PREPPING THE CUT: CAESAREAN SECTION SCENARIOS IN ENGLISH CANADA, 1945-1970 by SALLY ELIZABETH MENNILL BA, Simon Fraser University, 2000 MA, Trent University, 2005 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES (Women’s and Gender Studies) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) April 2012 © Sally Elizabeth Mennill, 2012 ii ABSTRACT At the beginning of the 21st century, Canadian public debates about caesarean section centre on the relative agency of mothers and medical professionals in choosing the preferred birthing method. A 2006 study at the University of British Columbia aims to determine why the Pacific has the highest caesarean rate in the country. According to its authors, BC’s rate is 27% despite the World Health Organization’s advocacy of a rate between 10 and 15 percent.1 The highlighting of this discrepancy in the pages of the popular Vancouver Sun typifies the public concern that today so commonly echoes professional unease. Sandwiched between the era of development and professionalization – 1900 to 1950 – explored in Mitchinson’s critical chapter on c-sections2, and the widespread acceptance that occurred in the 1970s and beyond, lie the often overlooked years, 1945-1970, which first saw c-sections solidified in treatment and entrenched in medical and social discourses. At the end of WWII, Canadian mothers and medical professionals were about to embark on a quarter-of-a-century consideration of how reduction of risk in c-sections could contribute to positive outcomes. This dissertation examines the social, technological, professional, and discursive factors that converged throughout the post-war period in Canada, arguing that medical technological developments of this time period coupled with developments in the professionalization of obstetrics, the substantial broadening of state health infrastructure post-WWII, and a significant shift in ideological constructions of motherhood according to white, middle-class standards contributed to an increased comfort with the practice of caesarean section. 1 “C-section rate under investigation,” Vancouver Sun, 17 October 2006, sec. B, page 3. 2 Wendy Mitchinson, Giving Birth in Canada (Toronto: University of Toronto Press, 2002): 231-259. iii TABLE OF CONTENTS ABSTRACT.................................................................................................................................ii TABLE OF CONTENTS...............................................................................................................iii LIST OF TABLES ........................................................................................................................iv LIST OF FIGURES .......................................................................................................................v ACKNOWLEDGEMENTS ...........................................................................................................vi INTRODUCTION ........................................................................................................................1 CHAPTER 1: A Critical Perspective on Women’s Bodies: Review of Literature and Methods 14 CHAPTER 2: Monitoring the ‘Traveler in Inner Space’: Technological Incongruity in Obstetrical Safety...................................................................................................................50 CHAPTER 3: Monitoring the Navigator in Outer Space: Professionalization of Obstetrics in Post-WWII Canada .................................................................................................................83 CHAPTER 4: “Submit with Good Grace for Your Own Sake”: Constructing the Ideal Birth in Post-WWII Canadian Popular Discourses.............................................................................109 CHAPTER 5: Caesarean Sections in Vancouver 1952-1970: St. Paul’s Hospital....................144 CONCLUSION........................................................................................................................183 BIBLIOGRAPHY......................................................................................................................190 iv LIST OF TABLES Table 1: St. Paul’s C-section Patient Ethnicity…………………………………….…….... 161 Table 2: Metropolitan Vancouver Population by Ethnicity……………………..………….162 Table 3: St. Paul’s Caesarean Section Patient Marital Status ………………….…………..163 Table 4: St. Paul’s births by Maternal Age…………………………………………………163 Table 5: British Columbia Births by Maternal Age……………………………………..…164 Table 6: Percentage by Indicator of St. Paul’s Caesarean Sections 1952-1970……………171 Table 7: Percentage by Indicator of St. Paul’s Caesarean Sections Continued...…………. 