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National Crises in Obstetrical Care: Competence and Risk Reexamined

Mary-Jo DelVecchio Good

in American Medicine: The Quest for Competence

This chapter examines national parallels to the local ethnography and the impact of the national crisis in malpractice and obstetrical care on the specialties of obstetrics and family medicine. The ... More

This chapter examines national parallels to the local ethnography and the impact of the national crisis in malpractice and obstetrical care on the specialties of obstetrics and family medicine. The research texts for the national story are drawn from the medical specialty literature of the period. During the 1980s, obstetricians throughout the country protested the rising costs of medical liability premiums; physicians went on strike, withdrew from practice, and questioned the unprecedented rise in malpractice claims. Fears confined to the specialty of obstetrics. However, as in Coast Community, the tensions created by malpractice claims quickly spilled over to affect obstetrical care offered by family physicians and nurse-midwives.Less

Political Showdown

Lisa Yarger

in Lovie: The Story of a Southern Midwife and an Unlikely Friendship

This chapter explores the resurgence of interest in home birth and midwifery (primarily among college-educated white women) as a result of second-wave feminism. Midwives such as Ina May Gaskin begin ... More

This chapter explores the resurgence of interest in home birth and midwifery (primarily among college-educated white women) as a result of second-wave feminism. Midwives such as Ina May Gaskin begin challenging the physician-controlled model of birth seen by many women as oppressive. Midwife-attended home birth also becomes popular among conservative Christians, who provide a new client base for Lovie. This chapter examines the response of the medical establishment to women's demands for more personalized care and details the political showdown in the early 1980s in which the North Carolina Medical Society pressured legislators to oppose home birth, despite Midwifery Study Committee findings about the safety of planned, attended home births. House Bill 814, passed in 1983, recognizes certified nurse-midwives for the first time and ends the licensing system for lay midwives. The bill also provides a “grandmother clause” for midwives who have practiced at least ten years. Lovie is one of two women to benefit from the exemption: although trained as a nurse-midwife, she did not maintain membership in the American College of Midwifery or seek to fulfill updated membership requirements. The other, Lisa Goldstein, becomes legendary among a new generation of midwives who have no idea of Lovie’s existence.Less

A World of Confusion and Fog

Lisa Yarger

in Lovie: The Story of a Southern Midwife and an Unlikely Friendship

This chapter explores how, unknown to Lovie, an underground home birth movement has quietly thrived in North Carolina in the several decades since the passage of the 1983 midwifery bill outlawing the ... More

This chapter explores how, unknown to Lovie, an underground home birth movement has quietly thrived in North Carolina in the several decades since the passage of the 1983 midwifery bill outlawing the practice of lay midwifery. This chapter also chronicles the founding in 1992 of a master’s level midwifery training program at East Carolina University in Greenville, a program that brought certified nurse-midwives (CNMs) into the eastern part of the state to train, teach and work. Two CNMs, Laurie Irwin-Pinkley and Maj-Liz Downey, befriend Lovie and facilitate her connection to the North Carolina chapter of the American College of Nurse-Midwives (ACNM). Lovie is flattered by their recognition of her as a pioneer but befuddled by the changes in her profession that make it difficult for her to identify completely with the younger nurse-midwives. Lovie tries and fails to understand her place in the new midwifery landscape.Less

Epilogue

Jenny M. Luke

in Delivered by Midwives: African American Midwifery in the Twentieth-Century South

The epilogue brings hope of positive change as the American College of Nurse-Midwives and the American Congress of Obstetrics and Gynaecology work on common ground to solve the pressing issues of ... More

The epilogue brings hope of positive change as the American College of Nurse-Midwives and the American Congress of Obstetrics and Gynaecology work on common ground to solve the pressing issues of American maternity care. A reassessment of the essential inclusion of both macro-level and micro-level components of care leads to the conclusion that Dr. J. Edward Hill subscribes to: good health care is local and when community activism is supported by state and federal funding and integrated into the structures of medicine and politics change will happen.Less

African American Nurse-Midwives

Jenny M. Luke

in Delivered by Midwives: African American Midwifery in the Twentieth-Century South

With the greatest need for improvements of maternity care in the south, this chapter returns the focus to the southern states. The National Organization of Public Health Nurses acknowledged the vital ... More

With the greatest need for improvements of maternity care in the south, this chapter returns the focus to the southern states. The National Organization of Public Health Nurses acknowledged the vital role African American nurse-midwives played in the public health education of black women and their families and two schools were established, one of which was the Tuskegee School of Nurse-Midwifery in Alabama. Much of the chapter is devoted to the specific training required to be effective in the isolated, poverty stricken communities of the rural south and shows how cultural sensitivity was central to nurse-midwives’ work.Less

Problems of Racism and Challenges to Professionalism

Jenny M. Luke

in Delivered by Midwives: African American Midwifery in the Twentieth-Century South

