Historical context of childbirth in New ZealandContexto histórico do Parto na Nova Zelândia

By Larissa Grandi and Mayra Calvette

The historical context that led to the medicalization of childbirth in New Zealand is similar to most Westernized countries.

For centuries, woman gave birth attended by an autonomous lay midwife who she knew well, in a familiar place to her; usually in their home or in the home of a female relative (Davis-Floyde & Cheyney, 2009).

birthing goddess

childbirth

Ancient civilizations, such as Maori, considered birth a normal life event and part of the society (Te Huia, 2005). In Maori culture, the placenta (whenua) was considered sacred and was buried in a secret place (Mikaere, 2000).

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Midwifery profession was first registered in the 1904 Midwives Act, introducing a national structure for registering midwives. The transition from home to the hospital in the 1920s and 1930s the midwifery profession and birth became institutionalized and dominated by medicine and nursing (Hendry, 2009). Midwives lost their identity as a profession. They also lost continuity care with women and their prestige as guardians of natural birth (Guilliland & Pairman, 1995).

Between 1916 and 1940, the majority of births happened at the hospital and the ‘Twilight sleep’ was largely practiced, promising ‘pain free’ childbirth but leading to large incidence of forceps deliveries and more exposure for infections (NZCOM, 2004). Socially, in the 1940s and 1950s, the woman’s role was limited to marriage and family, depriving women of the ability to make choices, particularly regarded childbirth and fertility (Stojanovic, 2004). As a result, much of our knowledge of ‘unmedicated and female’ birth was lost (Davis-Floyd, 2001).

sedated_birth

In New Zealand and internationally, the hospitalization led to fragmented maternity care, loss of control for women and their families, increased medical intervention and use of technology, loss of confidence in women’s bodies, and increased fear of birth (Odent, 2005; Donley, 1998).

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During the period from 1930 on, woman generally received their antenatal care from the local family doctor (GP) or in an atenatal clinic in the maternity hospital. She would be assessed for risks in relation to choice of birth place – primary low risk unit or obstetric hospital. Obstetricians worked in the obstetric hospitals and were especialized in complications during pregnancy, birth or post partum (Hendry, 2009).

When labour began she would go to the hospital. The midwife would take her to a prep room for routines procedures – pubic shave, enema, vaginal examination – and call the doctor to say the woman’s progress. She was cared by midwives during labor and when birth was eminent the doctor would come in, so he could earn their publicly funded fee (Hendry, 2009).

Women were feeling unhappy with this fragmented care, and would ask for the midwife not to call the doctor(Hendry, 2009).

The active involvement of a group of consumers and activist midwives were the catalysts for change.

Read in the next article, the tipping point!

References:

Davis-Floyd, R. (2001b). “La Partera Profesional: Articulating Identity and Cultural Space for a New Kind of Midwife in Mexico.” Daughters of Time: The Shifting Identities of Contemporary Midwives, Medical Anthropology. Ed. Robbie Davis-Floyd, Sheila Cosminsky, and Stacy L Pigg. Medical Anthropology special 2 part issue. 20.2-3: 185-243.

Guilliland, K. & Pairman, S. (1995). The Midwifery Partnership – A model for practice. Wellington: Victoria University of Wellington.

Hendry, Chris. 2009. “The New Zealand Maternity System: A midwifery renaissance.” In Birth Models That Work, eds. Robbie Davis-Floyd, Lesley Barclay, Betty-Anne Daviss, and Jan Tritten. Berkeley: University of California Press, pp. 55-86.

Mikaere, A. (2000). Mia I Kore kit e Ao Marama: Maori Women as Whare Tangata. Paper presented at NZCOM Conference; Seasons of Renewal. Cambrige, Septemper 30. 2.6.

New Zealand College of Midwives (2004). Centenary Timeline. Midwifery News Centenary Edition. December. Pages 9-16.

Stojanovic, J. (2004). Leaving your dignity at the door. Maternity in Wellington 1950-1970. NZCOM, 8th Biennial National Conference. September, p. 225-231.

Te Huia, J (2005). Midwifery. In Wepa Cultural Safety in Aoteraroa 1st ed. Pp. 114-121. Auckland: Pearson Education New Zealand.
Por Larissa Grandi e Mayra Calvette

O contexto histórico do parto na Nova Zelândia é parecido com outros países que aderiram o modelo ocidental de assistência ao parto.

