A headline-making hospital

By Andrew Stone

Fifty years ago a hospital dedicated to women and their babies opened in Auckland. Andrew Stone talks to Linda Bryder, author of a new book on its chequered history

The brand new National Women's Hospital at its opening in 1964. While its final years were mired in scandal, during its golden years it was the setting for world-leading research.
The brand new National Women's Hospital at its opening in 1964. While its final years were mired in scandal, during its golden years it was the setting for world-leading research.

Four years ago Linda Bryder wrote a book suggesting the Cartwright Report got it wrong. The academic heavens opened.

The historian has done it again touching, albeit far more briefly, on the 30-year-old scandal - the so-called "unfortunate experiment" - at National Women's Hospital. Whether sound and fury erupts once more awaits the release next week of her new book, a history of the once-illustrious institution.

The appearance of The Rise and Fall of National Women's Hospital coincides with the 50th anniversary of its opening.

Dr Bryder, a professor of history at the University of Auckland, is giving an address at a conference next Friday, drawing on her work over the past decade.

Whether the elephant in the ward - the entrenched battlelines that now surround the Cartwright Inquiry - is stirred by the occasion remains to be seen, but Professor Bryder sees no reason why she should again be the target of withering criticism.

"Maybe I'm being overly optimistic. My views haven't changed since the 2009 book came out," she said. That work, A History of the Unfortunate Experiment at National Women's Hospital, attracted immense scrutiny. A number of academics and senior medical figures, some with connections to ground-breaking inquiry, roasted its conclusions. Publishers Auckland University Press came under fire and were pressed to make corrections.

Professor Bryder said the experience was "horrible. It's not the sort of thing I court ... I didn't like it one little bit."

She feels that the issue - whether it is possible to advance revisionist views about the biggest controversy in modern New Zealand medicine - may have run its course.

"The people who are going to be attacking me won't be reading my book," she said.

"They didn't last time."

The new book completes what actually started out as the first book, before it ended in the medical cul-de-sac of the Cartwright investigation.

"When I put a proposal in [for funding] a decade ago, I pretty much said I didn't want the story to focus on Cartwright because I was interested in reproductive health.

"I thought I would simply summarise the inquiry findings and draw on Sandra Coney's [co-author of a Metro article which blew the scandal wide open] work. I didn't realise I was entering a minefield."

The landmines in the new book are wrapped up in a chapter called "Feminists, Midwives and National Women's Hospital", which surveys the push by activists to challenge reproductive practices and the established medical order.

But the lion's share of her history details the life and times of the purpose-built hospital and is a reminder that, while the final years were mired in scandal, during its golden years National Women's was the setting for world-leading research which saved the lives of infants and produced breakthroughs which altered the way science came to understand the growth of infants in the womb.

The hospital hit world headlines in 1965 when Shirley Lawson gave birth to quintuplets.
The hospital hit world headlines in 1965 when Shirley Lawson gave birth to quintuplets.

It made headlines around the globe in July 1965 when, against a backdrop of advances in reproductive medicine, the Lawson quins arrived, just the fifth set of surviving quintuplets in the world. Shirley Lawson, mother of four girls and a boy, was sitting up in bed two hours after giving birth, media reported.

Besides the 26-year-old Mrs Lawson, the hospital touched the lives of tens of thousands of New Zealanders during the second half of the 20th century.

Among them was the author. In 1992, she had her first child there.

She had planned a homebirth, feeling that, as a slightly older, professional woman "taken in by the ideology of the homebirth movement - that's what I wanted to do". After 24 hours of painful labour at home, she went to the ward.

Her second child was also born at National Women's, in 1997. Of the two visits, Professor Bryder says found the second had a far more pleasant environment. At the time of her first baby, she encountered tension between the hospital staff and her independent midwife.

Among the hospital's shining stars were New Zealanders Bill Liley, who pioneered antenatal blood transfusions in the early 1960s, and Graham "Mont" Liggins, whose work with paediatrician Ross Howie saved thousands of premature babies from respiratory failure with the treatment of steroids prior to delivery.

Liggins later wrote that a few cheap injections could save tens of thousands of dollars in intensive neonatal care and the long-term help needed for handicapped infants. The National Women's specialists made their discoveries in the 1970s. It took until the 1990s for the practice to be widely adopted.

