A history of private maternity care in NZ

Talk presented to the Auckland Medical History Society, 5 June 2014.

Collecting information on private maternity homes in New Zealand is one of my interests. I do not by any means claim expertise or detailed knowledge of every aspect of this part of our social history.

As a local historian based in Avondale, I started researching the maternity homes in my area after a number of enquries from family history researchers. These were people who had found that their ancestor or relative had been born at “Nurse Such-and-Such’s Place” – where was that?

A look at old postal directories answered their questions, but I wondered in turn how the women who ran such places fitted in with the development of maternity services to the community.

Private maternity services, as a historical study in this country, is a neglected one. It is eclipsed by the prevailing focus on the history of maternity care in hospitals, from the simple lying-in wards in attached refuges at established hospitals, to local and regional public obstetric facilities administered by charitable aid and hospital boards from the years just before the First World War. There is also a political aspect, a latter-day view of the story of women’s healthcare in New Zealand cast in terms of feminism (and that is a general description), which has tended to dominate sources on the topic. A bias and social commentary in history is fine, but I sought to find out a context for the establishment of the services which were, by and large, a series of small businesses dotted up and down the country.

Looking for the private maternity service providers is still an ongoing quest. Official records are still either sparse, or difficult to find. Not every practitioner advertised in the newspapers unless they could afford the fee. Quite a few nurses and midwives probably advertised on the street via printed bills, or by word of mouth, especially those without qualification. In Paris, so it was reported, midwives would “advertise on every wall”. It’s likely similar happened here in colonial New Zealand, along with word of mouth, to a greater degree than the printed word in the newspapers which cost money.

Published birth notices in the 19th century were also uncommon (again, involving a cost). Many didn’t record the place of birth, if away from the family home. Along with this, the nineteenth century there was no call to register the practitioner on birth certificates.

In the early 1880s therefore, judging from advertisements and birth notices in the Auckland newspapers, it might appear to our eyes that there were hardly any private residential nurses and/or female midwives assisting with childbirth and providing accommodation for the process in Auckland. But a response from the NZ Herald to a reader at that time tells us that there were actually several in the city.

X. Y. Z., Mercer, writes:—"Can you inform me what persons in Auckland take ladies in for confinement?"— There are several houses where such accommodation is furnished, but to name anyone might be construed into a recommendation of one to the disadvantage of the others. An advertisement inserted in our columns would no doubt bring several answers in response, in which the terms, &c., would be stated, if such information were called for in the advertisement. (NZH 16 July 1881)

The practitioners and operators of private maternity homes had a degree of invisibility as far as modern research is concerned, but they were still there.

Midwives have been in Auckland since early 1840s. The earliest “Lying-in” home found in the newspapers (so far) however – was Mrs Simson’s Cam Cottage in Kaiapoi, Canterbury, briefly from June 1859. This was a travellers boarding house operation serving also as accommodation for invalids and mothers-to-be. It could be described, from what little we know of the set-up there from sparse newspaper notices, in a way as a sort of private hospital.

Which leads us back to Auckland, and Dr Thomas Francis McGauran’s also briefly-existing Auckland Lying-in Hospital in Chapel Street (now Federal Street) from September 1859. McGauran, holding a licentiate in midwifery, in charge the Metropolitan Infirmary and Dispensary at the time, was apparently in charge at Chapel Street as well and advertised for “a steady, respectable, middle-aged woman wanted as Nurse to this institution.” He was provincial surgeon at the time, and president of the Auckland Medical and Surgical Society from April that year, but his career was soon came unstuck after being accused of being “of too great intimacy with a female patient” in March 1860, and politicians called for his head.

Mrs Shaw, five years later in 1865, advertised her “lying-in home” at Union Street in Freeman’s Bay. We don’t know how long she was there. Sporadically, a handful of midwives and nurses announced their services in Dunedin, Greymouth, Christchurch and Timaru over the next five years before we see Mrs Douglas of Norman’s Hill in Onehunga, in 1870, “prepared to RECEIVE as BOARDING INVALIDS who require change of air, or ladies from the country who wish to be near medical assistance, and to have careful attendance during their confinement. Inquiries as to Mrs. Douglas's qualifications as a nurse may be addressed to Dr. Purchas, who has kindly consented to allow reference to be made to him. The use of a Paddock and Stable can be had if required. Terms moderate.”

