In the colonial Caribbean, high infant mortality among the working class was a cause for great concern. While two Danish-born and trained midwives were sent out to the islands in the 1750s, they resided in the towns and served mainly the white population. On the estates, however, as high as 50 percent of the newborn children died. Counted in that figure were those who passed away during the birthing process and those who died in the nine-day confinement period following their birth.
Untrained enslaved women who were serving as midwives on the estates were seen to be the reason for such a loss of life. In the 1830s, Gov. General Peter von Scholten proposed that 10 native women be sent to the Lying In Hospital in Copenhagen to receive instruction; the burger council rejected the proposal as costing too much money.
In the 1870s, Frederiksted judge and police master, C.S. Sarauw, in a study he conducted found that 33 percent of the total number of infants born during the year had died. He compared the Crucian statistics with those of Denmark, where the infant mortality rate was 20 percent.
There were many reasons for the demise of so many infants. For the delivering woman there was the threat of toxemia, a condition in which there were poisonous substances in the bloodstream. This condition could easily lead to the onset of convulsions and eclampsia. For the baby, bacteria in the birth canal led to tetanus or lockjaw; impure water caused uncontrollable diarrhea.
In the estate villages where the greatest proportion of the population resided, living conditions were unsafe. With a lack of pit latrines, human excrement in the bushes seeped into streams and running water. From these sources, the household supply of water was collected and used to cook, wash children and the laundry. During heavy rains, flooding caused the further spread of bacteria in flowing water. As landlords, planters ignored and neglected the conditions under which the laborers and their family members lived and worked.
In 1885, chief doctor Kalmer put into action a portion of von Scholten’s plan by sending two Crucian women to Copenhagen for a one-year course in midwifery. They were part of a pan-Danish program in which women were also sent from Denmark’s outlying territories of the Faroe Islands, Greenland and Iceland.
With the implementation of midwives into each of the nine districts (quarters) of St. Croix, the rate of infant mortality decreased slightly. The contributing factors underlying high infant and adult mortality rates, however, were not addressed.
While the rest of the world was waging a war against bacteria, such a fight did not find its way to the remote estates in the islands until 1917, when the United States Medical Corps under the Naval Department gained a foothold and established a sanitation department.
Prisoners, U.S. Marines and Department of Public Works employees worked untiringly in cleaning out guts, re-directing flowing water, building cisterns and catchments in the hills and directing clean stream water from the hills to the towns, especially the hospitals. At the same time these sanitation procedures were being implemented, midwives were reassigned to the hospitals whereupon the role of the midwife took on a different philosophy.
One person at the crux of this transition was midwife-nurse Evelyn Richardson (1899-1989), who in two of her memoirs described this transformation.
At age 17, the same year as the Transfer of the islands, Richardson entered the nursing profession at the Frederiksted Municipal Hospital under the Naval Department. Her introduction to midwifery was through three native Danish West Indians who were part of the von Scholten legacy of sending women to be trained in Copenhagen. Besides formal training, these women had experienced many years working independently on five estates, each with 150-200 laborers, half of them comprising women of child-bearing age.
Sophia Cochrane Hill (1863-1938), Hilda Octavia Larsen Ford (1889-1980), and Maude Beatrice Abel Levy (1893-1968) were widows with children of their own.
Their role as midwives in the colonial society was a dual one. The colonial administration had sought their assistance as trained, authorized midwives to work to save a diminishing population. At the same time, the state wished to make them financially independent. For their services, they had a sliding scale rate, which they charged a woman depending upon her financial status.
With the funds that the midwives earned over the 30 years that they were in service, their names had been erased from the administration’s widows and children’s pension funds list. Before having become authorized midwives, they, as widows with children, had been entitled to monthly payments as they had formerly been married to Danish policemen or lower administrative clerks. Midwives also received monthly pensions after retirement.
Hospital deliveries
Richardson, in her memoir “One Moment of Glory,” recalled that in 1917, the Danish-trained midwives were reassigned to the hospital and were allowed to continue their practice of performing deliveries independently. Should a problem arise such as a lack of ante-partem procedures or a pending breech birth, they could depend on the assistance of a doctor on call.
The American doctors were gradually moving to delivering all babies themselves at the hospital. For women unable to be transported to the facility, an ambulance with a driver and a midwife fetched them (and their other children) from the remote estates. The children of the pregnant women then were cared for during the nine days of their mother’s confinement in the hospital at the nearby Queen Louise Home for Children.
