Forty-Two Years of Improving Health and Health Care for Mothers, Infants and Families through Nurse-Midwifery

    • June 28, 2012

In writing this brief essay, I am taking a liberty and adding two years to the 40 requested. I do so because the history of nurse-midwifery as an RWJF Force Multiplier actually began in 1970 through a relationship with RWJF Trail Blazer Terrance Keenan while he was at the Commonwealth Fund in New York prior to the establishment of RWJF.

The story I will tell begins with a three-site Refresher Program in Nurse-Midwifery, and Mr. Keenan as program officer. Mr. Keenan remained supportive of the work of nurse-midwives as program officer for their work throughout his career at the Robert Wood Johnson Foundation, seeing the establishment of the country's first freestanding birth center on New York's Upper East Side, to its replication in the Southwest Bronx and on to the District of Columbia. There, the nurse- midwifery care at the Family Health and Birth Center in Ward 5 has demonstrated significant reductions in the so-called intractably poor outcomes of the African American childbearing families living there. Secretary of Health and Human Services Sebelius visited in February 2012 to see for herself.

I. The 1970 Refresher program enabled Maternity Center Association, where I was newly general director, to bring back into practice prepared nurse-midwives who had been unable to function in full scope maternity care due to a dearth of practice positions and the opposition of competitive groups even though MCA had demonstrated the improvement of outcomes in its 1930 to 1959 community based work in serving Central and East Harlem families.

II. The Childbearing Center (CbC) based on East 92nd Street was set up in 1975 to answer the complaints of the young families who saw conventional care as unduly interventionist and unsupportive of them as families. Today there are at least 230 such centers operating around the country. Through the '80s and '90s a support organization, the American Association of Birth Centers was established, Standards of Care were written by a multi-disciplinary committee, and the Commission for Accreditation of Birth Centers was set up.

III. The Developing Families Center (DFC) in the District of Columbia opened in 2000 and is functioning today as a collaborative to provide families with (1) health care, the Family Health and Birth Center, (2) social supports and case management, the Healthy Babies Project, and (3) early childhood education, the United Planning Organization's ECD Center, all in the same former Safeway supermarket donated by a local business family. Thus, the perinatal period is being rewritten from its former definition as the period from 28 weeks of pregnancy through the child's fourth week of life, to one which begins in the preconception period, goes through the maternity experience, and on into the first two years of the child's life, as is being proposed by Michael Lu, MD, FACOG in his Life Course Theory.

Without the support of the Robert Wood Johnson Foundation and Terrance Keenan, one might add, this never would have occurred. A final word is a reference to the inclusion of nurse-midwifery services as a case study in The Future of Nursing: Leading Change, Advancing Health, the RWJF-supported report of the Institute of Medicine, 2011.

Submitted with heartfelt thanks and appreciation.