For much of Quebec’s history, childbirth was a deeply personal, community-centered experience. Families welcomed new life at home, surrounded by loved ones, with midwives offering guidance and support. However, the landscape of childbirth shifted dramatically in the mid-20th century, moving from home-based births to highly medicalized hospital settings. This transformation had profound implications, not only for those giving birth but also for broader societal perceptions of autonomy and maternal health.

To understand this shift, we spoke with Andrée Rivard, a birth historian, associate professor, and lecturer at the Université du Québec à Trois-Rivières. and Raymonde Gagnon, a midwife and professor at the Université du Québec à Trois-Rivières. Their perspectives reveal how these changes shaped birthing experiences, impacted families, and continue to influence birthing practices today.

A Look Back: Birth in the Early 20th Century

In 1926, 95% of births occurred at home. This “was a matter of tradition,” explains Andrée Rivard, “but also, of course, the perfect symbol of a safe and familiar haven; the family home was the most natural place to give birth.” Home also served as a space of “privacy,” a value increasingly emphasized in modern society.

Births typically occurred with a doctor’s supervision, often in an interventionist manner. In rural areas, a local midwife occasionally assisted with the delivery, while in remote regions, this responsibility often fell to so-called “colony nurses.” Their obstetric practices were comparable to those of midwives.

Those who give birth outside their homes do so out of obligation and typically go to maternity hospitals (most general care hospitals do not accept deliveries unless there is a serious danger). This marginalization condition leads them to such places, akin to a pregnancy outside of marriage. The most significant maternity hospitals were affiliated with a university, enabling medical students to practice on parturients (people in labor), “in a state of absolute submission, the novelties conceived as scientific.” Stigmatized, they “had nothing to say about their treatment, most of the time harsh and unfair.”

The Transition to Ultra-medicalized Childbirth

In Quebec, the historian continues, “the transition to hospital delivery care gained momentum in the mid-20th century. The tipping point, when the hospital delivery rate surpassed fifty percent, occurred in 1950.” Ten years later, this proportion had already increased to 85%, before rising to 95% in 1962. The shift was thus significant.

Several factors were behind this change, including:

• The process of modernizing the hospital network by opening maternity wards in general hospitals.
• The expansion of private hospital insurance coverage and the introduction of public hospital insurance in 1962.
• The messages of public health authorities, sometimes relayed by the media, emphasize feelings of absolute security and comfort.
• The refusal of doctors to support home births.

The decline in maternal and perinatal mortality rates, largely due to improved living conditions, enabled authorities to showcase the hospital’s advantages. “The hospital not only allows expectant mothers to avoid the terrible deaths associated with a dark past and the pains of childbirth, but it also ensures fragile newborns receive the best care […]. Moreover, the new mother […] will be able to enjoy comfort during her stay […]- comfort worthy of the best hotels!”  This, in any case, was what they wanted to convince the mothers to believe.

The Consequences of Hospital Transfer of Childbirth

The hospital has “completely transformed” the experience. Upon her admission, the “parturient” is separated from her partner and subjected to preventive and monitoring practices. Confined to her bed, she receives medication that induces drowsiness and regulates contractions. During the expulsive phase, she is transferred to the delivery room and placed on a table where she is immobilized before being “put to sleep” (general anesthesia will be supplanted in the early 1970s by alternative methods of anesthesia, including epidurals).

Episiotomies and forceps are common. “What has only been called obstetric violence for a few decades was once a common practice,” the historian emphasizes.

The suffering of indigenous people was worse, particularly because they were forced to give birth outside their communities, in hospitals often far from their homes, and some were sterilized without their consent.

The psychological impact is considerable. “Women’s testimonies illustrate how negative emotions continue to affect them, even decades after giving birth: feelings of resentment, shame, sadness, a sense of having been robbed of their childbirth experience, or even feeling violated.”

The Rise of Technology in Births

In the latter half of the 20th century, the technologization of birth further changed childbirth experiences. Raymonde Gagnon explained, “With the rise of technology and the culture of risk, pregnancy and childbirth have become highly medicalized. A ‘successful’ pregnancy is now perceived as inseparable from technological advances, which are considered reassuring.”

