1. Knowlton, Leslie


When an obstetrician suggested a career in midwifery to a young nurse who had recently given birth, she said, 'What's midwifery?'


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Since heeding that advice just shy of a half-century ago, nurse midwife Ruth Watson Lubic, EdD, CNM, FAAN, FACNM, established her Childbearing Centers and two freestanding birthing clinics in New York City. She then blazed onward to Washington, D.C., to found the Family Health and Birth Center, which she, the center's chairperson, calculated is saving the health care system more than $1 million a year.


Along the way, Lubic picked up a doctoral degree in applied anthropology from Columbia University, received five honorary doctorates from other universities, and won dozens of prestigious prizes, including the American Public Health Association's Martha May Eliot Award last November. She was also named one of the American Academy of Nursing's 2006 Edge Runners, as part of the academy's Raise the Voice campaign.


Other awards have included a John D. and Catherine T. MacArthur Foundation "genius" fellowship, whose funds she used to launch her Washington facility in an abandoned supermarket in the low-income Ward 5.


On the heels of her 80th birthday, Lubic related a mlange of memories about some of the events that in 2001 led the American Academy of Nursing to designate her a Living Legend for "contributions to the provision of health care services in the United States and in all regions of the world."


Lubic grew up during the Depression in a tiny town north of Philadelphia, where her pharmacist father owned a drugstore. "We had the store but no money," she said, "so he borrowed lots of money and even hocked my mother's ring to buy medicines to give to people who had nothing." Lubic considers her father her role model.


At age 48 her father died of a heart attack, and Lubic, then 14, helped her mother run the pharmacy. She considered becoming a physician because that had been her father's unrealized dream, but opted instead for nursing school at the University of Pennsylvania in Philadelphia.


After graduating in 1955, she married New York City attorney Bill Lubic and moved to Manhattan. There, she worked at Memorial Hospital for Cancer and Allied Diseases and attended Hunter College before transferring to Columbia University's Teachers College. In 1959, she received her bachelor's degree and gave birth to her only child, Douglas, at New York Hospital-Cornell Medical Center.


"I thought I'd be a good mother and stay home, but I almost went bananas," she recalled. "As much as I loved him, there was no intellectual stimulation. I just couldn't do the sitting on the park bench talking about where pork chops were cheaper."


About six weeks after giving birth, Lubic talked with her obstetrician about her positive birthing experience, which had included having her husband present at both labor and delivery (that was "unheard of in 1959," she said), and mused about becoming a maternity nurse.


That's when her physician planted the midwifery seed in Lubic's mind. Intrigued but wary, she parked the idea and returned to Columbia for a master's degree in cardiovascular nursing.


After graduating in 1961, she enrolled in the Maternity Center Association (MCA)-State University of New York Downstate nurse midwifery program in Brooklyn and never looked back.


"At that time, few midwifery programs existed," she reported, adding that it was the MCA that seeded programs at universities such as Yale and Johns Hopkins. "When I went to my first nurse midwifery convention, there were only 80 to 100 people there. Everyone knew everybody because it was such a small group."


After receiving her nurse midwifery certificate in 1962, she worked as an MCA parent educator because no midwifery jobs were available. She loved her work but left in 1967 to study anthropology at Columbia, an idea that had been sparked during her student midwifery days by a visit to the home of a Hispanic mother whose new baby was terribly constipated.


"So I'm trying to get this little baby's rectum unpacked and talking to the mother about what she's feeding the baby," Lubic said. "To make a long story short, she was taught, as we taught all mothers, to make formula from Karo syrup, [canned] evaporated milk, and water.


"She, being Hispanic, had her own cultural beliefs, and one was that anything that comes in a can is known to be hot-not hot in temperature, but a descriptive term for food that's canned. She believed you should never give hot things to babies, so she had been buying and feeding her baby whole milk, and babies can't digest that."


After completing her course work in 1970, Lubic became the MCA's general director. She intended to write her dissertation on how professionals should learn about the cultures of the people they serve, but after opening the first Childbearing Center in the MCA's uptown Manhattan townhouse in 1975, the topic became the story of that effort-"a political-anthropological analysis of barriers to innovating in the health care delivery system," as Lubic described it.


She explained that the MCA opened the Childbearing Center as the country's first freestanding birthing facility because "women had become disenchanted with hospitals and the way they were treated there, especially [women in] the counterculture, who didn't want to do anything the way it'd been done by Mom and Dad. There was a movement toward do-it-yourself home birth, and we felt that that was patently unsafe, that some monitoring was required."


But mainstream physicians and hospitals argued that a midwife's monitoring wasn't enough. "Their medical education was taking them [toward] a greater use of technology rather than a humanistic approach. They felt justified, because of their medical education, in questioning the efficacy of midwifery practice," Lubic said.


But Lubic and the MCA prevailed, and the Childbearing Center went on to serve as a model for more than 150 other centers nationwide.


In 1988 she established another Childbearing Center in the southwest Bronx, an area that had the second-worst infant outcomes in the country, better only than those in Ward 5 of Washington, D.C.

Figure. Ruth Watson ... - Click to enlarge in new window Watson Lubic (right) talking with Ruth Bader Ginsburg, associate justice of the Supreme Court, who visited the Family Health and Birth Center in Washington, DC, in June 2006.

"I wanted to redefine the stereotype of the low-income mother as being consistently high-risk," she said. "But I'd found that I couldn't entice poor women to come from Harlem to the MCA's double-wide townhouse, which obviously had been a rich man's home."


The Bronx center was built in partnership with a local community health center, and in 1992 the MCA fulfilled its promise to hand over the project as soon as it had become programmatically and fiscally successful.


The next year, Lubic received her "genius" award from the MacArthur Foundation and went south with the stipend to put it toward improving the nation's most dismal infant outcomes. She also wanted to be near the halls of Congress, to lobby to make the health care delivery system more responsive to families. By 2000, she'd raised enough additional funds to open the Family Health and Birth Center.


She's thrilled with the results. The facility's mothers now have half as many cesarean sections, preterm births, and low-birth-weight neonates as those in the rest of the city. When Lubic estimated the cost savings from improving outcomes, she arrived at a figure of $1,153,051 a year.


But even that kind of success has not made it easy for the center to stay afloat financially, although the D.C. Council now allocates funds to it. "We've saved the system more money than our own operating budget," Lubic said with a sigh, "and we're still struggling. I still have to go out and raise half the operating budget every year."


And physicians still dispute her work.


"It's been a hard road," she said. "I've been accused of burying dead babies and really stupid stuff [to improve a center's outcomes]," she laughed. "What's causing these outcomes is nurse midwifery care. They don't have clue one, but I am used to that."


In fact, Lubic said, she feels compassion for physicians and acknowledges their importance. "It's difficult to translate the midwifery approach for obstetricians. But we can't function without them and really need to be a continuum. Families can't have the best care without this partnership."