Problem: The United States spends more on health care than many other developed countries. Despite this, it has a comparatively poor record on key health indicators such as infant mortality, pre-term birth and low-birthweight babies.
Background: Eighty-four-year-old Ruth Watson Lubic, C.N.M., Ed.D.—a foremother of the nation’s thriving nurse midwifery movement, a godmother to inner-city pregnant women and their children, and a mother and grandmother in her own right—didn’t always like caring for moms-to-be and their infants.
In fact, when her long and storied career as a nurse, midwife and visionary began, Lubic dreaded rotations in the maternity ward—and for good reason. Back then, some five decades ago, pregnant women arrived at the hospital and were whisked away to a labor suite where they were often treated insensitively.
She still remembers women who, after being admitted to the labor suite, were put in beds with padded side rails and promptly sedated—no questions asked. Some became delusional, cursing and even biting attendants during labor, she recalls. During delivery, hands and feet were strapped to delivery tables. Afterward, new mothers, because they were considered to be unclean, were often barred from breastfeeding their newly born babies—or even touching them.
“How can you possibly mother in such conditions?” Lubic asks. That is why, in her first days as a nurse, Lubic steered clear of pregnant women and instead devoted her career to cancer patients.
But she had a change of heart after her own experience giving birth. In 1959, Lubic had a son after a long and trying bout with infertility. During her pregnancy, she had the good fortune to find a doctor who allowed what was then unthinkable: the father’s presence in the delivery room. The experience was so positive that six weeks later Lubic switched professional gears and decided to become a nurse-midwife.
It was a bold decision, given that nurse-midwives then—as in some parts of the country now—were regarded as poor substitutes for obstetricians. Unfazed, she enrolled in the country’s first midwifery school, where she was one of just six students. But no jobs in midwifery were available at the time, so instead she took a position at a nonprofit association that was striving to improve the quality of maternity care. She later earned a degree in applied anthropology.
Lubic then put her passion and her academic and medical training to work when she opened the country’s first state-approved birth center in 1975. Housed in a townhouse in New York’s Upper East Side and staffed by nurse-midwives, the birth center created a friendly, home-like atmosphere in which women could have their babies without IV drips and narcotics.
Despite widespread opposition from the medical community to this “unorthodox” approach, the birth center was a success. A few years later, Lubic’s organization decided to replicate it in one of the poorest neighborhoods in New York City—the South Bronx—because the board believed that low-income women in particular would benefit from maternity care from nurse-midwives.
The John D. and Catherine T. MacArthur Foundation agreed, and awarded her its “genius” grant in 1993. Lubic used the money—$375,000 over five years—where she believed it was needed most: in Washington, D.C., where the infant mortality rate—the highest in the country—was almost double the national average.
Solution: After six years of preparation, the D.C. Developing Families Center opened its doors in 2000 in a converted supermarket in the lower-income northeast quadrant of the city. It is now the home of a collaboration consisting of a birth center, a case management and social support organization and an early childhood development center.
The once dilapidated, vacant building now breathes with warmth and life. A sign welcomes visitors with an invitation to breastfeed babies wherever they choose. The waiting room is decorated with bright canvases of pregnant women and a colorful wall mural depicting a cheerful landscape. A play area includes toys, books and a Lilliputian table and set of chairs.
On one wintry day in Washington, pregnant women paint plaster molds of their extended bellies and enlarged breasts in one room. In another, toddlers play together and eat lunch under close supervision. Other rooms furnished like bedrooms await the next laboring woman to arrive.
In addition to the full scope of prenatal, birth, postnatal, gynecological and primary care services, the Family Health and Birth Center also offers breastfeeding counseling, doula services, and coordinated wellness programs. At any given time, visitors may also be taking free prenatal yoga classes, studying for the high school equivalency exam, using the Internet, or doing their laundry—all services provided by the collaboration.
The center’s goal is to reduce the infant mortality rate by giving low-income and other pregnant women access to all services they need to deliver and care for healthy babies. Some women require hospital care, which they get at a nearby hospital, with the same midwives in attendance.
A core principle is treating women and their families—regardless of race, class or background—as fellow human beings.
That means educating women about how to care for themselves and their children; empowering them to take charge of their own health and health care; knocking down barriers to care; and providing a full array of services under one, easily accessible roof.
Most fundamentally, it means “getting them while they’re young,” Lubic says. In her eyes, young means as soon after conception as possible—or, ideally, even before a baby is conceived. Ensuring that mothers are healthy, Lubic argues, is the best and simplest way to ensure that their babies will be healthy too.
“We midwives know the secret,” Lubic says. “We begin to work with women even before they become pregnant.”
Lubic’s secret is now an open one, thanks to studies that have documented the center’s astonishing successes. Women who deliver at the center have much lower rates of pre-term birth and low-birthweight babies—two key indicators of infant mortality—than pregnant women in the city as a whole. Fewer clients have medically risky Caesarian-section deliveries than other women in the city. And a higher percentage of women at the center breast feed, a key way to promote infant health.
These outcomes saved the health care delivery system $1.6 million in health care costs in 2006—which is more than the cost of the center’s annual operating budget. They have the potential to save the country billions of dollars if the birth center practices were implemented nationwide.
And yet, Lubic still has trouble raising enough money to keep the center operational. At 84, she is hard at work pursuing dollars from donors and continually seeks more substantial government funding.
“There’s a lot of rhetoric about saving money and improving outcomes,” Lubic says. “We’ve done it, but still can’t get what we need to be comfortable.”
But after a lifetime spent beating the odds, Lubic has no intention of giving up. “We’ll figure out a way to make it work,” she quips. “The important thing is that the center is here to see; it’s a demonstration, not just an idea.”
RWJF Perspective: The Robert Wood Johnson Foundation (RWJF) is a strong supporter of innovative nurse-led models of care. The Foundation was an early supporter of the Developing Families Center in Washington, D.C., providing critical early and operational funding for the center for a decade. In 2006, Lubic was named an Edge Runner by the American Academy of Nursing (AAN). The Edge Runner program is a part of Raise the Voice, an initiative directed by AAN to recognize innovators in health care. The program has also received funding from the Foundation.