant Mother and Baby’s First Years, London: Amalgamated Press, n.d.

Anon., The Royal Women’s Hospital Melbourne: Midwifery for Student Midwives, Melbourne, Vic., 1975

Allen, Monfort B. & Amelia C. McGregor, The Glory of Woman, Sydney & Melbourne: Walker R. Hayes & Co, 1896

Baker, Vera and Alwyn Birnie (eds.) Overseas War Brides Memoirs: Stories from the women who followed their hearts to Australia, East Roseville, NSW: Simon and Schuster, 2000

Barr, Peter and Deborah de Wilde, Stillbirth and Newborn Death: Death and Life Are the Same Mysteries, Camperdown, NSW, 1987

Broom, Dorothy, Unfinished Business: Social justice for women in Australia, Sydney: George Allen and Unwin, 1984

Davies, Rowena, Empowerment of Women, Birth: you know how to birth your own baby, Beaconsfield, WA: R. Davies, 1992 de Crespigny, Lachlan, Meg Espie and Sophia Holmes, Prenatal Testing: Making Decisions in Pregnancy, Ringwood, Vic.: Penguin, 1998

Deutsch, Helene, The Psychology of Women: A Psychoanalytic Interpretation, New York: Grune and Stratton, 1944

Eisenberg, Arlene, Heidi Eisenberg Murkoff and Sandee Eisenberg Hathaway, What to Expect When You’re Expecting, Sydney: Angus and Robertson, 1996

258 Enkin, Murray, Marc J.N.C. Keirse, Mary Renfrew and James Neilson, A Guide to Effective Care in Pregnancy and Childbirth, Oxford: Oxford University Press, 1995

Fordham, Judith, Doctors’ Orders or Patient Choice? The Law, What it is, and What it Could Be, Melbourne: Leo Cussen Institute, 1998

George, Janet, ‘Women, Health Policy and Social Work: Dilemmas of Theory and Practice’, in H. Marchant and B. Wearing (eds) Gender Reclaimed: Women in Social Work, Sydney: Hale & Iremonger, c1986, pp. 172-183

Kennell, J. and M. Klaus, Maternal Infant Bonding, St Louis: Mosby, 1976.

Klass, Dennis, Phyllis R. Silverman and Steven L.Nickman, Continuing Bonds: New Understandings of Grief, Washington D.C.: Taylor and Francis, 1996

Kurjak, A. and F.A. Chervenak (eds.) The Fetus as a Patient, Parthenon, New York and London, 1994

Kübler-Ross, Elisabeth, On Death and Dying, New York: Macmillan, 1970

Lemay, Helen Rodnite, Women's Secrets: A Translation of Pseudo-Albertus Magnus's De secretis mulierum with commentaries, Albany, NY: State University of New York Press, c1992

Leon, Irving, When a Baby Dies, Psychotherapy for Pregnancy and Newborn Loss, New Haven and London: Yale University Press, 1990

Marchant, H. and B. Wearing (eds.) Gender Reclaimed: Women in Social Work, Sydney: Hale & Iremonger, c1986

Marchant, H. and B. Wearing, ‘The gender dimension of social work education, past present and future’, in Edna Chamberlain (ed.) Change and Continuity in Australian Social Work, Melbourne: Longman Cheshire, 1988, pp. 84-94

Milford, F., Australian Midwife’s and Nurse’s Handbook, Melbourne: E.W. Cole, 1916

Naish, Francesca and Janette Roberts, The Natural Way to Better Babies, Sydney: Random House, 1996

Nicol, Margaret, The Loss of a Baby: Understanding Maternal Grief, Sydney: Bantam, 1984

Petticord, Douglas J. ‘Perinatal Death’, in George Stricker and Martin Fisher (eds.) Self- Disclosure in the Therapeutic Relationship, Plenum, NY: Springer, 1990, pp. 261-273

Plater, Diana, Taking Control: How to aim for a successful pregnancy After miscarriage, Stillbirth or Neonatal Loss, Moorebank, NSW: Doubleday, 1997

259 Proceedings of the Second Australasian Catholic Congress Held in the Cathedral Hall, Melbourne October 24 to 31, 1904, Melbourne: The Advocate Office, 1905

Richards, Eulalia S., Ladies Handbook of Home Treatment, Warburton, Vic.: Signs Publishing Company, 1939, Rev. ed.

