Sunday Morning ~ The Right Place at the Right Time
Mimba si kupha namwino. ~ The pregnancy does not kill the midwife.
~ Chewa proverb
November 5, 2023
At the Common Ground Fair in September, a woman came to our table in the Health and Healing tent and asked about the role midwives play in Maine. She had a friend in Augusta planning a memorial for Martha Ballard, a colonial midwife, from that area. I told her I knew the story of Martha Ballard very well and use the book about her for a course I teach on the history of women’s health care. The memorial was news to me and I was intrigued and excited. Could we possibly highlight midwifery and the good it could do in this state? I contacted the organizer and learned the celebration was still in the planning stages, but there were two events, one in the park where Martha Ballard’s statue would be situated, and one at the governor’s mansion in November. On September 27th I drove two hours to the park where the Kennebec river and Bond Brook meet. This is where Martha lived crossing the river frequently by canoe and on foot over the ice to tend her patients. There was music and food and local officials eager and enthusiastic about creating this park. I was impressed. Three of Martha’s descendants were there and each spoke eloquently about their ties to the area and her legacy.
Connie, the organizer, greeted me eagerly as if we were long lost friends. She asked me if I could get other midwives to attend the tea at the Governor’s Mansion on November 2nd. I told her I’d put the word out via the mailing list and was sure some would come. “Tell them the governor will be there. And, would you be a speaker? Would you do that?” she asked me. Without knowing what I would speak about I told her “I’d love to!” always eager to promote this profession. I had a month to think about it, but my many distractions with house guests and preparing my year away led me to a week of panicking as I tried to organize my thoughts.
I’d written many notes about Martha Ballard. I’d written personal reflections on each chapter of the book; I related to her in so many ways. In my class I used the book to compare her practice with current midwives’ and how health care for women is delivered now. We examine how medicine creeped into the care of women during pregnancy and birth and took it over, resulting in worse outcomes and more invasive treatment. I wrote my speech then edited out the anger. It’s tricky. I wanted to honor Martha Ballard while educating the audience about how far we have fallen. The press would be there. How often do you get a chance to speak to the governor?
A week before the event a gunman killed 18 people in our state, wounded thirteen others, and traumatized hundreds. We wondered if the event would be cancelled. It was not, but Governor Janet Mills was not able to attend. Understandable. It was exciting nonetheless, and though my mouth was so dry from nerves I had trouble articulating words, I got the message out, hoping ripples spread.
Here’s what I said:
Clara Barton, founder of the American Red Cross and grand niece of Martha Ballard, wrote “From the storm lashed decks of the Mayflower to the present hour, woman has stood like a rock for the welfare and the glory of the history of this country, and one might well add…unwritten, unrewarded, and almost unrecognized.”
Recognition of women in this country has improved since those words were written, but the profession of midwifery is still misunderstood and under-appreciated. For that reason, I am thrilled that midwifery is being celebrated here today with the incredible story of Martha Ballard.
I was a practicing midwife in Bar Harbor when A Midwife’s Tale was published. Its author, Laurel Ulrich was the keynote speaker that year for the American College of Nurse-Midwives and described her experience of discovering Martha Ballard’s diary. Though it had been disregarded by male historians as trivial and unimportant, she saw it as a rich text filled with detail about the role women and midwives played in colonial society.
With so little history told through the voices of women, Ulrich had the skill to take this diary and weave it into the story of Martha’s life, and the life of her community. Most women of that time could not read or write. The daily work of maintaining home and family was more than a full time job for them. There were no hospitals, yet society depends on a healthy population. Women were the healers and survival of the community depended on them.
From Martha’s diary we learn that a vibrant economy existed among women that was also vital to the survival of the community. Martha’s documentation of barter and exchange is an extraordinary description of an economic system of highly valued domestic work. Warping, weaving, quilting, carding, knitting, gardening, washing, all were essential jobs and part of the female economy.
