The century-long revolution in mother-baby care and a baby who never cried

Today the ravages of childbearing no longer define our lives, the way it defined my grandmothers' lives, but this safety has come at a cost.

So she went back to the table, half hoping she might find another key on it, or at any rate a book of rules. Alice in Wonderland p.9

The campaign from the beginning of the 20th century to medicalise the care of mothers and babies changed everything for women. Today, the ravages of childbearing no longer define our lives. But as the midwives remind us, this safety has come at a cost.

From 1912, in a legislative attempt to stop women dying in childbirth in Queensland, practitioners who wanted a license to help birthing women had to be hospital-trained. With the Maternity Act a decade later, maternity hospitals sprang up throughout the state.

In these hospitals, nurses trained in the Nightingale method, a health system innovation that was already saving countless lives due to infection control. The principles of cleanliness, order, routine, measurement, nourishment and ventilation – so effective in the care of the sick – were now applied with similar good results to the growing numbers of women giving birth in the state-owned lying-in hospitals.

In 1919, in the photo above, my Nana stood in her white cotton wedding dress gazing soberly out at her future by the side of the seated, sun-bronzed farmer who was her bridegroom. Social philanthropists and doctors had just opened the first maternal and child welfare clinic in Queensland, and these soon spread throughout the state. Maternal and child welfare nurses were trained in the latest Nightingale methods and emphasised regularity, hygiene and efficiency as the new scientific approach to infant care and household management.

My father was a late baby, the youngest of Nana’s four, born in 1933. By this time, standards of living were beginning to improve, and mothers were becoming consumers, at least in the cities. Women’s magazines promoted artificial feeds (derived from a suitable brand of cow’s milk) as scientifically advanced, and the maternal and child welfare nurses were formally trained in Dr Truby King’s method of scientific mothering. His daughter, Mary Truby King, promoted his method in her highly influential book, Mothercraft. She contended that 4-hourly feeding allowed more sleep for mother and baby, reduced the risk of ‘chapped nipples, abscesses, etc.’ and aided digestion and appetite.

"You and your baby will find health and happiness, if you follow my father’s rules … Truby King babies are fed four-hourly from birth, with few exceptions, and they do not have any night feeds … [the Truby King baby’s] education begins from the very first week, good habits being established which remain all his life."

But spaced feeds, as we have seen, even if not as infrequent as the Truby King or Cadogan methods, make life harder for many women. Spacing feeds puts women at risk of mastitis and breast abscesses, and suppresses milk supply, which makes babies hungry, which means they cry.

By the end of the World War II, two-thirds of Queensland births occurred in maternity hospitals. As the baby boom gathered pace, hospitals were plagued by severe staff shortages and overcrowding. Women pursued the goal of painless, scientific deliveries, and medicated labours (known as ‘twilight sleep’), often combined with forceps, were common. Although most women initiated breastfeeding, medicated births and the Nightingale and Truby King rules seriously interfered with breasts’ capacity to make milk. This is how our breastfeeding amnesia began.

By the time I was born, in 1960 in a country town in the Sunshine Coast hinterland, almost all births occurred in hospitals. After I was born, I’m told nurses wrapped me in a bunny rug and gave me to my mother to hold (though not to feed). Then I disappeared for hours, my mother says, while we were washed and tidied. The steepest decrease in breastfeeding occurred in those years around my birth, as commercially packaged artificial baby milk products became widely available, both compensating for, and contributing to, the calamity of the drying-up breasts.

The time of the first breastfeed was arbitrary in those days, anywhere between 4 and 48 hours after birth, and my mother was instructed in the first days to restrict feeds to a few minutes each side, gradually building up to a maximum of 10 minutes. She says I was produced from the central nursery like clockwork every 4 hours, day and night. My mother spent 7 days as an in-patient learning the rules of the hospital’s breastfeeding management system. Although these scientific rules set many on a trajectory of breastfeeding failure, my mother and I were lucky: somehow, we adapted, and were among those who were able to continue breastfeeding.

Once home, Mum was expected to rely on the white-uniformed maternal and child welfare sister for mothering expertise. The local Methodist church, and her visits to that neat little weatherboard building owned by the Country Women’s Association, were the mainstay of her early life with children. During the week, clinic visits were an opportunity to dress up and get out and meet other mothers. Every Thursday for the first 6 months of my life, and then every Monday for the first 6 months of my sister’s life (who arrived just 13 months later), my mother sat patiently in the waiting room with the other women and their children.

Once called in, the clinic sister weighed and measured. She advised on infant feeding, ‘settling techniques’, and the introduction of solids at 6 weeks, starting with egg yolk. I was allowed 3-hourly breastfeeds for the first 2 or 3 weeks at home (which probably saved our breastfeeding), but from then on Mum had to go back to the strict 4-hourly routine. She could not pick me up between feeds, for fear of spoiling me. The maternal and child welfare clinic was the crucible, the examination: miraculously, my sister and I gained weight adequately, and Mum’s competence was established.

I learnt the art of delayed gratification early on, and was classified as a placid baby. Not so my sister who screamed with ‘colic,’ stopping only when the fourth hour came around and she was allowed the breast. Sometimes, Mum confesses, she would pick my sister up and feed her before time, because of her screaming.

"But you never cried, so I didn’t pick you up early," my mother explains.

I ask my father, "Was it alright for you to cuddle me at feed-times too Dad? Could you give me cuddles?’ Dad immediately grasps the significance of the question.

"I definitely did, love," he replies firmly, over 80 now, hard of hearing but mentally sharp. "I definitely did, at feed-times and when we went out."

"Other ladies lived in fear of the clinic sister, and hated her," my mother reports. "But she was always nice to me."

Adapted 3 November 2015 from 'Appendix 1: An Intimate History of Mother-Baby Care in the English-speaking World,' The Discontented Little Baby Book, UQP: 2011;pp. 208-221.

References

1. Carroll L, Alice’s Adventures in Wonderland, first published Macmillan and Co., London 1866; Books of Wonder, William Morrow & Co., Inc. New York 1992.
2. Douglas P, ‘Yummy Mummy and the Medicalised Milkmother’, Hecate, 2010;26:119-135.
3. Thorley V, ‘Initiating breastfeeding in postwar Queensland’, Breastfeeding Review, 2001;9:21-6.
4. Thorley V, ‘Midwives, trainees and mothers: maternity hospital conditions in postwar Queensland’, Birth Issues, 2001;10:101-6.
5. Thorley V, ‘Printed advice on initiating and maintaining breastfeeding in the mid-20th-century Queensland’, Journal of Human Lactation, 2003;19:77-89.
6. Truby King M, Mothercraft, Whitcombe and Tombs Ltd, Sydney, 1936, pp. 5, 66.

Image credits

My paternal grandparents Andrew and Lucy Douglas on their wedding day, Queensland 1919.