Despite their recognized importance to maternity care African American nurse-midwives experienced both racial and professional discrimination. This chapter underscores the unyielding obstacles of ... More

Despite their recognized importance to maternity care African American nurse-midwives experienced both racial and professional discrimination. This chapter underscores the unyielding obstacles of racism. Issues of segregation, unequal pay for black nurses, and lack of funding led to the closure of the Tuskegee School of Nurse-Midwifery, and the American Association of Nurse-midwives determined that whiteness was central to its concept of the professional midwife. Physician-centered maternity care was advocated as a solution to what was termed racial dualism in health care and ultimately the implementation of the wartime Emergency Maternal and Infant Care accelerated the shift toward hospital birth.Less

Midwifery Becomes a White Woman’s Realm

Jenny M. Luke

in Delivered by Midwives: African American Midwifery in the Twentieth-Century South

In competition with a powerful medical establishment nurse-midwifery has struggled to gain legitimacy and carve out a space in which to practice. This chapter provides some historical background of ... More

In competition with a powerful medical establishment nurse-midwifery has struggled to gain legitimacy and carve out a space in which to practice. This chapter provides some historical background of the American College of Nurse-Midwives, the importance of “whiteness” to the preceding professional body, and the effect that state legislation has on the growth of the profession. The experience of Dr. J. Edward Hill demonstrates the benefits of a collaboration between physicians and nurse-midwives.Less

Choices in Childbirth: A Modern Midwife's Tale

in Bodies of Knowledge: Sexuality, Reproduction, and Women's Health in the Second Wave

This chapter tells the story of Fran Ventre, a midwife who developed a special place in the modern midwifery movement because of her ability to bridge the divide between lay midwives and certified ... More

This chapter tells the story of Fran Ventre, a midwife who developed a special place in the modern midwifery movement because of her ability to bridge the divide between lay midwives and certified nurse-midwives. It explains that these two fields of midwifery had different origins and philosophy about birth, and argues that the philosophical divide between the movements may help explain why proponents of natural childbirth have not been entirely successful in demedicalizing the process or empowering mothers-to-be. Thus, childbirth choices have largely been reduced to requests for cesarean sections and epidurals.Less

That Handmaiden Business

Lisa Yarger

in Lovie: The Story of a Southern Midwife and an Unlikely Friendship

This chapter discusses Lovie Shelton’s nursing training at Norfolk General Hospital (through the U.S. Cadet Nurse Corps) and early nursing experiences in the 1940s, when delivery room nurses were ... More

This chapter discusses Lovie Shelton’s nursing training at Norfolk General Hospital (through the U.S. Cadet Nurse Corps) and early nursing experiences in the 1940s, when delivery room nurses were little more than handmaidens to the doctors (often instructed, for example, to hold a laboring woman’s legs together to keep her from delivering before the doctor’s arrival). The chapter not only takes readers on an interesting historical side trip, but gives them a benchmark for gauging the significance of Lovie’s later career as a nurse-midwife attending home births by herself. The chapter also describes the highly routinized, medicalized hospital births at the time Lovie was in training and how birth in the U.S. arrived at this point. After graduation, Lovie worked for a country doctor and sometimes found herself attending deliveries of babies all on her own in homes. Wanting more training, she enrolled in the public health nursing program at the University of North Carolina at Chapel Hill, where she learned about nurse-midwives from visiting lecturer Laura Blackburn, a public health nurse-midwife employed by the state board of health in South Carolina. Lovie “caught on fire” to become a nurse-midwife herself.Less

Nurses on Horseback

Lisa Yarger

in Lovie: The Story of a Southern Midwife and an Unlikely Friendship

Lovie visits the world-famous Frontier Nursing Service (FNS), the first program in the United States to employ nurse-midwives. Founded in 1925 in a tri-county area of Kentucky’s Appalachian Mountains ... More

Lovie visits the world-famous Frontier Nursing Service (FNS), the first program in the United States to employ nurse-midwives. Founded in 1925 in a tri-county area of Kentucky’s Appalachian Mountains by Mary Breckinridge, a wealthy socialite and nurse, the FNS compiled a remarkable record and won the admiration of physicians and health professionals from around the country and the world. FNS midwives, originally recruited from the United Kingdom but later trained on site, rode horseback through creek beds and narrow coves to provide health care and deliver babies in remote mountain cabins. Lovie recounts how her three-month stint at the FNS sealed her interest in becoming a nurse-midwife.Less

God Dealt Well with the Midwives

Lisa Yarger

in Lovie: The Story of a Southern Midwife and an Unlikely Friendship

While pregnant, the narrator visits Lovie (who is still living with her daughter Nancy while her house is being repaired post-fire) and ponders how Lovie’s life looks like a stretched out version of ... More

