By Ruth Lubic. It is my distinct honor to be an awardee of this prestigious organization along with Dr. Omega Logan Silva and Diane Rehm.  I thank Katharine Weymouth for her enlightening opening words as well.

We awardees have been asked to speak briefly about “… how times have changed (or not) for women over the years.”  I would like to do this from two perspectives, first that of the management of the childbirth experience in the 1950′s when my son, Douglas, was born and also from that of the acceptance and utilization of midwives in this country in a similar time frame.  Keep in mind that my husband, Bill and I are “children of the Great Depression” and were taught to live frugally and to care about folks less fortunate than ourselves.

BIRTH IN THE 1950′s was often managed by the routine use of Demerol, a pain killer and scopalomine, an amnesiac, so that women would not “remember” the experience.   Laboring women, (there were no family members permitted), were restricted to a bed with padded side rails so their erratic drug-induced behavior would not harm them or their fetuses and when moved to the delivery room, had their hands cuffed in leather bracelets to the side of the delivery table so that they could not touch their “clean” baby with their “dirty” hands.  How destructive of a  mother’s instincts to hold and provide needed bonding with the new baby!  And how destructive of her perceptions of her ability to be a “good” mother when she might have vague memories of her negative behavior in labor.    Today, there are differing settings to cater to the mother’s and family’s  choices, with the nurse-midwifery operated freestanding birth center being the one with which I am most familiar.  The original Childbearing Center in Manhattan’s Carnegie Hill neighborhood was set up to offer sensitive care to young families who, disenchanted with conventional care, were engaging in “do-it-yourself” home birth, with little or no prenatal care and fathers catching their babies, a potentially very unsafe plan.  The success of the CbC evoked a response from hospitals in the form of in-hospital birth rooms, which, for the most part convert to standard delivery rooms and, even when fathers are present, usually do not offer any control, or even partnership, to the laboring family.

I would be remiss not to mention today’s rapid growth of cesarean section in the United States (from 10.4% of all deliveries in 1975 to 31.8% in 2007) which not necessarily cause, but is but certainly coupled with, an alarming increase in maternal death rates from 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 in 2006.  Amnesty International, which last week conducted a briefing on the House side of the Congress,  reported on this phenomenon in its recent publication,  “Deadly Delivery: The Maternal Health Care Crisis in the United States”

MIDWIFERY: In the 1950′s,  the last of the “foreign” midwives were being prohibited from practicing, and prepared nurse-midwives from one of the 8 schools, including Yale, Columbia and Hopkins, (in addition to the Maternity Center Association’s first school which was opened in 1931), had barely a toe-hold.    Indeed in some hospitals, a nurse did not acknowledge her preparation in midwifery; job loss could result.   In the ‘60′s, there were very few jobs in midwifery and then in 1971, a Joint Statement developed by the American College of Nurse-Midwives and the American College of Obstetrics and Gynecology was put into effect.   Jobs increased very little, but licensure became more available.  Then, in 1975, the freestanding birth center came on the scene and offered a home for the midwifery model of care which you will see when you accept our warm invitation visit the Family Health and Birth Center at 801 17^th St. NE!!  Hopefully, health reform’s attention to nurse managed centers will enable the opportunity to visit others as well in the District, which has the highest infant mortality and maternal mortality rates in the country—right here in our nation’s capital!!   The success of the FHBC, with its midwives, nurse practitioners, breast feeding peer counselors and community outreach workers, placed as it is in a collaboration with case management and early childhood education, is becoming legendary in its service to the primarily African American families seen, those with the worst of the so-called “intractable” infant outcomes.  FHBC outcomes for 2006 include reduction of pre term birth by 2/3, low birth weight by 3/4 and cesarean section by 2/3, while providing evidence of cost savings greater than its operating expenses of over 1 and ½ million dollars .  But most important is the empowerment of the women to take charge of their health and the health and lives of their families, bringing the unrealized talents of the African American 12% of our population to the forefront, and doing so through the provision of respect to those women who are so often disrespected by health care providers.   How else, Ladies and Gentlemen, will the United States be able to compete in a global economy?

Thank you!

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