Copyright is owned by the Author of the thesis.  Permission is given for 
a copy to be downloaded by an individual for the purpose of research and 
private study only.  The thesis may not be reproduced elsewhere without 
the permission of the Author. 
 



TOWARDS THE 
PROFESSIONALISATION OF 
NEW ZEALAND MIDWIFERY 

1840 - 1921 

A thesis presented in partial 
fulfilment of the requirements 

for the degree of Master of Philosophy 
in Midwifery at 

Massey University 

MARION A. COOPER 

1998 



ABSTRACT 

This thesis examines the reasons behind the move to formalise New Zealand European 

midwifery care in 1904 and the impact this had on midwifery practice. 'The Midwives 

Act, 1904' concentrated on providing a training system for midwives, hence traditional 

midwives found their duties circumscribed by their lack of knowledge and training. 

While women were seen as the appropriate case managers for women during parturition, 

the Midwifery Act set in place regulations that required advanced knowledge and set 

standards of practice. The setting up of a nation-wide structure at St Helens Hospitals1 

for the training of midwives reinforced the role of the trained midwife, who in some 

instances was also a trained nurse, and began the move towards the hospitalisation of 

maternity patients which came to fruition around 1938. 

The contention of this thesis is that the Midwifery Act contributed to the development of 

professional standards of midwifery practice leading to a more professionalised 

midwifery service in place of that which had, until 1904, been unstructured and 

informal. Through the inclusion of scientific developments into the syllabus of 

instruction the Midwifery Act gave formal direction to the training, examination and 

practices of midwives . Finally, it brought to the fore the trained midwife and single 

woman who replaced the traditional married midwife. 

The developments and changes in midwifery that occurred following the 1904 Midwifery 

Act had their beginnings well in advance of the Act. Maternal and infant mortality and 

morbidity rates had become a concern in England during the 1860s. As early as 1867 

maternity lying-in hospitals were beginning to develop protective mechanisms to prevent 

infection. In New Zealand an unstructured midwifery service comprised mainly of 

traditional midwives developed from 1840. Stringent use of antisepsis and advanced, 

professional, midwifery knowledge did not influence these midwives ' practices until 

1904 when the Midwives Act was implemented leading to the demise of the traditional 

midwife. 

St Helens hospitals does not have an apostrophe. 



ii 

ACKNOWLEDGEMENT 

I wish to express my gratitude for personal encouragement given by many people 

through their advice and support during the development of this thesis. To Dr. 

Julie Boddy for her faith in my ability to complete this thesis, her constructive 

criticism of numerous drafts, and particularly for her support during the time it 

was necessary for me to be in England. I am also grateful for the critical 

comments and suggestions from Dr. Margaret Tennant and to Dr. Jan Rodgers 

for her enthusiasm and support . 

I thank my colleagues at the Wellington Polytechnic School of Nursing, Health 

and Environmental Sciences especially the Year Two Team. I have particularly 

appreciated the friendship of Stephanie Orchard. 

My family have given me space, computer support and constant encouragement 

for which I am grateful. My pets have given their devotion and, in their need for 

exercise, a constant recreational pursuit. My Christian family have given me 

loving prayer support . 



iii 

TABLE OF CONTENTS 

Abstract 

Acknowledgments 11 

Table of contents lll 

Abbreviations IV 

List of Tables v 

List of Figures VI 

Introduction 1 

Chapter One Phases in the Development of a Profession 14 

Chapter Two The English Midwives Act 27 

Chapter Three New Zealand European Midwifery Practice 37 
Pre 1904 

Chapter Four New Zealand European Midwifery Practice: 54 
Introducing the 1904 Midwives Bill to 
Parliament 

Chapter Five Training and Education of Pupil Midwives 68 
1904-1913 

Chapter Six New Zealand European Midwifery Post 1904: 89 
The Effects of Formalisation - A Professional 
Career for Women 

Conclusion The Impact of Formalisation on New Zealand 107 
European Midwifery 

Appendix 1 120 

Appendix2 131 

Appendix 3 136 

Bibliography 142 



AJHR 

BCL 

BPS 

CMB 

JN-M 

JNNZ 

LOS 

MCNN 

NM 

NZG 

NZL 

NZPD 

NZOYB 

NZS 

TBID 

SCNZ 

SDNZ 

WARC 

WDNZFU 

WARC 

WTU 

LIST OF ABBREVIATIONS 

Appendices to the Journal of the 
House of Representatives. 

Bradford City Library, 
West Yorkshire, England. 

British Practical Statutes. 

Central Midwives Board. 

Journal ofNurse-Midwifery. 

The Journal of the Nurses of 
New Zealand. 

London Obstetrical Society. 

Midwives Chronicle and Nursing Notes . 

Nursing Mirror. 

New Zealand Gazette. 

New Zealand Listener. 

New Zealand Parliamentary Debates. 

New Zealand Official Year Book. 

New Zealand Statutes. 

The Bertillon Index of Diseases . 

Statistics for the Colonny of 
New Zealand. 

Statistics for the Dominion of 
New Zealand. 

Wellington Archives. 

Womens' Division of the New Zealand 
Farmers' Union. 

National Archives of New Zealand. 
Wellington. 

Alexander Turnbull Library. 

iv 



v 

LIST OF TABLES 

Introduction Table 1 7 

Table 2 7 

Table 3 8 

Chapter One Table 4 17 

Table 5 17 

Chapter Three Table 6 43 

Table 7 44 

Table 8 50 

Chapter Five Table 9 62 

Table IO 62 

Table 11 72 

Chapter Six Table 12 92 

Table 13 95 

Table 14 98 

Table 15 103 

Table 16 104 

Appendix 1 Table 17 121 

Table 18 122 

Table 19 123 

Table 20 124 

Table 21 125 

Table 22 126 

Table 23 127 

Table 24 128 

Table 25 129 

Table 26 130 



vi 

LIST OF FIGURES 

Chapter Four Figure 1 57 

Chapter Five Figure 2 74 

Figure 3 74 

Chapter Six Figure 4 94 



1 

Introduction 

This study examines the introduction of the 1904 New Zealand Midwives Act 

and the changes that occurred in midwifery as a result of the Act. The Act set in 

place a national structure for the training of midwives, the expected knowledge 

base for midwifery practice, and the development and organisation of a State 

midwifery service. The study reflects on why an Act was necessary and examines 

the movement away from an unstructured, unorganised service towards one 

which was ordered and regulated. The implementation of legislation, regulations 

and practices provided trained midwives with an approach to midwifery which 

reflected a new professionalism. 

The focus and direction of this thesis has been maintained by two research 

questions: 

1. Why did New Zealand midwifery formalise? 

2. How did formalisation effect the practice of midwifery in New Zealand? 

Midwifery practices m New Zealand between 1840 and 1921 experienced 

immense changes. Between 1840 and 1904 midwifery was almost exclusively the 

domain of traditional midwives in community settings. 1 This changed in 1904 

when training programmes for midwives were established in newly created state 

maternity hospitals. Women who had previously sought midwifery training 

overseas began to seek this training in New Zealand. Developing a body of New 

Zealand trained midwives was however slow with direct entry midwives 

outnumbering those who first trained as nurses. However the numbers of 

1 J. Raisler, The International Confederation of Midwives: Past History, Present Activities 
and Future Challenges, Journal of Nurse-Midwifery (JN-M), 39:5, September/October, 
1994, pp. 326-328. In discussing the history of midwifery organisations internationally 
Raisler indicates that prior to the late 19th century midwives throughout the world 'were 
traditional practitioners who learned their craft through apprenticeship'. 



2 

traditional midwives remaining in practice outnumbered trained midwives until 

1915 when the balance began to change. 

During the debate on the 1904 Act and immediately after, the impression given 

by parliamentarians was that women were seen as the appropriate group to assist 

women in childbirth. However, doctors, who had held professional status since 

1856 wanted to maintain their control over midwifery services which came into 

their range of contestable areas of concern. Midwifery training threatened the 

doctors ' scope of activity, and while midwifery training moved ahead, it was not 

without conflict. 

While the European childbearing population of New Zealand received midwifery 

services from neighbours or traditional midwives, by 1904 emphasis on 

knowledge about disease and childbirth traumas gave direction to both hospital 

and midwifery services, and the 1904 Midwives Act regulated for these features . 

The knowledge that infectious organisms could be contained through the use of 

antiseptics led to the introduction of Listerism into midwifery practice. The 

traditional midwife continued in practice well into the 1930s but in ever 

decreasing numbers, while the trained midwife numbers slowly increased. 

This thesis exammes the interpretation that professionalisation was a mam 

feature for the introduction of midwifery training in 1904.2 The traditional 

midwives were unwilling to receive a midwifery training. However, the trained 

midwife, who, in some instances had first trained as a nurse, became the greatest 

threat to the traditional midwife. The nurse-midwife was seen as having the 

required skill to extend her knowledge to areas of antisepsis and abnormalities 

associated with childbirth, combining her nursing knowledge with her midwifery 

knowledge. 

2 S. Wallace, 'The Professionalisation of Nursing, 1900-1930', BA Thesis, University of 
Otago, 1987. 



3 

Three New Zealand midwifery accounts have focused on midwifery practice. 

Philippa Mein Smith's book Maternity in Dispute: New Zealand 1925-1939, and 

thesis, 'The State and Maternity in New Zealand 1925-1935',3 examined the 

changing pattern of childbirth from home births and small, unlicensed one bed 

homes to the advent of an ideology that childbirth was best achieved in a public 

maternity hospital. Of relevance to this study is Smith's argument on the issue of 

maternal mortality which gave cause for concern in 1920. Central to the problem 

was the high incidence of puerperal sepsis which had consistently accounted for 

approximately one third of maternal deaths for the previous five years. 

Gaynor Smith in her BA Honours Essay, ' 'Essentially a Woman' s Question' : A 

Study of Maternity Services in Palmerston North 1915-1945 ', examined the 

trend towards hospitalisation of midwifery services in one city of New Zealand 

during a period when medicalisation was seen to be becoming a normal event for 

childbirth.4 The study sought to replicate Phillipa Mein Smith's study Maternity 

in Dispute: New Zealand 1925-1939 on a regional basis. Gaynor Smith focused 

on European women, as finding sources on Maori women' s experience was 

difficult . In particular Gaynor Smith identified the large number of Class B 

midwives who ran private maternity homes in Palmerston North. 

Both Phillipa Mein Smith and Gaynor Smith identified the undercurrent of 

eugenic ideology which directed the reasoning of many politicians, medical 

doctors and leading academics of the time. Although eugenics eased to some 

degree the passing of the 1904 Midwives Bill this was tempered by humanitarian 

and philanthropic thinking. 5 I arrived at this conclusion after studying the debate 

3 P. M. Smith, Maternity in Dispute: New Zealand 1925-1939, Wellington, V. R. Ward, 
Government Printer, 1986. P. M. Smith, 'The State and Maternity in New Zealand 1925-
1935' MA Thesis, Canterbury, 1982. 

4 G. Smith,' Essentially a Woman's Question': A Study of Maternity Services in Palmerston 
North 1915-1945', BA Honours Essay, Massey University, Palmerston North, 1987. 

5 Premier Richard Seddon, New Zealand Parliamentary Debates (NZPD), V 128, July 1, 
1904, pp. 70/73. Mr. Witheford, Member for Auckland City, NZPD, 1904, p. 74. Mr. 
Rutherford, (Member for Hurunui) NZPD, 1904, p. 76. Mr. Taylor, (Member for 
Christchurch City) NZPD, 1904, p. 77. 