While pregnant, the narrator visits Lovie (who is still living with her daughter Nancy while her house is being repaired post-fire) and ponders how Lovie’s life looks like a stretched out version of the Book of Job. The narrator meets and interviews younger midwives around North Carolina (including CNMs at a North Carolina chapter meeting of the American College of Nurse-Midwives) to help her put Lovie's career in context. Influenced both by these women and by her relationship with Lovie, the narrator considers delivering at the Women’s Birth and Wellness Center in Chapel Hill, a free-standing birth center, and ultimately decides to have a home birth with nurse-midwife Nancy Harman in attendance. This chapter also unfolds the story of the narrator’s home birth. Before moving with her husband and daughter to Munich, Germany to open a bookshop, the narrator visits Lovie with her baby and realizes she knows everything she needs to know to finish the book on Lovie.Less

Advanced Practice Nurses: Skilled Professionals or Cut-Rate “Physician Extenders”?

Sandy Summers and Harry Jacobs Summers

in Saving Lives: Why the Media's Portrayal of Nursing Puts Us All at Risk

Advanced practice registered nurses (APRNs) provide care that includes tasks traditionally done by physicians. APRNs combine the holistic nursing care model with additional practitioner training. ... More

Advanced practice registered nurses (APRNs) provide care that includes tasks traditionally done by physicians. APRNs combine the holistic nursing care model with additional practitioner training. Research shows that APRN care is at least as effective as physician care, contrary to the claims of some physicians and their organizations. Hollywood depictions tend to suggest that APRNs are merely skilled assistants to physicians. Other portrayals show disdain; consider a joking suggestion on Disney’s Lab Rats in 2013 that one character was a nurse practitioner because he had flunked out of medical school. Other shows have suggested that ambitious nurses aim for medical school. Some news stories have given a sense of APRN practice, but APRNs are usually ignored as health experts. Other press accounts have wrongly suggested that APRNs can treat only minor problems. The news and advertising media often reinforce the idea that practitioner care is provided only by “doctors.”Less

From El Paso to Lexington: The Formation of the Midwives Alliance of North America

Wendy Kline

in Coming Home: How Midwives Changed Birth

Chapter 5, “From El Paso to Lexington: The Formation of the Midwives Alliance of North America,” closely tracks the push to organize direct-entry midwives, beginning with the first international ... More

Chapter 5, “From El Paso to Lexington: The Formation of the Midwives Alliance of North America,” closely tracks the push to organize direct-entry midwives, beginning with the first international conference of practicing midwives in El Paso in 1978 and ending with the formation of MANA. Ideologically, many of them viewed midwifery as a feminist endeavor that enabled women to reclaim their bodies, rather than a medical profession. Barred from membership in the already established American College of Nurse Midwives, they sought to create a more inclusive organization that could provide them with the protection, legitimacy, and visibility needed to sustain and grow their trade. This would turn out to be an enormously challenging task.Less

Perinatal depression across the world: Prevalence, risk factors, and detection in primary care

Michael W. O’Hara and Lisa S. Segre

in Perinatal Psychiatry: The legacy of Channi Kumar

This chapter, like the entire volume, is dedicated to the memory of Channi Kumar. I first met Channi in August 1984 in Oakland, California, at the biennial meeting of the Marcé Society, hosted by ... More

This chapter, like the entire volume, is dedicated to the memory of Channi Kumar. I first met Channi in August 1984 in Oakland, California, at the biennial meeting of the Marcé Society, hosted by James Hamilton. I had already been impressed by Channi’s research but knew him only through his published work. In person, the man did not disappoint. He was elegant and kind, a man who treated everyone with respect. Over the years, my affection and admiration for Channi grew through many stimulating discussions and delightful social occasions. Even our last series of meetings focused on a new, exciting initiative of Channi’s: the ‘Transcultural Study,’ which he envisioned as a way to harmonize the detection, assessment, and treatment of perinatal mood disorders, across western Europe and even the United States, Asia, and Africa. Through experiences like these, Channi made my life richer, personally and professionally; and I greatly miss him as a mentor and a friend, and feel privileged, along with my colleague Lisa Segre, to contribute a small piece to honor this great psychiatrist and humanitarian. Michael W. O’Hara Perinatal depression is a significant mental health problem that afflicts women around the world at a time when they are highly vulnerable—pregnant or managing a new infant. In one form or another, perinatal depression has been recognized for thousands of years; however, only in the past 50 years has there been a sustained focus on the non-psychotic mental illnesses experienced by some during pregnancy and the postpartum period. The literature of the 1960s contains only a few papers with the words postpartum depression, postnatal depression, or perinatal depression. Not until the 1970s did these terms come into common use. Indeed, a search for at least one of these terms on the PsycNET database (from entries catalogued between 1884 and 9 September 2012) revealed the vast majority (2,743 or 75%) of 3,651 papers, books, and book chapters on perinatal depression were published after 2000. These findings show how work in the field of perinatal mental illness has expanded exponentially. Less