Rion, Hanna, Painless Childbirth and Twilight Sleep: A Complete History of Twilight Sleep from its Beginning in 1903 to its Present Development in 1915, T. Werner Laurie Ltd, London, 1915

Rossiter, Frederick M., The Practical Guide to Health, Melbourne: Signs Publishing, 1913, 3rd ed.

Saltman, Deborah, Women and Health: An introduction to issues, Sydney: Harcourt Brace Jovanovich, 1991

Smulders, B. and M. Croom, Safe Pregnancy: The complete handbook to a healthy pregnancy, South Melbourne: Ibis, 2005

Stonehouse, Anne and Bruce Sutherland, After a Miscarriage, Melbourne: Pitman, 1986

Stoppard, Miriam, Conception, Pregnancy and Birth, Ringwood, Vic.: Viking Press, 1993, Rev. ed.

Targett, Gabrielle, A Labour of Love: An Australian Guide to Natural Childbirth, Fremantle, Fremantle Arts Centre Press, 2006

Townsend, Lance, Obstetrics and Gynaecology for Medical students in the University of Melbourne, Carlton, Vic.: Melbourne University Press, 1959

______, Obstetrics for Students, Carlton, Vic.: Melbourne University Press, 1969

Warland, Jane, The Midwife and the Bereaved Family, Melbourne: AUSMED Publications, 2000

Weeks, Wendy, Women Working Together: Lessons from feminist women’s services, Melbourne: Longman Cheshire, 1994

Welford, H., Pregnancy: The Complete Australian Guide to Planning and Birth, Wetherill Park: Gary Allen, 1998

Williams, J.W., J. Pritchard and P. Mac Donald, Williams Obstetrics, New York: Appleton Century Crofts, c1980

GOVERNMENT PAPERS AND LEGISLATION

Australian Capital Territory Transplantation and Anatomy Act 1978

260 New South Wales Human Tissue Act 1983

Queensland Transplantation and Anatomy Act 1979

Royal Commission into the Decline of the Birth-Rate and on the mortality on infants in New South Wales, vol. 1, Report and Statistics, Sydney: NSW Government Printer, 1904

South Australia Transplant and Anatomy Act 1983

Statistical Register of the Colony of Western Australia, Perth, W.A: Government Printer, 1898-1902

Statistical Register of Western Australia, Perth, W.A.: Commonwealth Bureau of Statistics, WA Office, 1903-1968

Tasmania Human Tissue Act 1985

Victoria Human Tissue Act 1982

Western Australia Human Tissue and Transplant Act 1982

JOURNAL ARTICLES

Anon., (signed ‘Self-Preservation’), IMJA, 20th January 1909, pp. 631-633

Arthur, R., ‘Aseptic Midwifery’, AMG, March 21, 1898, p. 110

Barclay, Lesley, ‘Report on overseas midwifery practice’, ANJ, vol. 8, no. 7, 1979, pp. 18- 22

Bayer, Mary & Patty Brandner, ‘Feminism and nursing’, ANJ, vol. 4, no. 8, 1978, p. 33-34

Beischer, Norman A., ‘Projected Developments in Midwifery’, ANJ, vol. 8, no. 2, 1978, pp. 52-56

Bloom, Lynn Z., ‘Listen! Women Speaking’, Frontiers: A Journal of Women’s Studies, vol.2, no.2, 1977, pp. 1-2.

Bourne, Stanford ‘The Psychological Effects of Stillbirth on the Doctor,’ Journal of the Royal College of General Practitioners, vol. 16, 1968, pp. 103-112.

______., ‘The Psychological Management of Stillbirth’, The Practitioner, Jan 1983, no. 227, p. 54

Boyle, F.M., J.C. Vance, J.M. Najman and M.J. Thearle, ‘The Mental Health Impact of Stillbirth, Neonatal Death or SIDS: Prevalence and Patterns of Distress’, Social Science & Medicine, 1996, vol. 43, no. 8, pp. 1273-1282

261 Caelli, Kate, Angeline Downie and Jill Letendre, ‘Parents’ Experience of Midwife Managed Care Following the Loss of a Baby in a Previous Pregnancy’, JAN, vol. 39, no. 2, pp. 127-136

Callan, Victor J. and Judith Murray, ‘The Role of Therapists in Helping Couples Cope with Stillbirth and Newborn Death’, Family Relations, vol. 38, no. 3, 1989, pp. 248-253

Clarke, Angus. 'Is Non-directive Counselling Possible?' Lancet, vol. 338, October 19 1991, pp. 998-1001.

