A high-profile iconoclast within the field of obstetrics, Dr. Murray Enkin, who died in Victoria on June 6 at the age of 97, devoted much of his long career to humanizing the birth process for mothers and babies.
During the 1940s, as a medical resident, he had been appalled by what women endured during procedures, considered routine, for labour and delivery. Decades later, the memory of what he had witnessed still made him angry.
“Unless you were there, you can’t really believe what obstetrics was like,” he once told an author friend. “As soon as [an expectant mother] entered the hospital she ceased to be a woman. She became a patient, was put into a wheelchair, separated from her clothes, separated from her support people, her husband or anyone else, wheeled upstairs and was almost immediately given a narcotic … the most popular was heroin … and a barbiturate sedative as an amnesic. She became screaming and demented. The sounds in a labour room were similar to what you would expect in a torture chamber. And when she became fully dilated she was put to sleep with chloroform or ether and the baby was pulled out.”
Aghast at routine medical interventions that he felt were unnecessary and potentially harmful in a natural process, Dr. Enkin arrived at an unwavering belief that every woman should have a say in the delivery of her child. He considered personal choice and autonomy to be basic rights for all birthing mothers.
Those rights, now taken for granted in Canada, were once unthinkable. Opposition was fierce. Numerous colleagues, various hospital boards, a few drug and medical technology companies, even some patients disagreed with Dr. Enkin, but he refused to back down.
He insisted archaic birthing practices had never been proved to be beneficial and, to him, proof was important.
“Evidence is the best rhetoric,” he would say to opponents, with a mischievous twinkle in his eye. “Facts without feelings are useless. Feelings without facts are dangerous.”
This approach led him to become a pioneer in the emerging field of evidence-based medicine, although he wouldn’t entirely discount personal narratives in favour of statistics. His worldview could accommodate both.
In 1961, the non-profit International Childbirth Education Association was formed to support educators and health care professionals who believed in family-centred maternity and newborn care. Dr. Enkin became a speaker and advocate for the group, as well as a contributor to a number of influential books and papers on care during pregnancy and childbirth. Dr. Enkin believed in educating women about their options before, during and after delivery.
He proposed partners could be present during the birth process if mothers so wished, encouraged rooming-in with newborns, and he became a champion for the emergence of midwifery as a recognized profession in Canada even as other professionals disagreed.
In 1985, during a coroner’s inquest into the death of a baby following his delivery in a midwife-assisted home birth on the Toronto Islands, Dr. Enkin was called as an expert witness. After listening to what had transpired during the birth, Dr. Enkin said, “I don’t think I would have done anything different.”
Vicki Van Wagner, a midwife, now an associate professor of midwifery at Ryerson University, said his answer brought her to tears. “His support was so significant because midwives were working outside the health care system and had no protection against legal action or sanctions,” Prof. Van Wagner said.
Dr. Enkin testified the best available data seemed to indicate home births were safer than hospital births and had lower rates of medical intervention.
Another response that endeared Dr. Enkin to midwives during the inquest was: “You’re asking me about best practices. I’m not trained to do home births. You’ll have to ask the midwives what best practices are.” The case, and Dr. Enkin’s testimony, contributed to the establishment of midwifery as a recognized profession in Canada.
In 2013, for his efforts on behalf of midwifery, and for his innovative contribution to obstetrics, Dr. Enkin was invested as a member of the Order of Canada. It was the second such honour in the Enkin family. In 1983, Dr. Enkin’s father, Max, the successful owner of a menswear clothing company, was named to the Order of Canada for assisting the federal government to integrate thousands of displaced persons, many of them Jewish tailors, into Canada after the Second World War.
Murray William Enkin, born in Toronto on May 29, 1924, and his brother Larry, born four years later, made up the well-to-do family of Max and Pearl Enkin. At Oriole Park elementary school in Toronto, Murray developed a love of books, poetry and music. He also stumbled across philosophy. At the age of 8, he experienced what he called his “moment of enlightenment”: He decided he was an atheist. His parents would have none of it. They told him he could become an atheist if he wanted, but not until after his bar mitzvah.