4 

on the midwives Bill alongside P. J. Fleming's MA thesis, 'Eugenics in New 

Zealand, 1900-1940'6 and two articles by Eric Olssen, 'Breeding for the 

Empire', 7 and 'Truby King and the Plunket Society: An Analysis of a 

Prescriptive Ideology' . 8 Eugenic issues are not referred to in the body of this 

thesis. 

Elaine Papps and Mark Olssen's book, Doctoring Childbirth and Regulating 

Midw~fery in New Zealand: A Foucauldian Perspective, argues that midwives 

'got pushed out of the birthing room in New Zealand' and place the cause of this 

upon the shoulders of doctors who wished to have control over women's 

birthing practices.9 Papps and Olssen trace the legislative changes in midwifery 

from the 1904 Act to 1994. Their conclusion was that doctors resisted and 

contested midwives' place to act as the lead provider of maternity services in 

New Zealand. While this book takes a particular theoretical perspective and a 

wide scope, some elements have application to this thesis. I incorporate an 

investigation into the 1904 Midwives Act however a F oucauldian perspective is 

not used and this thesis is focused on a shorter time span. 

Athena A Hill in her thesis 'The History of Midwifery from 1840 to 1979, with 

Specific Reference to the Training and Education of the Student Midwife', 

examined the training and education of midwives in New Zealand from 1904 up 

to 1979.'0 Hill ' s thesis focused more on the later years of the period and included 

a detailed examination of the years 1973 to 1979. The training and education of 

6 P. J. Fleming, MA Thesis, Massey University, Palmerston North, 1981. 

7 E. Olsen, 'Breeding for the Empire',New 'Lea/and Listener (N'LL) , 12 May, 1970, pp. 18-19. 

8 E. Olsen, 'Truby King and the Plunket Society: An Analysis of a Prescriptive Ideology' , 
New Zealand Journal of History, 1, April, 1981, pp. 3-23. 

9 E. Papps, M. Olssen, Doctoring Childbirth and Regulating Midwifery in New Zealand: a 
Foucauldian perspective, Palmerston North, Dunmore Press, 1997. 

'
0 A. A. Hill, 'The History of Midwifery from 1840 to 1979, With Specific Reference to the 

Training and Education of the Student Midwife', M A Thesis, University of Auckland, 
1982. 



5 

midwives also features in my thesis but is confined to the years immediately 

following the 1904 Midwives Act. 

The application of Listerism in midwifery practice was not uruque to New 

Zealand. Rather it was reflective of an international trend which has been 

examined by Irwin Louden in Deaths in Childbirth: An International Study of 

Maternal Care and Maternal Mortality, 1800-1950.11 In this study Louden 

identified puerperal sepsis as the major factor in maternal mortality and the 

scientific developments which assisted in reducing the incidence of this process. 

New Zealand was included in the study which identified the passing of legislation 

controlling the practice of midwives as a major factor in the reversal of death in 

childbirth. I also examined overseas legislation in relation to that developed in 

New Zealand but restricted my inquiry to the English Act of 1902 which was 

replicated in New Zealand. Ann Ward' s two part article on 'The Passing of the 

Midwives' Act, 1902' has been helpful in identifying practice issues and key 

features in the history of English midwifery which preceded the passing of the 

English Midwives' Act and were also present in New Zealand midwifery 

practice.12 Unlike Ward' s study I have extended my investigation beyond the 

acceptance of the Act and examined the professional development of the midwife 

through training and education. 

The professional status of nurses and midwives has been a topic of debate in 

recent years. Sandra Wallace has examined the professionalisation of nursing 

practice in New Zealand between 1900 and 1930. 13 Midwifery as a branch of 

nursing was included in this process and is linked to the establishment of 

legislation requiring training, education and registration. The criteria for 

professionalisation Wallace provided support midwifery' s identity as a profession 

11 I. Louden, Deaths in Childbirth: An International Study of Maternal Care and Maternal 
Mortality, 1800-1950, Oxford, Clarendon Press, 1992. 

12 A. R. Ward, 'The Passing of the Midwives' Act, 1902', Midwives Chronicle and Nursing 
Notes (MCNN), Part 1, June, 1981, pp. 190-194. Part 2, July, 1981, pp. 237-242. 

13 S. Wallace, BA Thesis, University ofOtago, 1987. 



6 

from 1904 but not prior to this time (See Table 1 ). Rosalind Marshall in 'Birth of 

a Profession', gave a much stronger argument for the existence of professional 

midwives prior to 1904.14 Marshall believed that women who were recognised in 

their community as midwives and who earned their living in the practise of 

midwifery were professional midwives (See Table 2). Belgrave supported this 

argument stating that within a developing medical economy a group of 

professionals existed prior to 190415 including midwives. 16 Belgrave refers to 

training, in some instances through apprenticeship, as an aspect of professional 

identity. His reasons for identifying midwives as a professional group is related 

to their inclusion ' in the health section in the professional classification of the 

census from 1874'. 17 

Thomas W. H. Brooking in teasing out the early developments in New Zealand 

dentistry provides four major stages in the development of a profession. 18 These 

stages are recognisable in the development of all professional groups including 

midwifery (See Table 3, p. 8). Brooking' s description of the different stages has 

assisted in the development within this thesis of a progressive profile which, with 

other definitions, can be used to discern the professional status of an 

occupational group over time. This thesis however does not examine midwifery 

in all the stages defined. The third and fourth stages are not applicable to the 

period under study within this thesis. Chapter one brings together the work of 

14 
R. Marshall, Birth of a profession, Nursing Mirror (NM), 157:22, November 30, 1983, pp. 
i-vi. 

15 
M. Belgrave, 'Medicine and the Rise of the Health Professions in New Zealand, 1860-1939 ' 
p. 7-24. In L. Bryder, ed., A Healthy Country: Essays on the Social History of Medicine in 
New Zealand, Wellington, Bridget Williams Books, 1991. 

16 ibid. p. 11 and 20-24. 

17 ibid. p. 11. 

18 
T. W. H. Brooking, A History of Dentistry in New Zealand, Dunedin, The New Zealand 
Dental Association Inc., 1980, p. 21. 



Table 1: Defining characteristics of a profession identified 
by Wallace. 

1 . Systematic theory leading to a formal qualification 

2. A distinct culture 

3. A service orientation 

4 . Ethical codes 

5. Autonomy 

Source: S. Wallace, 'The Professionalisation of Nursing, 
1900-1930', BA Thesis, University ofOtago, 1987. 

Table 2: Summary of pre-formal definition of Profession 

1 . The work involved is a persons occupation 

2. Society recognises the person as someone offering a 

particular service, e.g. midwife 

3. The person receives remuneration for services rendered 

Source: R. Marshall, Birth of a profession, Nursing Mirror, 
157:22, November 30, 1983, pp. i-vi. 

7 



Table 3: Stages in the development of a profession. 

1. Sub professional - relates to the pre-formal definition of a 

profession 

2. Semi-profession - relates to the dictionary definition of a 

profession and is marked by the separation of practitioners 

into two groups. 1. Sub-professional, 2. Demi-professional, 

seeking to distance self from sub-professional by education 

as opposed to apprenticeship. Embraces apprenticeship 

[practical skills] and moves beyond. 

3. Fully-professional - excludes all uneducated practitioners 

from practice. Relates to the dictionary definition of 

profession. 

4. Post-professional - Relates to the nursing/medical 

dictionary definition of profession. 

Source: T. W. H. Brooking, A History ~f Dentistry in New 
Zealand, Dunedin, New Zealand Dental Association, 
1980, p. 21. 

8 



9 

Wallace19 and Brooking through analysis of the concept of professionalisation 

and development of a profile for measuring the professional standing of 

occupational groups over time. 

Application of the profile of a professional nurse is demonstrated in Christopher 

Maggs' book, The Origins of General Nursing. 20 Maggs included a chapter on 

the training and education of nurses and followed this with an examination of 

careers in nursing. I also investigate the training and education of pupil nurses in 

the first New Zealand midwifery schools, St Helens Hospitals. These early 

training programmes for midwives changed the career options for nurses and 

single women by opening up a new professional direction for those interested in 

women's health. An examination of the career paths of a small group of these 

early trained midwives is included in this thesis. 

Statistical evidence of the need for change in the delivery of midwifery care was 

a principal element in the introduction of the Midwives Bill. Figures for both 

maternal and infant mortality were used to support the argument of the Bill.2 1 

These same issues continued to feature in arguments surrounding and related to 

midwifery care over the next two decades and beyond. 22 The inconsistencies in 

the keeping of statistics up until 1908 have been pointed out by Geoffrey W. 

Rice in his essay 'Public Health in Christchurch, 1875-1910: Mortality and 

Sanitation' .23 Rice included a historiography on the relationship between sanitary 

reform and mortality statistics internationally before focusing on the impact of 

these issues in Christchurch. Sanitary reform does not feature in my thesis but 

19 S. Wallace, BA Thesis, University ofOtago, 1987. 

20 c . J. Maggs, The Origins of General Nursing, London, Croom Helm, 1983. 

2 1 Premier Richard Seddon, NZPD, V 128, 1904, p. 70. 

22 
P. M. Smith, 1986. G. W. Rice, 'Public Health in Christchurch, 1875-1910: Mortality and 
Sanitation', in L. Bryder, ed. , A Healthy Country: Essays on the Social History of Medicine 
in New Zealand, Wellington, Bridget Williams Books, 1991, pp. 85-108. F. S. Maclean, 
Challenge for Health: A History of Public Health in New Zealand, Wellington, R E. 
Owen, Government Printer, 1964. 

23 G . W. Rice, in L. Bryder, ed. , 1991, pp. 85-108. 



10 

the issues Rice identified in relation to the official keeping of mortality statistics 

have relevance to the analysis and interpretation of my research findings. 

The Open University, England, have published a study guide, Caring for Health: 

History and Diversity, edited by Charles Webster.24 This book links together five 

themes including the contribution traditional care providers made to health and 

the changes professionalisation had, and was expected to have, on health 

services. The interconnection identified between these two variables are 

confirming of the findings of this thesis. 

Archival sources on early childbirth practices (1840 to 1900) are limited. 

Records become more readily available following the 1904 midwifery legislation. 

The archival material used in this thesis comes from a variety of sources. The 

Alexander Turnbull library (WTU) holds personal files written by amateur and 

trained midwives. Frederick Truby King's Papers date from 1885 and include 

lecture notes on midwifery which reflect the teachings of Sir James Young 

Simpson, 1811 - 1871.25 A contemporary book, A Short Practice of Midwifery 

for Nurses, Third Edition, Revised, dated 1908, written by Henry Jellett, who 

was Master of the Rotunda Hospital in Dublin 1910 to 1919, and was viewed as 

an authority on obstetrics, was a supporting text. 26 A medical text of Jellett's 

featured as a text for medical students in New Zealand prior to Jellett's arrival 

here in 1925. A contemporary nurses dictionary, The Nurse 's Dictionary of 

Medical Terms and Nursing Treatment, by Honnor Morten was used to define 

some of the terms used in files and texts.27 The Health Department files held at 

National Archives provided input for practice aspects of midwives work, and the 

24 Charles Webster, editor, Caring for Health: History and Diversity, Open University Press, 
1993. 

25 King, Frederick Truby (Sir) 1858-1938, MS 1119-1121, Lecture Notes on Midwifery and 
Gynaecology, 1885, WTU. 

26 H. Jellett, A Short Practice of Midwifery for Nurses, Third Edition, Revised, London, J. & 
A. Churchill, 1908. 

27 H. Morten, The Nurse's Dictionary of Medical Terms and Nursing Treatment, London, The 
Scientific Press Limited, 1900. 