Durante séculos, a mulher deu à luz com a presença de uma parteira leiga autônoma que ela conhecia bem, em um lugar familiar para ela, geralmente em sua casa ou na casa de um parente do sexo feminino (Davis-Floyde & Cheyney, 2009).

birthing goddess

childbirth

As civilizações antigas, como a Maori, considerava o nascimento um processo natural e integrado na sociedade (Te Huia, 2005). Na cultura Maori, a placenta (whenua) era considerada sagrada e era enterrada em um lugar secreto (Mikaere, 2000).

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A parteria como profissão foi registrada pela primeira vez pela Lei das Parteiras em 1904, uma estrutura nacional para registrar as parteiras. Com a transição da casa para o hospital na década de 1920 e 1930 a profissão parteira e o nascimento se tornaram institucionalizados e dominados pela medicina e enfermagem(Hendry, 2009).

Entre 1916 e 1940, a maioria dos partos aconteciam no hospital e “sono do crepúsculo” era amplamente praticado, prometendo o parto “sem dor”, mas levando a grande incidência de fórceps e mais exposição para infecções (NZCOM, 2004). Socialmente, nos anos 1940 e 1950, o papel da mulher limitou-se a casamento e família, privando as mulheres da capacidade de fazer escolhas em relaçao ao parto e fertilidade (Stojanovic, 2004). Como resultado, grande parte do nosso conhecimento de parto “não medicados e foi perdido (Davis-Floyd, 2001).

sedated_birth

Na Nova Zelândia e internacionalmente, a hospitalização levou a assistência à maternidade fragmentada, com a perda de controle das mulheres e suas famílias, aumento das intervenções médicas e uso de tecnologia, a perda de confiança no corpo feminino e aumento do medo do Parto (Odent, 2005; Donley, 1998).

lying-in_hospital_nursery

Em torno da década de 30, a mulher começou a receber o cuidado pré-natal a pelo médico de família local (GP) ou em uma clínica de pré natal na maternidade. Ela era avaliada em relação aos riscos em relação à escolha do local de nascimento – unidade primária para gestações de baixo risco ou no hospital. Os médicos obstetras entravam na cena nos casos de complicações durante gravidez, parto e pós parto (Hendry, 2009).

Quando o trabalho de parto iniciava, a gestante ia para a unidade primária ou hospital. A parteira profissional do local a levava para uma sala de preparação para realizar procedimentos de rotina – pubianos barbear, enema, exame vaginal – e avisava o médico sobre o progresso da mulher. Ela era atendida por parteiras profissionais durante o trabalho de parto e quando o nascimento era eminente o médico entrava na sala para “fazer o parto”, ganhando pelo procedimento (Hendry, 2009). .

As mulheres estavam infelizes com esta atenção fragmentada, e freqüentemente pediam para parteira não chamar o médico(Hendry, 2009).

A participação ativa de um grupo de consumidores e parteiras ativistas foram os catalisadores da mudança.

Leia no próximo artigo, como aconteceu o ponto da virada!

References:

Davis-Floyd, R. (2001). “La Partera Profesional: Articulating Identity and Cultural Space for a New Kind of Midwife in Mexico.” Daughters of Time: The Shifting Identities of Contemporary Midwives, Medical Anthropology. Ed. Robbie Davis-Floyd, Sheila Cosminsky, and Stacy L Pigg. Medical Anthropology special 2 part issue. 20.2-3: 185-243.

Guilliland, K. & Pairman, S. (1995). The Midwifery Partnership – A model for practice. Wellington: Victoria University of Wellington.

Hendry, Chris. 2009. “The New Zealand Maternity System: A midwifery renaissance.” In Birth Models That Work, eds. Robbie Davis-Floyd, Lesley Barclay, Betty-Anne Daviss, and Jan Tritten. Berkeley: University of California Press, pp. 55-86.

Mikaere, A. (2000). Mia I Kore kit e Ao Marama: Maori Women as Whare Tangata. Paper presented at NZCOM Conference; Seasons of Renewal. Cambrige, Septemper 30. 2.6.

Te Huia, J (2005). Midwifery. In Wepa Cultural Safety in Aoteraroa 1st ed. Pp. 114-121. Auckland: Pearson Education New Zealand.

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