A New Irrigating Apparatus.

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Modernizing Midwifery: Managing Childbirth in Ontario and the British Isles, 1900–1950

This dissertation considers the differences, as well as the similarities, between midwifery and childbirth practices in Ontario and in Britain in the first half of the twentieth century. Addressing the modernization of medical practices on either side of the Atlantic, the periodization of this project reflects the increasing concerns about maternal and infant morbidity and mortality alongside medical and political attempts to ensure the involvement of trained medical professionals during pregnancy and childbirth. In Britain, the establishment of the 1902 Midwives Act regulated midwifery so that only midwives approved by the Central Midwives’ Board were allowed to practice. British midwives helped to improved maternal and infant health and welfare by making childbirth a co-operative, medically-managed event in conjunction with physicians. The medical training of midwives and physician support meant that British midwives thus participated in, and contributed to, advances in obstetrics through their access to obstetrical medicine and technology. In contrast, physicians in Ontario worked to exclude midwives from participation in the modernization of birth management, emphasizing a physician-exclusive concept of “medicalization”. Under Ontario legislation, only physicians were legally allowed to act as primary attendants during childbirth, and nurses and midwives were prohibited from practicing midwifery. Nurses and midwives in Ontario, unlike their counterparts in Britain, were excluded from developments in obstetrics. This study challenges the medical profession’s claims that the exclusion of midwives in Ontario was necessary for maternal safety or the medicalization of childbirth. The British alternative, where midwives were seen as partners rather than obstacles, illustrates that medicalization in the interest of maternal and infant safety could be integrated, effectively and efficiently, with the work of midwives. By ensuring that midwives were trained medical professionals with access to obstetrical medicine and technology, greater numbers of British women had widespread access to affordable medical attention during childbirth, at an earlier date, than was possible for Ontario mothers having to deal with the physician-centred model. Comparative maternal and infant mortality statistics for the first half of the twentieth century indicate which was the more effective approach in saving mothers and babies

Modernizing Midwifery: Managing Childbirth in Ontario and the British Isles, 1900–1950

This dissertation considers the differences, as well as the similarities, between midwifery and childbirth practices in Ontario and in Britain in the first half of the twentieth century. Addressing the modernization of medical practices on either side of the Atlantic, the periodization of this project reflects the increasing concerns about maternal and infant morbidity and mortality alongside medical and political attempts to ensure the involvement of trained medical professionals during pregnancy and childbirth. In Britain, the establishment of the 1902 Midwives Act regulated midwifery so that only midwives approved by the Central Midwives’ Board were allowed to practice. British midwives helped to improved maternal and infant health and welfare by making childbirth a co-operative, medically-managed event in conjunction with physicians. The medical training of midwives and physician support meant that British midwives thus participated in, and contributed to, advances in obstetrics through their access to obstetrical medicine and technology. In contrast, physicians in Ontario worked to exclude midwives from participation in the modernization of birth management, emphasizing a physician-exclusive concept of “medicalization”. Under Ontario legislation, only physicians were legally allowed to act as primary attendants during childbirth, and nurses and midwives were prohibited from practicing midwifery. Nurses and midwives in Ontario, unlike their counterparts in Britain, were excluded from developments in obstetrics. This study challenges the medical profession’s claims that the exclusion of midwives in Ontario was necessary for maternal safety or the medicalization of childbirth. The British alternative, where midwives were seen as partners rather than obstacles, illustrates that medicalization in the interest of maternal and infant safety could be integrated, effectively and efficiently, with the work of midwives. By ensuring that midwives were trained medical professionals with access to obstetrical medicine and technology, greater numbers of British women had widespread access to affordable medical attention during childbirth, at an earlier date, than was possible for Ontario mothers having to deal with the physician-centred model. Comparative maternal and infant mortality statistics for the first half of the twentieth century indicate which was the more effective approach in saving mothers and babies

County health administration

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Woman centred care? : an exploration of professional care in midwifery practice

This thesis explores what ‘woman centred care’ means to both women and midwives and how this care is offered by midwives and perceived by women. It is set within the context of current health care policy and the way in which this impacts on both the organisation and implementation of maternity care. A flexible qualitative design was used to explore both women’s and midwives’ experiences of current maternity care over the full trajectory of maternity provision. A modified grounded theory approach was used framed within a feminist perspective. The fieldwork was undertaken in two phases. In phase one and interviews were undertaken with twelve women in early pregnancy, later pregnancy and after the birth; a total of twenty-five interviews with women were completed. Nine midwives were also interviewed in phase one. Preliminary and tentative categories were identified from both sets of interviews and were used to inform phase two of the study. Five women participated in the second phase of data collection. This included both informal, telephone contact and in-depth interviews spanning from early pregnancy until after the birth and included observation of their care in labour. The community midwives and delivery suite midwives specifically involved in their care were also interviewed. The data demonstrated a continued mismatch between the women’s and the midwives’ perspectives and it was evident that despite the policy drivers and consumerist rhetoric of ‘woman centred care’ and its original underpinning principles of continuity, choice and control, that this was not the overriding experience for the women who participated in the study. Data analysis highlighted some opportunities for negotiation but these were not explicitly recognised or realised by the women or midwives and there was little time or flexibility in the system to accommodate such opportunities. The increasing bureaucracy of the maternity care system also constrains continuity of carer over the full spectrum of the childbearing trajectory and reduces the potential for women to know the midwife who provided care. Thus for many midwives being ‘with the institution’ was more likely than ‘being ‘with woman’.EThOS - Electronic Theses Online ServiceGBUnited Kingdo