Today is International Day of the Midwife and we reflect on the changing face of midwives in New Zealand. It has been a journey from autonomous carers, to assistants and back again, fraught with politics, medical conflicts and women's rights.
Here are nine key points of the history of midwifery in New Zealand.
1. Women managed childbirth in New Zealand pre-1904
While a few midwives received formal training from overseas before emigrating to New Zealand, most learned by working with other midwives. Experience and observation passed from woman to woman was their mode of learning.
Most births were at home or in maternity homes run by midwives. Some were skilled, some were not.
2. The pioneer midwives were part of the home
Early midwives were very much a part of the family, arriving several days before the birth to look after the household and pregnant woman. She would deliver the baby and stay around to help for a few days and ensure breastfeeding was established.
3. Formal training of midwives in New Zealand began in 1904
Concerns over the falling Pakeha birth rates as well as high maternal and infant mortality rates due to wide variances in midwife competence led to the 1904 Midwives Act. The training took place in seven St Helens hospitals that were set up between 1905 and 1920.
4. "Perfect motherhood is perfect patriotism"
In an effort to increase safe maternity in New Zealand, a campaign with the slogan "Perfect motherhood is perfect patriotism" was launched in 1924 because of the continued high maternal mortality due to puerperal sepsis, septic abortion and toxemia. Hospital birth rates rose from 58% in 1926 to 76% in 1934.
5. Strict care regimes changed the way both mum and baby were treated
File photo / NZ Herald
In an effort to eliminate infections, strict new hospital protocols were introduced including: shaving of pubic hair, enemas, surgical scrubbing and gowns and masks for all those attending the birth. Women spent ten days in hospital following a delivery and received four hourly perineal swabbing with antiseptics for the first few days. Babies were kept apart from their mothers, except when they were brought in for four-hourly feeds. The maternal mortality rate reduced significantly.
6. 'Half-dead baby system'
In the mid-1930s, the ability to have a pain-free childbirth was introduced with a cocktail of morphine and scopolamine which produced a 'twilight sleep'. Free from pain, sedated and subsequently unable to remember the delivery it became the perfect solution to painful childbirth. The Health Department was unhappy, calling it the 'Half-dead baby bystem' as it could cause respiratory problems for the baby - or even death.
7. Midwives relegated to assistant to the doctor
Photo / Thinkstock
While The Health Department advocated that a pregnant woman was not a sick woman and therefore only required midwifery care, The Obstetrical Society successfully campaigned for all deliveries to be attended by a doctor, assisted by a midwife or maternity nurse.
8. The politics of pregnancy
With the rise of feminism in the 1970s came a desire for women to have more control over their bodies and more choices in their maternity care. Midwives had been unable to practice without supervision of a doctor since 1971 and an increasing number of women and consumer groups such as Parents Centre New Zealand and the Home Birth Association fought for the rights of a woman to make decisions about her care and reassert birth as a natural process.
9. Midwifery comes full circle
The introduction of the 1990 Nurses Amendment Act meant that midwives returned to their status as separate and distinct professionals. Women could now choose to have their pregnancy and birth solely under the care of a midwife, and midwives no longer required to train as a nurse first - they could enter directly into midwifery training.