11 

organisation of the St Helens Hospitals, the State maternity hospitals set in place 

from 1905 onwards. 

Overseas archival sources were located in the Bradford City Library, (BCL), 

West Yorkshire, England. These documents supported the arguments in the 

secondary sources on English midwifery practice during the 1800s and early 

1900s. They also demonstrated practices amongst untrained midwives parallel to 

those found in New Zealand following the 1904 Midwives Act . These documents 

assisted in the development of chapter two. 

Other popular histories on midwifery have aided by identifying women who 

practised as midwives, and movements of these women throughout New 

Zealand. Accounts of midwives from the memories of members of the Women's 

Division of the New Zealand Farmers' Union, Joan Donley's Save the Midw~fe, 

and hospital histories served a purpose by indicating who were the midwives 

when other formal documentation does not. 28 However, like many celebratory 

histories, these accounts blur the narrative with subjective anecdotes and refrain 

from placing the history within the context of the social period. 

While this thesis focuses on the New Zealand Midwifery Act of 1904 and the 

changes that occurred as a result of the Act, it begins with the wider issue of 

midwifery changes in England. It shows that New Zealand consciously followed 

standards set by England with minor alterations. Chapter two examines these 

changes and the Act which was implemented in 1902. 

European midwifery practice in New Zealand had developed with the arrival of 

the immigrant population. In 1904 there was an uncoordinated, unsatisfactory 

service comprising mainly of traditional midwives. Chapter three examines this 

service. 

28 
J. Donley, Save the Midwife, Auckland, New Women' s Press Ltd., 1986. Anon, Brave Days: 
Pioneer Women of New Zealand, Women's Division of the New Zealand Farmer's Union, 
(WDNZFU), Dunedin, A. H. & W. H. Reed, 1939. J. Rattray, Great Days in New Zealand 
Nursing, London, George G. Harrap & Co. Ltd., 1961. 



12 

Chapter four examines the introduction and acceptance of the New Zealand 

Midwives Bill as a directive for midwifery practice. One directive was the 

provision of state maternity hospitals known as St Helens Hospital, which were 

opened in the four main centres. 29 These served as both training schools for 

midwives and a safe, affordable, environment where the wives of working men 

could give birth.3° Chapter five examines the programmes for pupil nurses. 

A second directive of the Midwives Bill was the regulation of midwifery practice 

which included inspection of the untrained registered midwives and simple 

instructions which introduced them to Listerism. Suggestions that they attend the 

lectures that were given to pupil midwives in St. Helens Hospitals were rejected 

and other alternatives were provided. It was proposed by Grace Neill with 

support from Premier Richard Seddon to admit single women to the midwifery 

schools. This caused some discussion during the debate on the Midwives Bill 

with some parliamentarians wishing to exclude single women from training or 

proposing that they be prevented from marrying as a means of retaining them in 

practise. Chapter six examines the integration of untrained registered midwives 

into the new midwifery service. The career paths of fifty seven women who 

trained in the Wellington St Helens Hospital are also examined to identify the 

appropriateness of admitting single women to the training programmes. The 

average length of careers within the identified group was eight years. To examine 

each midwife' s length of service for a minimum of eight years the investigation 

spanned the years 1907 to 1921 . The last group of pupils to qualify as midwives 

did so in 1914. (See Appendix 2). 

The Midwives Act of 1904 was designed to provide a safe, state midwifery 

service which would improve the quality of care and reduce maternal and infant 

mortality. This service was to serve as a training environment for pupil midwives 

who were to eventually replace traditional midwives. The Act constituted a 

29 The Midwives Act 1904, [4 EDW II, No. 31] New Zealand Statutes, [NZS] 1904. 

30 Health III, B64 111 , St Helens Hospitals - General, 1905-38, W ARC. 



13 

change in professional direction for midwives separating nursing and midwifery 

through legislation and establishing a forum within which future professional 

development could take place. 



Chapter One 

Phases in the development of a profession: 

a concept analysis with application to the profession of midwifery. 

Professionalism is a dynamic concept the defining of which changed considerably 

in the late 1800' s and early 1900' s.1 This was a period when work groups moved 

from informal to formal organisation and expected knowledge and skills of a 

named group were formalised . The expected professional characteristics of a 

person practising a given occupation also changed and traditional practitioners 

found themselves challenged in their calling. In the mid 19th century many 

professional groups were traditional practitioners. By the early 20th century 

members of these groups had successfully lobbied for state legislation which set 

the formalities of their calling into statute and dictated the educational 

requirements for entry to practice. This excluded or confined the activities of the 

traditional practitioner. This chapter examines the defining characteristics of a 

profession over time and relates these to professions in general and to New 

Zealand midwifery. 

The pre-formal definition of a profession included any person in a community 

who regularly provided a particular service for which they were paid either in 

money or in kind .2 (See Table 2, p. 7. Introduction). The people in history who 

fit this description are frequently described as traditional practitioners. Their 

knowledge was acquired through practice, sometimes within an apprenticeship. 

Many professions acknowledge the presence of this type of practitioner within 

the history of their profession. 3 However not all professional histories refer to the 

traditional practitioner as a professional. An alternative description identifies 

1 S. Wallace, BA Thesis, University ofOtago, Dunedin, 1987, p. 66. Wallace states that the 
term 'professional ' is ambiguous and often misused. 

2 R. Marshall, NM, 1983, pp. i-vii. 

3 M. Belgrave, in L. Bryder, editor, 1991. p. 10. 

14 



these practlt10ners as sub-professionals. 4 Their professional activities were 

frequently linked with other specific activities. 5 In New Zealand society doctors 

were often gentleman farmers. Dentistry, usually teeth pulling, was performed by 

chemists who competed with doctors in this as well as in diagnosing and 

dispensing medicines.6 This early dental activity was also performed by 

blacksmiths. 7 

When the pre-formal definition of a profession is applied to midwifery the early 

professional midwife becomes a person, usually a woman, recognised within 

their community as someone who provided care for women in childbirth and who 

received payment for this service. 8 This activity may or may not have been linked 

with general nursing duties. In this phase of midwifery history the midwife could 

be considered a traditional practitioner. Alternative names by which traditional 

midwives were known are ' handywoman'9 and lay-midwife.10 The term 

'handywoman' often became confused with that of monthly nurse, a woman who 

supported the doctor during confinements and also attended to the laying out of 

the dead.11 Sairey Gamp is the personification of a monthly nurse whose 

professional characteristics left much to be desired. 12 Australia began training 

4 T. W. H. Brooking, 1980. 

5 M. Belgrave, in L. Bryder, 1991 , p. 10. 

6 ibid. p. 18. 

7 T. W. H. Brooking, 1980. 

8 R. Marshall, NM, 1983, pp. i-vii. 

9 N. Leap, B. Hunter, The Midwives Tale: An oral history from handywomen to professional 
midwife, London, Scarlet Press, 1995. R. Perks, Life as a Textile Worker and a Midwife 
(MBE), BHRU Unrestricted, A0067, Bradford City Library, (BCL), 1984. 

1° C. M Parkes, 'The Impact of the Medicalisation of New Zealand' s Maternity Services on 
Women' s Experience of Childbirth, 1904-1937' , in L. Bryder, editor, A Healthy Country: 
Essays in the Social History of Medicine in New Zealand, Wellington, Bridget Williams 
Books Limited, 1991, pp. 165-180. 

11 J. Towler, & J. Bramall, Midwives in History and Society, London, Croom Helm, 1986, p. 
160-161. The Midwives Act 1904, [4 EDW VII, No. 31] 1904. The midwives trained 
under this Act were required to have a knowledge of the monthly nurse' s duties. 

12 C. Dickens, Martin Chuzzlewit, Wordsworth Editions Limited, 1995. 

15 



'ladies' monthly nurses' in 1861. 13 These women were usually widowed or 

married women with personal experience in childbirth. Lack of personal 

experience of childbirth was a common reason for excluding single women from 

the profession of midwifery within the pre-formal period. 14 

Further verification of the professional status of pre-formal midwives is found in 

the census returns. 15 As a public document defining the characteristics of a 

society this document separates occupational status into professional and non­

professional groupings. As early as 1874 the census returns for New Zealand 

included midwives as a professional group. This alignment continues in the 

formal phase of professional development and beyond. 

As professions formalised the definition of profession changed. The general 

definition identifies a profession as a calling to do a particular type of work for 

which the individuals have obtained special training in liberal arts or sciences. 16 

Such professionals declared themselves to have a calling in a particular type of 

work and obtained the special training required to support the calling. (See Table 

4). 

The general definition is narrow in comparison to that given in nursing and 

medical dictionaries. These dictionaries embrace the general description but also 

identify wider requirements. 17 These include autonomous practice grounded in 

higher learning with a commitment to continue enlarging the body of knowledge 

of the profession. High standards of achievement and conduct are maintained 

13 F. M. C. Forster. 'Mrs. Howlett and Dr. Jenkins: Listerism and Early Midwifery Practice 
in Australia', The Medical Journal of Australia, 11:26, December 25, 1965, pp. 1047-
1054. 

14 ibid. p. 1048. 

15 M. Belgrave, in L. Bryder, editor, 1991. p. 10. 

16 J. M. Hawkins, R Allen, The Oxford Encyclopedic English Dictionary, Oxford, Clarendon 
Press, 1991, p. 1154. 

17 B. F. Miller, C. Brackman Keane, editors, Encyclopedia and Dictionary of Medicine, 
Nursing and Allied Health, Fourth Edition, Philadelphia, W. B. Saunders Company, 1987, 
p. 1014. 

16 



Table 4: Summary of dictionary definition of Profession. 

1. A vocation or calling 
2. Occupation requiring special training in liberal arts or 
sciences 
3. The body of people in such a profession 
4 . A declaration or avowel 

Source: P . Hanks, T. H. Long, L. Urdang, editors, 
Collins Dictionary of the English Language, 
London, Collins, 1979, p. 1167. J.M. Hawkins, 
R. Allen, editors, The Oxford Encyclopedic 
English Dictionary, Oxford, Clarendon Press, 
1961 , p. 1154. 

Table 5: Summary of the Medical/Nursing dictionary 
definition of Profession. 

1. A callin or vocation 
2. Requires specialised knowledge, methods and skills 
grounded in scholarly, scientific and historical principles 

ained in an institution of hi her leamin 

4 . Functions autonomous! 
5. Maintains high standards of achievement and conduct 
throu h force of or anisation or concerted o inion 

7. Members of body committed to providing practical 
services vital to human and social welfare 

Source: B. F . Miller, C. Brackman Keane, editors, 
Encyc/opdia and Dictionary of Medicine, 
Nursing and Allied Health, Fourth Edition, 
Philadelphia, W . B. Saunders Company, 1983, p. 
1014. 

17 



through the organisation and concerted opinion of the professional group. This 

is achieved through continued study following successful completion of basic 

studies. This professional group is committed to providing services which meet 

the vital needs of human and social welfare and which it places above personal 

gain. (See Table 5). The progressive development of professions embraces these 

two definitions. Three distinctive phases are identifiable. 

