Ruth Watson Lubic, CNM, Ed D.
Banquet Address given at the AABC 10th Annual Meeting - 1994 Reprinted with Permission from the AABC News
As we planned to defy the conventional obstetrical wisdom that families who live in low income areas are high risk by virtue of their address alone, the MCA staff had a deeply held conviction. We believed in the ability of responsive community-based comprehensive maternity care to evoke change in the health habits of families. It was no surprise to us that women were as responsive to childbearing center care as they were at demonstrating outcomes which indeed defied the stereotypes held about their reproductive capabilities. That the birth experience empowered them also came as no great surprise. Two things, however, did surprise us:
It is on this effect that the hope for disadvantaged areas and inner cities rest, in my opinion. Once again, the problem is one of our making. We professionals and policy makers have emphasized the behaviors of less strong low income families, behaviors which are also to be found among the affluent on Park Avenue, to the exclusion of the behaviors of the extraordinarily strong families who also are to be found. It is these strong families on whom we should focus, joining with them in a facilitating partnership while they put their considerable skills to work on behalf of their neighbors and communities.
Those of us who are privileged to work with families in this health event called pregnancy and birth hold the key to enhancing their important strengths. This has been a wonderful secret that we must now share with the world. Attention is being focused on the need to strengthen families, and there are no other health workers who have the opportunity we have to do so. Crisis health care does not enable the same harming environment and opportunity over a period of time in which we trust can be established and health teaching provided. It is as Carol Ambers says in Hope Reborn: Empowering Families in the South Bronx, "The best thing about the birth center concept is that it empowers women and they in turn empower their families which empowers their communities and it grows and grows." We need to take this message of discovery to the world at large and stand firm for the inclusion of the empowering aspects of birth center care as we are sought for partnership, merger, and other business arrangements which have yet to be consummated.
One of the basic tenants of the education and practice of business administration is to "turn threats into opportunities."
Indeed as a guiding principle, that advice has great worth for us birth center folks today. This meeting has addressed repeatedly the change and uncertainty that is all around us. I congratulate the AABC board and leadership for the proactive stance which has been adopted. The trick will be to firmly establish ourselves as effective Davids in a world which is more and more one belonging to Goliaths. And we must take care as we are cajoled, pressured, and even seduced to enter the "mainstream", on the terms of those who have amassed size and power while often forgetting or ignoring the needs of the people to be served. It may be difficult for us to remember our origins and the reason we came to be some two decades ago to meet the needs of childbearing families.
Some of you are aware that I developed a list of eleven operating principles for professional life. Among them are:
There are others, and the one I would like to explore further with you tonight is to "Be aware that the medical model has failed to serve the people of this nation." That principle started out as "Beware the medical model; it has failed to serve the people of this nation." At some point the word "beware" was attenuated into "be aware". Tonight I choose to restore the principle's original strength and exhort you to "beware" and not to just "be aware". I do so because of the ever present danger of "cooptation", sometimes masquerading as "cooperation." What power there is in words, n'est-ce pas? And I do so because of the difficulty of ascertaining whether a slight alteration in practice can be adopted without affecting overall mission or whether that alteration is the initial step on a slippery slope.
Perhaps it would be helpful if I defined for you my impression of what the medical model is. Essentially the medical model as I see it is health practice which is oriented toward satisfying the practitioner rather than the recipient of care.
Descriptors which can illustrate the model are:
You probably can add to my list.
My message to you this evening is to hold closely and tightly to your mission. I encourage you to think through carefully the overtures you receive, neither abandoning your principles as you experience the joy and relief of being courted by those who a few short years ago shunned you, nor digging in your heels in fear of being "eaten alive". These are times of peril and yet they are times of opportunity to extend your philosophy into previously forbidden halls thus benefiting more childbearing families.
To assist you as you confront the days ahead, I now exhort you to use my concluding principle. "Remember, the people you serve are your strength." Take difficult decisions to the people you serve for their opinions and insights. Recall that is exactly what we did at the Childbearing Center of Morris Heights when confronted with the inclusion of medical learners in that setting. In the first instance we were advised by the families not to accept the proposal and we respected their wishes. The families then proceeded to solve the problem for us. Zakiyyah Madyun did not emphasize on opening night the effects of the Community Action Committee's decision not to have the residents at the birth center. Rather, they decided to go to rounds at the back-up hospital to teach the residents about the birth center and, most important, to share in an open, candid, but not abrasive or angry way the elements of the hospital experience which drove them away. I was told a few months later by the director of the residency program that a number of young physicians were moved to tears by that presentation. Eventually the committee relented and residents did come for rotation but on the terms that individual permission be gotten from each mother and family involved. "Remember, the people you serve are your strength."
In conclusion, I want to share with you two positive signs of change -- at least for me.
On April 5, 1994 a reception was held at MCA to honor the life of Robert Willson who served each of us as a member of the AABC Board for eight years. The event for me was a breakthrough and harbinger of positive change.
Gathered at MCA's house on 92nd Street to join together to speak in praise of this visionary and courageous man were: Teresa Marsico, CNM, President of the American College of Nurse-Midwives. Richard Schwarz, MD, FACOG, Acting President of the Health Sciences Center at SUNY and recent past president of the American College of Obstetricians and Gynecologists.
John Boyce, MD, FACOG, Chairperson, District II, ACOG
Marion McCartney, CNM, President of AABC
Lucy Johnson, President of MCA and myself.
It was an evening of rapprochement, an initial step. We all thought of Bob, who in death achieved what he worked so hard for in his life, but did not realize.
We have come very far in our quest to make health care delivery responsive to families and we have done so in a comparatively short period of time. Remember:
We have gotten here in half the time!
Remember the people you serve are your strength; serve all people of the nation in this New Birth of Opportunity.