Midwifery is a profession requiring long periods of time away from the home. In Martha’s time a midwife’s career began around age fifty after their children were raised. Martha documents a communal system of women providing care with a deep spiritual connection to their environment. It makes one acutely aware of how desperately they needed each other. If no one was home tending the hearth for Martha, she could not be out attending to the sick and needy. In this isolated setting, neighbors were dependent on each other, and professions were dependent on their children’s gender for success. For example, farmers depended on having sons; a midwife was more able to tend her patients if she had girls to tend the home.
Martha was the first person in this country to keep a record of vital statistics. Without explaining why, she recorded each birth, the sex of the baby and condition of both baby and mother. From these records, Ulrich calculated Martha’s complication rate at 5.6%. This is remarkably consistent with current midwifery rates of 6%. We know from Martha’s diary that 38% of babies were conceived out of wedlock, debunking a social myth of that time. Birth certificate data is now used for determining health care policy, allocating funding, hiring staff, planning for schools and public health services. Could Martha have imagined any of this?
Midwives are healers and have always cared for the poor and underserved; they still do. In the dark ages, women healers were feared and eliminated, often violently. They took with them wisdom and knowledge of ways to tend the poor and desperate, people who then suffered more desperately from the loss of their caregivers. Though modern persecution does not include being burned at the stake, elimination of midwifery practice still exists. In rural communities all over this country, women’s services are being eliminated and, I believe, is a form of gender and professional discrimination. Midwifery services are the most cost effective means of providing women’s health care, with lower complication rates and healthier outcomes.
We know from Martha’s diary that her birth numbers changed from year to year. She did not, however, discontinue serving women because of fewer chances to profit. In Maine, eleven rural hospitals have discontinued maternity services even though midwives could provide safe, respectful care in those communities. Studies show women have the healthiest pregnancy outcomes when they are cared for by a trusted member of their community close to home, or at home. The CDC reports that 84% of maternal deaths are preventable. This means having a trusted, skilled caregiver available. There were not enough midwives to care for the growing population in Maine in the early 1800’s, and today we have a similar story.
Martha describes her travels to attend patients. She documents long and sometimes dangerous journeys to care for women in need as opposed to writing about the birth itself. Ulrich surmised that, “Martha, having mastered her craft, had no need to describe it. It was the journey that was the story.” Our current practice makes vulnerable women do the traveling, leaving their families and support systems, forcing them to do this on small roads in winter storms and summer traffic. Wouldn’t it make more sense to have a Martha Ballard in every Maine community?
Despite her advanced years and physical limitations, Martha did not hesitate to run to a neighbor when there was a report of physical violence. She was called and she went, and she dealt with the situation she found. In the aftermath of that violence Martha describes sitting with a traumatized woman and doing ordinary tasks, understanding that familiar rituals are necessary in times of confusion, chaos, and despair.
Martha’s craft was learned by apprenticeship, what we now describe as clinical teaching. Currently there are few midwifery education programs nationwide and none in Maine, despite the desperate need. Creating an education program both for Certified Nurse Midwives and Certified Professional Midwives is necessary and possible.
Martha’s diary documents physician involvement leading to increased maternal mortality. Aggressive maneuvers led to higher rates of infection and hemmorhage. She mistrusted the new young doctor in town. He had a higher fee and higher complication rate. Martha doesn’t record training another midwife to carry on her role after her death. It’s not known whether no one showed interest, or didn’t have the calling, but Ulrich wondered, “did the aggressiveness of the new doctors discourage younger women from practicing midwifery?” Now, when looking at how to best care for women in Maine, Martha Ballard’s diary provides historical context and insight and we should be paying attention.
Martha attended a birth on April 26,1812 and died about a week later. In her last diary entry she wrote “made a prayer adapted to my case” then signed her name. At a time when women had to surrender their names and identity to men, she was wise enough to know how important her name was.
In closing, I have five lessons to take from Martha Ballard:
1. Live the life you are passionate about
2. Be devoted to your community
3. Be respectful in caring for others
4. Help your neighbors
5. Storytelling is powerful. Tell your story
Thank you to those who are telling Martha’s story, recognizing what a midwife contributed to this state, to the people she cared for, and to this young country.
The Blaine House
November 2, 2023
Love to all,