In this major history, Linda Bryder traces the annals of National Women's Hospital over half a century in order to tell a wider story of reproductive health. She uses the varying perspectives of doctors, nurses, midwives, consumer groups, and patients to show how together their dialog shaped the nature of motherhood and women's health in 20th-century New Zealand. Natural childbirth and rooming in, artificial insemination and in vitro fertilization, sterilization and abortion: women's health and reproduction went through a revolution in the 20th century as scientific advances confronted ethical and political dilemmas. In New Zealand, the major site for this revolution was National Women's Hospital. Established in Auckland in 1946, with a purpose-built building that opened in 1964, National Women's was the home of medical breakthroughs scandals. This chronicle covers them all.
In this major history, Linda Bryder traces the annals of National Women's Hospital over half a century in order to tell a wider story of reproductive health. She uses the varying perspectives of doctors, nurses, midwives, consumer groups, and patients to show how together their dialog shaped the nature of motherhood and women's health in 20th-century New Zealand. Natural childbirth and rooming in, artificial insemination and in vitro fertilization, sterilization and abortion: women's health and reproduction went through a revolution in the 20th century as scientific advances confronted ethical and political dilemmas. In New Zealand, the major site for this revolution was National Women's Hospital. Established in Auckland in 1946, with a purpose-built building that opened in 1964, National Women's was the home of medical breakthroughs scandals. This chronicle covers them all.
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In this major history, Linda Bryder traces the annals of National Women's Hospital over half a century in order to tell a wider story of reproductive health. She uses the varying perspectives of doctors, nurses, midwives, consumer groups, and patients to show how together their dialog shaped the nature of motherhood and women's health in 20th-century New Zealand. Natural childbirth and rooming in, artificial insemination and in vitro fertilization, sterilization and abortion: women's health and reproduction went through a revolution in the 20th century as scientific advances confronted ethical and political dilemmas. In New Zealand, the major site for this revolution was National Women's Hospital. Established in Auckland in 1946, with a purpose-built building that opened in 1964, National Women's was the home of medical breakthroughs scandals. This chronicle covers them all.
Product Details
| ISBN-13: | 9781775587248 |
|---|---|
| Publisher: | Auckland University Press |
| Publication date: | 02/01/2014 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 328 |
| File size: | 2 MB |
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The Rise and Fall of National Women's Hospital
A History
By Linda Bryder
Auckland University Press
Copyright © 2014 Linda BryderAll rights reserved.
ISBN: 978-1-86940-809-1
CHAPTER 1
Childbirth Services in New Zealand, 1900–1939
National Women's Hospital was opened in 1946, at a time when most New Zealand babies were born in hospital. This had not always been the case. The twentieth century opened with New Zealand's Liberal government firmly committed to developing childbirth services managed by midwives and not necessarily located in hospital. Yet just over three decades later, a Labour government passed legislation giving all women the right to give birth in hospital free of charge and with a doctor in attendance. The views expressed in a government inquiry into maternity services, set up by the Labour government in 1937 under Labour MP and general practitioner Dr David McMillan, were crucial to this development. This chapter investigates those views, and in particular the role of doctors and consumers in persuading the government to go down the path of hospitalised childbirth, and to found a new maternity hospital in Auckland, which became National Women's Hospital.
A State Midwifery Service and the New Zealand Obstetrical Society
Under the Liberals who governed New Zealand from 1891 to 1912, New Zealand gained an international reputation as a 'social laboratory', as a consequence of its extensive social legislation. Reforms that New Zealand proudly boasted as world firsts included granting women the vote in 1893, setting up a Department of Public Health in 1900 and passing a Nurses Registration Act in 1901. In 1904 the government passed the Midwives Registration Act with the aim of improving maternity services in New Zealand. The Act provided for the registration of midwives and for setting up maternity hospitals where they would be trained and where the wives of working men would be catered for. Seven public maternity hospitals, called St Helens after the birthplace in Lancashire of New Zealand's Premier (Prime Minister), Richard Seddon, were established by 1921.
The Liberal government's interest in maternity services arose directly from its preoccupation with the future strength of the nation, an anxiety that New Zealand shared with other Western nations and as part of the British Empire. A popular slogan of the early twentieth century, which New Zealand borrowed from Australia, was 'Babies are our best immigrants'. Introducing the midwives' Bill into the Legislative Council, Attorney-General Albert Pitt explained that the aim of registering and training midwives was to reduce infant deaths. The government considered a growing population a national asset. Discussing the Infant Life Protection Bill a few years later, one member of New Zealand's Legislative Council declared, 'The real reason for our solicitude ... is that population, which is decreasing, is indispensable to national safety and national progress. We must have soldiers and workers, or our prosperity will be imperilled and our industry will decay.'