And another five year stretch before Mrs Boyle, a midwife first at Freeman’s Bay in 1875, then 10 years later in 1885 at the Fernleigh Villa in Ponsonby.

The early 1880s seems to mark the beginning of a new period in the story. The newspapers here in Auckland, and down south in Christchurch and Dunedin began to see many more notices than before from providers of private maternity accommodation. More nurses and midwives arriving perhaps, along with other immigrants? We also see private maternity providers becoming more stable and longer-term in the nature and location of their businesses. Mrs Seatree, possibly Harriett Seatree, started at Worcester Street East in Christchurch in 1883, then moved to Cranmer Square in 1889 where she advertised right up to 1896 – a lengthy period of service for those days.

The increase in publicity for private midwives and maternity nurses petered out by the mid 1890s. Possibly, due to economics again – the women, as mentioned before, were likely still there, still practising. Enough so that when the drive toward national registration of nurses took place in the colony in the early 1900s, midwives and maternity nurses were included, midwives with their own registration act in 1904, and the establishment of the system of St Helens Hospitals for training and maternity services from 1905.

There had been earlier registration systems, of a sort. I found that the St John Ambulance Association in Canterbury, from around 1888, kept “a register of nurses for accouchement, medical and surgical cases. The efficiency and good conduct of these nurses, and their observance of sanitary rules is vouched for by the Medical Staff of the Association.”

In 1901 -- Nurses Registration Act – Enacted from January 1902 – those nurses which had either had four years training in a hospital, were 23 years old or over with three years training, or had a certificate from a medical officer or hospital outside of NZ, were entitled to be registered on payment of £1.

In 1904 -- Midwives Act … provided that after a certain date (1906) only those midwives who were duly registered would be qualified to practise on their own account.

Midwives registered under the latter Act were able to take responsibility for delivering babies without the supervision of a medical practitioner. Those who had no formal training, but had been practising as midwives for at least three years and applied on or before 1 January 1906 could be registered. They also applied if they already held a certificate in midwifery from a recognised training school, the London Obstetrical Society, or any other certificate approved by the Registrar. The third way was to undergo training at any of the state maternity hospitals set up by the Act – the St Helens hospitals.

Unregistered midwives could still practice as “maternity nurses” (although that term wasn’t legalised until 1925) as long as they were under the supervision of a medical practitioner.

Registration and the provision of training at St Helens seems to have led to the next bloom of private maternity homes in the country. Former students from St Helens did indeed set up their premises in increasing numbers, advertised the fact of their registration, experience and/or St Helens training, and appear in larger provincial towns such as Tauranga in relatively plentiful numbers.

The new regulations didn’t end there.

The Private Hospitals Act, 1906 came into force on the 1st January, 1907 providing “for the licensing, management, and inspection of private hospitals. All such institutions must be licensed, and every application for a license must be accompanied by a statement giving full description of the house proposed to be used, number of patients, and class of cases proposed to be received. The licensee shall state whether it is in respect of a lying-in private hospital or a surgical and medical private hospital, and no lying-in patient shall be received in a private hospital unless it is licensed for such cases, and no patient other than a lying-in patient shall be received in a private hospital licensed for lying-in cases only.

“For every private hospital there must be a resident manager, either the licensee or some person appointed by the licensee, and in every case the manager must be a legally qualified medical practitioner or a registered nursein the case of a surgical and medical hospital, or a registered midwife in the case of a lying-in hospital, or a registered nurse and midwife, or a registered nurse having as resident assistant a registered midwife in the case of a hospital licensed for both purposes. No license shall be granted in respect of a house not previously licensed until such house and annexed buildings have been approved by the Inspector General of Hospitals, and no addition shall be made to any private hospital until it has been so approved. No license shall be granted until the character and fitness of the applicant have been proved satisfactory, and the license must be renewed on the 1st January of each year.”