In her book, Professor Bryder explores reasons for the delay, which was discussed at two big London conferences.

One explanation lay in "territorial jealousies" between rival disciplines, which created barriers to collaboration. Another rested on the origins of the research, and the disbelief that such an important finding could come from such a "primitive backwater" as an Auckland hospital.

"It was a tight international community, of which New Zealand was a part despite the tyranny of distance, but at the same time it seems that national and personal rivalries abounded."

Mont Liggens research into labour included looking at sheep.
Mont Liggens research into labour included looking at sheep.

Liggins devoted much of his research life to understanding the complex mechanisms which triggered birth. Born in Thames, his rural background saw him work intensively with sheep and apply those findings to the environment at National Women's. It was his genius that led to a far deeper understanding of the fetus, as not simply "a passenger in the womb but rather as the patient and in charge of the case".

Bryder notes that as long ago as the mid-1970s Liggins was confident, based on his work identifying the trigger for the onset of labour in sheep, that the mystery of the profound puzzle of the initiation of labour in humans would soon be solved. When Liggins died, in 2010, the mystery remained.

Professor Bryder, who specialises in the interplay of social forces on science and medicine, says the hospital folded in the end because it fell so far in public confidence.

The two inquiries that turned the spotlight on its work - Cartwright and the chest-tapping investigation under Helen Cull, QC - were essentially, she argues, about distrust in the medical profession as protectors of health. Beyond the walls of its wards, the hospital came under such pressure from the feminist movement, turf wars between doctors and midwives and from a media with an appetite for scandal, that the only cure in the end was closure.

Scandals easier to conceal in an era of public trust

Long before the "unfortunate experiment" and the 1999 chest-tapping inquiry, National Women's Hospital had a scandal that barely created a ripple.

Its impact, however, on affected infants and their families was catastrophic - a technique to help premature babies survive inadvertently caused "an epidemic of blindness".

One specialist involved was neonatal expert Jack Matthews. Trained in Britain, Matthews joined the Auckland hospital in 1949 and stayed until 1983. He supervised the care of premature babies in some of the earliest incubators where they received oxygen treatment.

Extra oxygen was given because the babies were at risk of brain damage due to lack of oxygen in the womb. But little control was exercised over the amount of oxygen given to the babies, which led to a number of infants going blind from a disorder called retrolental fibroplasia, where fibrous tissue forms behind the lens of the eye.

Not every hospital gave oxygen to premature babies. A 1953 study by ear, nose and throat specialist George Fenwick, of 212 babies at Auckland's Karitane Hospital and National Women's, found no babies with the condition at Karitane. At National Women's, the country's premier institution for the care of babies and just a few kilometres away from Karitane, Fenwick found 23.7 per cent - nearly one in four - babies were affected.

The practice, used widely in hospitals throughout the Western world, was abandoned as a "well-intentioned but misdirected therapeutic intervention".

Author Linda Bryder says it was a shocking outcome. Matthews went public about the disaster and the impact for him and the hospital was entirely different from the convulsions which followed the Cartwright Report.

The treatment was provided in an era when the public image of the hospital and the status of doctors were almost untouchable, says Professor Bryder. On the other hand, the "unfortunate experiment" inquiry took place against a backdrop of distrust, when the public was ready to accept that specialists put research above the needs of patients. Research at National Women's was again a subject of media headlines when a number of premature babies developed brain lesions. All the infants had undergone chest physiotherapy, a treatment which followed overseas practice and was meant to clear secretions. A subsequent chest-tapping inquiry in 1999 cleared hospital staff of blame but did little to enhance public confidence.

Reports Professor Bryder: "The 1980s and 1990s saw public trust of health professionals at an all-time low, in New Zealand as elsewhere, aided by the press."

It didn't end there. In 2002, the Herald reported that a hospital study involving the use of a special cap to cool the heads of potentially brain-damaged newborns breached ethical guidelines. Two years later the Auckland work became the the focus of an international trial, with the potential to save thousands of infants.

"Taken together," writes Professor Bryder, "the two Herald pieces demonstrate how perceptions of National Women's see-sawed between accusations of breaching ethics and praise for its ground-breaking international research."

The Rise and Fall of National Women's Hospital by Linda Bryder (Auckland University Press $49.99)

- NZ Herald

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