Although medical imaging and early detection have improved maternal care, their overuse has created new problems. According to Ms. Gagnon: “Ultrasound now tends to replace the emotional connection with the baby. The systematization of interventions, like the intolerance of pregnancies beyond the expected due date, erodes trust in natural processes and increases dependence on medical experts.” This development has not only medicalized pregnancy, it has also transformed decision-making processes, often to the detriment of the autonomy of pregnant people.

Challenges in Modern Birth Practices

Challenges remain despite growing awareness of the need for respectful and personalized childbirth. Obstetric violence – ranging from coercive medical practices to lack of informed consent – continues to be an issue. “Too many people still experience obstetrical violence, with a higher prevalence among racialized, Indigenous, and marginalized people,” Gagnon stated, citing recent studies on the issue.

Despite the growing demand, access to midwifery care remains limited, particularly in rural areas, depriving many of the genuine opportunity to give birth as they wish. “Regional disparities are partly explained by differences in medical practices and the merger of institutions, which has led to the creation of large birth centers,” she continues. “To manage these centers, strict policies and procedures are implemented, which deviates from the personalized approach essential for an intimate event like birth.”

The Movement’s Role in Defending Childbirth Autonomy

Faced with the growing medicalization of childbirth, our Movement has firmly committed to defending the autonomy of pregnant individuals, striving for both systemic transformation and the preservation of the right to informed choice. For several decades, we have actively advocated for the development of midwifery services, the legitimate recognition of births outside hospitals, and the protection of the rights of pregnant individuals, confronting a system that often prioritizes medical control over self-determination.

Our organization has played a crucial role in assisting policymakers in expanding access to midwifery services and birthing centers through continuous advocacy, public awareness, and community support. Our efforts have empowered more individuals—regardless of their location or financial circumstances—to access a birthing experience that aligns with their personal values.

Andrée Rivard emphasized the crucial role played by the Movement’s activists from the very beginning. “They were very active in the mobilizations aimed at securing the legalization of midwives in 1999, marking a significant step in women’s long march toward expanded choices regarding their childbirth.”

Our activism extends beyond the political realm. We work directly with families to guide them through restrictive hospital protocols and to amplify the voices of those who have experienced obstetric violence. As Ms. Gagnon emphasizes the importance of continuing this mobilization: “The Movement plays a crucial role in this fight by enriching collective reflection and uniting energies. It is essential to bear witness and take action to improve childbirth conditions in Quebec while combating fear and misinformation. In doing so, it helps counterbalance the dominant narrative.”

Looking Ahead: Hope for the Future

Despite the slow pace of change, Gagnon sees signs of progress. “There is momentum emerging toward greater awareness, both in society and among professionals, of obstetric violence and the importance of respectful care,” she said. “Professional bodies are more attentive to abuses and are taking greater action to prevent and manage breaches.”

Recalling Simone de Beauvoir, Andrée Rivard emphasizes that “women’s rights are never a guarantee.” They must always remain vigilant about their maternity rights. “Hope lies in individual and collective social action, in vigorous activism.”

Personally, she wants to “uncover a history of childbirth that is full of hope. […] What Quebec women are currently experiencing is only one chapter in a very long story. All that remains is to close this chapter and move on to another, happier one. We are the ones writing.”

As we reflect on the history of childbirth in Quebec, it becomes clear that advocacy and mobilization remain as crucial as ever. By amplifying the voices of birthing individuals, advocating for policy changes, and protecting birth autonomy, we continue to push for a future where every person has the right to a respectful, informed birthing experience. We invite you to join us in this fight by sharing your birth story, supporting our advocacy work, or exploring resources from experts like Andrée Rivard and Raymonde Gagnon.

We invite you to discover the books written by our featured guests:

Raymonde Gagnon: Experiencing Pregnancy and Giving Birth in the Age of Biotechnology

Andrée Rivard: History of Childbirth in Modern Quebec
Of Birth and Fathers: A History of Fatherhood in the 20th Century