In the early twentieth century the government assumed that midwives would play an important role in future maternity services in New Zealand, which is why it wished to upgrade their training. Conjuring the image of Charles Dickens' fictional character Sarah Gamp, Seddon declared that some midwives 'indulge[d] a little too freely, and ... the sooner we have legislation which will ensure competent midwives – sober and especially clean midwives – the sooner you will prevent loss of life'. Dr Duncan MacGregor, Inspector-General of Hospitals and Charitable Institutions, predicted that, 'With the passing of the Midwives Registration Act the day of the dirty, ignorant, careless woman, who has brought death or ill health to many mothers and infants, will soon end.' While this was not a true reflection of the competency of many midwives, 761 of whom were registered under the Act as midwives 'of good character', it was part of the professionalising trend of midwifery. The future midwife was to be a young, single, professional woman, just like the new nurse mandated by the 1901 Nurses Registration Act.
The St Helens hospitals, set up following the 1904 Act and under the jurisdiction of the Department of Public Health, accommodated married women whose husbands earned less than £4 a week and who would contribute towards the cost of confinement to avoid the stigma of receiving charity. The hospitals also provided a district maternity service for women who chose to have their babies at home. Midwives ran these hospitals, and there were no resident doctors; the latter were called only to deal with complications. Medical superintendents were appointed to the hospitals but they did not live on site and were summoned at the matron's discretion.
The Health Department continued to view the St Helens hospitals and a midwifery service as central to maternity care in New Zealand well into the 1930s. The 1937 Committee of Inquiry into Maternity Services noted that in a number of countries, 'the trend is towards a service in which the bulk of the normal midwifery is conducted by highly trained midwives' and that 'in such a scheme the general practitioner is excluded from all normal midwifery practice'. This was specifically the case in Holland and Scandinavia 'where the maternity services are recognized to be of a very high order'. The report referred to a British committee representing the Ministry of Health, the British Medical Association (BMA), and the British College of Obstetricians and Gynaecologists, which recommended a national midwifery service for England and Wales, 'based on the principle of midwife attendance in normal labour' and which had been introduced there in 1936. The report cited the evidence of Dr Henry Jellett, formerly master of the Rotunda Hospital, Dublin, who had immigrated to New Zealand in 1920 and was consultant obstetrician to the Department of Health from 1924 to 1931. In Jellett's view, for normal births, 'it is a mistake to bring in the complication of the medical man who has to attend all kinds of disease, statistics and history having proved over a period of years in other countries, and also at Home, that these cases can be attended more satisfactorily by midwives'.
Generally, however, the 1937 committee did not favour the British model of a midwifery-based service. While two of its six members, Dr Sylvia Chapman, medical superintendent of Wellington's St Helens Hospital, and Dr Tom Paget, the Health Department's inspector of hospitals, advocated a midwifery service, the report endorsed doctor attendance for all births in hospital.
Doctors had lobbied against a midwifery system for a decade prior to this inquiry. In 1927 a group of doctors formed the New Zealand Obstetrical Society (NZOS) to represent the interests of doctors who practised obstetrics. At its 1929 meeting, members resolved to draft a maternity services plan since 'Dr Jellett had recently published his proposals for the future midwifery service of this Dominion, which proposals eliminate the doctors from attending cases of normal confinement.'
In the midst of the economic depression in 1933, the Obstetrical Society noted that Paget had recently ordered the various hospital boards which ran New Zealand's public hospitals to make provision for indigent maternity cases within their areas, based on a scheme that was 'an exact parallel of the English midwife service'. The society was concerned that this policy, perhaps introduced as an emergency measure, might become the 'thin edge of a permanent wedge'. It resolved to reaffirm the principle that 'the ideal obstetrical service for every confinement in this Dominion is a doctor and a midwife or a doctor and a maternity nurse attending'. The following year the society repeated this resolution in the light of a perceived trend for more women to be confined by midwives alone, declaring their belief that 'for reasons of safety to mother and infant, reasonable pain relief, and elimination of future pelvic weaknesses', a doctor and a trained nurse should be present at every delivery.
