I had an experience in Barbados in 1973 that changed my life. I was a 22-year old medical student, and chose to spend my two-month elective on the maternity ward of Queen Elizabeth Hospital in Bridgetown. I had never experienced health care outside our beloved Canadian system. It was a culture shock.
There were no screens on the windows, no hot water. Hospital food was rice and peas at every meal. I saw pathology that I had not seen before or since. I saw my first septic patient on death’s door following a criminal abortion. I was asked to do a pap smear and discovered a full blown carcinoma of the cervix, like a cauliflower. I realized poor women in Barbados were not getting preventive care like we have in Canada, although the Family Planning Association was able to boast they’d lowered the average family size from 10 children to 5.
Doctors were revered by these patients. They had faith that a physician knew all after a single exam; it didn’t matter if you had tuberculosis or an ectopic pregnancy. The patient thought that all they had to do was tell the doctor they had “da bad feels” and the doctor would be able to make the diagnosis. In my training we were taught that the diagnosis was 90% history, the patient’s story. I felt truly inadequate, unable to help, as I begged the patients to tell me more.
The maternity ward was different, run by midwives who operated in a parallel universe to the doctors and nurses. There seemed to be a hierarchy with an older matron in charge. These women were so calm; midwives made all the tough decisions in the maternity ward and doctors seemed to be called only called if sutures were needed.
Most of the women who came to the hospital already had a number of children. They therefore made it look easy! Families had to bring their own diapers and towels and baby blankets. One woman showed up with the whole kit and the baby too. She had accidentally delivered the infant at home but came to the hospital to get a break from the other children.
There was a huge open ward filled with forty mothers, and babies in tiny cots at the foot of every bed. Each mother looked after her own baby, perhaps with the help of relatives. I remember that ward with 40 babies all swaddled in the traditional way. I remember seeing the women plaiting one another’s hair. It was a wonderful community of healthy moms and babies. The system seemed to work so well, and it made me question why babies were separated from their mothers at birth and sent to the nursery back home in Canada.
I was born at the Wellesley Hospital in Toronto in 1950. It was an era when women were heavily medicated during birth. The activists described it as no parent being present as the child’s birth: father’s not allowed in, and mother’s drugged to unconsciousness! My mother was told she needed an elective Caesarian section. Unfortunately, they misjudged the dates and I ended up being born early at four pounds. My mother and I each had two Caesarean sections. Midwifery had no legal status in Canada.
Canada’s specialized medical model of birthing was built for the convenience of doctors. It was an interventionist approach. Medical students were taught to be frightened of obstetrics and of everything that could go wrong. Birth was a disaster waiting to happen. My experience in Barbados persuaded me that birth was actually normal.
I became an obstetrics activist. I was the first in my family to attend university, and received my medical degree in 1974. I did my residency at Wellesley Hospital and then went into practice there, determined to pursue family medicine in a very different way.
At my practice in the Annex in Toronto women arrived in my office armed with a copy of Our Bodies, Ourselves, the new bible on sexuality and reproductive health. They were all prepared to change the system. Whether it was about birth control or childbirth, Canadian women had begun to question the 1950s model of knocking women out and then wondering why they can’t have a baby.
Medicine should not be a repair shop. It must be focused on keeping people well. I didn’t want to be a doctor who just fixed things. Nurses and midwives needed to be an essential part of the team. My patients were not passive recipients of their care. They were empowered patient, effective advocates, and engaged citizens. Together we pushed for labour room deliveries and allowing families at the birth – only some of the reforms we take for granted today.
I learned from the midwives of Barbados that birth was a normal occurrence, where women did the work and the job of the midwife was to add expertise and ensure delivery was safe. I saw some thirty births in Barbados that winter of 1973, and probably another two thousand over my career. Each one was like the first birth I ever attended – a miracle, so often so beautiful, so wonderful, like a ballet, Mother Nature at her best.
I am so grateful that one experience, my days in the Bridgetown maternity ward, changed my life.
(Editor’s note: the author is six-term Liberal MP for St. Paul’s, Ont., and former Minister of State for Public Health)