One of the “old school” of private maternity service providers, a “practical midwife” Mrs Mary Ann Follas, was caught out by this new era of regulation. She had started in Upper Symonds Street in 1892, then moved to Devonport in 1900 (starting that suburb’s first known maternity home.

In 1909, five years after the Midwives Act and four years after the Private Hospitals Act: “Mary Ann Follas was charged with acting as a midwife without a license, and with keeping a private hospital, also without a license, at Devonport. She was convicted, and fined £1 on each charge, with costs.” Then in 1911 “Mrs. Follas, who failed to register the birth of a child within the statutory time, was fined £2, and 9s costs.” She died 1915, aged 74.

In the pre-First World War period, provincial hospital boards outside the main centres embarked on a programme of establishing side obstetric hospitals, similar to the early maternity wards at Greenlane’s Costley building. This new period of expansion in the numbers of practitioners in the country, both public and private sector, came to a halt during World War I, when many nurses volunteered to serve overseas, while others took up positions in the main hospitals.

This was also, of course, a time when suburbs began to expand around the cities, and the operators of private maternity homes no longer needed to advertise widely afield to attract country clients in order to keep their businesses afloat, although many in the suburbs of Auckland still did have a rural client base into the 1920s and 1930s.

In 1920, the situation remained that most babies were still born at home. Around 65% of births were outside hospitals (institutions with two or more beds).

4% at the St Helens Hospitals.

5% in hospital board or Salvation Army hospitals.

26% in private hospitals.

Sometimes, private maternity nurses ended up in the courts, due to lack of proper registration like Mrs Follas, because children died or sickened in their care, or because now and then a private maternity nurse became an abortionist. But these were relatively uncommon cases.

Still, in an era of increasing concern with regard to health and awareness of the discomforts and dangers of childbirth, the Kelvin Home scandal made headlines. Five women died soon after giving birth at the Kelvin Home in Remuera, which sparked the Kelvin Commission of 1924 which in turn led to the Nurses and Midwives Registration Act, 1925. This provided for a Nurses and Midwives Registration Board, and a standard of training first in terms of being a general nurse, then in being a midwife, (which were both provisions as per the previous regulations). But this time, “maternity nurse” was a term included explicitly in the Act, and was the mandatory qualification before a woman could go on to train as a midwife.

There was still a place for the private maternity homes in the period after the Kelvin Home tragedy. In 1938, those preparing a Report of Committee of Inquiry into Maternity Services found: “The private hospitals in Auckland and suburbs provide ninety-four beds. According to the evidence tendered and inspections made it would appear that in the majority of private hospitals the facilities provided are satisfactory, but the most popular of the hospitals are overtaxed, the tendency being, as in other parts of New Zealand, for cases to go to hospital rather than be confined in the patients' own homes. The fees charged range from £4 10s. to £8 8s. per week. According to the opinion of leading obstetricians and also of the Medical Officer of Health there is need in Auckland for the further provision of private-hospital accommodation. There is at present no private maternity hospital equipped for surgical work, and difficulties arise when operations such as Caesarean sections are necessary. The Committee is of opinion that the provision of more private accommodation is to be encouraged.”

The 1939 Social Security Act, however, meant that there was from that point no charge for patients in State or hospital board hospitals while only a partial allowance was paid for patients in private hospitals or maternity homes. This probably did start the decline in numbers in the private sector, coupled with the fact that the nurses and midwives in private practice grew older as time went on, or became sick, and left their businesses to retire into the 1940s to 1960s. This decline was likely accelerated in Auckland by the establishment of obstetric hospitals supported by the hospital boards on the isthmus (National Womens at Cornwall Park), West Auckland, North Shore, and Howick.

Some women in the last half of the 20th century probably preferred the “at-home” feel of the private maternity homes, though. In other cases, unwed mothers and illegitimacy for example, a private hospital probably sounded a better option than a public institution. But, by and large, the private maternity homes became rarer as the century began to draw to a close.

-- Lisa J Truttman