Filling the Cradles: Private residential maternity homes

Notes for a talk given at Auckland Library, 14 August 2013 Lisa J Truttman

Now and then, I receive enquiries from folks who are tracing their ancestors and come across notations that births had happened 70-90 years ago at “the residence of Nurse Such-andSuch”. In the case of Avondale, most of the enquiries were to do with three of our four known residential maternity homes: those run by Nurse Mary Manning, Nurse Edwards, and Nurse Kathleen Maude Addison-Saipe. I wanted to know just how these women, and others around Auckland, fitted into the overall story of maternity care in the period between when most babies by far were born in the home – and today where hospital births are the norm. Historically, most births were carried out in the family home. Older women in the family could possibly assist – or older women called in who had experience in childbirth (midwives). Alison Clarke, in Born to a Changing World (2012) noted that it isn’t possible to know for certain what proportion of births in 19th century Colonial New Zealand were assisted by professionals or expert practitioners – because there was no requirement to name a birth attendant on the certificate. Midwives practised in Auckland almost from the very start of the city, and as in other parts of the country combined midwifery with general nursing services for accidents etc. Catherine Conway was apparently practising right from 1841. (Southern Cross, 11 December 1871) “At an early hour on Saturday morning last, Catherine Conway, aged fourscore years and ten, was found stark dead in a small dwelling in Durham-street, where she had lived for a time. "Old “Head of an Old Woman with Granny"— for this was the name the old woman was known White Cap -- The Midwife” by had lived for thirty years in Auckland, having reached the Vincent Van Gogh, 1885 age of sixty before she sailed from old Erin of which she was a native for the shores of a new colony. “Old Granny" had during the last quarter of a century obtained a respectable livelihood as midwife and nurse. She had heard the first-born wail of many of our now wealthiest Provincialists, and she had listened to the last moan, had heard the last dying wish expressed, and had leant over and received the last breath of many good colonists long since departed from our midst, but not yet forgotten. Catherine Conway, poor and humble in her sphere of life, was a full-souled, fine-hearted old woman high-spirited, and knowing not what fear meant. Yet was she kind and gentle in her ministration, as many a hale man, once a valetudinarian, can vouch for. The deceased was "waked" on Saturday night, and conveyed to her last resting-place yesterday. Requiescat in pace. Ninety years, one-third of which has been spent in a relaxing climate, is a long life's lease. Total abstainers will tell us that had “Old Granny" not regularly taken her glass of ale on each day of the seven days of the week, and occasionally a

little, a very little of something which made her old blood to course more cheerily through her veins, she might have lived longer. It may be so but there are those who will doubt it.”

Southern Cross 3 June 1843

Some came with qualifications from either overseas schools of midwifery (Britain or other colonies) or from the lying-in hospitals …

Southern Cross 10 March 1857

… others just “at the request of friends.”

Southern Cross 16 June 1865

The earliest private maternity home found in Auckland is one in 1865 advertised at Union Street in Freemans Bay, run by Mrs Shaw, a midwife who also advertised that “a medical

man was always in attendance.” By the early 1880s, an example of fees charged was £1 5s per week before the birth, and £2 10s per week afterward – a huge cost except for those reasonably well off. This level of cost carried over into the early years of the 20th century. The private maternity homes were essentially places for “lying-in”, the period of confinement before a birth, and any required bed rest afterward, for those who could afford it. The era of institutional “lying-in hospitals” began in Britain in the mid 1700s: an attempt to bring childbirth under professional medical management in an institutional setting. Into the Victorian era these became over time associated with destitution and the work of charities with “fallen women”.

City of London lying-in hospital, built 1770

Female pupils were admitted into the hospitals to learn midwifery, usually for a period of six months. The institutional lying-in hospitals, however, became infamous for increased incidents of puerperal fever (from the medical term puerpera = a woman who had recently given birth) and other infections which were lethal for mothers. Instances of puerperal fever climbed during the 19th century, passed on by improperly sterilised equipment, the insufficiently cleaned hands of practitioners, and other defects in sanitation.