Dr Bernard Dawson, professor of obstetrics and gynaecology at the Otago Medical School, warned his colleagues that 'a small cloud can herald a thunderstorm'. With an eye to Britain, where he said the percentage of midwife deliveries had increased from 58 to 75 over the previous decade, he averred, 'It is usual for methods adopted by England to be advocated sooner or later in her Dominions', adding that the midwife system of maternity service already had advocates in New Zealand. He advised the medical profession to devise a scheme that included midwives 'rather than be left inarticulate and bereft when some Bill for Maternity Services detrimental to our interests becomes an enactment'. Dawson clearly saw midwives as competitors.
Dr Thomas Corkill, at that time president of the NZOS, not surprisingly was also outspoken about doctors' involvement in births. Graduating in medicine at Edinburgh in 1915 (where he also completed his MD in 1920), Corkill practised obstetrics in Wellington from 1921. He became a member of the (British) College of Obstetricians and Gynaecologists in 1934, and a fellow in 1937. In a 1933 article in the New Zealand Medical Journal (NZMJ) he addressed the argument put forward by Jellett, among others, that maternal mortality was much lower for midwife-conducted births than doctor-attended cases. He noted that textbooks often warned against a doctor's presence during labour, as this was 'more likely than anything else to promote weariness and tempt interference' which were detrimental to the woman's welfare. Yet he argued that one advantage of the doctor's presence at the time of delivery was 'much more satisfactory anaesthesia'. His main argument in favour of doctors attending normal births, however, was that only by such experience could they gain a sense of the abnormal. In his view, doctors should be involved in normal births to enhance their knowledge of obstetrics for the greater good of all. Corkill was one of the members of the 1937 Committee of Inquiry into Maternity Services.
The 1937 inquiry was not swayed by medical argument alone, however. Three members of the committee of seven represented women's organisations, Mrs Amy Hutchinson, Mrs Agnes Kent-Johnston and Mrs Janet Fraser. Whilst the latter was the wife of the Minister of Health and later Prime Minister Peter Fraser, she was also active in women's issues in her own right. All three were explicit about their preference for hospital births, as were some of the women who came before the committee as witnesses. For instance, when Dr Paget asked Mrs McGuire of the Onehunga Labour Party whether she preferred a maternity hospital or a nurse service in the home, she replied, 'We think a hospital is the better.'
Hospital Births and Pain Relief: Women's Demands
In the early twentieth century most women delivered their babies at home. In 1920 fewer than 35 per cent of births occurred in hospital (defined as an institution with two or more beds). At that time the Health Department's Director of Nursing, Hester Maclean, supported home births, believing that the 'large majority' of births could take place at home provided conditions were 'reasonably comfortable'. Yet a decade later 57 per cent of New Zealand births occurred in hospital. In 1936 Dawson maintained that the fact that over 60 per cent of New Zealand women gave birth in hospital proved that the majority preferred hospitals, 'even in perfectly normal confinements'. The 1937 Committee of Inquiry contrasted New Zealand with England and Wales, where only 15 to 25 per cent of births took place in hospital compared to 81.75 in New Zealand. This was the case despite the fact that in New Zealand most women had to pay for the privilege.
New Zealand's health system prior to the 1930s was a mixture of private and public hospitals. Public hospitals, run by elected hospital boards, were funded by a combination of government subsidies, voluntary donations and patients' fees, with those patients who could pay being required to do so. In 1930, with a population of under 1.5 million and about 27,000 births per annum, New Zealand had well over 1500 maternity beds available in institutions. This included 76 public hospitals containing maternity wards or maternity annexes, providing 506 maternity beds. New Zealand also had 274 private maternity hospitals; most of these were small, with an average of fewer than four beds per institution (and 873 beds in total). There were also unregistered private one-bed institutions run by midwives; Auckland alone had at least 25 of these in the 1930s. Finally, the St Helens hospitals, with their heavily subsidised fees, accounted for an additional 121 beds. Still it was not enough. By the 1930s New Zealand women almost took it for granted that the best services for childbirth were hospital-based. New Zealand's National Council of Women (NCW), which had been set up in 1896, had long kept a watching brief over women's affairs. When the Auckland branch of the NCW set up a sub-committee to look into maternity services in 1936, they called it 'The Committee on Maternity Hospital Services in New Zealand'.
This was partly a reflection of the changing public image of hospitals generally. In the nineteenth century, hospitals had been regarded as places of last resort, where someone would go when they could not be cared for at home. The advances in scientific medicine changed the public image of hospitals; gradually the public came to accept them as respectable places of curative medicine. Women in childbirth wanted all the advantages that modern science could give them. Historian Judith Leavitt noted of America that 'women in alliance with obstetrical specialists decided to move childbirth to the hospital', and explained that 'they made this decision because they believed in medical science'. Canadian historian Wendy Mitchinson also argued that Canadians had developed faith in science, and that, 'Much in a hospital setting gave the patient the feeling that everything that modern medical science could offer was available to her.' Jane Lewis concluded from her research into the history of maternity in Britain that women went into hospital because of fear of the pain and the health consequences of childbirth.
