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"One of our own": ethnicity politics and the medicalization of childbirth in Manitoba.

Article Excerpt
By 1895, the process of medicalizing childbirth was well underway in North America. It was characterized by an increase in physician-attended births, increased reliance on medical technology and science, and a slow but steady decline in midwifery. In fact, by the end of the nineteenth century, it was becoming the norm for physicians to attend to birthing women. (1) The increase in physician-attended births is directly correlated to the steady decline of popularity and numbers of midwives at that time. However, the practice of midwifery did not disappear uniformly across all strata of society. As Wendy Mitchinson suggests, the few remaining midwives that held out against the increasing domination and authority of the medical profession remained active in isolated or immigrant communities, in maternity homes for the poor or unmarried, and in Aboriginal communities. (2)

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In Manitoba, the speed with which childbirth came under the domain of licensed medical doctors was uneven and was tempered by ethnic politics. This paper examines a specific instance of an attempt to bring medical childbirth to the Mennonite block settlement in South Central Manitoba known as the Mennonite West Reserve. The case of Katharina Thiessen's prosecution by Morden doctors and the College of Physicians and Surgeons points to the dynamics of making childbirth and illness the exclusive domain of licensed practitioners. In contrast to Adam Scalena's analysis of the contest between licensed doctors and chiropractors and osteopaths, which argues that economic motives played a lesser role in Manitoba than in other jurisdictions, Thiessen's case suggests that the medicalization of childbirth was an economic issue for individual doctors who had a license to practice. (3) The presence of folk remedies, midwives and other purveyors of traditional medicine represented a loss of revenue for them. Doctors also made every attempt to medicalize childbirth by emphasizing their gender and social superiority in order to gain control of the lucrative medical market of the Mennonite West Reserve. Further, Thiessen's case illustrates how an ethnic group was able resist the intrusion of the doctor, an ethnic outsider in the 1890s, into the private realms of illness and childbirth. Finally, the case of Katharina Thiessen suggests that giving doctors exclusive domain over illness and childbirth was a precarious project in the 1890s. The intervention of ethnic politics forced the College of Physicians and Surgeons to abandon the project of medicalizing childbirth among Mennonites because of the risk of jeopardizing their goals in the province more generally.

The practice of midwifery was based on traditional views of childbirth as a natural process. Midwives relied on their practical experience to guide them as to whether or not they should intervene in the birthing process. Physicians, however, had formal training at medical schools that gave them social esteem and allowed them to project an air of intellectual and practical superiority over midwives. Further, most midwives were female and most doctors were male, and thus, as Judith Leavitt points out, an element of gender-based status differences existed that put men at an advantage over women regardless of skill or education. (4)

Doctors emphasized their superiority over midwives in part because doctors had an economic interest in showing that birthing was a medical process. Wendy Mitchinson's research has shown that obstetrics was a foot in the door to a larger and much more lucrative family practice. (5) Contact doctors made with a family during childbirth helped to familiarize the family with what physicians had to offer and gave them the opportunity to gain the family's trust. This in turn led to the possibility of the doctor being called on for other medical concerns of the family. Thus, Mitchinson shows that if a midwife was called instead of a physician to help a birthing woman, she was not only depriving the doctor of his medical fee but also denying him the opportunity for career advancement. (6) Midwives capitalized on this process of familiarization and building trust through birthing practices in the same way physicians did, so major competition between doctors and midwives understandably developed. (7)

Equally frustrating to doctors was that midwives could get away with charging little or nothing for their services because they often had other means of support. Further, in addition to the delivery itself, midwives offered other related services to the family that physicians did not, such as doing chores, preparing meals, and providing after-care to mother and infant. Physicians, however, were forced to charge their patients at least a moderate fee for their services because their profession was their only income. Thus, many people in the community, particularly the poor, chose to rely on the services of a midwife because they seemed to be the "sensible choice." (8) The economic competition that midwives created in the medical profession was very threatening to physicians and therefore was one motivation for doctors to show that birthing was a medical process, not a natural or social process as it had been thought about traditionally.

Doctors also emphasized their gender and social superiority in order to medicalize childbirth. For example, William Buchan, a late nineteenth century physician, challenged women's involvement in the birthing process entirely, suggesting that the labouring mother was the only woman that should be involved. He believed that many of the difficulties that women had in birthing could be prevented by disallowing women's practice of midwifery "unless they are duly qualified." His statement makes it sound as though he was willing to accept that midwives could provide a valuable service if they were appropriately trained. However, Buchan goes on to ask, "Was any female ever duly qualified? I believe not."...

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