State chapter of the AMA ends a successful hospital-based nurse-midwifery program providing normal birth services to low-income women that greatly reduced perinatal mortality ~ 1963

by faithgibson on May 21, 2023

in The Art & Science of Midwifery, Women's Reproductive Rights

In 1963, the California state lobbyists for the AMA and the those for the American College of Obstetrics and Gynecologists {ACOG) stopped a hospital-based nurse-midwifery program that provided physiological management of normal childbirth to very low-income population of women.

Shutting down an effective nurse-midwifery program resulted in a rise in neonatal mortality from 10.3 to an astonishing 32.1 per 1,000 live births.

Acting on behalf of California’s obstetrical lobby, members of the state chapter of the American Medical Association (the California Medical Association) shut down a very successful hospital-based nurse-midwifery program. From 196 to 1963, professional nurse midwives were hired by a local hospital to provide physiologically managed (i.e. normal) birth services to these very low-income women, many of whom were migrant workers. The use of the midwifery model of care greatly reduced the need for obstetrical interventions during normal childbirth.

Nurse-midwives do not give drugs to laboring women, or use obstetrical interventions such as forceps or C-sections. This low-intervention model helped to reduce the perinatal mortality in women who received care during their pregnancy and childbirth from the nurse midwives.

From July 1960 to June 1963, a pilot nurse-midwife program was established at Madera County Hospital in California that served mainly poor agricultural workers. During the three-year program, prenatal care increased, and prematurity and neonatal mortality rate decreased at the county hospital.

After it was discontinued by the California Medical Association, the neonatal mortality rate increased even among those women who had received no prenatal care. This suggests that intrapartum care by nurse-midwives may have been far more skillful than delivery by physicians.

After pulling the plug on the hospital-based nurse-midwifery program, access to prenatal care decreased substantially, while prematurity rose from 6.6 to 9.8%; neonatal mortality rose from 10.3 to an astonishing 32.1 per 1,000 live births.

The study concluded that the discontinuation of the nurse-midwives services was the major factor in these changes. [published by Dr. Levy, et al, 1971].


Identifying the historical motives for shutting down a much-needed and successful midwifery program that served low-income women

This is only one of the thousands of instances in which the American obstetrical profession actively worked against common sense and scientifically-proven principles. The undeclared medical experiment by American obstetricians to turn normal childbirth into a surgical procedure has already been discussed in dozens of posts on this website, so if you want to read the whole story.

The bottom line is that Dr. J. Whiridge Williams (also more about him in other posts) came up with a plan for small hospitals to fund their own modernization adding a small lying-in ward. Then they began o actively solicit the patronage of white, middle- and upper-class maternity patients as paying customers. New mothers are very inexpensive to care for and they stayed in the hospital after the birth for the traditional 14-day “lying-in” period.  This turned the maternity ward the ‘cash cow’ of the hospital business.

The steady and very profitable revenue stream this generated provided a way to self-fund their own remodeling. It also allowed them to purchase capital-intensive medical equipment such an X-ray machine, an industrial autoclave and adding a new operating room.

Also, the profits from the maternity department made up for financial losses in other departments of the hospital, when patients couldn’t pay their bill or died.

It’s a safe bet that more than one hospital administrator saw hospitalized pregnant women as the answer to their prayers.

But even more exciting this profitable income paid for gradually upgrading and expanding their facility

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