Midwives in PEI

It may surprise people to know midwives still play an important part in pregnancy and delivery in many countries. But, do they have a role in PEI?

By the mid nineteenth century, the average Island woman gave birth to seven children. While most births were successful, there was a high infant mortality rate due to rickets, poor nutrition, and unsanitary conditions. 

In most cases, the pregnant woman turned to her mother, aunts, sisters, female friends, or midwives for help delivering. There were not enough doctors in rural areas and having a doctor deliver your baby was expensive. As time went on, more women turned to doctors but even in 1932, many women were still turning to midwives. That year, the Prince Edward Island Medical Association complained that too many women were using midwives.

Interestingly, in 1808 and 1843 doctors unsuccessfully petitioned the Island government to ban individuals from practicing without a license. Had either of these gone through, women would be legally bound to turn to doctors rather than midwives. Leading some historians to ask, did doctors view midwives as a threat?

Giving birth was always risky, and given the time period it is understandable why a woman would prefer a midwife over a doctor. Midwives were less expensive, there were more of them in rural areas, in many cases they were mothers who understood what the woman was going through, and they specialized in pregnancy.

Stories like the following did not help - 

On January 20, 1856, John Tetson called on Dr. Mackieson. His 20 year old pregnant wife had been in labour for about 18 hours with their first child. When Dr. Mackieson arrived he took control from the midwife and gave Mrs. Tetson two doses of ergot. Ergot, while it promoted abdominal contractions, also brought extreme discomfort.

The baby's head became stuck on her pelvic bone and he could not dislodge it. Dr. Mackieson, fearing for the mothers health, took out forceps and pulled with all his strength. While this did lead to the child being born, he died within a week. Dr. Mackieson listed the cause of death in his medical logs as unknown. This is not a slight against Dr. Mackieson. He was known to be a good doctor and a strong proponent of mental health.

Now, if you are thinking, "well childbirth is dangerous and in that period both mother and child could have been lost if Dr. Mackieson hadn't intervened," here are some important things to know:

1. Doctors in the 1800s and 1900s had a habit of trying to intervene as they usually saw birth as pathology or a procedure. Midwives usually saw it as a natural process and understood there would be differences between births, ie. pain, length of labour, etc. As a result, doctors were more likely to intervene when no intervention was necessary.

2. Many countries still use midwives. In the UK they deliver or participate in  about 50% of deliveries, include Kate Middleton's three children. In Sweden, Denmark, and France, they oversee about 75% of births. In the United States, they participate in less than 10% of births.

3. In 2015, the infant mortality rates of the countries listed above were:

UK - 9.2

Sweden- 4.4

Denmark - 4.2

France - 7.8

United States - 26.4

I tried to find the rates for Canada but couldn't. I will say, currently, PEI is developing a midwife program as we are one of the few provinces without one. If you are an Islander thinking you may want to become a midwife, the PEI government website has some information here. The closest programs look to be in Quebec and Ontario.

4. In the United States, there were very pronounced class and racial elements to doctors trying to abolish midwives in the 1800s and 1900s. They claimed midwives of colour were dirty and not smart enough and that poor people, of any race or ethnicity, should go to charity hospitals where new doctors could essentially practice on them.

Although midwives were not common used after the mid-1950's on the Island, midwives still play an important part in medical care and there are benefits. 

1. 'Free up' other medical personnel. Midwives can assist with births in hospitals or lead low-risk ones. This frees up doctors and nurses for other patients who may need their care more.

2. Choose where you give birth. Midwives offer more choices for where you can give birth. Midwives can do home births, but these are low-risk pregnancies. In many cases, midwives work in the hospital and can handle low-risk births. High-risk births would be led by a medical doctor.

3. Midwives can do pre/post natal care. This is an advantage for new parents who may have questions or concerns but have a hard time getting in touch with their family doctor, if they even have one. 

4. Accessible. Socially, geographically, financially, etc. 

5. Lower mortality rate

In summary, midwives still have a large role to play in healthcare and soon, PEI will join most of Canada in regulating midwives, ensuring they can practice, and expanding birthing options. 

Baldwin, Douglas. Prince Edward Island: An Illustrated History. Toronto: Nimbus Publishing, 2009.

Chakraborty, Ranjani. "The Culture War Between Mid-Wives and Doctors, Explained." Vox. May 29, 2008. https://www.vox.com/videos/2018/5/29/17406838/midwives-doctors-united-states