Trailblazers in maternity care: an editor's personal recollections.

Abstract

Before too much time slips by, it occurred to me to share my recollections of some remarkable people—trailblazers in maternity care. For upwards of 50 years and more, these women and men have made vital contributions to the care of mothers, babies, and families, and in so doing, have greatly influenced my own life's work over the past 35 years. They are Murray Enkin, Kitty Ernst, Doris Haire, John Kennell, Marshall Klaus, Sheila Kitzinger, Ruth Lawrence, and Nancy Sutherland. When I think of Murray Enkin today, I picture him resplendent in a brilliantly colored and flowered vest, designed and presented to him by Sheila Kitzinger at a memorable tribute to him and his wife Eleanor one evening in June 1998. There, at the 12th Birth Conference in Boston, a group of long-time friends and colleagues gathered to honor Murray, professor emeritus in obstetrics and clinical epidemiology of McMaster University in Hamilton, Ontario, for his extraordinary contributions to women's health, beginning in the 1940s. It is significant to note, too, that without his urging, Birth and the Family Journal, forerunner to Birth, might never have been launched by Madeleine Shearer in 1973. Soon Murray joined forces with activists and childbirth education organizations of the day to initiate reforms in woman- and family-centered care—the time when I first met him. Then, in 1978 came the beginning of his ongoing collaboration and crusade with Iain Chalmers, and later Marc Keirse, forming a united and powerful voice to challenge and reform current obstetric practices. Their landmark, two-volume, Effective Care in Pregnancy and Childbirth was published in 1989—a detailed meta-analysis of the systematic reviews and observational data of the evidence. It was followed by the summary text, A Guide to Effective Care in Pregnancy and Childbirth (1989, 1995, 2000), which today's birth practitioners describe as their ‘‘bible'’ and is my essential and primary reference to the research. Next, in 1993, these three pioneers established the rapidly growing Cochrane Collaboration, an international group that prepares systematic reviews about the effects of clinical interventions. We are grateful that through Murray's endorsement, Birth was able to receive permission to reprint abstracts from selected Cochrane Systematic Reviews. Today, Murray is an honored charter member of the Birth Editorial Board. More than any others, he and his collaborators have established a solid scientific basis for effectiveness and excellence in perinatal care, setting the gold standard for research and clinical practice everywhere. I often wonder where childbearing and maternity care would be today if it were not for Kitty (Eunice K.) Ernst, who began her life's work with the Frontier Nursing Service in Kentucky in the 1940s. Certainly, it is because of the vision and efforts of two nurse-midwives and ‘‘movers and shakers,‘’ Kitty Ernst and Ruth Lubic, that childbearing women in North America and other countries have a real choice today about where their baby will be born. Kitty and Ruth were the pioneers of today's free-standing birth centers and continue to be two mainstays of midwifery in the United States. I think back with warmth and gratitude to the time when I enjoyed wonderful hospitality at Kitty's country home in Perkiomenville, Pennsylvania. That was in the early days of the National Association of Childbearing Centers (NACC), which Kitty and Ruth established under the Maternity Center Association of New York about 20 years ago. Kitty became NACC's first Director, and with her strong guidance, it became a highly respected, progressive, and primary resource for birth centers—setting birth center standards, regulating and accrediting birth centers, conducting research, and promoting birth centers through workshops, conferences, a web site, and other programs. Then, in 1982, as a pioneer in distance learning, Kitty founded the Community-Based Nurse-Midwifery Education Program. She fought many battles with ‘‘the establishment'’ in her untiring efforts on behalf of mothers, babies, and families and to achieve recognition for the importance and safety of birth centers— always with marvelous and unfailing good humor, tenacity, political mastery, and courage. She continues today to offer wonderful support and sage advice to me and countless others throughout the world in the field of maternity care. I first met Doris Haire while on my Greyhound bus travels (‘‘99 Dollars for 99 Days'’) through the United States in 1963 as a tourist with my mother, who already knew about Doris's work to improve hospital maternity practices. A decade later her writings, encouragement, and advice were invaluable to me as I began my own efforts to change maternity care. For 40 years or more, Doris has been a tireless and brilliant consumer advocate and spokesperson in her work to reform maternity practices in North America. The classic and landmark manual, Family-Centered Maternity Care with a Central Nursery, by Doris and her ever-supportive husband John, published in 1971 by the International Childbirth Education Association (ICEA), literally became