INTERVIEW WITH Dr. BEN TOANE By Gudrun von Selzam previously published in Birth Issues Fall 1999
Gudrun von Selzam : When did you start being involved in home births, and how did your colleagues react ?
Dr. Ben Toane : I started doing home births in April 1978. I recognized that I would need the assistance of midwives to monitor the progress of labour. Several midwives who worked in city hospital case rooms helped me until the late summer/early fall of 1978 when I made contact with Noreen Walker who was present for the birth of my first daughter, Carey, on October 3, 1978. Soon after, Sandy Pullin returned from working as a nurse in Whitecourt to join our home birth team. The atmosphere was extremely charged in those early days as the College of Physicians and Surgeons discovered that I was involved in home birth and made it clear that in the event of any civil litigations by patients, I would find no support from the College for my position. The early books from NAPSAC (National Association of Parents and Professionals for Safe Alternatives in Childbirth) were a source of inspiration and guidance for me. In the absence of any medical support for my position in Alberta and indeed Canada, these gave me support for my position that providing a safe alternative at home was indeed legitimate.
Gudrun : You organized the first meeting of people concerned with child Birth Issues over 20 years ago. What were the motivating factors – the hopes and concerns at that time?
Ben : I soon realized that a large part of the success of a safe home birth program would be to involve the consumer, that is the parents, in organizing themselves. This involved the active participation of parents to express their needs for particular birth experiences, to provide mutual support for each other in the face of a lot of public opposition to what they wanted, and to start the political lobbying of hospitals and licensing authorities for physicians and nurse midwives. I felt that a good way to carry this out would be to form a local chapter of NAPSAC in Edmonton. This would use the umbrella of an already established organization, which was gaining credibility through its conferences on alternative child birth practices and publications available to convince the powers that be that there was some objective verification going on. So, in 1979 I drafted a letter introducing these ideas and sent it to all my patients , past and present, who had expressed an interest in home birth and other alternative child Birth Issues, and to their friends, inviting them to a founding meeting for an association of consumers and professionals. This took place at the home of Ray Rasmussen and Sandra Dowie, with close to one hundred people attending. After a few introductory comments about my hopes and concerns, I turned things over to the meeting itself to establish the origins of the organization, which later formally joined NAPSAC as the Association for Safe Alternativse in Childbirth for Edmonton. The hope was to provide some protection for the professionals from conservative and hostile professional groups such as the College.
Gudrun : When and why did you stop attending home births ?
Ben : I continued to be involved with attending home births until the end of 1980. Sandy and Noreen would attend the labouring women at home and I would come closer to the delivery. Very soon the midwives proved their expertise and I was left to be present as needed for medical back-up, should complications occur. It was very much a team approach with all members of the team providing equal input into decision making. In those early days the biggest thing that I provided was a legal umbrella so that the midwives could function and learn their craft. As home births became more frequent and more public, the College of Physicians and Surgeons flexed its muscles by making it more difficult for physicians to legally involve themselves in home births. They passed a ruling which by the end of 1980 forbade physicians to attend home births unless they had active hospital privileges. I had lost my courtesy privileges at a local hospital because of my involvement in home births. So, in essence, it was a way of trying to stop home births without outright banning physician involvement. There was probably about half a dozen births towards the end of 1980 where I sat in a car outside the door waiting for the birth to occur should I be needed in an emergency situation. In early 1981, despite a comprehensive presentation of research to the College, it saw fit to outright ban physician involvement.
Gudrun : How do you feel physicians can make a difference in the way pregnancy and childbirth is handled these days ?
Ben : Physicians can make a huge difference in the way in which pregnancies and childbirths are delivered. The most important thing they can do it to acknowledge to the pregnant woman and her partner that pregnancy and childbirth are first and foremost normal, natural events which in all likelihood will proceed safely and without complication. I believe that a physician should do everything possible to reaffirm the woman’s ability to birth normally and naturally. He or she can do this by their attitudes and conduct throughout the pregnancy to support what the pregnant couple is doing to educate themselves and prepare themselves physically, emotionally, and intellectually for their birth experience. He/she can do so throughout the labour process by patiently watching the natural process unfold and only intervening if absolutely necessary. Physicians can also involve the patient along every step of the way by educating them and informing them about their options and their ownership of their birth process. The physician has to realize that although he/she may have hundreds of deliveries throughout their career, most parents may have just a few such experiences. These experiences, if made meaningful by their active participation and their taking personal responsibility, will set them on the pathway to more affective and loving parenting.
Gudrun : Please share some of your memories related to ASAC and the childbirth movement with us.
