Maternity in Dispute. New Zealand 1920–1939

PHILLIPA MEIN SMITH, Maternity in Dispute. New Zealand 1920-1939, Wellington, New Zealand, Historical Publications Branch, Department of Internal Affairs, 1986, 8vo, pp. xvii, 180, illus., $14.95. This book deserves a wide circulation. It is brief, but excellent. The 1920s and '30s were intensely worrying for all concerned with maternal welfare, not least the mothers themselves. Maternal mortality had become a major issue. In some countries (for instance Scandinavia and The Netherlands) maternal mortality had fallen to low levels by the beginning ofthis century. In others, no appreciable fall took place between the 1870s and the mid-1930s although other mortality rates, notably infant mortality, were steadily declining. If one constructed a league table of maternal mortality in developed societies, at the bottom with the highest maternal mortality rate was the USA, followed closely by New Zealand, Australia, and Scotland. Somewhere near the middle was England and Wales, but at the top, competing for the cup for the safest maternity service were The Netherlands, Sweden, Denmark, and Norway. In most countries, including New Zealand and the USA, for women aged 15-44 puerperal deaths came second only to tuberculosis; what was so worrying was that experts agreed a large proportion of maternal deaths, probably as many as forty per cent, were, as the Australian Maternal Mortality Committee pointed out, preventable "by a degree of care which is not excessive or meticulous, requiring only ordinary intelligence and some careful training". There must have been, or so it was believed, negligence somewhere. At all events, doctors, midwives, health departments, and special committees met, argued, fell out with each other, and advocated different remedies for what had become one of the major public health scandals of the century the unnecessary death in childbirth of thousands of young women in their prime. Accusations of incompetence and negligence lay at the heart of "Maternity in Dispute". Some blamed the mothers. Some blamed the midwives. Above all, the general practitioners were blamed for carelessness, poor antiseptic technique, and excessive intervention. Most agreed that poor obstetric education was at the bottom of it, and that maternal care should be encouraged to take one of two directions, both of which, incidentally, involved the partial or total elimination ofthe GP obstetrician. One was to imitate the Dutch and Scandinavian system, in which the majority of deliveries were undertaken by trained midwives; the other (favoured in the United States) was to take all the mothers into hospital under the care of specialist obstetricians. New Zealand encouraged the trained midwife while moving to hospital delivery even earlier than the United States. In a country where the annual number of births in the 1930s was much the same as in Lancashire or Middlesex, and half the number of Paris, what was decided depended on the personalities of a few individuals. New Zealand had its share of forceful characters. There was Truby King, the infant feeding expert, oddly suggestive ofa fast food chain; and there was Henry Jellett, one-time Master ofthe Rotunda, who went to New Zealand in 1920 partly because he was persona non grata with Sinn Fein and partly for the fishing; and there was the formidable Dr Doris Gordon. They and others can be seen in the centre of this book, so large, square-jawed and determined that you suddenly sense where the All Blacks' pack came from. The part these men and women played in the development of the maternity services of New Zealand is told very well indeed by the author. She writes clearly with perception, wit, and that rare quality, bounce. Because what happened in New Zealand was happening throughout the Western World, this is more than a local study. It is a very good account ofmaternal welfare and maternal mortality in the western world in the 1920s and 1930s, and her brief chapter on septic abortion is memorable. In the 1930s, New Zealand had one of the highest death rates from septic abortion in the world. Much of it was found amongst married women and much was self-induced. In a country in which the Director General ofHealth said it was "much better for a married woman to hold a baby in her arms than a pet poodle", advice on birth control was deliberately withheld because