Traditional Maori Practices — Normal activities were maintained until the last few days prior to birth, when the woman went to live briefly in a place specially built for her, as she was considered tapu (unclean (as in prior to being made sacred)) for a period before and after birth.
Her attendants were her female relatives, especially if it was her first child and subsequent births may have been unattended. The woman’s husband may be the attendant, her husband being the only man who could see or touch her.
Attendants would encourage the woman in her silent labouring with affirming words and would assist directly by adding gentle pressure to the upper part of the woman’s poho (abdomen), the pressure increasing as the pains grew stronger, to help the baby down. A woman labouring on her own may have used a tree branch to provide the resistance on her poho.
Once born, the baby was shaken upside down to remove the nanu (secretion) in its mouth and nose (any that remained was sucked out by the attendant). The iho (umbilical cord) was tied off and cut and the baby was wrapped in soft cloth. The whenua (placenta) was taken away by the woman’s mother and buried in a pre-prepared secret place. After the birth of the whenua the woman was seen as able to attend to herself and the baby. A week or so after the birth she would return to the kainga (village). By this time the iho would have fallen off to also be secretly buried. Prior to her return to the kainga she would have a tohi (cleansing ceremony) to lift the tapu from both mother and baby. The tohi was a “dedication of the new baby to the care of the gods” during which the baby was made tapu (sacred) again, according to it’s gender.
1840s-1870s — Settlers now living in New Zealand, are having families of 6-7 children. Women work extremely hard in primitive conditions, where there is a lack of sanitation, poor housing, insecure water supplies and minimal recovery time following childbirth. Men are not involved in birth and women attend women—either women who have learned midwifery skills in the homeland or who have personal birthing experience. Midwives often travel many miles on foot or horseback to attend women with no other medical services in the local district. Midwives are often unpaid and attend to the mother and baby, clean house, get meals, get older children to school and do washing for weeks after the birth.
1847 — A first assistant in a maternity hospital in Vienna identifies puerperal septicaemia (a ‘blood poisoning” that develops following childbirth), as an inquired infection, exogenous in nature (introduced to the body by others). He identifies that “putrid particles” are being transferred between women during vaginal examinations administered with unclean hands. His theories are not accepted by the medical profession.
1880 — There are 3.43 maternal deaths per 1000 live births.
1882 — European women with no support begin to travel to the larger cities to birth in hospital where there is support, but the numbers are minimal.
1885 — The number of maternal deaths has increased to 7.31 per 1000 live births.
1885—1894 — There are now 4.8 births per marriage.
1886 — The first inspector of hospitals thinks it is unnecessary to have birthing facilities in hospitals—where provided they should be housed separately.
1890-1913 — A decrease in the maternal death rate to 5.42 to 3.58 per 1000 live births.
1895—1904 — The birth rate per marriage continues to decline and is now 3.59 births per marriage.
1902 — A method of pain relief called Twilight Sleep is developed in Germany. The labouring woman is given several drugs that cause narcosis and remove the memory of birthing. It is recognised as not for common use as it holds dangers for both the mother and baby, including delayed labour, post-partum haemorrhage and babies who needed resuscitation.
1904 — The Midwives Registration Act is passed establishing formal education and registration of midwives. Following the Act’s establishment, 698 untrained women, following negotiation, are registered on certification from a doctor when they have been practising for a minimum of 3 years. However, these women are not readily accepted and efforts are made by local doctors to stop them practising because they are seen as competition to the medical profession, which was increasingly claiming childbirth as their domain.
The majority of births are occurring in rural locations — of the 22,766 births in New Zealand during 1904 only 5,970 are in the main centres of Auckland, Wellington, Christchurch, Dunedin and their suburban boroughs.
1905 — The first maternity services run by the Health Department begin with the opening of the St Helen’s Hospital in Wellington. Eventually seven of these hospitals open and they train midwives and provide services to the wives of working men. They are cheaper than private hospitals.
1908 — The Tohunga Suppression Act is passed, banning traditional Maori healers and diminishing Maori childbirth practices.
1909 — The Midwifery training at the St Helen’s Hospitals means antenatal services are available to women planning to birth there.
1913-1920 — Another increase in the maternal death rate to 6.48 per 1000 live births, which becomes a catalyst in accelerating the shift to hospital.
1918 —Dr Doris Gordon, a Stratford GP introduces Twilight Sleep, using it in her private hospital. She wants ‘universal pain relief’ for all those who seek ‘partial or total oblivion’ from the pain of childbirth, but only at a price. Those who can’t afford the fee have to make do with chloroform.