Clarke, M. and A.J. Williams, ‘Depression in Women After Perinatal Death’, Lancet, vol. 8122, no. 28, 1979, pp. 916-917

Clarkeburn, Henriikka. ‘Parental Duties and Untreatable Genetic Conditions’, Journal of Medical Ethics, Oct, 2000, vol. 26, no. 5, pp. 400-405.

Cockburn, Jill and William A.W. Walters, ‘Communication Between Doctors and Patients’, Current Obstetrics/Gynaecology, 1999, vol. 9, pp. 34-40

Cowen, Lady ‘Report of Second National Midwives Congress, Melbourne February 1981’, ANJ, vol. 10, no. 9, 1981, p. 13

Downe-Wamboldt, Barbara & Mary-Lou Ellerton, ‘The Parent Connection: Self-help for Families of Chronically Ill Children’, ANJ, vol. 13, no. 11, 1984, pp. 50-52

Editorial, ‘The Health of Australia's Mothers and Babies’, MJA; no. 164, 1996, pp. 198-199

Editorial, AMG, March 20, 1903, p. 116

Eddy, Kaye, ‘Aspects of Neonatal Nursing’, ANJ, vol. 7, no. 1, July 1977, pp. 32-33

Giles, Patrick, ‘Reactions of Women to Perinatal Death’, ANZJOG, vol. 10, 1970, pp. 207- 211

Gosling, Edith, ‘Letter to the Editor’, ANJ, no. 6, vol. 8, 1978, pp. 6-8

Grant, Richard, ‘Remembrance Services: Letter’, AD2000, vol. 13, no. 11, p. 15

Faust, Beatrice, ‘Foetophilia: A Most Blinkered Affliction’, Australian Humanist, no. 24, Summer 1972-1973, pp. 11-18

Harrison, Judith, ‘Caring in Nursing: Are We Being Sidetracked?’ ANJ, vol. 9, no. 11, June 1980, pp. 43-44

Jolly, Hugh, ‘Loss of a Baby: Transcript from ABC Radio Programme ‘Guest of Honour’, ANJ, vol. 7, no. 4, 1977, pp. 40-41

Jotkowitz, Max. ‘Re: Maternal suicide after pregnancies in a rudimentary horn’, Letter to the Editor, ANZJOG, vol. 45, no. 5, October 2005, p. 465

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Katz, A., ‘Self-help Organizations and Volunteer Participation in Social Welfare’, Social Work, 1970, vol 15, pp. 51-60

Kennell, J. M. Klaus and H. Slyter. ‘The Mourning Responses of Parents to the Death of a Newborn Infant’, New England Journal of Medicine, no. 283, pp. 344-349.

Kovacs, Gabor and Donna Howlett, ‘If at first you don't succeed, try, try, try again: A successful birth after 37 cycles of assisted reproductive technology over 11 years’, ANZJOG, vol. 44, no. 6, pp. 580-582

Knowles, Simon. ‘A Passage Through Grief: The Western Australian Rural Pregnancy Loss Team’, British Medical Journal, vol. 309, pp. 1705-1708

Lewis, Emanuel. ‘Reactions to Stillbirth’, Psychomatic Medicine in Obstetrics and Gynaecology, Third International Congress, London 1971, pp. 323-325

Lewis, Emanuel, ‘The Management of Stillbirth: Coping with an unreality’, Lancet, September 18 1976, pp. 619-620

Lewis, Emanuel, ‘The Abhorrence of Stillbirth’, Lancet, June 4 1977, p. 1188

Lewis, Emanuel and Anne Page, ‘Failure to mourn a stillbirth: An overlooked Catastrophe’, British Journal of Medical Psychology, no. 51, 1978, p. 240

Mason, John G., ‘A prayer book for Australia?’ ACL Online, July 1995. http://acl.asn.au/old/mason_pbrk.html. Accessed 15 January 2008.