A semi-professional phase in the profile of a profession followed the informal 

period. 18 In this phase of development two distinct groups within a profession 

existed side by side. Firstly the sub-professional group described above 

continued to practice within communities. Secondly a demi-professional group 

developed and distanced itself from the traditional practitioners. 19 This group 

sought to change the entrance of new practitioners into the occupation from that 

of an apprenticeship to one of education in schools of higher learning. Linked to 

this change was the introduction of registers of practitioners who had graduated 

from the schools.20 Registers were linked with the passing of legislation 

controlling practice. Much of the early New Zealand legislation controlling 

groups of health practitioners was adoption of similar Acts passed in Britain.21 

The formalisation through statute excluded uneducated or traditional 

practitioners from practice and moved the occupation into a phase of full 

professionalism. 22 

The semi-professional phase of professional development separated out several 

occupational groups. Dentistry, pharmacy and medicine are examples of 

professions which developed their own body of knowledge and formalised into 

18 T. W. H. Brooking, 1980, p. 21. 

19 ibid. p. 21. 

20 ibid. p. 33. 

21 F. S. Maclean, 1964, p. 11. 

22 T. W. H. Brooking, 1980, p. 21. 

18 



separate groups of health professionals.23 Nursing and midwifery are inter-related 

professions which have been linked together as one profession through time. 24 

Both professional groups however followed separate pathways following 

formalisation of knowledge to the extent that both had a separate Act governing 

preparation and registration of practitioners. 25 Massage was viewed as a skill 

which supported health professionals in their work yet it developed into the 

profession of physiotherapy.26 Following completion of nursing courses New 

Zealand certificated nurses in the late 1800' s were encouraged to take courses in 

massage.27 Some nurses followed this advice including one Class B midwife, a 

Miss Margetts, 28 who with her sister ran a private maternity hospital in 

Auckland. 29 

Professions are not static in their practices and progression continues beyond full 

professionalism into a phase described as post-professionalism.30 This phase 

embraces another major shift in educational expectations within preparation of 

individuals entering the profession. It is characterised by changes in the expected 

proficiency of graduates completing the preparatory courses. In the semi­

professional phase of development certificates of proficiency were issued to 

successful candidates from occupational courses.31 The fully-professional phase 

23 M. Belgrave, in L. Bryder, editor, pp. 16-20. 

24 S. Wallace, BA Thesis, University ofOtago, Dunedin, 1987, pp. 17-20. C. J. Maggs, 
1983, pp. 82-84. 

25 The Nurses Registration Act, 1901 [l EDW, VII, No. 12] NZS, 1901. The Midwives Act, 
1904 [4 EDW, II, No. 31] NZS, 1904. 

26 M. Belgrave, in L. Bryder, editor, 1991. pp. 13-16. 

27 S. Wallace, BA Thesis, University ofOtago, Dunedin, 1987, pp. 17-20. C. J. Maggs, 
1983, p. 55. 

28 List of Registered Nurses, NZG, 1922, p. 369. 

29 Report on Private Hospitals, AJHR, H22, 1907, p. 3. 

30 T . W. H. Brooking, 1980, pp. 21-22. 

31 
M. Belgrave, in L. Bryder, editor, 1991. T. W. H. Brooking, 1980. S. Wallace, BA, 
University ofOtago, Dunedin, 1987. 

19 



embraced the certificates of proficiency as acceptable for practice but sought to 

introduce degree status for all practitioners. The success of individual groups 

striving to achieve this level of professional standing has been variable. 32 Nursing 

in New Zealand made an early attempt to establish a degree course but this did 

not come to full fruition. 33 

The application of knowledge by members of a professional group is the fabric 

by which a profession is judged. Where practice is negligent, particularly when it 

affects the lives of others, then the profession is found wanting. It is in this 

situation that competent practitioners within the profession and other interested 

parties within society take action to change the status quo.34 Seeking to distance 

themselves from the questionable practice and to stop such activities these 

people call for formal preparation of practitioners in educational settings. They 

also seek certification of competency through examination of knowledge as a 

pre-requisite to entering the profession. Such activity was demonstrated across 

the health related professions internationally during the late 1800s and early 

1900s as part of formalisation . 35 

In English nursmg and midwifery Florence Nightingale and Alice Gregory, 

although not instrumental in the fight to gain legislation to control midwifery 

practice, did recognise the need for preparation of midwives and provision of a 

safe place for childbirth to be conducted. Nightingale abandoned her own 

endeavours to establish a training school for midwives and turned to the study of 

maternal mortality, an activity which gave rise to her proscription for midwifery 

training schools. 36 Gregory, a competent midwife herself, established a training 

32 ibid. 

33 S. Wallace, BA Thesis, University ofOtago, Dunedin, 1987, pp. 17-20. C. J. Maggs, 
1983, pp. 57-60. 

34 J. 0 . C. Neill, The Story of as Noble Woman, Christchurch, N. M. Peryer Limited, 1961. 

35 M. Belgrave, in L. Bryder, editor, 1991. S. Wallace, BA Thesis, University ofOtago, 
Dunedin, 1987. C. J. Maggs, 1983. 

36 F. Nightingale, Introductory Notes on Lying Jn Institutions, London, Longmans, Green, 
and Co., 1871. 

20 



school for midwives. 37 The fight to gain legislation to control practice was left to 

another group of women. Over a period of several years these trained and 

certificated midwives strove to achieve legislation and improve the professional 

standing of their profession.38 In New Zealand nursing and midwifery Elizabeth 

Grace Neill and her allies worked unstintingly to establish legislation which 

would remove incompetent nurses and midwives from practice and replace them 

with well prepared practitioners. 39 

The process of formalisation usually, but not always, included statuary legislation 

which established the boundaries of knowledge and ethical practice of the 

profession. 40 If a profession is viewed internationally then this phase can be 

distinctly observed, if examined from a national perspective then it can appear to 

merge with the next stage. New Zealand midwifery is a good example of this 

blending of the two stages. Having adapted the English Midwives Act of 1902 to 

suit colonial requirements, the architects of the New Zealand Midwives Act, 

1904, set in place legislative changes which changed the profession of midwifery 

in New Zealand. England took much longer to blend these two stages and in fact 

made the process of developing the profession in New Zealand much easier for 

Neill and her colleagues.41 

Clear stages in the progressive development of all professional groups have been 

identified within the literature dealing with issues of professionalism. A set of 

characteristics which assist in establishing the professional standing of 

occupations also emerges in relation to the nursing profession (See Table 1, p. 

37 E. Morland, Alice and the Stork: the life of Alice Gregory 1867-1944, London, Hodder 
and Stroughton Ltd., 1951. 

38 A. R Ward, MCNN, 1981, p. 238. 

39 J. 0. C. Neill, 1961. 

40 T. W. H. Brooking, 1980. p. 21 & p. 33. 

41 A. R Ward, MCNN, 1981, p. 238. 

21 



7).42 The application of these characteristics do not support the notion of 

professionalism in the pre-formal phase described but are relevant to the other 

phases. They do assist in forming theory on characteristics of professionalism in 

the pre-formal phase of nursing and midwifery. 

The systematic development of knowledge is formally embraced within and 

beyond the semi-professional phase of professionalism. Legislation related to all 

professions dictates the training period within which theory and practice relating 

to the profession are to be attained. Histories of professional groups identify this 

development of knowledge.43 Establishing the development of a traditional 

practitioner's knowledge base is relevant to the understanding of a professional 

within the pre-formal phase of professionalism. This knowledge would have to 

be linked to the knowledge claimed by the semi-professionals who rose from the 

ranks of the traditional practitioner. 44 

The popular and folk history of traditional midwives internationally suggests a 

sequential approach to development of knowledge which is partially subscribed 

to by the circumstances of the practitioner.45 Personal experience of childbirth 

was a socially required knowledge which traditionally precluded the single 

female from practice. 46 It was expected that married, sometimes widowed, 

females would practice midwifery. Geographical location placed some women 

into situations where neighbour helped neighbour in health related matters. 47 In 

this type of situation women applied their personal experience of childbirth to the 

experience of another women in similar circumstances. Such learning related to 

42 S. Wallace, BA Thesis, University ofOtago, Dunedin, 1987, p. 66. 

43 M. Belgrave, in L. Bryder, editor, 1991. T. W. H. Brooking, 1980. S. Wallace, BA Thesis, 
University ofOtago, Dunedin, 1987. 

44 T. W. H. Brooking, 1980. 

45 Anon, WDNZFU, 1993. 

46 NZPD, 1904, pp. 70-71. B. Salmon, 1991, p. 305-307. 

47 An on, WDNZFU, 1993, p. 36. 

22 



childbirth has been described by a politician in derogatory terms as something the 

midwife 'picked up' .48 Despite the irregularity of this method of acquiring 

knowledge if assisting neighbours in childbirth became a regular practice for 

some women then a body of knowledge would develop. The quality and 

application of that learning would be individual and may well replicate the 

ministrations of the mythical Sairey Gamp. There was however just as much 

chance that a woman could become an exemplary practitioner as did women like 

Granny Harrold49 and Granny Cripps. so Doctors frequently sought married 

women to assist them in their midwifery practice. 51 When this happened the 

doctor assisted in the development of the woman's knowledge of midwifery. 

A distinct culture arising from the application of Nightingale's legacy to nursing 

has been described.52 A wider view of culture would align nursing and midwifery 

with other health related professions. In the described view of culture the 

qualities Nightingale bequeathed to nursing are relevant . However during the 

transition from sub-professional to semi-professional nursing and midwifery53 

both embraced knowledge and skills which emerged from the realms of 

medicine. 54 Incorporation of medical knowledge into the skills used in nursing 

challenges the received view of culture. Listerism is a prime example of a 

scientifically based practice which emerged from the scholarship of a medical 

48 Premier Richard Seddon, NZPD, 1904. p. 70. 

23 

49 M. Barlow, 'Agnes Harrold', in W. H. Oliver, (ed), A People's History: 11/ustrated 
Biographies from The Dictionary of New Zealand Biography, Volume One, 1796-1869, 
Wellington, Bridget Williams Books Limited/Department of Internal Affairs, 1992, pp. 101-
102. 

5° F. A. B. Bett, Micro MS Papers 1836-1957, Reel 2, Series 1, Folders 5 - 27, 29, WTU, 

51 F. M. Forster, 'Mrs. Howlett and Dr. Jenkins: Listerism and Early Midwifery Practice in 
Australia', The Medical Journal of Australia, II:26, December 25, 1965, pp. 104 7-1054. 

52 J. A. Rodgers, 'Nursing Education in New Zealand, 1883 to 1930: The Persistence of the 
Nightingale Ethos', MA Thesis, Massey University, Palmerston North, 1985. 

53 S. Wallace, BA Thesis, University ofOtago, Dunedin, 1987. Within this thesis nursing and 
midwifery are considered as one and the same profession. 

54 I. Louden, 1992. 



man. 55 Application of the principles of Listerism changed the culture of a wide 

range of health related professions including that of nursing and midwifery. In 

the sub-professional phase the culture of midwifery practice embraced the 

characteristics Sairey Gamp and her contemporaries displayed. 56 This culture 

brought fear and anxiety into the experience of childbirth. 57 

Sacrifice of self in the care of others has been linked with the legacy Nightingale 

bequeathed to nursing through the dedication and devotion to duty she 

preached. 58 This interpretation of service is linked with the semi-professional 

phase of nursing and midwifery. Records indicate that traditional practitioners of 

these professions were in many instances as dedicated in their service to others. 59 

In the colonial situation which prevailed in New Zealand circumstances brought 

forth qualities in people which were equally self sacrificing. 60 Within midwifery 

care this sacrifice in some instances deprived the family of a wife and mother, 61 in 

other situations the call to serve others was passed from one generation to the 

next as a service was provided. 62 

Codes of ethics were linked with censure of unsafe practices and practitioners. 