1920 — 35% of births are taking place in hospital—4% in the St Helen’s Hospitals. The first private hospitals (in that they offer 2 or more beds) were initially altered nurses’ homes and were maintained as home-like environments. There are some 200 private maternity hospitals in the 1920s and they are leased, or owned and operated, by nurses or midwives who often struggle to make ends meet.
1920’s — The Minister of Health advises women to have neither anaesthetics or doctors in attendance during labour. However, birth is seen as the gateway to the family (and more patients) so getting involved was valuable for the GP’s practise.
1921 — New Zealand’s maternal mortality rate is second highest in a US list of nations, prompting an official enquiry which sows the principle cause of death as puerperal septicaemia and directly relating to the increase in obstetric practise by men. The exogenous theory is still not accepted.
1924 — Having a doctor in attendance at birth is more common as many women are now able to afford the doctor’s fees due to insurance assistance.
1925 — The Nurses and Midwives Registration Act is passed, making it unlawful to attend a labouring woman unless the attendee is: a registered midwife; a registered maternity nurse; a certified lay midwife; or a medical practitioner. The Health Department introduces strict measures to prevent infection and a system of antenatal care begins through the St Helen’s Hospitals, though most women have no antenatal care at all.
1926 — Midwives and Plunket Nurses run antenatal clinics in the four main centres, although the medical profession continues to largely overlook antenatal care. Doris Gordon urges doctors to wrest control of antenatal care from the state and midwives by forming an Obstetrical Society.
NZ’s hospital birth rate is 58% (which is considerably greater then Great Britain’s (15% – restricted to abnormal cases) in 1927).
1927 — The Obstetrical Society is established, to restore credibility to doctors following the Health Department’s reduction of maternal mortality rates. Guided by Gordon, the Obstetrical Society declares that labour is now a ‘surgical operation’ and, with support from the National Council of Women, re-educates the public that birth is a health problem, requiring a doctor’s assistance. This creates fear amongst the public and a demand for pain relief, especially Twilight Sleep. Doctors are required to attend to administer the drugs and are then also required to attend to provide the instrumental deliveries made necessary with unconscious women.
1932 — Hospital boards are legally obliged to provide maternity services for Maori women, although many have made “limited provision” prior to this.
1935 — The different types of bacteria that cause infection are identified and the puerperal sepsis exogenous theory is finally accepted by medicine.
1936 — The New Zealand’s hospital birth rate has increased to 81.75%.
Maori women are dying at twice the rate of European women and Maori infants at 4 times the rate. This can be attributed to colonisation which caused declining health and gradually subjected Maori women to the came controls as European women in childbirth.
1937 — Following the push by the Obstetrical Society, antenatal care is now seen as the doctor’s job and is included in medical training at Otago University, though only 27.5% of childbearing woman attend antenatal clinics. Health Officials claim that traditional Maori practices of birthing in raupo whare (house made of bulrushes) provides healthy birthing for Maori.
There are 191 private maternity hospitals and 71 public—the public maternity services are unable to deal with the increase in women wanting to birth in hospital. New Zealand is using analgesics or anaesthetics more frequently than many other countries, including Great Britain.
The 1937 Committee of Inquiry into Maternity Services recommends that New Zealand’s Maternity services be based on birthing in hospital and endorses the medical practitioners role in maternity services (even with considerable overseas evidence to refute their position).
A list of referral criteria is established to define particular health needs or physical characteristics that could be pathological (diseased) in the pregnant mother and/or baby. If any of the factors are exhibited, the need for a doctor’s involvement is indicated.
With this hospital focus, training midwives is deemed as no longer necessary, as more maternity nurses are required for hospital based services. However, the Director of Nursing (Department of Health) argues that, particularly in rural areas, midwives are the only providers of maternity services and, at the eleventh hour, midwifery services are retained. Maternity care continues to develop atypically to several successful overseas models which are midwifery based.
Late 1930s — With pain relief coming at a price, the use of it is becoming an issue of class. Add to that the fact that women no longer accept the patriarchal, suppressive biblical myth of paying in perpetuity for Eve’s sin of leading Adam astray and women want sedation for the release from fear and pain it provides. Women’s organisations lobby for effective pain relief for all women at the St Helen’s Hospitals.
1938 — 17% of Maori women are birthing in hospital. Even Maori with traditional birthing knowledge are advocating hospital, as are Health Officials.
The Social Security Act 1938 introduces the first medical benefit, the Maternity Benefit, which provides free hospital care and causes a rapid rise in the use of public rather than private hospitals. The Act also places obligation on doctors to provide antenatal “supervision” if they claim the maternity benefit.
8% of births are occurring in St Helen’s Hospitals.
1940s — Plunket’s advice on the place of birth is aimed at husbands — hospital birthing is “generally safer for mother and baby” than home birth.
1945 — After World War One many private hospitals close down leaving many towns without any private maternity facilities.