Ben : Probably one of the fondest memories is the actual founding meeting of ASAC in Edmonton. This was the coming together of a passionate group of people in a time of great change and unfolding options here in this city. My compliments are to those early women and their partners who had the courage to stand up for what they really wanted and put their money where their mouths were, so to speak, by forming an organization and doing all the hard work necessary to make their views known. The other very memorable moments were at an ASAC conference in 1981 held at Grant MacEwan College, which was very well organized and involved leading representatives of various options in natural childbirth from the city and from the United States. Physicians and nurses from all over the province were invited and I believe the conference was a real pioneering event in the history of alternative childbirth here in this city. Also memorable were the ASAC sponsored visits by Dr. Robert Mendelson and Shiela Kitzinger to Edmonton. These were two of the individuals who added their genius to this movement. I remember when Dr. Mendelson presented obstetrical rounds at the University Hospital to an extremely hostile reception. As a Chicago-born physician he was completely unperturbed by this response. A very irate obstetrical resident shouted at him from the back of the room stating that he would be responsible for the death of any baby who dies at home in the province. The resident demanded the references to the statements made in Dr. Mendelson’s books: Male Practice, Confessions of a Medical Heretic. Dr. Mendelson clamly told him that all the references where held by his lawyer in a safe in Chicago and that if the resident wanted the resources he could look them up himself. After all, Dr. Mendelson had to do so. He took great delight in translating the name of Dr. Roy LeRiche, a controversial registrar of the College of Physicians and Surgeons in Edmonton, saying, “Only in Alberta would the registrar have the name The Rich King”. It must be added, however, that really we can credit Dr. LeRiche with the establishment of midwifery as a profession in this province, because he single handedly convinced physicians to prohibit their colleagues from attending home births in this province, thereby leaving the door open for the venerable profession of midwifery to find its rightful place.
Dr. Ben Toane is a family physician in Edmonton, Alberta, who has been a long-standing supporter of midwifery and home births. 30 years ago he initiated a meeting that brought together a huge group of people who later founded the Association for Safe Alternatives in Childbirth (ASAC). He practiced with midwives Noreen Walker and Sandy Pullin.
Gudrun von Selzam home birthed three children including twins. She is currently working as the Nursery school teacher for the Waldorf Education Society of Edmonton. She has been a member of ASAC since 1992, and a past editor of Birth Issues Magazine.
NOREEN WALKER: EULOGY FOR MAY 7, 2017, CELEBRATION OF LIFE As read by Dr. Benjamin Toane
Good afternoon every one!
My name is Benjamin Toane and, for those of you who do not know me, I am a family physician who has practiced in Edmonton since 1977.
I am here today to honour Noreen Walker, midwife extraordinaire and really the mother of modern midwifery in Alberta. She has deeply touched all of us in so many ways over the past 39 years, helping us to fulfill our hopes and dreams for safe and meaningful childbirth experiences.
First of all, can you tell me how many of you ladies in this room have had a home birth or a birthing center birth or hospital birth with a midwife? How many of you have had Noreen as your midwife? How many of you kids have been born at home or in a birthing center? How many of you kids were caught by Noreen? I say caught because really, it was your mothers who delivered you.
We are all, today, members of a very special human tribe. We honour and treasure children. We honour women especially in their roles as mothers. We honour families and their greater communities who help them raise their children. We honour and treasurer all of life’s transitions, the special and pivotal events of life, especially childbirth. We want to make childbirth – not only safe but – a powerful, emotional, even spiritual, experience that binds us deeply to our newborn child and to our families. We want to give women and their partners the freedom of choice to determine the kind of birth experience they desire and to support them in all ways possible to make this experience as natural as possible.
I would like to give you a brief history of home birth and midwifery in this part of Alberta over the past 39 years. Noreen Walker is at the center of this. She helped to birth this story.
It started in 1978. As a young family physician, I moved from the Peace River country to Edmonton in the fall of 1977. I was very interested in obstetrics and had been entranced with natural childbirth, particularly a delivery program called Leboyer birth without violence. I have no idea why this happened, but it was not long before women began to approach me to help them have their babies at home. First, as a product of conventional medical training, I gave the conventional opinion about childbirth and home birth. I told them that home birth was unsafe, that too many things could happen in childbirth to risk this as a location for birth.
Somehow or another, these women’s earnestness affected me and I started to do some research. I read everything I could about childbirth practices in Europe and the United States. I learned that actually, homebirth could be very safe.
I remembered stories about my aunt Thale who was a nurse proudly catching babies in the late 30s, 40s and 50s in the Bon Accord area, just north of Edmonton, in the occasional unplanned situation.
I was told stories about my great-grandmother, Clara Simpson, who was a midwife in the Waskatenau and Newbrook area, north-east of Edmonton, in the early 1900s.