Also other actions classified as indictable offences would be dealt with under the 

55 I. Louden, Chapter4, 1992. J. 0 . C. Neill, 1961, p. 89. 

56 
C. Dickens, Martin Chuzzlewit., Wordsworth Editions Limited, 1995. J. 0. C. Neill, 1961. 

57 NZPD, 1904, pp. 70-91. 

58 S. Wallace, BA Thesis, University of Otago, Dunedin, 1987, p. 70. J. A Rodgers, M A 
Thesis, Massey University, Palmerston North, 1985. 

59 
M. Barlow, ' Agnes Harrold', in W. H. Oliver, (ed), 1992, pp. 101-102. F. AB. Bett, Micro 
MS Papers 1836-1957, WTU. Anon, WDNZFU, 1939. 

60 J. Donley, 1986, pp. 27-28. Anon, WDNZFU, 1939. 

61 
J. A Salmond, ' Salmond, Sarah 1864-1956', in The Dictionary of New Zealand Biography, 
Volume Two, 1870-1900, Wellington, Bridget Williams Books/Department of Internal 
Affairs, 1993, p. 213 . 

62 
K. Duder, 'Hicks, Adelaide 1845-1930, in The Dictionary of New Zealand Biography, 
Volume Two, 1870-1900, Wellington, Bridget Williams Books/Department of Internal 
Affairs, 1993, p. 213 . 

24 



code of ethics. 63 A code of ethics within the sub-professional phase of nursing or 

midwifery is identifiable within anecdotal accounts which identify the concern 

some traditional midwives had in relation to their practice. This mainly 

surrounded the safe delivery of a healthy baby and survival of the mother. 64 

Formalisation of a professional service began the establishment of parameters of 

safe and acceptable care. Such standards were embedded in the legislation 

governing professional practice and did not take effect until 1902 for New 

Zealand nursing and 1904 for midwifery. 65 These Acts called for a register of 

practitioners which included many traditional practitioners working at the time 

the Acts were passed. 66 These same Acts provided for the supervision of all 

practitioners and the removal from the register of those deemed to be unsafe or 

of unacceptable character. 67 In this way some traditional midwifery practitioners, 

later identified as Class B midwives, were removed from the register.68 

Payment for services has been identified as a factor in determining professional 

status. 69 This is a controversial characteristic of a profession and is closely linked 

to autonomy within practice, an identified characteristic of semi-professional 

practitioners. 7° Central to the issue of payment for services is the idea that the 

person practising the profession charges a fee for services rendered as opposed 

63 S. Wallace, BA Thesis, University ofOtago, Dunedin, 1987, p. 70. 

64 Sarah Higgins, MS Papers 1146, WTU. M. Cooper, 'The Midwives Case 1920 to 1930, in 
N. Chick, J. Rodgers, editors, Looking Back, Moving Forward: Essays in the History of New 
Zealand Nursing and Midwifery, Palmerston North, Department of Nursing and Midwifery, 
Massey University, 1997, p. 37. J. Donley, 1986, p. 28. 

65 The Nurses Registration Act, 1901 [l EDW, VII, No. 12] NZS, 1901. The Midwives Act, 
1904 [4 EDW, II, No. 31] NZS, 1904. 

66 
The Midwives Act, 1904 [4 EDW, II, No. 31] NZS, 1904. Regulations under the Midwives 
Act, 1904, NZS, 39, April 27, pp. 1022-1023. 

67 
The Midwives Act, 1904 [4 EDW, II, No. 31] NZS, 1904. Regulations under the Midwives 
Act, 1904, NZS, 39, April 27, pp. 1022.:.1023. 

68 Health I, 21/29, Removal ofregistered midwives from the register, W ARC. 

69 M. Belgrave, p. 8, in L. Bryder, editor, 1991. 

70 S. Wallace, BA Thesis, Uni~ersity ofOtago, Dunedin, 1987, p. 66. 

25 



to drawing a salary from an employer. If the person charges a fee for their 

services then the services would have been provided independently by the 

practitioner, that is as a part of private practice. Many midwives were practising 

independently and collecting a fee, albeit in kind, prior to the passing of 

legislation to govern practice. With legislation a choice came into force . 

Midwives could choose to work in state run hospitals and draw regular monetary 

reimbursement for their services. The state run hospitals provided a subsidised 

care within the St Helens Hospitals with clients of moderate means expected to 

pay a nominal amount for the care they received. 71 This arrangement ensured 

that all women received professional care of a high standard from professional 

practitioners. These activities were no less professional than the service provided 

by other midwives who autonomously ran maternity homes and received 

reimbursement directly from clients who chose private care. 72 The independence 

and autonomy of midwives who were employed by the state to work throughout 

the country in isolation from other professional practitioners was demonstrated 

in the publication of accounts of their experiences. 73 

Professionalism is dated from pre-formal practice within all health related 

professions. The dynamic nature of professionalism is integrated with change 

which advances the profession but excludes or curtails the practice of some 

members of the group. Viewed longitudinally this change can be demonstrated to 

occur within a continuum with peaks of activity constituting major change, 

frequently linked with legislation. These peaks translate into phases within the 

concept of professionalism. Four phases have been identified. (See Table 3, p. 8, 

Introduction). To find answers to the research questions the sub-professional and 

early semi-professional phases within New Zealand midwifery have been 

examined within the next five chapters. 

71 J. 0 . C. Neill 1961, 50. 

72 AJHR, H22, 1907, p. 3. 

73 
N. Kelly, 'My First Case of Twins', The Journal of the Nurses of New Zealand, [JNNZ}. 
V:IV, October, 1912, p. 118. F. McDonald, 'Backblocks Nursing - My First Experience', 
JNNZ, VII:ill, July, 1914, pp. 123-124. 

26 



27 

Chapter Two 

The English Midwives Act 

Maternal and infant mortality and a decline in the birth rate were pnmary 

concerns which directed the development of midwifery practice in England and 

gave rise to the British Midwives Act of 1902. Florence Nightingale did an in 

depth study of maternal mortality which led to a prescriptive model for a 

midwifery training school. Scientific knowledge developed prior to the 1902 Act 

was adopted in the training and education of midwives directed by this Act . This 

included the stringent use of antiseptics. These events were the blueprint from 

which New Zealand midwifery developed after 1904 when a Midwives Act was 

implemented. These early Midwifery Acts represent one of the first formal moves 

in the standardisation and progressive development of the midwifery profession. 

Although midwifery training was available in England prior to the 1902 Act a 

large proportion of the practitioners were untrained and ignorant of the new 

scientific findings which were revolutionising health care. 1 This chapter examines 

the new order of maternity practices in England post 1860. 

While in recent years historians have questioned the influence Florence 

Nightingale had on nursing, her influence on the training and education of 

midwives cannot be questioned. In 1861 Nightingale arranged with Kings 

College Hospital to open a maternity ward which, within a period of 5 years, 

was closed following alarming numbers of maternal deaths.2 Over the next five 

1 A. R. Ward, MCNN, 1981, pp. 190-194 & 237-242. 

2 F. Nightingale, 1871, p. 3. 



28 

years Nightingale studied maternal mortality statistics supplied by vanous 

individuals within England and overseas.3 She corresponded with vanous 

individuals on the topic, including, according to one biographer, Sir James 

Young Simpson in Edinburgh. 4 This investigation led to the publication of a 

book, Notes on Lying-in Institutions, in which Nightingale detailed her 

investigation and the conclusions to which she came.5 Although this book was 

less than informative on the care of women in childbirth it did state the 

importance of keeping the maternity wards apart from general wards, preferably 

in separate buildings. More important, Nightingale concluded that the home was 

at that time the safest place for women to give birth. 6 

Nightingale's interest in midwifery was to provide a training school for women 

who intended to practise independently as midwives. 7 These midwives would be 

educated women and would be known as ' lady midwives'. Although this venture 

foundered the knowledge gained from the inquiry which followed found 

expression in recommendations for the establishment and running of midwifery 

schools.8 

Nightingale's venture into the education of midwives was part of the challenge to 

traditional midwifery being waged during the nineteenth century. Traditional 

midwives had no formal education as practitioners having learnt the art and craft 

3 C. Woodham-Smith, Florence Nightingale 1820-1910, London, Constable and Company 
Ltd., 1950, p. 474. Nightingale took three years to develop her conclusions. The work was 
conducted alongside other issues Nightingale was involved in and the book on lying-in 
institutions was collated by her friend Dr. Sutherland. 

4 ibid. p. 474. 

5 F. Nightingale, 1871. 

6 ibid. pp. 3. 

7 F. B. Smith, Florence Nightingale, Reputation and Power, London, Croom Helm, 1982, p. 
160. 

8 F. Nightingale, 1871, pp. 69-70. 



29 

of their profession9 through apprenticeship with established midwives in their 

community.10 A strong move was underway from various groups to educate 

midwives.11 Several lying-in hospitals offered training and education in 

midwifery.12 Recognition of women' s midwifery knowledge was made by the 

London Obstetrical Society (LOS) in 1872 when they offered certificates to 

women who were able to successfully pass a midwifery examination.13 

Establishing a socially recognised body of knowledge for midwives through 

education, training, and examination, was a step in the process of redefining the 

professional status of midwifery.14 This move from traditional to educated 

midwife assisted in making midwifery a respected profession for women. 

Certificates awarded to successful examinees set them apart from the uneducated 

women personified by Sairey Gamp.15 Traditional midwives were predominantly 

married women, the new practitioners were often young, single women from 

respected families . 16 

A move to implement legislative changes controlling midwives' practices had 

been made by the LOS in 1870.17 The Bill they brought before parliament sought 

to exclude from practice midwives without any formal training. An inquiry they 

had conducted showed that very few midwives had any formal preparation and 

many were both ignorant and incompetent. This Bill was not successful but was 

9 R. Marshall, NM, 1983, pp. i-vii. In her article Marshall states ' professional' to be 
applicable to any person who regularly participates in an occupation for which they are paid 
and by which society recognizes them. 

10 J. Raisler, JN-M, 1994, pp. 326-328. 

11 
A. R. Ward, MCNN, 1981, pp. 190-194. & pp. 237-242. F. B. Smith, 1982, p. 162. J. 
Towler, J. Bramall, 1986 

12 J. Towler, J. Bramall, 1986, p. 159. 

13 A. R. Ward.,MCNN, 1981 , pp. 237. 

14 S. Wallace, BA (Hons) Thesis, University ofOtago, 1987, p. 66. 

15 
A. R. Ward, MCNN, 1981, p. 192. C. Dickens, Wordsworth Editions Limited, 1995. 

16 E. Morland, 1951. A. R. Ward, MCNN, 1981, pp. 192. 

17 
J. Towler, J. Bramall, 1986, p. 160-161. A. R. Ward, MCNN, 1981 , pp. 237. 



30 

the first of a number of similar Bills introduced over the next thirty years with the 

aim of regulating midwifery practice. 18 

In 1881 educated, certificated midwives, began to form a society, the Trained 

Midwives' Registration Society, later known as the Midwives' Institute.19 This 

group worked to improve the public image of midwives through publication of a 

register of educated, certificated, midwives. A sister organisation was formed 

five years later with the aim of gaining compulsory registration of all midwives 

through parliamentary statute. Early Bills were defeated through lack of support 

and opposition from the General Medical Council. 

In 1892 a government committee report revealed that many traditional midwives 

lacked proper training. Further there was a distinct lack of the use of antiseptics 

within their practice20 and a high incidence of maternal deaths from post natal 

septicaemia as a result. 21 Other leading causes of maternal and infant mortality 

included miscarriages, ante natal toxaemia, and problems in labour.22 These 

deaths were linked with the poor care given by uneducated midwives. 