In those days, when not tinkering with a chemistry set that once sent smoke billowing through the family duplex, he played at being Tarzan. A swing in his backyard became a vine with which he could traverse the jungle to rescue Jane.
“My father had a natural affinity for women,” Dr. Susan Boron said. “He tended to see himself as their protector and enjoyed their company.”
One woman for whom he felt a strong affinity was Eleanor Wolfe, a domestic science student at the University of Toronto and a music enthusiast. At the time of their meeting, Murray was studying medicine at U of T. He had wanted to study chemistry, but his father told him that during antisemitic times it was better to be your own boss, so he should study medicine instead.
Dr. Enkin followed his father’s advice, graduating in 1947, and marrying Eleanor shortly afterward. She remained his constant love, confidante, travel companion, researcher and assistant through four children and 72 years of marriage.
Kerreen Reiger, a social historian working on a biography of Dr. Enkin, visited the doctor and Ms. Enkin at their summer home in Victoria in 2009. After being taken to dinner, she followed them outside to find them holding hands and dancing in the street. They took great joy in each other, and in music, particularly classical music and Dixieland jazz. Ms. Reiger wrote, “They were clearly a fascinating pair, and still madly in love.”
Asked how the couple stayed happily married for so long, Dr. Enkin liked to reply, “Neither of us has died yet.”
Dr. Enkin’s original intention had been to practise general family medicine with good maternity skills, but an obstetrics specialty eventually won out. In a diary, referring to himself in the third person, he wrote “Murray discovered when he did his obstetrics rotation that he wanted maternity as his career – he found he loved pregnant women and wanted something better for them.”
During an internship in Vancouver, he taught prenatal classes and, after private practice in Regina, looked for a small town where he could settle.
In one interview he was asked if he was Jewish. After saying that he was, the interviewer responded: “I’m sorry. We don’t want any more Jewish professionals in the town.”
Dr. Enkin knew he could sue for discrimination but didn’t want the legal hassle. He chose instead to settle in the small Saskatchewan town of Shaunavon. He would have stayed there happily, but his wife wanted a bigger landscape for their young daughters. Dr. Enkin acquiesced and, in 1952, left family practice to follow his original passion for obstetrics during a residency at Long Island College Hospital in Brooklyn, N.Y. Three years later, at the height of the McCarthy era, with its rampant paranoia over communism, the Enkins returned to Canada.
They settled in the steel town of Hamilton, where Dr. Enkins received his certification as an obstetrician-gynecologist from the Ontario College of Physicians and Surgeons. He became a Fellow of the Royal College of Surgeons in 1966 before accepting a position as departmental chief of obstetrics and gynecology at St. Joseph’s Hospital, run by nuns at the time. Despite working in a Catholic environment, Dr. Enkin remained staunchly pro-choice, offering assistance to women who ran into medical problems as a result of abortion.
In 1974, he joined the faculty of the new McMaster University Medical School and relocated his practice to the McMaster University Medical Centre.
During sabbaticals he frequently worked with Oxford University in England on issues related to epidemiology and childbirth. He also contributed to studies being conducted by Sir Iain Chalmers, founder of the Cochrane Collaboration, a non-profit organization set up to evaluate randomized medical control trials worldwide.
One result of their collaboration was the book A Guide to Effective Care in Pregnancy and Childbirth. The two-volume hardcover set, when published as a single paperback, became a must-have for primary caregivers and childbearing women around the world.
During his later years, Dr. Enkin coined the word tokothanatology, meaning the study of birth and death. He and his daughter Dr. Boron often discussed similarities between the two universal events; both involve emotion and ritual, as well as affecting the life and roles of other people surrounding them. Dr. Boron is working on a book about it, titled Book Ends.
Known for his philosophical aphorisms, Dr. Enkin was particularly fond of one by poet George Santayana and quoted it often: “There is no cure for birth or death save to enjoy the interval.”
Dr. Enkin felt the enjoyment in the interval of his life had come from being in the right place at the right time. He often told his wife, “We were lucky. We are lucky.”
Ms. Enkin died in 2019. Dr. Enkin leaves his children, Susan, Nomi, Jane and Randy; his brother; seven grandchildren and a great-granddaughter.