172 v LIST OF FIGURES Figure 1: St. Paul’s Hospital Caesarean Section Rate, 1952-1970………………….160 Figure 2: St. Paul’s Hospital Patient Addresses…………………………………………165 Figure 3: St. Paul’s Hospital Births, 1952-1970………………………………………...167 Figure 4: Canada Births, 1952-1970…………………………………………...………..167 Figure 5: BC Births, 1952-1970………………………………………………...……….167 Figure 6: Top St. Paul’s Caesarean Indicators, 1952-1970……………………….……170 Figure 7: Relative Indicators for Caesarean Section at St. Paul’s, 1952-1970…………177 Figure 8: Changes in Proportion of Absolute and Relative Caesarean Section Indicators at St. Paul’s, 1952-1970………………………………………………………………180 Figure 9: Caesarean Section Rates, Canada and BC, 1969-1990………………………183 Figure 10: Relative Indicators in BC, 1986-1992………………………………………184 vi ACKNOWLEDGEMENTS I have had the great fortune in my life to have encountered many talented and wise historians who have mentored me, both personally and professionally. I remember every history teacher I have ever had and I thank them all from the bottom of my heart. In particular, I would like to thank Mark Leier, Joan Sangster, and Bryan Palmer for their inspiration and intellect as educators and mentors throughout the course of my post- secondary education. As far as gratitude to historians goes, I cannot thank my graduate supervisor enough. Veronica Strong-Boag is an extraordinary scholar, mentor, and friend whose support and guidance have been immensely helpful to me. Every budding historian should be as fortunate as I am to have a supervisor who takes you on not just as a person writing a thesis, but as a scholar, a teacher, and a human being. I would also like to thank Mona Gleason and Jude Kornelsen for their similar dedication and camaraderie over the past six years. Their wisdom and guidance have helped me grow as a scholar and as a person. No graduate school journey would be complete without peers and colleagues to share the ups and downs. I thank all of my fellow graduate students at UBC’s Centre for Women’s and Gender Studies for their support and commiseration during this process. Additionally, the staff and faculty in this department provided crucial support and guidance throughout my years of study. Together we fostered a warm, welcoming and supportive scholarly environment in which to simultaneously play and learn. More personally, I have shared this adventure with scholars outside my department and institution. Patricia Barkaskas, Janice Barry, Sonja Boon, Chelsea Horton, Erin McGuire, and Meghan Winters, whose friendships continue to prove motivating and supportive, have provided many sessions of commiseration and fun along the way. vii I am indebted to the librarians, archivists and records maintainers who lent their time and expertise to my project. I am especially thankful to Wendy Hunt at the BC Medical Association Archives, Donna Humphries at the Providence Health Care Archives, and the staff at the St. Paul’s Hospital Records department for their knowledge and patience. Without the financial support from various avenues I would not have been able to complete this degree, nor, indeed, my entire education debt-free. Associated Medical Services and the Social Sciences and Humanities Research Council of Canada provided much-needed funding at various points in my research to allow me to research and write without taking on waged work. UBC and CWAGS provided four glorious tuition-free years as well as numerous small allowances for professional development. Veronica Strong-Boag and Jude Kornelsen furnished me with research assistantships, allowing me to broaden my research horizons while making a wage at the same time. And my parents, Paul and Sandi Mennill, provided special “research grants” along the way that made the difference between Kraft Dinner and real food. I am especially grateful to Gail Edwards, with whose help I obtained a faculty job in the history department at Douglas College. Rewarding waged work is a luxury for an emerging historian in the 21st century! The legacies of three very dear relatives were also crucial in the maintenance of my graduate career, both financially and emotionally. Throughout their lives my late aunts Jean, Kit and Marnie provided me with ongoing encouragement and motivation. In particular, their independence, intelligence and feminism (whether or not they would have called it that) contributed to my sense of self and the decisions I have made as an adult. In their deaths they each left me enough money to keep going as a scholar at different stages and while I would viii instantly give it back to have them with me, I am immensely grateful for their contributions. I would truly not be who I am without the legacies of these amazing women. By the same token, I am forever thankful my