Nevertheless it was not until 1902 that The English Midwives Act was passed. 

This Act was intended to prepare midwives to recognise the identified problems 

and minimise or prevent the effect they had on women' s health in childbirth. 

The Act was ' to secure the better training of Midwives and to regulate their 

practice' and was to take full effect on the first day of April, 1910. 23 Such a 

delay gave midwives in practice the opportunity to become aquainted with the 

18 A. R. Ward, MCNN, 1981, p. 238. 

19 ibid. p. 237. 

20 ibid. p. 238. 

21 
R. Perks, Life as a Textile Worker and a Midwife (M.B.E.), BHR U Unrestricted, A 0067, 
Bradford City Library [BCL]. 1984. 

22 ibid. 

23 The Midwives Act, 1902 [2 EDW VII, CAP 17) BPS 1902. 



31 

Act and to provide the necessary documents required to demonstrate they were 

entitled to appear on the roll of midwives which was published each year. 

Midwives notified their local council or borough council at the beginning of each 

year of their intent to practice. These bodies were responsible for supplying a 

list of midwives practising in their area to the Central Midwives Board. The roll 

of midwives was compiled from these lists. The local bodies were to make the 

roll available for the public to inspect. 

Supervision of midwives was also carried out by these local bodies. Rules were 

established for the guidance of supervision.24 These included investigation of 

charges of malpractice, suspension from practice of midwives likely to spread 

infection, reporting of midwives convicted of offences and on the death of 

practising midwives in the area. Provision was made for midwives to appeal any 

suspension or disciplinary action taken. 

Supervision of midwives at the local level proved difficult where midwives lived 

in outlying districts and were out at a case or other business associated with a 

birth. A report presented by an inspector in the City of Bradford, Yorkshire 

demonstrates some of the frustration felt in the face of these difficulties. 25 This 

report deals with issues which have been associated with setting the standards 

for the character and behaviour of untrained midwives. The report related to the 

inspection of 93 midwives comprising both certified and uncertified but 

practising midwives. Out of this group only 4 were fully trained and 6 described 

as satisfactory. Many of the midwives were described as being 'of the clean and 

old fashioned type, but very ignorant. '26 

Ignorance was identified as the inability to write and a lack of knowledge of 

disinfectants. Identified practices related to the storage of equipment and the 

24 ibid, Clauses 6 and 8. 

25 Report of 30.12.1905, Report of the Work of Female Sanitary Inspectors 1902-11, Wm. 
Byles & Sons Limited, Printers, Piccadillyffapp & Toothill Ltd., Printers, Charles Street, 
Bradford. 

26 ibid. 



32 

keep and cleanliness of the midwife's home. Several midwives were stated to 

keep their scissors in tangled and untidy drawers. The report indicated that most 

of the cases of puerperal fever occurring during the period covered by the report 

were related to the carelessness of the midwives and it suggested the need for a 

lady to be appointed full time to administer the Midwives Act of 1902.27 Later 

reports indicate that this suggestion was acted upon. 28 Despite this appointment 

the high number of untrained midwives in practice, and their lack of knowledge, 

made the inspectors' work difficult. This was compounded by a poor level of 

literacy and record keeping. 

Carelessness in practice included a lack of handwashing and cleansing and 

sterilisation of instruments, particularly syringes which were used for both 

enemata and vaginal and uterine douching. Inspection of this instrument in some 

cases demonstrated contamination with both blood and faeces .29 When puerperal 

fever occurred this went undetected as the signs were not observed and acted 

upon. Changing these practices called for a strategy which encouraged the 

midwives to want to change. With the backing of the Mayoress of Bradford a 

series of lectures followed by a tea and prize giving for those who attended was 

arranged. 30 The reduction in the death rate from puerperal septic diseases could 

be attributed in part to this type of instruction since the number of trained 

midwives in practice did not increase. The death rate which in 1893 had been 

27 ibid. 

28 ibid. Reports between 1902 and 30. 9. 1904 were signed by C. F. Stephens who bore the 
title of Associate R. Sanitary Inspector. Reports from 30. 12. 1904 were signed by Eva H. 
Jones. Her title was Associate R. Sanitary Inspector until 31 . 3 .1908 when she became Chief 
Woman Inspector. The report of 30.12.1906 indicated Jones had completed a course of 
study which led to the Diplomee Nat. Health Soc. 

29 ibid. Report of 30. 9. 1906. King, Frederick Truby (Sir) 1858-1938, MS 1120, Lectures on 
Midwifery and Gynecology, 1885, WTU. These lectures identify unwashed hands and dirty 
instruments as a direct cause of puerperal sepsis. The use of handwashing and vaginal and 
uterine douching were considered prophylactic measures in the prevention of puerperal 
sepsis. 

30 Report of the Work of Female Sanitary Inspectors 1902-11, Wm. Byles & Sons Limited, 
Printers, Piccadilly./ Tapp & Toothill Ltd. , Printers, Charles Street, Bradford. 



33 

202 per million living females was reduced in 1907 to 81 per million females 

living.31 

The incorporation of antiseptics into midwifery practice and the enforcement of 

strict hand washing and sterilisation of instruments used in the provision of 

midwifery care was only possible due to the work of medical men in different 

locations who were investigating puerperal sepsis. They formed a chain of 

scientific findings which led to the changes in midwifery practice with the aim of 

eliminating puerperal sepsis.32 Ignaz Philipp Semmelweiss (1818-1865) is the 

person popularly associated with puerperal fever. Alexander Gordon (1752-99) 

and Oliver Wendell Holmes (1809-94) were also looking for the cause of the 

condition. Gordon' s carefully documented observations indicated that the 

incidence of puerperal fever was confined to the practice of a small group of 

midwives. Gordon accurately predicted that patients attended by these midwives 

would develop puerperal fever.33 

Gordon also identified the spread of the fever in his own practice. He practised 

bleeding and purging and believed early intervention in this manner to be 

imperative to the recovery of his patients.34 Holmes' s work on puerperal fever 

resulted in a paper on the topic which was based on research of written accounts 

of the disease rather than his own clinical experiences. 35 

Semmelweiss is credited with making links between the practices which took 

place in the Vienna Maternity Hospital and puerperal sepsis. Having attended the 

post-mortem of a colleague who died of septicaemia he was ' impressed by the 

31 ibid. 

32 I. Loudon, 1992, Chapter 4. pp. 49-84. 

33 ibid. 

34 ibid. pp. 59. 

35 ibid. pp. 49-84. 



34 

similarity of certain pathological lesions to those seen routinely in women dying 

from puerperal fever'. 36 Semmelweiss recorded his reflections from this 

experience including the idea that 'cadaverous particles' could adhere to the 

knife used in the post-mortem. 37 When used for other purposes these cadaverous 

particles could transfer to the surfaces of the person or article, causing infection 

to spread. Developing from this experience was the idea that the 'cadaverous 

particle' should be washed from the hands before attending a labouring or lying­

in woman. Similarly the link between the attendants' clothes and the spread of 

the infection was identified. 38 

Between 1865 and 1879 the isolation of bacteria causmg puerperal fever 

occurred. Several individuals contributed to the evidence that a causative 

organism was responsible for the condition. Louis Pasteur ( 1822-1895) made 

the final discovery that the vaginal discharge of all women sick with the disease 

would grow bacteria. 39 Joseph Lister ( 1827-1912) is credited with a method of 

preventing surgical sepsis. Lister applied carbolic acid dressings to the wounds of 

his patients as a barrier to bacteria. Soon after he used a carbolic spray to 

prepare the theatre where he performed his surgery. These measures were the 

forerunners of the aseptic technique which was adopted. The process became 

known as Listerism. 40 

Simpson first identified the similarities between surgical sepsis and puerperal 

sepsis.41 He believed that following childbirth the lining of the woman's uterus 

needed to heal, particularly the placental area. The cervix, vagina and perineum 

36 ibid. pp. 49-84. 

37 ibid. 

38 ibid. pp. 65-66. 

39 ibid. pp. 78. 

40 
J. M. Hawkins; S. Le Roux; Editors, The Oxford Reference Dictionary, London, Guild 
Publishing, 1987, p. 483. H. Morten, The Nurse's Dictionary of Medical Terms and 
Nursing Treatment, London, The Scientific Press Limited, 1900, p. 82. 

41 King, MS 1120, 1885, WTU, 695-709. I. Loudon, 1992, pp. 203-204. 



35 

could also have been injured during the birth. Simpson considered these wounds 

as reciprocal to the wounds of a surgical patient and believed them to be a point 

of entry for bacteria in the post partum woman. 42 Healing of these areas took 

place over the next few weeks, particularly within the first two weeks. 

Treatment, he said, began with prophylaxis and included washing hands and 

instruments in antiseptic solution, and wearing clean clothes when attending 

women in childbirth. 43 The application of Listerism to childbirth was an 

appropriate step towards controlling puerperal sepsis. 44 

The moves to develop the professional status of midwifery in England had 

implications for midwifery in New Zealand. The English Midwives Act of 1902 

was a model for the New Zealand Midwives Act of 1904.45 Incorporated into the 

New Zealand Act was the Nightingale model of a midwifery training school. 46 

The certificates awarded by the LOS and the Central Midwives Board (CMB) 

were two of the several recognised in New Zealand. The holders of these 

certificates were registered in New Zealand as Class A midwives. (Years later 

the CMB were to state that granting of such certificates was not a guarantee of 

creditable practice).47 The midwifery curriculum incorporated Listerism into the 

practice of midwifery with pupil nurses required to demonstrate their ability to 

apply the use of antiseptics in their practice. 

42 I. Loudon, 1992, Chapter 4, 49-84. 

43 King, MS ll20, 1885, WTU, 695-709. 

44 H. Morten, l 900, p. 82. 

45 
The Midwives Act, 1902 (2 EDW VII, CAP 17] Bristish Practical Statutes 1902i [BPS] 
Premier Richard Seddon - New Zealand Parliamentary Debates, [NZPD], 28th June - 28th 
July, 1904, 128. 

46 
The Midwives Act, 1904 (4 EDW. II, No. 31] NZS, 1904. F. Nightingale, 1871. Midwifery 
Training, JNNZ, VII:III, October, 1914, p. 174. 

47 
Health I, 79/5, Marlborough Hospital Board - Maternity Hospital Blenheim, W ARC, Memo 
dated 17.10.1916 identifies a Class A midwife with CMB certificate who did not practice at 
the standard expected of a well qualified midwife. C. J. Maggs, 1983, p. 145. 



36 

The New Zealand Midwives Act of 1904 legally changed the practice of 

midwifery by incorporating Nightingale's midwifery training scheme into a State 

system of lying in hospitals. The training programme improved the experience of 

childbirth for women throughout the colony. Untrained women who were in 

practice at the time the Act was passed were enabled to continue in practice if 

they met the requirements as stated in the Act. The untrained women who 

registered and practised in New Zealand post 1904 provided as much of a 

challenge to the New Zealand midwife inspectors as did their counterparts in 

England. The following chapters examine these changes and challenges in the 

history of New Zealand European midwifery. 