In New Zealand too childbirth was feared in the early twentieth century. In her history of childbirth in nineteenth-century New Zealand, Alison Clarke explained that women were very aware of their vulnerability as they prepared to give birth. She noted that letters frequently included expressions of relief and gratitude following childbirth, reflecting the very real dangers women had faced. These fears were common knowledge. Premier Richard Seddon was not alone when he spoke of 'the dark hour of maternity', and nor was another MP who referred to 'that great dread which is felt as the time of maternity approaches'. This apprehension was heightened after the First World War when it was announced that New Zealand had the second-highest maternal mortality rate in the Western world. Women were not reassured by a pronouncement of a Board of Health committee set up in 1921 to look into this situation that, 'Childbirth is a normal physiological process, and to the healthy woman in healthy surroundings is attended with very small risk.'
There were reasons other than health concerns for women to prefer hospitals for childbirth. Lewis wrote of Britain, 'A ten-day rest in hospital made sense in the context of the hard household labour performed by working-class women.' In the American context, Leavitt considered the physical and psychological isolation of many women to be important in their decision to enter hospital; they could not find the help they needed in their own homes. With its perennial shortage of domestic servants and the frequent absence of extended family, New Zealand shared these characteristics. Dr Emily Siedeberg McKinnon, medical superintendent of Dunedin's St Helens Hospital, mentioned a factor counterbalancing the attraction of hospital births, however, when she told the 1937 Committee of Inquiry, 'I do not know whether it is difficult to get [domestic] help or not, but I do know that a fair number of mothers are afraid of the infidelity of their husbands. That is a definite difficulty in persuading a woman to go into hospital, and even when they do go to hospital they are always anxious to get home again on that account. As a member of the Society for the Protection of Women and Children I have encountered many such cases.'
One of the clearly recognised drawcards of hospital births (and probably outweighing any concerns about their husbands' infidelity) was that pain relief was more readily available in hospital than at home. Pain relief dates back to the mid-nineteenth century. First administered in 1846 by an American, Dr William T. G. Morton, it quickly spread to Europe and began to be used in childbirth as well as surgery. In 1847 Professor James Young Simpson of Edinburgh gave a birthing woman ether inhalation anaesthesia, and later tried another inhalational anaesthetic, chloroform. Shortly after, an American dentist, Horace Wells, published his work on nitrous oxide. Very soon these three general anaesthetics became widely known and were all used in childbirth. Some opposition persisted, based on the biblical injunction that 'in sorrow thou shalt bring forth children' and the related belief that women were meant to suffer in childbirth. Opponents of pain relief, sometimes including husbands, also argued that anaesthesia gave doctors unchecked powers over their patients. Opposition faltered, however, after Queen Victoria had chloroform for her eighth delivery in 1853. Wealthy women, in particular, began to pressure doctors for chloroform. With regard to America, Leavitt described nineteenth-century women as more eager than their physicians to invest in pain-relieving agents such as chloroform and ether. The same was true in nineteenth-century New Zealand. In her history Alison Clarke related the story of Amy Barkas who demanded chloroform: 'Amy was a determined woman, wealthy enough and assertive enough to find a doctor willing to do what she wanted.'
(Continues...)
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Table of Contents
Acknowledgements vii
Abbreviations ix
Introduction 1
1 Childbirth Services in New Zealand, 1900-1939 9
2 National Women's Hospital and the Postgraduate School of Obstetrics and Gynaecology 26
3 A Tripod: Patient Care, Research and Teaching, the 1950s to 1963 46
4 A Woman's World: Mothers, Nurses and Midwives at National Women's, the 1950s to 1963 70
5 From Premature Nursery to Paediatric Department, 1950s to 1963 88
6 A Bright New Age: Advances in Reproductive Medicine, 1964-1980s 103
7 The New Patient and Perinatal Medicine 117
8 Contraception, Sterilisation and Abortion 142
9 Obstetrics and the Winds of Change, 1964-1980s 166
10 Feminists, Midwives and National Women's Hospital 190
11 A Hospital in Trouble, 1990-2004 210
Conclusion 234
Notes 243
Bibliography 294
Index 314