Very strongly, I was influenced by the fact that my wife was pregnant with our first child, due in early October, 1978. We deeply wanted natural childbirth: natural childbirth at home.
On the negative side, when I sought input from the College of physicians and surgeons, the licensing body for medical doctors in Alberta, I was told that while homebirth itself was not prohibited at that time, the risks were too high. “Why would anyone want to have the baby at home anyway while hospitals were so safe?”
More importantly, a colleague warned me that participating doctors could find themselves open to legal and disciplinary problems should they participate, and that they would have no support from the College in the event of a complication that occurred at home and if a malpractice suit was brought by the patient.
Despite all this, I finally decided that it was not that I believed that birth at home was unsafe, or that I as a physician could not assist women safely. It was that I worried what my fellow physicians would think about my doing homebirths and what my College would do to me if anything went wrong.
I remember thinking that if these women were responsible enough to request knowledgeable backup for their pregnancy and childbirth, I could set aside my apprehensions and fears and do it.
So, I plunged in. I gathered all of the equipment, the instruments, the oxygen, the medications I thought I might need and waited for my first client.
The first birth that I attended was with Linda Peters on April 2, 1978. In customary irony, there was a complication after delivery which required Linda’s transferring into the hospital. Mother and baby were well but I had my first taste of the disapproval of my medical colleagues.
Somehow, in my stubborn and determined way, I persevered. After all, I was going to be a father in October and I had better get prepared, but (big but), as a practicing family physician with patients to see in my medical office, I knew that I could not do this alone: that I could not do this without help.
I needed a midwife to go to the woman’s home when she was in established labour, to sit with her and make certain that her labour was progressing normally and to support her in the hard work of labour. For the first four or five births, I found a few case room nurses who would help if they were not working.
Then, in the summer, or early fall, of 1978, something wonderful happened to me: somehow, Noreen Walker and I found each other. I soon discovered that Noreen had a calling. This was what she wanted to do with her career and her life, to help women have babies. Noreen had a friend who shared her passion. With very little persuasion, Sandy Pullin left her nursing job, I believe in White Court, to move back to Edmonton to join our birthing team.
Looking back, I feel like a big brother. I provided a legal umbrella for those dangerous medically political times for Noreen and Sandy to developed their skills, gain experience and confidence. They attended births and, when a few hours before delivery seems reasonable, they would call me and I would come to the home. Very quickly, perhaps from my perspective too quickly, they got to catch all the babies. I was there as medical backup and, happily, that was only occasionally required. I had to do something, did I not? So very soon, if there was not an assigned photographer, I took the pictures. Those homebirths, like all of the ones that Noreen, Sandy and all the subsequent midwives have attended, were very exciting and magical. With partner, children, mother and fathers, and friends surrounding the bedside, there was rarely a dry eye. Then, with mom, baby and birthing bed cleaned up, and baby nursing, we got to celebrate: good food, birthday cake, and probably wine or champagne to toast the new mother and baby. It was always special afterwards, to leave the family in the comfort and security of their own homes with their new baby and family. Noreen and, or, Sandy, along with myself, would check back for the next few days.
Noreen was made for this calling. She was very calm and natural. She was very knowledgeable and confident and quirky, a little bossy in her offhanded way. She was perpetually smiling or laughing and always putting everyone at their ease. She wanted women to know if they could do this, and they were made for having babies. As only a competent and confident midwife can do, she instilled calm and confidence in her mothers and, as a result, I am certain that their labours and deliveries went more quickly and smoothly.
In the first few years, Sandy and Noreen would come to my office and carry out prenatal care along with me. A little later, they rented rooms upstairs in my office and gave prenatal classes in the big living room there.
I said earlier that I felt like a big brother in those early days. I provided some guidance, knowledge, and protection. Then, in 1981, my College finally laid down the law that prohibited Alberta doctors from involvement in home births. I was forced to stop. Noreen and Sandy grew up and moved on, no longer needing a big brother.
That took a tremendous amount of courage as they never were quite sure whether my College, and the law, would come after them. That was indeed borne out a few years later for Noreen and, despite all adversaries, she hung on and continued to provide the competent and personal care she became famous for. Later, with the help of consumer organizations like the Association for Safe Alternatives in Childbirth, midwifery became a legal and recognized profession: finally to be financially supported by our health care system. The bottom line was, Noreen wanted to be left alone with this wonderful tribe, to be left alone to catch babies, and she did that up to a week or so before she died.
So please tell your birthing stories to your kids, to your friends, to your families, to everyone who needs convincing, so they can believe that childbirth is safe, normal, and natural. It is not to be feared. It is to be anticipated as one of the most profound experiences of our lives.
I believe that this is what Noreen would want us to do.