37 

Chapter Three 

New Zealand European Midwifery Practice Pre 1904 

European colonisation of New Zealand began in 1840. Sixty years later the 

settlers had established a Hospital and Charitable Aid system which embraced a 

series of hospitals in main areas of settlement. The hospitals administered 

charitable aid to the needy, the elderly and sick were cared for, and in some 

hospitals provision was made for lying-in cases.1 The hospitals in the main 

centres independently established a training programme for nurses and awarded a 

certificate to all successful students.2 Many of the immigrants were young 

females of childbearing age yet no state provision was made for either the 

preparation of midwives or the care of women in childbirth. 3 By 1904 an 

unstructured midwifery service had developed. Women received care from the 

most appropriate person in their area. This could be a medical man, a midwife, 

traditional or trained, or the woman next door. These various practitioners 

played a part in the delivery of midwifery care in pre 1904 New Zealand society.4 

The nineteenth century was a time of professional transition in New Zealand 

nursing and midwifery. In traditional practice the art and science of nursing and 

midwifery was demonstrated through the application of homeopathic, aromatic, 

and herbal remedies and in the use of clean running water, fresh air, and 

I AJHR, H-23 , 1882, pp. 1-7. 

2 D. Macdonald Wilson, A Hundred Years of Healing, Wellington Hospital 1847-1947, 
Wellington, A.H. & A. W. Reed, 1948. p. 78. P. C. Fenwick, The Christchurch Hospital: 
Historical and Descriptive Sketch, Christchurch, Andrews, Baty & Co. Ltd., 1926, p. 20. 

3 C. Macdonald, A Woman of Good Character: Single Women as Immigrant Settlers in 
Nineteenth Century New Zealand, Wellington, Bridget Williams Books, Historical Branch, 
1990. 

4 A. R. Ward, MCNN, 1981, p. 191. Ward states that the term midwife was used freely to 
refer to any person who was available and attended a delivery. 



38 

sunshine.5 Rest and nutritional beverages were also used.6 The person who 

traditionally practised nursing or midwifery and was recognized in their 

community was a professional within the context of that society's understanding 

of professional. 7 

A changing paradigm in the understanding of the spread and containment of 

infectious conditions challenged the management of surgical and midwifery 

cases. By 1885 the use of antiseptics to cleanse both the skin of patient and 

practitioner and to sterilise instruments was incorporated into an expanding body 

of theoretical knowledge. When applied to the clinical situation this reduced the 

incidence of mortality and morbidity.~ Translation of this new scientific 

knowledge into practice was demonstrated through the art of nursing and 

midwifery. Training and education was needed to understand and apply the new 

knowledge. Certification was the formal verification of that knowledge. These 

elements were embraced within a new definition of a professional person, as 

nursing and midwifery moved towards the preparation of women for their role of 

nurse or midwife.9 

The hospitals established in New Zealand from 1846 onwards provided very 

simple care for those in the population who did not have a home and family to 

care for them.10 The development of anaesthesia enabled simple surgery, 

particularly amputation of limbs, a procedure that could be carried out in a 

5 M. Hughes, Women Healers in Medieval Life and Literature, New York, King's Crown 
Press, 1943, p. 110. R. W. Johnson, Friendly Caution to the heads of families and others, 
Philadelphia, 1804, p. 56., E. B. Hanbury, The Good Nurse: Hints on the management of 
the sick and lying in chamber and the nursery, London, And. W. Phillips, 1825, Chapter 
xx. 

6 B. Harper, Petticoat Pioneers, South Island Women of the Colonial Era, Book Three, 
Wellington, A.H. & A. W. Reed Ltd., 1980. H. Morten, 1900, p. 114. 

7 R Marshall, NM, 1983, pp. i-vii. 

8 King, MS 1120, I 885, WTU. I. Louden, 1992. 

9 S. Wallace, BA Thesis, University ofOtago, Dunedin, 1987, p. 66. 

'
0 R. E . Wright-St Clair, Caring for People: Wanganui Hospital Board 1885-1985, 

Wanganui, Wanganui Newspapers Ltd., 1987, p. 9. 



39 

person's home. The introduction of antiseptics into practice made procedures 

safer by reducing the incidence of infection. These two innovations increased the 

possibilities for surgery and created an increased need for hospital care. The need 

to upgrade hospital conditions was perceived by society. Expansion and 

upgrading of existing buildings occurred.11 Despite these changes provision was 

not made for lying-in care. The majority of beds provided care for general 

patients with most being allocated to male patients.12 

Two hospitals are identified in the 'Hospital Returns For I 881' as providing for 

General and Lying-in patients. These are Dunedin and Dunstan hospitals, both 

situated in the province of Otago. 13 A special report on hospitals in 1883 

describes the accommodation set aside for the care of lying-in women.14 In 

Dunedin Hospital the lying-in department was accommodated in a wooden 

annexe on the north side of the main hospital. 15 The midwifery service was 

provided independently from the rest of the hospital the building having been 

divided into two wards, a small kitchen and a private room for the midwife. 16 

These arrangements were superior to those in Dunstan Hospital where the female 

ward is described as being in a wing of the main building. 17 Staffing did not 

include a midwife but instead a husband and wife acted as house stewards. 

Despite the poor quality of the building a high level of cleanliness and order was 

indicated in the inspectors report showing that the stewards understood the 

importance of good hygiene. The arrangements in the Dunedin Hospital 

replicated the recommendations Nightingale and Simpson believed should be 

11 D. Macdonald Wilson, 1948. p. 25. 

12 AJHR, H-23, 1882, pp. 2-7. 

13 ibid. pp. 1-7. 

14 AJHR, H-3A, 1883, pp. 1-28. 

15 ibid. pp. 7-8. 

16 ibid. p. 7. 

17 ibid. p. 8. 



40 

implemented for all midwifery cases. 18 Their understanding was that this would 

reduce the incidence of maternal mortality caused through the spread of 

puerperal sepsis. 

One way of preventing the spread of puerperal sepsis was to isolate women who 

developed the infection. Women nursed in their own home could be isolated 

during the course of their infection. This could not be achieved as easily in 

hospital unless provision was made for an isolation ward. Neither Dunedin nor 

Dunstan Hospitals appear to have had this provision. Dunedin Hospital had three 

lying-in beds accommodated in two wards. Dunstan Hospital had four beds in the 

'female sleeping-ward'. The number of lying-in beds is not stated which could 

mean that both lying-in women and females receiving general hospital care were 

nursed together. One hospital which did provide for isolation of lying-in women 

was Wellington Hospital. This did not happen until 1890 when a puerperal fever 

ward with four beds was added to the existing isolation hospital. 19 The frequency 

with which this was used is uncertain. The possibility is that the use was 

infrequent.20 In the event that the woman did not recover from the fever she 

became part of the statistical returns for the colony. Until 1908 puerperal fever is 

listed under the category labelled ' Septic Order of Zymotic Diseases' 21 which 

makes it difficult to provide a finite figure of deaths due to puerperal fever. 22 

There was no requirement to provide the authorities with information on each 

case of puerperal fever that occurred. 

18 F. Nightingale, 1871, p. 33. C. Woodham-Smith, 1950, p. 474. 

19 D. Macdonald Wilson, 1948. P. 27-28. 

20 ibid. p. 28. 

21 W. T. McLeod, Managing Editor, Collins Dictionary and Thesaurus in One Volume, 
England, HarperCollins Publishers, 1994, p. 1173. Zymotic refers to diseases caused by 
infection. 

22 Statistics for the Colony of New Zealand, (SCNZ), 1904, Wellington, Government 
Printer, p. 41. NZOYB, 1920, p. 43 . 



41 

Death in maternity was no stranger to the immigrants. Letters and journals 

indicate the uncertainty of childbirth. The safe arrival of many of the early 

pioneer children was placed in the hands of people like Granny Cripps, a 

traditional midwife practising in the Wairarapa. 23 Granny Cripps, like many other 

women, rendered assistance in an area where the nearest doctor was many miles 

away or if the local doctor was unavailable.24 Women placed their lives and that 

of their unborn baby equally in the hands of whoever was available, and in God, 

the Lord who sustained them in all things. 25 Mary Cuddie who acted as a midwife 

in Dunedin is believed to have based her practice on personal experience linked 

with respect for the natural process oflabour and birth and a faith in God.26 This 

faith did not prevent tragedy from happening. Babies were stillborn27 or died 

soon after birth,28 women died in or soon after childbirth.29 

These deaths were blamed on the ignorance of the traditional midwives who 

attended the births. 30 Lacking in knowledge related to the management of safe 

labour and birth they contributed to the uncertainty associated with childbirth for 

23 Francis A. B. Bett,, Micro MS Papers 1836-1957, Reel 2, Series 1, Folders 5 - 27, 29, 
WTU, The account of Granny Cripps life was written for presentation on a 'Womens ' 
Hour' program with information provided by her Grandson who was known to Dr. Bett. 

24 F. Porter, C. Macdonald, "My Hand Will Write What My Heart Dictates: The unsettled 
lives of women in nineteenth-century New Zealand, to sister, family and friends, " 
Auckland, Auckland University Press/Bridget Williams Books, 1996, pp. 341-342. 

25 F. Porter and C. Macdonald, 1996, p. 346. Letter from Mary Preece to Charlotte Brown, 
Tauranga, 1842. 

26 Dr. F. 0 . Bennett, 'Mary Cuddie', in G. J. Griffiths, (ed.), The Advanced Guard Series JI, 
Dunedin, Otago Daily Times, 1974, p. 168. Dr. Bennett states that Mary Cuddie' s 
obstetrical knowledge 'was probably based on personal experience ... respect for a natural 
process and on faith in the Lord. ' 

27 F. Porter and C. Macdonald, 1996, p. 346, Letter from Mary Preece to Charlotte Brown, 
Tauranga, 1842. 348, Letter from Mary Marshall to her Grandfather, 1850. 

28 ibid. p. 356. Letter from Helen Hursthouse to her sister, Lely Richmond, 1861. 

29 ibid. p. 351-2, Letter from Douglas (Susan) McLean to her husband, New Plymouth, 1852. 

30 Premier Richard Seddon, member for Westland, NZPD, 1904, 28th June-28th July, 1904, 
p. 70-71. 



42 

both mother and baby.31 Lack of knowledge of the control of infection through 

the use of antiseptics was a major part of this uninformed practice. Although 

some traditional midwives had this knowledge32 many others did not. 33 

Furthermore they were unable to understand and apply the concept of 

sterilisation or aseptic technique within their practice or to detect the presence of 

fever in their patients through the use of a clinical thermometer.34 

From the time New Zealand has kept statistics childbearing age has been placed 

between the years 15 to 45. 35 (See Table 6). This interpretation is based on the 

age parameters of married women in the colony36 and does not acknowledge that 

girls under 15 years could have babies nor that women over 45 years continued 

to expand their families . It does indicate a strong moral code relating to marriage 

and legitimacy and supports the notion that the majority of women gave birth 

between the ages of 15 and 45 . Death could happen at any point within this 

continuum and at any stage in pregnancy. This is indicated in the official records 

of statistics, a record which also identifies cause of death. 

Abortion or miscarriage, puerperal convulsions and placenta previa all 

contributed to maternal mortality.37 The category however which claimed the 

31 J. 0 . C. Neill, 1961 , p. 89. M. Tennant, 'Mrs Grace Neill in the Department of Asylums, 
Hospitals and Charitable Institutions', The New Zealand Journal of History, 12:2, October 
1978, pp. 3-16. 

32 C. I. Baldwin, 'Jacobson, Inger Katherine 1867 to 1939', in The Dictionary of New 
Zealand Biography, Volume Three, 1901-1920, Auckland University Press/Department of 
International Affairs, 1996, p. 246-247. 

33 Health I, 21/29, Removal of registered midwives from the register, WARC, Memo dated 
16.8.24. 

34 ibid. 