McGreal, Diane, Barry J. Evans, Graham D. Burrows, ‘Gender differences in coping following loss of a child through miscarriage or stillbirth: A pilot study’, Stress Medicine, vol. 13, no. 3, 1997, pp. 159-165

Milliken, Diane, ‘Changes in the neonatal nurses role,’ ANJ, vol. 8, no. 4, 1978, pp. 30-33 & 40

Nicol, Margaret T., Jeffrey R. Tompkins, Norman A. Campbell and Geoffrey J. Syme, ‘Maternal grieving response after perinatal death’, MJA, vol. 144, March 1986, pp. 287-289

O’Neill, Brett. ‘Stories: A Father’s Grief, Dealing with Stillbirth’, Nursing Forum, vol. 33, no. 4, pp. 33-37

Peppers, L.G. and R.J. Knapp, ‘Maternal Reactions to Involuntary Fetal/Infant Death’, Psychiatry, vol. 43, 1980, pp. 155-159

Radwin, L.E., ‘Knowing the Patient: A review of research on an emerging concept’, JAN, no. 23, 1996, pp. 1142-1146

Robinson, D., ‘The self-help component of primary health care’, Social Science and Medicine, vol. 14A, 1980, pp. 415-421

263

Seitz, P.M. and L.H. Warrick, ‘Perinatal Death: The Grieving Mother’, American Journal of Nursing, vol. 74, no. 11, 1974, pp. 2028-2030

Shoebridge, Jane, ‘Questioning Current Attitudes in Nursing and Midwifery’, ANJ, vol. 9, no. 3, 1979, pp. 44-49

Speedy, S. ‘Feminism and the Profession of Nursing’, AJAN, vol. 4, no. 2, pp. 20-27

Taylor, Peggy, ‘Some perspectives on neonatal intensive care’, ANJ, vol. 11, no. 7, 1982, pp. 35-37

Taylor, W. ‘The Position of the Medical Profession, With Special Relation to the State of Queensland,’ AMG, 1901, p. 507

Whaley, Patricia ‘Two Home Births’, ANJ, vol. 8, no. 1, 1978, p. 41-44 & 47

Wolff, J.R. B.E. Nielson and P. Schiller, ‘The Emotional Reaction to a Stillbirth’, American Journal of Obstetrics and Gynecology, September 1970, no.108, pp. 73-77

NEWSPAPER ARTICLES

Alexander, Jennifer, ‘When a Baby Dies’, Age, 9 December 1992, p. 1

Alexander, Miriyana, ‘Healthier Mums Lift Live Births’, Sunday Star-Times, 22 June 1997, p. 5

Bird, Heather, ‘Love and Loss Come Full Circle’, SMH, 3 June 1996, p. 15

Burns, Andrea, ‘Selfish Mothers-to-be Leave Me Fuming’, Sunday Herald-Sun, 25 November 2007, p. 114

Button, Victoria, ‘Grief, and how to come to terms with it’, Age, 16 September 1995, p. 8

Cafarella, Jane, ‘A Long Journey Without Arrival’, Age, 10 January 1996, p. 16

Callaghan, Linda, ‘What do you tell a mum who has lost her baby?’ Subiaco Post, 31 January 1998, p. 11

Carter, Helen, ‘Smoke Link to 63 Baby Deaths a Day’, Herald-Sun, May 26 1999, p. 1

Critchley, Cherie, ‘The Taboo of Lost Babies’, Herald-Sun, 24 February 1999, p. 19

Editorial, ‘A Heartless Piece of Cost-Cutting’, Advertiser, 11 January 2000, p. 16

Ellicott, John, ‘Work Stress Brings on Baby’, Australian, 7 September 1998, p. 1

Gelastopoulous, Evie, ‘Tears For Lives Which Never Had a Chance’, Daily Telegraph, 19 March 1999, p. 21

264

Gough, Kristine, ‘Late Expectations’, Australian, 25 November 1999, p. 14

Harris, Margaret, ‘Breakthrough Test to Save Deformed Babies’, Sun Herald, 29 October 1988, p. 3

Hatfield, Louisa, ‘The Lost Children’, SMH, 31 January 1996, p. 11

Juan, Stephen, ‘The Junkie Baby: A child development nightmare’, SMH, 23 June 1988, p. 18

Kelly, Angie, ‘The Baby Making Diet’, Sun-Herald, 25 April 1999, p. 8

Knowles, Lorna, ‘Moral issue’, Advertiser, 26 May 1999, p. 9

Lahey, John, ‘At Last, the Touch of the Child She Never Saw’, Age, 11 June 1994, p. 3

McKnight, David, ‘Australian Surgeons Not Far Behind’, SMH, 9 October 1986, p. 19

Morrell, Sally, ‘We Need to Put Kids First’, Sunday Herald-Sun, 28 May 1999, p. 19

O’Brien, Susie, Colin James and Rebecca Holmes, ‘Corridors of Shame’, Adelaide Advertiser, 27 June 2001, p. 1.