SO 4004, 1885, LINZ records Crown Copyright

As far as Auckland was concerned, what must have been a rudimentary maternity ward, with just four bedrooms, had existed at the women’s refuge on the Auckland Domain from at least the late 1880s. It was probably along the lines of the “fallen women” homes managed at the time by church authorities, catering for those who needed medical help but were unable to afford midwife or accoucheur or man midwife. (Letter by W J Suiter, Auckland Star, 30 August 1887) “The Maternity Ward was closed, and properly so. What right have taxpayers to pay for the support of a place wherein young women can congregate from all parts of the North Island to hide their disgrace?” It was reopened after discussion by the Charitable Aid Board. (NZ Herald 13 May 1889) “For some time past the Charitable Aid Board have been endeavouring to reduce the numerous abuses in connection with the maternity ward at the Hospital. At one time young women were sent there for two or three months to live in comparative idleness, being found in everything gratuitously. An admission fee of £1 is now charged, not with any hope of heading them off, but to provide the necessaries which have hitherto been furnished at the public expense.” This was transferred to the Costley Ward at Greenlane in the 1890s. (NZ Herald 27 August 1889) “Dr. Beale called the attention of the ladies [of the Auckland Benevolent Charity] to the necessity for establishing a Maternity Charity. A dozen beds would be needed. On the lines on which he proposed it to be managed, it would be pretty nearly self-supporting. They would get a subsidy from the Government against all their contributions. Working men who had not suitable accommodation at home for their wives, would be glad at such a time to pay £1 a-week for the privileges of the charity. The establishment of a Maternity Charity would prevent the scandalous cases which had taken place. He threw out the suggestion to the ladies for consideration.”

Elizabeth Cowie, Auckland Weekly News 21 August 1902, Sir George Grey Special Collections, Auckland Library

Elizabeth Cowie set up her Women’s Home at Parnell in 1884, “to receive young women desirous to return to virtuous living,” where the inmates worked a laundry to earn their keep. This over time evolved into the St Mary’s Home in Otahuhu which has had maternity functions last century.

Another example is the Salvation Army’s Bethany Homes, 10 of which had been founded around the country by 1914. Terms from the 19th century, now obsolete and forgotten by the general public: Accoucheur – a man midwife (from 1730s), a doctor who dealt with childbirth. Today an obstetrician. Accouchement / Confinement / “time of illness” / “time of trial” – awaiting birth Monthly Nurse – a nurse who would stay at a woman’s house for a month, arriving just before a baby was due, staying for around two weeks afterward. “Sarah Gamp” in Dicken’s The Life and Adventures of Martin Chuzzlewit” was a monthly nurse. This led to “Gamps”: slang for unqualified maternity nurses.

Moves were made from the late 1890s for New Zealand to be amongst the first countries in the world to have a formal standard of registration for both nurses and midwives.

Nurse holding an infant, [c. 1900] Reference Number: 1/4-016328-G, National Library

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 on payment of £1 to be registered. (Nurses Registration Act 1908, consolidated) 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. (NZ Official Yearbook 1925) 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. (Papps & Olssen, p.84) 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.

Auckland Weekly News 9 August 1906, Sir George Grey Special Collections, Auckland Library

By 1905 “there are seven State maternity hospitals now open for the use of the public. The St. Helens Hospital at Wellington was opened in June, 1905, and a new and up-to-date building in July, 1912; that at Dunedin was opened in October, 1905; that at Auckland in June, 1906, and a new building in February, 1923; that at Christchurch in April, 1907. State institutions have also been opened at Gisborne, Wanganui, and Invercargill.” (NZ Official Yearbook )

Auckland Weekly News 23 August 1928, Sir George Grey Special Collections, Auckland Library

The St Helens Hospitals in Auckland, Wellington and Dunedin were initially set up by Elizabeth Grace Neill, with the strong support of Seddon, recognising that at the time there was a need to assist working class families with the expense of childbirth. Only those women whose husbands earned less than £5 a week were admitted, up until 1939 when the national welfare system took effect. The hospitals were closely associated with the Premier, named after his home town in Lancashire. The Auckland St Helens Hospital was opened to patients in June 1906, in a two-storey former home of Dr A G Purchas (later replaced by a concrete building in 1924) but had no official opening, due to Seddon’s death on 10 June (his successor, Sir Joseph Ward, ordered that the hospital forego an opening). The Pitt Street hospital closed 1968, and one in Western Springs closed 1990.

28 March 1908

To close the door further on the era of unqualified midwives and monthly nurses or gamps going from house to house without proper training, more regulations came into effect, this time for the private maternity hospitals. “The Private Hospitals Act, 1906, which came into force on the 1st January, 1907, provides 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 nurse in 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 InspectorGeneral 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. “In every private hospital there must be kept a register of patients showing particulars as to name, age, abode, and date of reception of each patient, date when such patient left, or in the event of death the date thereof, name of medical practitioner attending, and such other details as may be prescribed. Inquiry may be made at any time as to the management and conduct of any such private hospital, and if such inquiry prove unsatisfactory the license may be revoked, and no new license shall be granted to the person whose license is so revoked, for a period of five years. “The fact that two or more persons, not members of the occupier's family, are received into any house in any one month as lying-in cases, or who there receive medical or surgical treatment, attendance, or care, shall be sufficient evidence that the house is a private hospital, whether or not it is proved that any charge is made for such treatment, attendance, or care. “The Governor may from time to time make such regulations as are necessary for carrying the Act into effect, and substantial penalties are provided for breaches of its provisions. The first regulations under the Act were published in the New Zealand Gazette on the 30th May, 1907.” (NZ Official Yearbook 1907).