my maternity care ‘‘bible'’ and remains one of the most valuable items in my library. Her monographs, The Cultural Warping of Childbirth (1972), The Pregnant Patient's Bill of Rights (c1971), and How the FDA Determines the ‘‘Safety'’ of Drugs—Just How Safe is ‘‘Safe'’? (1980) have had lasting influence. Doris and John were co-presidents of ICEA from 1970 to 1972. Later they established the American Foundation for Maternal and Child Health, and convened an outstanding series of conferences in New York City on obstetrics management and birth outcomes. Over the years Doris and I worked together on many state and national health advisory groups. She has fought for reforms in informed consent and patients’ rights, and frequently gave testimony and lobbied the United States government, especially the Food and Drug Administration, on the safety of obstetric drugs and need for patient package inserts. Her enduring work has given major impetus to improvements in women's reproductive health and maternity care both in the United States and abroad. John Kennell and Marshall Klaus are two remarkable neonatologists who have probably stimulated more reforms in the humane care of newborns and their families than anyone else. Their landmark research paper, ‘‘Maternal Attachment: Importance of the First Post-partum Days” (N Engl J Med 1972;286:460–463) and their book, Maternal-Infant Bonding (1976), changed hospital care of infants forever and also, incidentally, the direction of my life's interest and work. Books in maternity care were often sent my way when I was employed as a free-lance medical book editor for The C.V. Mosby Company in St. Louis, and in 1975, the extraordinary manuscript of Maternal-Infant Bonding arrived on my doorstep and into my hands. Because of my interest and knowledge of the topic, the publishing company, in an unusual step, agreed for me to talk to, and then meet the authors in Cleveland to visit their hospital and discuss the book. Thus, one memorable night, I spent 5 hours or so in a motel bedroom with John and Marshall, intensely re-working the manuscript. And so our friendship began! Together these two pediatricians, through their research and writing, have brought to the world's attention the importance of the maternal-infant bonding process, the significance of the first minutes and days after childbirth to mother and newborn, the need to humanize and improve hospital care of sick and premature newborns, the importance of using doulas to attend mothers in labor, and more. Marshall, with his wife Phyllis, wrote The Amazing Newborn (1985), and together with John, the noteworthy Mothering the Mother (1993) and Bonding: Building the Foundations of Secure Attachment and Independence (1995). Birth and its readers have benefited enormously from their work and expertise—Marshall Klaus has been a valued and long-standing member of Birth‘s Editorial Board, and he, John, and Phyllis continue to author articles and review manuscripts for the journal. But, most of all, Marshall and John forever humanized and changed the care of newborns so that families could have the best possible start in life. I am one of the worldwide legions of Sheila Kitzinger admirers and individuals whose work has long been influenced by her writing, teachings, and example. Sheila, world-famous childbirth educator, consumer advocate, author, and activist, is an institution all by herself. Her countless books on pregnancy, childbirth, and reproductive health have found their way into homes all over the world. In England and many other countries, she has campaigned relentlessly for the rights of childbearing women, for the elimination of unnecessary medical intervention, for midwifery, and for reforms in health care and services, using every strategy at her disposal—lobbying the government, institutions, and health professions; working the media; testifying for expert panels; bending the ear of whoever will listen; locking horns with the powerful; and always writing, lecturing, and energizing others in her causes. After sharing several conferences with Sheila and marveling at her ability to captivate her listeners, I had the pleasure of visiting her splendid home near Oxford, where I first discovered another realm of her special talents—art and textiles. Some of this work is included in Sheila's recent Rediscovering Birth (2000), an elegant and exciting book that reveals childbirth in all its emotional and physical power. Sheila, through her writing and teaching, more than anyone else, has influenced individual women to change the way they birth their babies. We are tremendously fortunate that Sheila has contributed to Birth for many years, and her lively ‘‘Letter from Europe'’ regularly provides readers with updates and provocative commentary about current birth issues. In education and advocacy for childbirth, without a doubt, she is paramount. One of the world's leading authorities on breastfeeding and human lactation, neonatologist Ruth Lawrence began her illustrious medical career in 1950 at the famed Yale-New Haven Hospital—home of the country's first ‘‘rooming-in'’ unit under Edith Jackson. Ruth and I met in the late 1970s at the University of Rochester Medical