Birth, a Natural Part of Life

Midwife Problems, and Solutions, part 4

This is part four of a series on midwifery in Sweden and the United States. To read part one click here, part two click here, part three click here. 

     Johanna Hedén was poised: her hair, perfectly done in a Victorian up-do; her skin, clear and light; her nose, straight and petite, and her eyes, soft and friendly. This was the portrait of a woman who was professional and competent, the perfect image of a midwife. 
     She was born in 1837, actually a decent time to be a woman in Sweden. During her lifetime, she would see the beginnings of women’s emancipation. In 1845, a woman got the right to inherit her husband’s property, and in 1858, an unmarried woman over 25-year old was no longer considered her father’s ward. 

Portrait of Johanna Heden in the Swedish Journal of Midwifery, Jordemodern.

Certificate of training from the midwifery school in Goteborg, where Johanna Heden taught.

      For the independent-minded Hedén, marriage and motherhood was not all she wanted out of life. With the encouragement of a family she worked for as a maid (hembiträdande), she went to Stockholm to study midwifery. In 1858 at the age of 21, she passed the midwifery exam. As a woman, she could be a school teacher or a midwife. Her own mother had died in childbirth with inadequate help a hjälpgumma, an untrained birth assistant, so early on she saw the damage that a lack of knowledge and training could have on birth. Midwifery became her calling, and for twenty years, she delivered babies and taught midwifery.

     There were so many chances for Johanna Hedén’s path to diverge from not just becoming alias Syster Stork in Jordemodern, but becoming the mother of modern midwifery in Sweden. At the age of 40, she actually did marry and have a daughter. But tragedy struck: by 1880, her husband and child had both died. And this was one of those moments; perhaps if they had lived she wouldn’t have rededicated herself to her profession. She didn’t remarry and spent the rest of her life committed to elevating the midwife intellectually, socially, and economically.

Record of a birth, 1879.

     This elevation was not only for the good of the profession, but for the good of society. In 1863, one out of every ten women in Sweden would die during childbirth. Giving birth was probably the single scariest moment a woman in the 1800s would experience whether she was in Sweden or the United States. Labor was almost guaranteed to happen -- there was no reliable birth control, and pregnancy was dangerous. Women knew it was painful and could leave them permanently disabled or even kill them. A death left her family motherless, and soon, doctors realized this could be prevented. ​

E.W. Wretling portrait in Jordemodern.

     Dr. E.W. Wretlind wrote, “Birth is such a natural part of life, that one might imagine that no scientific aid from a trained person should actually be necessary.” But he knew the reality of the situation: scientific aid in the form of a trained birth attendant was necessary. 
     Wretlind was the perfect person to join Johanna Hedén. He too was accomplished and dedicated, and he had the privilege of being a man and well-connected. Wretlind was one year younger than Heden, and had studied at medicine at the University at Uppsala. He focused on physical therapy and opened a medico-gymnastic institute in 1867. 

     Wretlind met Heden in 1876, when they were both teaching at the midwifery school in Goteborg. He moved to Stockholm in 1886, and started publishing and was a member of the Parliament, both things that would make him invaluable to the Midwives Association. 

Johanna Heden and the first meeting of the midwives association, 1886.

The Swedish Midwives Association steering committee.

     ​Johanna Heden created the Goteborg Midwives Association in 1885, during a time when many Swedish workers were creating unions to advance fair pair and working hours. Perhaps Heden saw these as an inspiration -- some of her first goals were to make sure that all midwives were properly trained, and that there were mechanisms in place for fair pay and retirement income. Because of the way that Sweden was a central power, Heden realized that just having an association in Goteborg was not enough. The next year, she planned a meeting in Stockholm where all Swedish midwives would be invited. This was the first step in creating a national organization. 
          In 1888, Wretlind published the first issue of Jordemodern, which would serve as a tool for midwives to communicate about their practice, share new information and techniques, and be connected as a professional organization, which all served to create an increased pride in their work and occupation. ​

     The midwives association, the publication Jordemodern, and the community of midwives elevated the profession before there was even a serious discussion about the safety of childbirth in the United States, or England or Germany for that matter.
​     Sweden's commitment to regulation and education saved lives, a legacy that still lives on today. All women see a midwife and the focus is on the healthiest birth a mother can have. In the United States, 90% of women see a doctor, a surgical specialist. Birth outcomes show the difference of this culture and history: in Sweden, maternal mortality is 4 per 100,000 live births, while in the U.S. it is nearly three times as high at 14 per 100,000. C-section rates in Sweden are 17%, while they are 33% in the U.S. -- a number that the American College of Obstetricians and Gynecologists has said is too high. Infant mortality in Sweden is 2 deaths per 1,000 births compared with 6 per 1000 in the U.S.