Midwives in Passage

Cynthia R. Comacchio is an assistant professor of History at Wilfrid
Laurier University in Waterloo.

This book is a carefully detailed sociological analysis of the
twentieth-century development of midwifery in Newfoundland and Labrador.
The author, a Newfoundland-born sociologist, sympathetically examines
the eclipse of traditional midwifery with the acceptance, in the past 30
years, of the bureaucratized hospital setting as the virtually exclusive
site of childbirth. Her story, on one level, reinforces the view of male
medical conquest of the traditional feminine spheres of childbirth and
child-rearing that occurred with modernization and professionalization.

Benoit relies largely on first-hand accounts gathered from retired
“granny women” and practicing midwives from villages, towns, and
major urban centres in Newfoundland and Labrador. She places her “test
case” within a comparative sociological perspective by examining
published research on midwifery in mainland Canada, the United States,
and western Europe. Significantly, Benoit takes to task recent feminist
analyses that have “tended to depict midwifery in terms of an
historical transformation of midwives from a situation of occupational
autonomy and high status when lay midwives worked in clients’ homes to
the present period of practice in large complex hospitals, characterised
by patriarchal medical dominance and deprofessionalization.” As Benoit
argues, close comparative analysis of both the historical and current
organization of maternity care raises questions about the validity of an
analysis of professionalism “that is almost exclusively based on
American and British data.”

In Newfoundland and Labrador, the transition of midwifery services from
the home to bureaucratic settings was gradual. Lay midwives continued
serving isolated communities until after World War II. Thus, first-hand
accounts of traditional midwifery provide a crucial “reality test”
for current interpretations of historical childbearing patterns. In
Newfoundland and Labrador, midwifery not only survived the shift to
hospitalization but developed in the small cottage hospitals in a way
that “even today resists bureaucratization.”

The author talked to 45 women from four types of obstetrical practice:
traditional “granny women,” solo practitioners in rural clinics,
midwives in small cottage hospitals, and those now working in large
hospital settings. Her conclusion is that only midwives in the small
cottage hospitals (which were established during the 1930s and still
exist in some areas), approached the kind of secure occupational status
desired by all: “a considerable degree of professionalism dominated
neither by community nor bureaucracy.” Benoit points out the important
policy implications of this experience for those Western countries now
attempting to reorganize their maternity-care systems and in particular
for developing societies now contemplating changes in traditional
birthing arrangements.

Of particular interest to social historians is Chapter 3 on the
midwives’ work worlds. Here we get to see the midwives’ assessment
of the various sites of practice, the amount and nature of training, and
the dark side of midwifery: the sheer drudgery, hard work, problematic
remuneration, sense of isolation and general physical and emotional
stress that are often involved. Remarks Benoit, “it is telling that
none of those interviewed recommended a return to homebirth practice.”
The cottage hospital alternative, which flourished between the mid-1930s
and mid-1960s, seems to have provided the ideal birthing and work
environment, allowing for personalized client care and increased
professional autonomy for midwives in an intimate, nonthreatening, yet
medically advanced environment. By the mid-1950s most babies outside the
two large urban centres were being delivered in cottage hospitals. Yet a
mere decade later the switch was made to the depersonalized,
bureaucratized setting of large teaching and referral hospitals.

Benoit presents convincing arguments against a too-facile acceptance of
the superiority of home births by revealing the “darker side” of the
midwives’ own testimony. She also demonstrates that theories which
correlate increased training, specialization, and
bureaucratization—whether positively or negatively—with
professionalization are also too simplistic and unidimensional. What is
required now is a more detailed comparative analysis between what was
happening in this area and in other Canadian provinces during the early
twentieth century. The “unique” experience of Newfoundland and
Labrador suggests much for upcoming social policy, but how is it
explained in historical terms? Why did midwifery follow such a different
path in Newfoundland and Labrador than in other provinces, whose pattern
was much like that of the rest of North America and western Europe?
Benoit’s analysis has provided much food for thought for social
analysts and social historians alike.