Also, in the early years, the naval doctors permitted the Danish- trained midwives to deliver white and well-to-do African-Caribbean women’s babies at home. Such was the confidence the Naval doctors had in them. Gradually, However, as Richardson explained, the Danish-trained midwives were used for teaching the new recruits under the Naval system.
Richardson noted that her mentor, Hilda Larsen Ford, known as “Fordie,” had earned a diploma of the first class from the Copenhagen Lying In Hospital, which meant that she was the top student who had taken both the written and practical segments in the Danish language. Of her practical skills Richardson said, “She knew obstetrics to her fingertips and practiced it accordingly.”
American Medical System
Just as her mentor worked to be the top student, Richardson herself earned that accolade out of six young women studying to be nurse-midwives under the first set of Naval doctors. Richardson took Dr. William O. Bailey’s challenge and was rewarded with a paid position even before her graduation. She was assigned to serve as a nurse-in-charge at the Kingshill Poor Farm, now called the Herbert Grigg Home for the Aged, the former gendarme barracks which was reconstructed in 1920.
Richardson served for one year, before returning to her first love, obstetrics.
Unlike work in the countryside, at the hospital there was clean running water, washed bandages and linen and sterilized instruments. There was support staff such as ward nurses and laundresses and cooks. The nurses were housed on the top floor of the three-story hospital. There were regulated shifts and set hours of work. Richardson remembered that even though they worked 12-hour shifts, they were in town within walking distance to all the amenities of a vibrant hub. Richardson especially loved to hear the various Naval and local bands playing concerts on the gallery of the Customs House.
Nursing in New York
While under the American system, midwives did not have to individually charge their patients as they did in the Danish days, but were under a set annual salary as employees of the Department of Health. All might agree that the rate of pay did not compensate for the number of hours they worked.
Even before 1917, a number of Danish-trained nurses became disgruntled and resigned from midwifery in the Virgin Islands. In the Nov. 12, 1904 Avis, Lucinda Neumann and Sophia Awilda Olsen’s resignations were announced, and their replacements were announced. Soon after others followed, including Hilda Larsen.
In 1931, with the transfer of the Naval period to a civilian government, the administration of the islands was under the Department of the Interior. Richardson was promoted to supervising nurse at the Frederiksted Hospital.
According to the municipality of St. Croix budget of fiscal year 1933, a midwife was earning $1,500 annually. The same rate of pay was given to a school nurse. From the listing, Richardson would have been making $3,000 as a graduate nurse in the hospital, the same as the graduate nurses in Christiansted Hospital and the one assigned to the Insane Asylum. According to the salary scale, the nurse receiving higher wages than she was that of the head nurse at the leper asylum, who was earning $3,600.
One can deduce from the American scale of salaries that a midwife did not earn the rate of salary one would expect of a person who underwent additional training beyond that of a graduate nurse.
In 1936, after having served as supervising nurse for five years, she resigned and traveled to New York.
Once in the city, the Virgin Islands midwives were no longer able to practice their profession. Richardson wrote how she could not get used to seeing male doctors as the central authority in the delivery room.
Richardson worked at Beth Moses Hospital in Brooklyn. Under the American system, she had to take further classes in order to qualify as a registered nurse and was approved to practice nursing in New York City (Outstanding Virgin Islanders).
Due to the additional courses required for a nursing position, other former Crucian midwives chose lower positions such as nurse assistants or became nurses for private families.
Richardson worked in the city, was a lover of music and had joined the Metropolitan Opera support group, and sang in the Church of the Transfiguration choir. After 26 years, she retired and returned to Frederiksted.
Reflections on nursing
In the preface to her memoir, Richardson admired “the rigorous attitude and firm manner” that the Naval personnel took “in maintaining the hospital and all areas of sanitation.”
From the start of her tenure as a nurse in Frederiksted, she sensed that “a new heightened medical awareness” was afoot, something that had never been experienced in the islands previously. She felt that “the hospital and its programs reflected the noticeable changes brought about by the Naval Administration in the entire island.”
She reflected on her decades of dedication to midwifery: “Being a midwife was a form of service and a source of material reward, but even more than that it was an inner calling: an assertion of being.”