Pain, Susan, ‘No Funds for Fighting Sorrow and Loss’, Age, 7 July 1994, p. 12

Parnell, Sean, ‘Caffeine Raises Birth Risks’, Courier-Mail, 26 November 1999, p. 16

Rasdien, Peta, ‘Scans a Loss to Peace of Mind’, West Australian, 11 January 2000, p. 5

Robotham, Julie, ‘Anxiety May Cause Low Birth Weights’, SMH, 16 January 1999, p. 6

______., ‘Stillbirths Rise: Links to Older Mothers’, SMH, 18 January 1999, p. 3

Rouse, Rada, ‘Smoking Mums Kill Their Babies’, Daily Telegraph, 5 June 1997, p. 21

Shanahan, Angela, ‘Populate or Perish the Thought of a Full Life’, Australian, 18 November 1999, p. 17

Steene, Mark, ‘Body parts: doctors defend practice, we did it all for science’, Adelaide Advertiser, 28 June 2001, p. 1

Vale, Susan, ‘How Smoking Puts the Unborn Child at Risk’, Age, 2 June 1993, p. 13

265 ORAL HISTORY AND PERSONAL CORRESPONDENCE

ORAL HISTORY INTERVIEWS

New South Wales Bicentennial Oral History Project

Baxendale, Kathleen, interview with Josie Castle, 31 August 1987

Saunders, Ida, interview with Bronwyn Hughes, 1987

Battye Library Collection, State Library of Western Australia

Carpene, Victor (Vic), interview with Gail O’Hanlon, 29 October and 12 November 1993

Manners, William (Bill), interview with Gail O’Hanlon, 10 May – 10 June 1993

Oral history interviews undertaken by Susannah Thompson (tapes and transcripts in possession of researcher)

Anderson, Robert, 16 November 2004

Astrid, 3 June 2005

Audrey, 1 June 2005

Barbara, 10 June 2005

Brenda, 4 April 2005

Christine, 7 June 2005

Claire, 9 June 2005

Daphne, 9 May 2005

Dorothy, 1 August 2005

Iris, 12 October 2005

Ivy, 6 May 2005

Janet, 3 August 2005 (pseudonym)

Jennifer, 24 May 2005 (pseudonym)

Jennings, Belinda, 18 November 2004

Julie, 31 May 2005

266 Kelly, 24 May 2005

Lena, 2 June 2005

Liz, 18 May 2005 (pseudonym)

Lloyd, Libby, 17 November 2005

Lynette, 30 May 2005 (pseudonym)

Marie, 19 May 2005 (pseudonym)

Margaret, 31 March 2005

Maureen, 16 May 2005

Mead, Mrs, 29 August 2005

Melanie, 24 May 2005

Michelle, 3 August 2005

Rayma, 3 October 2005

Robin, 11 August 2005

Shane, 30 July 2005

Personal Correspondence with Susannah Thompson (letters and emails in researcher’s possession)

Angelina, Email, 14 June 2005

Brain, Peter, Letter, 27 October 2005

Charlotte, Email, 12 August 2005

Coralie, Letter, 19 May 2005

Denise, Email, 11 May 2005

Janice, Email, 23 May 2005

Jodie, Email, 12 May 2005

Karen, Email, 15 January 2008

Katie, Email, 5 May 2005

267 Kaye, Letter, 27 July 2005

Miro, Letter, 7 August 2005

Nancye, Email, 12 May 2005

Pam, Email, 8 May 2005

Penn, Email, 20 December 2007

Sally, Email, 31 May 2005 (pseudonym)

Suzanne, Email, 12 May 2005

Valerie, Letter, 25 August 2005

Vicki, Letter, 8 June 2005

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JOURNAL ARTICLES

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UNPUBLISHED THESES

Featherstone, Lisa, Breeding and Feeding: A Social History of Mothers and Medicine in Australia, 1880-1925, PhD thesis, Macquarie University, 2003

Murray, Suellen, A history of menstruation in Australia, 1900-1960, PhD thesis, University of Western Australia, 1996

Selby, Wendy, Motherhood in Labor’s Queensland 1915-1957, PhD thesis, Griffith University, 1992

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