Our Bodies, Our Babies

Kerreen Reiger

• Publisher: Melbourne University Press Digital
• Year: 2013
• ISBN:
  9780522863475
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This is a wonderful book... read it and consider what has been won, and how much more needs to be won, in the childbirth revolution!
Barbara Katz Rothman, City University of New York Kerreen Reiger is absolutely right to see the childbirth movement as the forgotten women's movement, and the great pleasure of this book is to find in every chapter the right questions being asked.Janet McCalman, University of Melbourne
For most of the twentieth century, childbirth and the care of mothers and babies in Western countries was controlled by doctors and a hospital system headed by men.
In Our Bodies, Our Babies, Kerreen Reiger traces the struggle of Australian women and others to change approaches to childbirth, to claim their right to choices in childbirth, and to educate themselves about birth and breastfeeding. She explores the movement which radically changed our maternity care practices, allowing fathers to participate in the birth of their children and babies to 'room-in' with their mothers.
This absorbing story draws on interviews with mothers, midwives and doctors, and on archival material from relevant women's organisations. It shows how the childbirth and breastfeeding movements are relevant to feminism and women's rights. Much has been achieved, but Reiger sees a need for still more political action.
Any woman who has given birth, and anyone who has cared for mothers and babies, will want to read this book.

1 having babies:
the postwar scene

When the management of birth and infant feeding became a matter of dispute in the 1960s, it was in the context of the social changes and the development of maternity services during the postwar years. In a period of rapid expansion of industry, population and suburbia, health services were stretched to capacity. The ‘baby-boom’ period was one of housing shortages but many new products also appeared on the market, from kitchen gadgets to cars. Technology and science therefore acquired new prestige, and developments in medical care, such as the introduction of antibiotics, gave increased authority to doctors. A general atmosphere of optimism went hand in hand with the rapid economic growth. It was overshadowed somewhat by Cold War political tensions, which also fuelled government concerns about Australia’s sparse population. Both the massive immigration program and a strong pro-family ideology reflected the argument that Australia must ‘populate or perish’. The structures of maternity care were therefore shaped by a variety of factors.

Rather than discuss these events through facts and figures, an account of the quite typical experience of Tricia Robb’ evokes the context in which many families were formed. Having met her husband in the Army, she married in 1948 in Melbourne, had their first child in 1949, another in 1950, and another two in 1954 and 1956. They got caught up in the immediate postwar ‘rush to get married’:

I wasn’t terribly serious, I must admit, because I wasn’t mad about the idea of getting married at all. That wasn’t really in my program . . . I got carried along a bit because everyone was getting married, men were coming back from the war and there was a real rush of engagements. I suppose it became the fashion!

She did not think she really wanted children, and had acquired her sex education very much through hearsay and her own reading, but she was ‘fatalistic’ about contraception. She was not altogether surprised then to find herself pregnant: ‘any excitement that I felt was overpowered by the problems that it was posing: accommodation and finance and things like that’. ‘Tricia’ and her husband ‘Bill’ rented lodgings in a house with an older widow, an alcoholic. They embarked on the quest for their own home by buying a block of land in an outlying suburb, and on Sundays ‘Bill’ cycled the long miles there to ‘do it himself, to hasten the building which was delayed by shortages of materials. By the time they had two babies, still all living in one room and sharing kitchen and bathroom facilities, life was quite difficult and they moved as soon as possible into a very unfinished house.1

Tricia Robb’ described her first birth, which took place at a small church-run hospital, as a long slow, fairly uneventful labour, in which she felt very much alone. She had not been to antenatal classes: ‘They didn’t have them so much then. They hadn’t started that sort of thing. You had to go and rush to the hospital and book in as soon as you suspected. A lot of people booked in before they were pregnant, because it was so difficult at that time.’ Towards the end of her pregnancy, she no longer felt as ill as in earlier months:

[I] was a bit over confident, I suppose, and thought there was no reason why this shouldn’t go according to the schedule and that there shouldn’t be any difficulties . . . I went over the due date . . . By the time I did finally get to the hospital I was a nervous wreck again. I think you don’t really know how bad a pain to expect . . . they were short staffed. They had no one to leave with you. Oh, it was uncomfortable. The blankets kept sliding off and it was cold. I was utterly miserable!