35 
Registrar General's Report, Statistics of New Zealand 1886, Wellington, Government 
Printer, 19th October, 1887, p. xiv. 

36 ibid p. xiv. 

37 
Statistical Tables in Anticipation of the Annual Volume of Statistics of New Zealand, 1887, 
Wellington, Government Printer, 1887. 



43 

largest number of mothers was labelled 'other accidents of childbirth' .38 (See 

Table 7). The death of a woman from puerperal convulsions left a new born baby 

without a mother to nurture it. When bleeding occurred from placenta previa 

during labour heroic attempts to effect a vaginal delivery sometimes saved the 

life of mother and/or child. 39 The statistics give no indication of the time of death 

making it difficult to link placenta previa with the loss of both mother and foetus, 

lack of the word puerperal attached to the term indicates the deaths occurred in 

the ante natal period. 

Table 6: Maternal mortality in relation to age. 

Year~ 1873 1879 1900 

Age -i.. 

15 and ..J.. 20 0 4 0 

20 and ..J.. 25 6 8 2 

25 and ..J.. 30 9 13 0 

30 and ..J.. 35 13 10 2 

35 and ..J.. 40 11 13 0 

40 and ..J.. 45 3 7 I 

45 and ..J.. 50 I 1 I 

Source: Statistics for the Colony of New Zealand, 1873, Wellington, 
Government Printer. Statistic for the Colony of New 
Zealand, 1879, Wellington, Government Printer. Statistic for 
the Colony of New Zealand, 1900, Wellington. Government 
Printer. 

During the first year of life children were at their most vulnerable, particularly in 

the first month. The number of such deaths gradually increased by one fifth 

38 SCNZ, 1886, 

39 ABBR 6090211, Home Delivery Casebook 1907-1913. WARC. Cases 422, 423 - Ante 
Partum Haemorrhage occurred in this case with the infant stillborn. Bleeding is not 
specifically linked to placenta previa. 363 - This woman bled due to placenta previa. The 
doctor 'plugged and performed podalic version and delivered the baby as a breech. ' 
Despite sustaining a fractured clavical during the delivery the baby thrived and was 
entirely breast fed. 



Table 7: Maternal Mortality 1894-1903. 

Year~ 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 
Cause of Death ..!. 

Abortionlrvliscarriage 15 6 13 14 17 20 8 10 16 25 

Puerperal Mania 1 3 0 0 2 1 1 I 0 0 

Puerperal Metritis I 0 0 0 0 l 0 I 0 I 

Puerperal Albuminuria 7 14 14 10 13 9 8 6 11 8 
Eclampsia 
Placenta Previa [flooding] 13 18 20 11 10 4 14 12 18 Jl 

Phlegmesia Dolens l 2 0 3 4 0 2 I 0 I 

Other accidents of childbirth 35 26 30 26 26 36 18 39 40 54 

Puerperal Septicaemia, 38 32 10 l8 19 15 24 20 25 28 
Puerperal fever, Pyaemia, 
Septicaemia * 
Total Maternal Deaths 73+38 69+32 77+10 64+18 72+19 7 1+ 15 51+24 80+20 85+25 100+28=1 

= Ill = 101 = 87 = 82 = 91 = 86 = 75 = 90 = 110 28 
% Of Total Births 0.59% 0.54% 0.46% OA3% OA8% 0.45% 0.38% 0.43% 0.53% 0.58% 

Total Births 18528 18546 18,612 18.737 18.955 18,835 19.546 20,491 20,655 21 ,829 

Source: Statistics of the Colony ofNew Zealand for the years 1894 - 1903, Wellington, Government Printer. Key: * - These conditions 
appear in the section labelled Septic Order of Zymotic Diseases. 

44 



45 

between 1899 and 1903 with prematurity at a consistent high level. 40 The 

statistics relating to these deaths caused concern to Richard Seddon and were 

used by him in 1904 when he wrote his Memorandum on Child Life Preservation 

in New Zealand.41 This work preceded the introduction of the Midwives Bill 

into parliament and formed the catalyst for his introduction of the Bill. 42 Seddon 

stated that the loss of infant life would have appeared much higher if stillbirths 

and maternal deaths in pregnancy and maternal/foetal deaths in labour had been 

taken into consideration.43 Stillbirth occurred after the twenty-eighth week of 

pregnancy the foetus not having 'made a complete breath' .44 Registration of 

stillbirths was not required until 1913. 45 

The lack of provision for maternity care forced communities and individuals to 

make their own arrangements. From 1840 to 1904 the provision of midwifery 

care varied from one community to another. Celebratory anecdotes indicate that 

immigrants who arrived in the early days of colonisation had to make 

arrangements for themselves. Accommodation was primitive, often a partially 

finished building constructed by the settlers themselves. 46 Immigrant ships 

travelling to New Zealand often had a ship' s surgeon or a midwife who intended 

settling in New Zealand upon arrival here. These individuals provided midwifery 

care in the area they settled in. 47 

40 NZOYB, 1905, Wellington, p. 252. 

41 
Seddon, MS 1619, WTU, Richard Seddon' s Memorandum on Child Life Preservation in 
New Zealand, May 7, 1904. 

42 Premier Richard Seddon, NZPD, 1904. 

43 ibid. Seddon's comments illustrate one of the inconsistencies found in the official 
statistical data and which challenges the historical interpretation of maternal and infant 
mortality issues. 

44 H. Morten, 1900, p. 128. 

45 F. S. Maclean, 1964, p. 184. 

46 An on, WDNZFU, 1939, p. 85 . 

47 J. S. Gundry, Dr. Gundry 's Diary, Part II: Commencing Practice in Christchurch June­
October 1851, Christchurch, The Naggs Head Press, 1982. Anon, WDNZFU, 1939, p. 85. 



46 

One such woman was Granny Harrold, (1830/31 ?-1903) of Stewart Island. This 

lady was recognised in her community for her skill as both a nurse and a midwife. 

She used 'squaw tea', a brew of raspberry leaves and tansy, which she gave to 

women in labour and to young girls with period pains. 48 Within her practice 

Granny Harrold was demonstrating the art and craft of the old order of 

professional midwives.49 She also used other ideas within her practice which a 

hundred years later are applied under the umbrella of active birthing. 50 This 

included keeping the woman up and mobile during the process of first stage 

labour and kneeling on the floor for the delivery of the baby. Recognising the 

need to keep the baby warm after birth she wrapped it in clean linen and a 

garment she had worn during the birth and which was warmed by her own body. 

Her final care of the mother was to give a cleansing sponge and nourishment in 

the form of a bowl of gruel. 

The care Granny Harrold provided was not unique. Another woman who lived 

and worked in Ashhurst also used herbs. 51 This woman referred to Culpepper 's 

Complete Herbal52 for the remedies she used in her midwifery practice. Herbal 

cures were also part of the care Florence Bennett ( 1882-1962) used in her care 

48 
M. Barlow, 'Agnes Harrold', in W. H. Oliver, (ed.), A Peoples History: Jllustrated 
Biographies from The Dictionary of New Zealand Biography, Volume One, 1796-1869, 
Wellington, Bridget Williams Books Limited/Department of Internal Affairs, 1992, pp. 
101-102. The exact year of Agnes's birth is uncertain. It was either 1830 or 1831. 

49 R. Marshall, NM , 1983, pp. i-vi. 

50 
M. Barlow, 1992, pp. 101-102. J. Balaskas, New Active Birth : A Concise Guide to 
Natural Childbirth, London, Thorsons, 1991. 

51 
J. A. Rodgers, M. A. Thesis, Massey University, Palmerston North, 1985, p. 4. 

52 
N. Culpepper, Culpepper 's Complete Herbal, Hertfordshire, Wordsworth Editions Ltd., 
1995. This edition is a modem publication of the original book by Culpepper which gives 
the reader an indication of the type of remedies used by this woman and others who used 
Culpepper's herbal medicines. 



47 

of the people m the Te Arakura district, care which included midwifery 

practice. s3 

Herbal remedies were not the only form of relief available to women. The use of 

anaesthesia in childbirth, although not common, had been the subject of 

experimentation in Edinburgh. 54 Chloroform was introduced by Simpson to assist 

in cases of contracted pelvis.ss This experimentation was part of the changing 

paradigm which slowly encroached upon traditional practices. A new immigrant 

to New Zealand, Elizabeth Cauldwell, is reported to have used chloroform when 

giving birth to her fifth child in November 1850. Newly arrived from Edinburgh 

she had brought a supply with her for use during the birth of the baby.s6 

Although chloroform became fashionable with women who could afford its7 there 

is no indication it was widely used in childbirth in New Zealand until after 1904 

by which date records are available to substantiate both the use and abuse of the 

anaesthetic agent. ss 

Not only were untrained women practising professionally as midwives, in some 

areas they organized themselves into groups each taking responsibility for a part 

of their community. This was the case in the North East Valley of Dunedin 

s3 E. Carthew, B. Williams, ' Florence Bennett', in C. Macdonald, M. Penfold, B. Williams, 
The Book of New Zealand Women: Ko Kui Ma Te Kaupapa, Wellington, Bridget Williams 
Books, pp. 81-83. 

s4 A. E. L. Bennett, MS 1346-211, WTU. J. 0 . C. Neill, 1961. In a letter dated 1909 from 
Grace Neill to Agnes Bennett, Neill tells Agnes Bennett that she was 'one of Sir J. Y. 
Simpson' s first experiments in maternal chloroforming. ' Neill was born on 26 May 1846 
to James Archibald Campbell and Maria Grace Cameron. 

ss M . Poovey, Uneven Developments: The Ideological Work of Gender in Mid-Victorian 
England, London, Virago Press Limited, 1989, p. 24-50. 

s6 E. Washbourne, Courage and Camp Ovens: Five Generations at Golden Bay, Wellington, 
A.H. & A. W. Reed, 1970, p. 65. 

s7 F. Porter, C. Macdonald, with T. Macdonald, 1996, p. 339. 

ss ABBR 6090211, Home Delivery Casebook 1907-1913. WARC. Health 1, Midwives 
Registration - Hester McLean, W ARC. Memo from Miss Bagley to the District Health 
Officer for Auckland dated 26 August 1916 which deals with reports of untrained 
midwives, some registered but untrained, administering chloroform to labouring women. 



48 

where Mary Cuddie (1821-1889) was the midwife on one side of Saddle Hill and 

Mrs. Allan worked on the other side. 59 This form of organization extended to 

recognition of seniority amongst the midwives themselves. Alice Helena Thomas 

( 1859-1917) is identified as a chief midwife and medical adviser. 60 Whilst the 

organization within midwifery practice ensured a service to the communities this 

service required the midwives to be available for long periods of time. This 

commitment to others took a toll on family life as the midwives could be so busy 

that they had no time to look after their own families. Sarah Salmond ( 1864-

1956), the daughter of a midwife practising in Queenstown, was taken out of 

school at the age of eleven to look after the family when her mother was 

working. 6 1 

The continuation of such organized midwifery care was ensured in many 

communities through the socialization of generations of daughters into the 

practice their mother had begun. Adelaide Hicks (1845-1930) who established a 

practice in Mosgiel was helped in this work by several of her daughters. 62 This 

practice continued into the twentieth century and is demonstrated in the early 

gazetted lists of midwives printed after 1904. Mrs. Clerkin and her daughter 

practised together in Hokitika, 63 as did Mrs. Boyce and her daughter in 

Wellington, and Mrs. Whiting and her daughter in Hawera64
. 

59 F. 0 . Bennett, 1974,