Wednesday, November 22, 2006

A Canadian Midwife Minute


SynopsisUntil well into this century, most Canadians were born at home and theonly professional hand guiding their arrival into the world was themidwife'sThe first midwife began her practice, so the saying goes, nine monthsafter God placed two women and one man on the earth. The office ofmidwife, which literally means 'with wife,' is an ancient one.Throughout history, babies were delivered with the assistance of amidwife. At least until the 20th Century, women controlled the processof childbirth in all cultures.

Traditionally, women gave birth at home, attended by mothers, aunts, andother female relations. Sometimes, whole groups of women attended abirth, but central to the event was always a knowledgeable and experienced midwife. Not only did she aid the labouring mother and"catch the baby;" the midwife also offered essential support and comfortto the mother. In 19th Century Canada it was not unusual for a midwife to attend the birth, then stay on to clean the house, cook the food, and do the laundry. Cultural attitudes, religious beliefs, and notions of respectability kept men outside of the "mystery" of childbirth. Men had little knowledge of the birth process, or of female anatomy. Physicians in ancient societies considered midwifery beneath their dignity, and male midwives would be called upon only when surgery was needed.

Midwife, a Historica Minute, dramatizes the importance and stature ofthe midwife in Canadian history. In the televised mini-drama, a skilled midwife risks the hazards of a rural winter to deliver a child on an isolated farm. The mother and father depend upon the midwife's calm skill and training, she probably received from her own mother.The mini-drama's portrait of the midwife, who confidently takes charge of the home birth, is a marked contrast to the usual childbirth procedures that have predominated in our modern hospitals.

For most of this century, a labouring woman could expect to be rushed to a hospitaland wheeled immediately into a delivery-room, where the doctor,anaesthetist, and nurse waited in masks and sterilized gowns. With the efficiency of modern surgical practice, the doctor would deliver the baby under the bright lights of the operating table. When the mother awoke from the anaesthetic, she discovered that she had, somehow, given birth to a baby girl or boy.

How did this transformation in childbirth practice occur? How did a natural occurrence within a community of women become a clinical experience largely controlled by men? And in this modernizing process,what has happened to the traditional midwife? Like many cultural changes, the transformation in childbirth procedures was initiated by the introduction of a new technology. The invention ofthe forceps in the early seventeenth century meant that a child could be pulled from the womb when manual skills were not enough to do the job. In some circles, the power of the forceps reached mythical proportions. Women, believing that the instrument could shorten labour, wanted the benefit of this great invention. In fact, the inventors enhanced the mystique of the forceps by hiding them in elaborate wooden boxes and blindfolding the labouring mothers. So successful were they at concealing the design of their instrument that it remained a "familysecret" for almost a hundred years.

The use of forceps marked the beginning of the medical science ofchildbirth. Subsequent medical discoveries and advances in technologyhave eliminated many of the risks women faced when giving birth, but scientific interest also marked the decline of the role of the midwife.The new technology gave control of childbirth to men. In the eighteenth century both men and women generally believed in the intellectual superiority of men. It was felt that even if women were given then ecessary training, they would never be able to use medical instruments properly. Some said their hands were too small. Others claimed that their overly emotional characters would interfere with the cool exerciseof judgement necessary in surgical situations.

As one 19th Century doctor put it, a woman "has a head almost too small for intellect and just big enough for love." We may laugh at these notions now, but by the nineteenth century, most North American women came to believe that doctors provided more safety (and respectability) in childbirth. Such attitudes put practising midwives in a double bind. Midwives had noformal organization or licensing, yet women who wanted to becomelicensed doctors were denied access to medical schools.By the beginning of the 20th Century, midwifery was confined to poor or rural areas in Canada. As the century progressed, a further development saw childbirth move away from the home and into the hospitals. Beforethat time, hospitals had been overcrowded and dirty places, serving onlythe poor. But hospital conditions gradually improved because of a growing knowledge of sanitation.

By the 1920s women saw hospital birth as the "germ-free" alternative to the often messy home birth. As the trend continued, the vast majority of women chose to give birth inhospitals.In the late 1960s, however, attitudes again started to change. Women began to question the experiences they were having in hospitals. Was there not more to motherhood than the sterile, assembly-line routine that put the needs of the hospital before the needs of the woman?

A renewed interest in the process of birth developed, giving rise to the idea of "natural" childbirth. Hospitals began to allow fathers to participate in births in the warmer environment of "birthing rooms. "Finally, in this new climate, the home birth movement [re]emerged - awoman giving birth in her own bed, surrounded by her family, andassisted by a midwife. Progress has brought us full-circle in balancing the benefits of medical science and the values of old traditions.

Across Canada, the role of midwifery in the health care system is being considered and legislationis being revised. BC and Ontario have passed legislation regulating midwives and midwifery is fully publicly funded in these provinces. Midwifery training programs have been initiated in three Ontario universities. Despite these changes, midwives across canada are stillstruggling to be recognized as professionals who are integral to the health care system.

Provinces like Alberta and Saskatchewan have regulated midwifery, but midwives do not receive any public funding. Although midwives are not fully integrated into the health care system across the country, the recent changes to the legal status of midwives in some provinces is returning midwives to the important and respected role they once held in Canada, and that they currently hold in many European countries.

For more information regarding the emergence of Midwifery in Saskatchewan visit There are plans to introduce funded midwifery in this province in 2007.

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