She would have liked to have had her mother there, or even anyone, because she was getting frightened because it was taking so long: ‘I was on the verge of hysterics and not wanting to make any noise. It wasn’t much fun at all.’ ‘Tricia’ was given injections, of what she didn’t know, for pain relief, but remembered little of the actual delivery: ‘because, right at the last minute, they put me out with chloroform, ether, whatever it is’. In this account of quite a typical labour and birth, the husband was absent, and there was little expectation of ‘Tricia’ having much involvement in decision-making, for the well-being of mother and baby was assumed to rest in the hands of the doctor and nursing staff.

The details of ‘Tricia Robb’s’ family life are of course a part of her own unique biography, but they reflect a wider story. The social circumstances of the postwar years provided the backdrop for the formation of many new households. Families were changing, however, and, by the 1960s, a new era was established. In spite of a temporary rise after the war in both the numbers of married couples and the birthrate, the long-term trend to smaller families was under way. A wider range of contraceptives had slowly become available in the interwar years as technological developments, especially in vulcanised rubber, improved the effectiveness of condoms and diaphragms. Nonetheless, their use remained limited and abstinence was also commonly accepted. By the postwar decades, attitudes towards marriage and having a family changed, as more people married ‘for love’ and ‘in a carefree way’, but were also more likely to use contraception, especially the ‘pill’ which arrived in the 1960s. Women started to express their views more forcefully and publicly than in earlier generations. Even in the late 1940s, one wrote to a government inquiry saying that women owed little to Australia, for it ‘starved us and our children after the last war and it will do the same after this If We Let It’, so women were limiting their families by passing contraceptive and abortion knowledge among themselves: ‘Things will have to be mighty attractive in the New World before we consider the inconvenience of big families’.2 There were still few formal avenues of information, but doctors had moved towards grudging support of contraceptive advice, at least for married women, by the 1940s. Increased medical concern over maternal mortality rates also hastened the acceptance of contraception, with doctors and public health authorities expressing anxiety at the potential loss of women as childbearers.

Even during the 1930s recognition of the need for antenatal care prompted many doctors in private practice to encourage women to control weight gain in pregnancy, even excessively so at times.3 The larger public hospitals had developed prenatal clinics, which provided dietetic and exercise advice. The Royal Hospital for Women at Paddington set this trend as early as 1912 but others were as late as the Royal North Shore in Sydney in 1954; by the late 1940s in Brisbane a physiotherapist came to the Women’s Hospital to conduct antenatal classes in the ‘rather unsatisfactory surroundings’ of the basement.4

Medically supervised antenatal care was linked to increased hospitalisation of women for birth. In Medical Dominance, Evan Willis discusses the struggle of the medical profession to increase their role as obstetricians particularly vis-a-vis midwives.5 Over many years the doctors pursued a campaign, assisted by nurse-trained midwives, to discourage independent midwifery practice in the home in favour of women viewing childbirth as a condition requiring medical direction. They were supported by the state, through the ‘Maternity Allowance’ or ‘baby bonus’ which encouraged women to use the services of doctors rather than midwives, leading, in the decade to 1923, to a halving of the births attended by midwives.6 In the interwar years, women often birthed in local community maternity hospitals which were of variable quality. An historical account of midwifery in New South Wales notes that, ‘The period of the small midwifery hospital, especially in the war years, was a time of warm service by many devoted and experienced midwives. Many friendships were formed between mothers as they walked in the garden, enjoyed the home-cooked meals, and fed their newly born babies.’7 A more critical view, reflecting that of leading medical opinion, is taken by historian Janet McCalman, who comments that in Victoria many midwifery hospitals were ‘too often unsanitary and understaffed’.8 No doubt there is truth in both accounts.

However, women themselves were increasingly seeking hospitals with more technology, with the large metropolitan public hospitals, such as the Women’s Hospitals in Melbourne and in Sydney, setting new standards. Mothers seem to have supported the hospitalisation of childbirth which occurred in the interwar years partly because they accepted the doctors’ arguments concerning the ‘safety’ model of birth, and also because they appreciated the care and attention afforded by a stay in hospital, away from normal domestic responsibility. They used various organisations, such as the Countrywomen’s Association in rural areas, to agitate state health authorities about the shortage of maternity beds, spending many hours in fundraising for community hospitals. By the 1950s, however, many smaller hospitals were struggling to keep up with increased costs of staffing and technology and sought refuge through state subsidies. For example, even the substantial St George’s Hospital in the middle-class eastern suburbs of Melbourne, was in difficulty. Originally established as an Anglican private hospital, with a largely midwifery clientele, it was sold to the Hospital and Charities Commission in 1949 when the Church Sisters and the hospital Committee found it quite impossible to keep up with rapidly rising staff costs and antiquated accommodation and equipment.9

The 1950s, then, involved the consolidation of trends already set in train before the war, those towards greater medical management of childbirth, with hospitals increasingly supported by governments. The circumstances of the baby boom and rapid economic development of the reconstruction years led to attempts to expand maternity services through provision of extra beds and staff. Medical and nursing education were also given priority, but the strong focus was on health care as being hospital- rather than community-based. Women’s own demands were also couched primarily in terms of ‘more of the same’, but with better facilities.

