The History Behind Midwifery
Midwifery in New Zealand

The History Behind Midwifery

Midwives and midwifery in some form have always existed. In fact the midwife is mentioned in the book of Genesis 35:17 "And when she was in hard labour, the midwife said to her "Fear not, for now you will have another son." The derivation of the word midwife is from the Anglo-Saxon "mit wif" or with woman. The ancient Jews called her the wise woman - as she is known in France (sage-femme) and Germany (weise frau).

In primitive societies the work of the midwife had both a technical or manual aspect as well as a magical or mythical aspect. The midwife had knowledge and skill in an area of life that was a mystery to most people. During the middle ages midwives and witch-craft were thought to be linked and this eventuated in many midwives and women healers being killed.
By the 1600s and 1700s midwives in Western Europe could be divided into 2 main groups: "urban" and "traditional" midwives. Whereas urban midwives were highly qualified and supervised by professional bodies traditional midwives practiced in small rural towns and villages without training or supervision.
The standards of midwifery varied enormously and it is a myth to suppose that midwives did not intervene in childbirth.

"the actual midwives of traditional Europe and England intervened in the natural processes of birth. Constantly tugging and hauling at the birth canal they were captive of a folkloristic view that the best midwife is the one that interferes the most."
A History of Womens' Bodies Shorter 1982

The urban midwives before 1750 or so were probably better than the doctors and represented the best practice of the time in terms of the knowledge then available.

Male midwifery before 1750 was most frequently associated with attendance at emergencies. Between 1750 and 1875 men-midwives and medical doctors managed to erode the public confidence in the midwife's abilities.
Medical doctors gradually extended their control from coping with difficult births to managing pregnancy generally as part of an enlarged role in the normal care of the patient.
Two forms of technology: the speculum and the forceps introduced during this time enabled doctors to alter the dynamics of the previously female only domain of childbirth.

The speculum enabled the circumvention of the prohibitions on touching the female genital organs by men. The forceps in a more profound way came to represent intervention and manipulation as the foundation of knowledge. Both of these instruments were responsible for the marginalisation of the midwife.

A more pervasive social trend also assisted in this change: the emergence of the lying-in hospital which began to occur towards the end of the 19th century. This shifted the place of the birth from the home to the hospital and reinforced the power of the medical establishment.

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Midwifery in New Zealand

In New Zealand The Midwives Act of 1904 established state control of midwives and provided for the establishment of state maternity hospitals both to ensure the better training of midwives and to address concerns about the health of childbearing women.
These hospitals were named St Helens and the first of these hospitals was opened in Wellington in 1905 followed by Dunedin in the same year and Auckland in 1906. Further hospitals were opened in Christchurch, Gisborne, Wanganui and Invercargill over the next 10 years.
The purpose of the St Helens Hospitals was to provide training facilities for midwives and subsidized care for married working class women. Initially they were managed and run by midwives but by the 1930's the situation had changed and the medical profession had gained access and eventual control.

Although midwives were autonomous in the community as independent practitioners the role was altered in the hospital environment where midwives became subordinated to the medical profession.

Despite the establishment of state maternity hospitals, admission to hospital for childbirth was only to occur gradually over the next 25 years. In 1920 about 35% of Pakeha women delivered in hospital. By 1938 the overall percentage of hospital births was 87%. Maori women ,in contrast ,were slow to break from their traditional practices and in 1938 only 18% delivered in hospitals.

The 1920's and 30's were to witness bizarre medical interventions under the pretext of lowering the high maternal mortality rate. Twilight sleep was one of the more infamous of these experiments whereby labouring women were rendered near comatose by drugs in order to safeguard mother and baby. Needless to say such interventions had little effect on mortality figures and only the advent of antibiotics, blood transfusion facilities and ecbolic agents in the 1940's began to impact favourably on these outcomes.

During this period midwives in New Zealand became peripheral to the politics of childbirth. The use of drugs to control pain meant increased hospitalisation and a change in the scale and type of hospitals as well. Small midwife-run maternity hospitals progressively closed in the post war period and political power shifted from the Department of Health to the Medical profession.

This trend continued so that by the 1970's childbirth services in New Zealand were almost entirely provided by hospitals and firmly under the control of the medical profession. The Nurses' Act of 1971 entrenched this position by preventing autonomous midwifery practice. If a woman wanted to have a midwife provide care for them during labour this was possible but only if primary responsibility was maintained by a doctor.

During the 1970's a new feminist ideal emerged with women seeking to regain control of their own bodies. This coincided with a movement by the public and greater nursing workforce questioning the acceptability of many of the doctrinaire medical practices of the day. A stronger ,more focused, midwifery profession began to assert itself and to redefine the values of maternity care. Although challenged by the medical establishment: notably by the Dennis Bonham led National Womens' Hospital the midwifery movement created a momentum of its own.

The Nurses Amendment Act of 1990 introduced by the then Minister of Health Helen Clark enabled a registered midwife to undertake responsibility for the care of women throughout pregnancy and childbirth, without being supervised by a medical practitioner.

The Act also made provision for direct-entry midwifery education. The net effect of the Act was to greatly expand the choice for women in relation to childbirth. Although the medical profession did not publicly oppose the principle of autonomy and it was thought that a team approach would ultimately benefit women it was evident by the mid 1990's that with a ballooning maternity budget and the development of the LMC system co-operation between doctor and midwife was effectively curtailed. Today only a small vestige of the once strong GP Obstetrician workforce still exists.

Childbirth care in New Zealand has turned full circle with Midwifery now newly established as the mainstream system of care. It is unlikely with the mass exodus of GPs from Obstetrics that the Medical model of care could return in its former state but it is hoped the hard fought improvements in maternity care are upheld by the midwifery profession.

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