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. (more…)

By Ruth Lubic. The release this week of Amnesty International’s new report, Deadly Delivery: The Maternal Health Care Crisis in the USA,  highlights the poor outcomes of African American women in particular. 

When I set up The Developing Families Center in Washington DC’s Ward 5, it was with the goal of addressing this very issue, particularly from the point of view of infant mortality.

At a rate of 12.22 per thousand live births, the District has the highest infant mortality of any of the states, with only Mississippi, at 10.74 also experiencing a double digit rate.

For those not familiar with the concept’s history, a demonstration Freestanding Birth Center was established in 1975 on Manhattan’s East Side as an alternative maternity service. It targeted those who were disenchanted with the conventional care which did not treat them as families or honor the social, emotional and spiritual aspects of childbearing. The originators of this model, in concern for the quality and safety of the replications, developed standards and advocated for both its licensure and its accreditation. No state forbids its replication. There is accreditation available through the Commission on Accreditation of Birth Centers which was set up by, but operates independently of, the American Association of Birth Centers.

At the outset, the model honored the wishes of families by providing respectful care which enhanced the normal aspects of childbirth. At the same time, it provided through a coherent system of health care the consultation and special medical expertise needed in some cases. It did this through the formation of professional teams which provide the warmth of personalized nurse-midwifery care along with the availability of hospital-based obstetrical care when needed.

Originally, it was middle class women and families who sought out this care, and some 200 centers around the country were established. Today such Centers have proven they are able as well to lower the disparate outcomes suffered particularly by African American families. Because it differs in concept from the practices of conventional in-hospital maternity care, the Freestanding Birth Center concept has had a struggle to be accepted.

What are the outcomes and savings?

Outcome Data and Cost Savings*

After 5 years of operation, FHBC outcome data showed substantial lowering of preterm birth, low birth weight and cesarean section rates compared to those of the District:

(FHBC aggregated data for 2003-2005 were shown to be statistically significant by epidemiology and biostatistics faculty of the School of Public Health of the University of North Carolina.)

Preterm Birth Savings $619,200

Low Birth Weight Savings $277,716

Cesarean Birth Savings $343,882

Total Savings 2005 $1,240,798

Also in 2005, the total Operating Budget of the FHBC was $1,074,014. Therefore, the FHBC saved for the system a figure greater than its own operating budget!

*Sources:

Preterm Birth-Chapter 12 “Societal Costs of Preterm Birth” in Preterm Birth: Causes, Consequences and Prevention, Institute of Medicine 2006

Low Birth Weight-Cost of Illness Handbook Environmental Protection Agency 3/31/06

Cesarean Birth-National cost as reported in the Wall Street Journal (2/21/06)