In common with other Western countries in the baby-boom period, the Australian childbirth picture was a lively one. Here I draw on interviews with some fifteen Melbourne obstetricians, the memories of several midwives who trained in the postwar years, and interviews with women who had their babies in the late 1940s and early 1950s. While their experiences cannot cover the full range of hospital conditions and general circumstances, a fairly consistent picture emerges from their accounts, one consistent with hospital sources.10 It starts with the sheer ‘busyness’ of the postwar baby boom which had major implications not only for the mothers and babies but also the staff called upon to care for maternity clients. Hospitals were overcrowded, with women labouring in corridors, in pan rooms and on verandahs, sometimes even giving birth there. For mothers and their babies the situation in large urban hospitals, even for private patients, was fairly barbaric, with little individual attention during labour, often impersonal delivery, and regimented aftercare in which babies were locked away in the nursery.

Quite frequently there was little privacy for women in labour, especially in the public sections of large metropolitan hospitals: wards there sometimes resembled barracks, often presided over by ex-army nurses now trained as midwives. In Brisbane for example, the Women’s hospital faced an acute accommodation crisis during and immediately after the war, and even the addition of three extra stories to the building, begun in 1946, was of little help—for with the shortages of materials, it took until 1953 to complete.11 The hospital remained severely overcrowded, and even after the extensions were available in 1957, 400 patients were crowded into accommodation for which 274 beds was the official limit. The annual number of births was around 9000-10 000 for most of these years, as in other large metropolitan hospitals in Sydney and Melbourne. As one respondent whose babies were born in 1951, 1954 and 1958 commented, ‘When you think of the population explosion, it had to start somewhere!’12 While she had a reasonable experience at the Mercy Hospital in Melbourne, she had felt: ‘Surrounded by other people having babies. It was one of those peak times—1951. So you were not isolated by any means. It was the going thing . . . They were lining the passages, the corridors. It wasn’t just in a ward. There were just so many people.’

For many women the overcrowding occurred in antenatal clinics, waiting in early stages of labour and then in the labour wards. In Brisbane controversy over the problem at the Women’s became a matter of public debate—one woman wrote to the Courier Mail in 1953 saying that a dozen other women were having babies when she was admitted to the labour ward which, she said, doctors referred to as ‘the Stables’:

What details I couldn’t hear, could be seen as the curtains separating the beds were not even drawn. The two sisters and two nurses on duty were doing the best they could, running from one bed to the next as the babies were being born, at the rate of about six to eight an hour.

She found this all too much, and left before her baby was born, but the account does not state where she went! 13

One unusually critical doctor, Percy Rogers, soon to become a leader of the childbirth reform movement, said, ‘I was absolutely horrified at the conditions under which the women gave birth . . . The obstetrical wards [were] absolutely appalling. The sisters in charge, I’m certain, had been recruited from the concentration camps’.14 He was referring particularly to the Women’s Hospital in Melbourne and his description of conditions tallies precisely with that of other staff who trained or practised there in the early 1950s. A midwife, Thelma Matson, who trained there and rose to become a very significant member of staff, provided a graphic picture:

If I could just describe the actual delivery suite and the archaic and barbaric conditions under which women, I believe, had their babies . . . It was a great big Florence Nightingale ward. On one side there were four beds, and we had screens round it. At least it wasn’t like Crown Street [Sydney]. As late a...

Table of contents

• foreword
• contents
• illustrations
• acknowledgements
• abbreviations
• editorial note
• introduction
• 1 having babies: the postwar scene
• 2 mothers on the move: organising for change
• 3 the politics of birth: sisters in struggle
• 4 ‘bustin’ out all over’: maternalism incorporated
• 5 the work of organising: from fun to fundraising
• 6 professional mothers: practices of identity construction
• 7 ambivalent alliances: mothers’ organisations and feminism
• 8 the challenge to professionals: struggles over knowledge
• 9 assessing change: the organisation of birth
• 10 managing babies: the breastfeeding revival
• 11 spreading the word: the personal becomes public
• conclusion: women’s rights in childbearing
• notes
• interviews
• select bibliography
• index