1947 — New Zealand has the highest birth rate it has ever known and there is a shortage of maternity hospitals, nurses and midwives. In order to work around the shortages, hospitals need to be organised more efficiently to utilise the full compliment of staff available during office hours, so a need arises to manipulate the unpredictable patterns of labour to ensure the availability of medical personnel and services.
9 out of 31 pages in The Department of Health’s publication Suggestions to Expectant Mothers discusses the home birth option.
Late 1940s — the medical model of birth is well established in New Zealand due to the frequent use of anaesthetics requiring doctor’s involvement.
1951 — The Social Security Amendment Act guarantees payment for anaesthetists, ensuring the availability of anaesthesia for all women in hospital.
1952 — The Natural Childbirth Group (formed in 1951) becomes the Natural Childbirth Association. They provide information to women as to maternity homes, doctors and midwives who will support natural birth and they learn about exercises and relaxation for labour that assist with pain relief. In mid 1952 the name Natural Childbirth Association was changed to Parents’ Centre, to help elicit the support of health professionals.
1958 — A woman having her first baby (primigravida) is seen as being able to birth in about 16 hours. Subsequent babies in about 10 hours.
1960’s —The protocol for active management of labour in women having their first baby is formalised by Dublin doctors. It incorporates routine breaking of the amniotic sac, early use of synthetic hormones and a commitment that labour will not go longer than 12 hours, which ensures that a woman will birth during daylight hours, before the overnight down staffing in the hospitals. This also ensures that labouring women have fewer caregivers involved in their labour (one caregiver can attend several women at a time) so hospital staff can cope with staff shortages.
To allow attendants to quickly measure the progress of labouring women, birth is compartmentalised into 4 stages. Regular vaginal exams are used to assess dilation of the cervix and descent of the baby. These details, and others, are plotted on a chart, a Partograph, which enables attendants to monitor labour progress without continuous attendance on the woman, merely visiting at set intervals for more data gathering. The Partograph sets women up for “needing” interventions and doctors’ tolerance for the length of labour progressively diminished.
1972 — There is just 24 homebirths throughout the whole of New Zealand.
1973 — The new edition of Your New Baby: Suggestions for Expectant Mothers is released, without a single reference to homebirth in its 81 pages.
1978 — The Auckland Homebirth Association is launched (although there has been a Homebirth support group in Christchurch for 18 months).
1982 — The Maternity Services Committee, which has 13 members and not one midwife, reviews New Zealand’s maternity services. It makes 25 recommendations to the Board of Health in relation to home birth practise—including a list of 55 pregnancy risk factors, which make it more likely that hospital birth and specialist services will be necessary. The unborn baby alone has 26 factors that, if indicated, require referral to a paediatric specialist for transfer to NICU. However the amount of home births is growing—there are 728 Home Birth Association members in NZ.
1984 — A study in New Zealand finds that birthing in small facilities run by general practitioners and midwives is safe (contrary to popular belief).
1989 — The Department of Health forms a group, with representatives from many groups including midwives. Among other things, the group decides that the 1982 risk factor list needs revision.
The time in which a first time mother is now expected to birth has reduced to within 12 hours (and within 4 to 8 hours with subsequent babies). Manipulation of labour is the institutional management strategy to ensure both cost and work force efficiency.
On the home birth front, low pay and bad conditions for homebirth midwives discourages more midwives from offering home birth services. Home birth women and midwives have to work closely together to avoid hostility from other medical practitioners and this partnership becomes the cornerstone for the development of the New Zealand College of Midwives during this year.
1990 — The Amendment to the Nurses Act, 1977 gives autonomous practice back to midwives and threatens the medical grip on maternity services.
1995 — Home birth has risen to 2.9% of all live births in New Zealand.
1997 — The 1982 referral list is finally upgraded by The Transitional Health Authority (THFA) Maternity Project Team, who consult with represent-atives of the professional organisations representing obstetricians, paediatricians, general practitioners and eventually, midwives. The resulting list now includes 250 factors which may indicate necessity to transfer to hospital or to specialist services (204 for women and 46
Present — such things as Electronic Foetal Monitoring, Foetal Scalp Electrodes and ultrasound scanning continue to be commonplace for many women and babies birthing in hospital. These things can set a woman up for the cascade of intervention that arises when the first intervention necessitates the next intervention, and the next and the next, even from very early in pregnancy.
Home birth continues to be an option for women in New Zealand through the support and actions of those midwives and families who believe in the strength and ability of healthy, well women to birth their babies safely at home. May the home birth rates continue to rise.
Please read Maggie Banks’ Homebirth Bound, Mending the Broken Weave for more historic details and further information on the current maternity climate in New Zealand.