Various advertisements, 1903-1904

“The private hospitals came under the supervision of the Hospitals Department on the 1st January, 1907… At the beginning of the year there were 293 private hospitals for which licenses had been issued by the Public Health Department; of these 193 have been inspected. The first visits paid were in Auckland, where there were nineteen houses licensed in and

around the city. These vary very much in every way. Some are well-equipped, up-to-date, and comfortable houses, managed by registered nurses and midwives. Auckland is very well provided with accommodation for private patients. For surgical patients may be mentioned Miss Green, Miss Foote, Miss Morrison, the Mater Misericordiee (managed by Roman Catholic Sisters trained as nurses), and several others of a fair type. The Misses Margetts's maternity hospital is comfortable and homelike, also Mrs. Goddison's and several other small places suitable for the poorer class of patients. There are, however, one or two places which have been taking cases without license, and which will need careful watching.” (Report on the Hospital and Charitable Institutions of the Colony, AJHR, 1907, H-22)

In 1920, 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. Legislation in 1920 marked the passing of the ‘era of environmental health protection’ and the ushering in of the ‘era of personal health endeavour’.” (Health Act 1920) Three divisions were established in the reorganised Health Department – Child Welfare, School and Dental Hygiene. All came through from the Education Department, the Child Welfare division from the “Special Schools” for destitute, orphaned, homeless, juvenile offenders, deaf, blind, feeble-minded children.

Sir Frederic Truby King, 1936 Reference Number: 1/1-018663-F National Library

The Child Welfare Division was essentially one man, Dr Truby King of Plunket fame, and his area of concern spanned from conception through pregnancy, birth and on to the end of primary schooling. Maternal welfare was not a major political priority at the time – the focus was on the child, the future citizens of the country and the Empire. (Maternity in Dispute, pp. 1-5)

From Maternity Mortality Report 1921, AJHR

There remained general fears amongst mothers of puerperal sepsis or fever, toxaemia, and septic abortion. Puerperal sepsis was the topic of note in the 1920s.

When five women died shortly after child birth at the Kelvin Nursing Home in Remuera in the early 1920s, the result was the 1924 – Kelvin Commission, and their report. “The Private Maternity Hospital System.- -The Commission submits the following views The private maternity hospital system in New Zealand is unsatisfactory at present …

…slender financial resources of the licensees, who are, as a rule, registered midwives, and not often the owners but merely the licensees of the premises. …the majority of these hospitals are private houses converted, as far as the finances of the persons concerned permit, to the important purposes of a hospital. …private maternity hospitals which do not completely comply with regulations … should be subjected to a process of gradual extinguishment, and that in their place efficiently equipped accommodation for maternity cases be provided by the Government or Hospital Boards, or by both in conjunction, for all classes of the community —rich, poor, and those of moderate means —the patients being required to pay for the service rendered in accordance with their financial ability.”(Report of the Kelvin Hospital Commission, AJHR 1924 H-31 pp15-16) The Nurses and Midwives Registration Act, 1925, 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. In 1930 this was amended: The requirements for training were as follows:— Maternity Nurses.—In the case of a person who is a registered nurse the period of training is six months, and in the case of any other person is a period of eighteen months. At the end of this time the candidate is eligible to sit for the State Maternity Examination. Midwives.—No person may be accepted for training as a midwife until such person has been registered as a maternity nurse; the duration of the course of training will be then a period of six months, at the end of which the candidate is eligible to sit for the State Midwifery Examination. (NZ Official Yearbook 1940) A midwife thus had to first be trained as a nurse, and then train as a midwife, before qualification.

There were still mortality scares, however, even those involving St Helens Hospitals. This one from 1929, four years after the tightening of regulations.

By 1935, 78% of children born in maternity hospitals – 8% of these at St Helens facilities, 27% in public maternity hospitals, 43% in private maternity or mixed maternity/general hospitals. Maternity in dispute, p. 1

Report of Committee of Inquiry into Maternity Services, AJHR 1938 H-31a

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.