Center (when I was in my consumer advocacy role) to talk about the best ways to meet the emotional and social needs of young hospitalized children. At the time, as I mentioned earlier, I was working as a medical book editor for The C.V. Mosby Company. Then, one day Ruth telephoned me to ask if I thought that a breastfeeding guide for health professionals would be of interest to medical publishers. Well! I remember how excited I was—nothing like that was available, and I couldn't phone Mosby fast enough to put publisher and author together! The rest, as they say, is history, and Breastfeeding: A Guide for the Medical Profession (1980) is now in its fifth edition, one of Mosby's most influential and best-selling texts. Since then, I have enjoyed working with Ruth on various maternal-child health and breastfeeding advisory groups in New York State and nationally. She has been an essential member of the Birth Editorial Board since 1990 and speaker at Birth conferences. One of her notable efforts to improve breastfeeding rates nationwide was organizing and chairing the U.S. Surgeon General's Workshop on Breastfeeding and Human Lactation in1984. Later she was instrumental in developing the Baby Friendly Hospital Initiative in the United States. Indeed, her advocacy for breastfeeding and her tireless work educating professionals for 45 years or more have contributed enormously to scientific understanding of human lactation and, thereby, both to the improvement in breastfeeding rates in the United States and to the health of mothers and babies. Nancy Sutherland, consumer advocate and activist extraordinaire, and now aged 93 years, of Auckland, New Zealand, is not only my mother, but also has been my role model and inspiration all my life. She was years ahead of her time in the health and social welfare causes and campaigns to which she devoted her life—education for childbirth and parenting, antenatal exercises, children's rights, rooming-in, pregnant teenagers, single mothers, breastfeeding, emotional needs of hospitalized children, mother-infant attachment, sex education, family planning, home birth, child care centers, social welfare reform, services for the elderly, and more. She is the mother of five—two sets of twins and one single—and was New Zealand's first mother to use the Grantly Dick-Read method of natural childbirth for her first set of twins in 1938. She was a powerful speaker, fluent writer, and masterful tactician—talents that stood her well in politics as a City Councillor in Christchurch in the 1970s, when she implemented many progressive social welfare reforms. She was a co-founder of the Christchurch Parents Centre and later established the Family Life Education Council. Her work was meticulously researched, and it always amazed me that she wrote her many articles and radio broadcasts by hand, copied on carbon paper that was reused until it fell apart. She never had a typewriter. She refused to accept awards—it was enough for her to do what she had set out to do, and then to move on to whatever had to be done next. Nancy is a truly remarkable woman and pioneer, who championed and fought for many reforms in the health and well-being of mothers, children, families, and the elderly in New Zealand during her long life. Her achievements have made me enormously proud. I have been privileged to know and work with these women and men during the past 35 years. Each has left an indelible mark in the field of maternal and newborn health care, and has made a significant and positive difference in the lives of countless mothers, babies, and families. I thought that Birth readers might like to know some of these people too. The Editor and Editorial Board of Birth are saddened to inform our readers of the recent sudden death of David A. Nagey, MD, PhD, at age 51 years, on April 21. David has been a valued and active member of the Birth Editorial Board for the past 5 years. He was Director of Perinatal Outreach, Associate Professor in the Departments of Gynecology and Obstetrics and Maternal and Child Health at Johns Hopkins University, Baltimore, Maryland, and consulting perinatologist for 10 Maryland hospitals. He was a recognized authority in the management of high-risk pregnancies, and his mission was to provide consultant care on a local level through outreach. His colleagues observed that David Nagey showed unwavering personal commitment and tireless professionalism in his pursuit of excellence in perinatal care. ‘‘He was one of the most significant contributors to the care of mothers and children in the state. He was humble, compassionate, and a true leader,‘’ said Harold E. Fox, MD, professor and director of gynecology and obstetrics at Hopkins. A special fund has been set up in his memory. Donations can be sent to The David A. Nagey Memorial Fund for Perinatal Outreach, C/o Ms. Barbara Chase, The Johns Hopkins Hospital, Department of Gynecology and Obstetrics, 600 N. Wolfe St., Phipps 254, Baltimore, MD 21287. It was an honor to have David serve on the Editorial Board of Birth. He always brought a thoughtful, broad-based, and scholarly input to the journal, touched often with a dry wit, and his contributions and support will be greatly missed.