Social Security Act: The inauguration of a system of medical and hospital benefits Maternity Benefits.—Maternity benefits include ante-natal and post-natal advice and treatment by medical practitioners, and the services of doctors and nurses at confinements in maternity hospitals or elsewhere. No charge was to be made in respect of confinements in State maternity hospitals, or in maternity hospitals conducted by Hospital Boards. In respect of confinements in private maternity hospitals, provision is made for the payment of prescribed fees which will be in partial satisfaction of the charge, payable by the patient or any other person in respect of the confinement. Essentially, maternity benefits covered childbirth overseen by a medical practitioner and a maternity nurse, over those cases overseen only by a midwife alone. The midwife-operated public maternity hospitals appear to have offered less options with regard to pain relief during childbirth than private hospitals at this point, whether “twilight sleep” or chloroform. (Committee of Inquiry into Maternity Services, AJHR 1938 H-31a) So, there was more incentive to have the birth at a fully-subsidised public hospital, which offered a wider range of pain killing options than the old St Helens hospitals as well. Still, for a time, the maternity benefit system did help keep a number of private residential nursing homes open. By 1940, despite overcrowding experienced at state hospitals at the beginning of World War II, statistics showed that midwives and private maternity nurses took in only 8 patients per annum on average, a figure which seems to have remained fairly static during the period. Hospital birth by now was the preferred norm.

In 1945, the hospital built during wartime on Cornwall Park was converted to become a maternity hospital, and became known as National Womens by 1955. From this point, the era of the private maternity home on the Auckland isthmus came to an end, after around 80 years.
(Annual report of the Director-General of Health, AJHR 1946, H-31)

“A feature of the year has been the closing of a number of private maternity hospitals because of shortage of domestic and nursing staff, and because, as elderly licensees give up the private maternity hospitals that they have conducted for many years, younger nurses are unwilling to undertake the burden of taking over or establishing maternity hospitals. Hospital Boards have, in many cases, had to purchase or lease the private maternity hospitals until such time as permanent maternity accommodation can be built …” By the early 1950s, approximately 95 per cent of all confinements took place in the various types of maternity hospital—a maternity annex to a public hospital, a St. Helens Hospital, or a private maternity hospital. Under the Nurses and Midwives Act, 1945: control over establishing and managing maternity homes was passed to hospital boards. “All private hospitals were required to be licensed under the Hospitals Act 1957, and the Department of Health saw that standards regarding buildings, equipment, and staff are observed. “Except in an emergency, no persons other than registered medical practitioners and registered midwives are allowed to conduct confinements, and only registered midwives and registered maternity nurses are permitted to nurse women in childbirth.” By 1960 “approximately 97 per cent of all confinements take place in the various types of maternity hospital—a maternity annex to a public hospital, a State (St. Helens) Hospital, or a private maternity hospital.” (NZ Official Yearbook 1960) By 1970, approximately 99 per cent of all confinements take place in the various types of maternity hospitals. But these, in the main, were no longer the converted residential homes used by nurses and midwives in New Zealand since almost the beginning of the Colonial-era New Zealand. Where to find more information: Books used researching this talk: Born To A Changing World: Childbirth in Nineteenth-Century New Zealand, by Alison Clarke (2012) A very good general overview of the topic (at least for the 19th century), including both Maori and Pakeha perspectives. Maternity in Dispute: New Zealand 1920-1939, by Phillippa Mein Smith (1986) Doctoring Childbirth and Regulating Midwifery in New Zealand, by Elaine Papps and Mark Olssen (1997) Both of these books take a distinctly political-sociological view of the topic of maternity care

in New Zealand during the 20th century. Rather difficult to pick out the finer historic detail in amongst the point both books make that the 20th century was a midwives versus doctors scenario. Other sources. Directories & Papers Past These can be used in combination to try to track down where people were born when it comes to the maternity homes, both the small two bed ones and the larger facilities, as well as some background as to when they started, and when they disappeared. Not all were like the Kelvin Home, appearing in the papers in blazing headlines. Most are referred to only in the birth notices, inserted by grateful parents – and also death notices, where things didn’t go so well. Archives NZ So far, I’ve yet to track down a research list for maternity care from Archives NZ. Hopefully one will be arranged at some point, but the topic is both vast and complex in the range of records. Here are just some: AAFB W3255/1 The Midwives Register of New Zealand 1905-1909 (Wgtn office) AAFB W3255/2 Register of Trained Midwives in New Zealand 1905-1925 (Wgtn Office) YCBH 4298 Midwives, maternity nurses, and community nurses registered from St Helens Hospital 19071980 (Auckland Office) YCBH 4380 Register of midwives and maternity nurses 1933, and 1935 (Auckland Office) AAFB 632 W2883/109 Social Security benefit files obstetric nurses received subsidies under the 1938 Act, so appear in the Archives NZ files by name Eg. Social Security - Maternity Benefits - Obstetric Nurse - Maria Knight, 33 Stokes Valley Road, Lower Hutt 1955-1975 St Helens Hospital -- Auckland Files mainly in Wellington, and mainly to do with building plans. Also look under “Private Hospitals”

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