Search

Maternity care in the United States is characterized by racial and income disparities in maternal and infant outcomes. This article describes an innovative, hospital-based doula model serving a racially and ethnically diverse, low-income population. The program's history, program model, administration requirements, training, and evaluations are described.

Cuba's maternity homes were founded in 1962 as part of the gen-eral movement to extend health services to the whole population in the context of the post-1959 social transformations. The over-arching goal of the homes was to improve the health of pregnant women, mothers and newborns. Hence, in the beginning when there were few hospitals in Cuba's rural areas, their initial pur-pose was to increase institutional births by providing pregnant women a homelike environment closer to hospitals. There, they lived during the final weeks before delivery, where they received medical care, room and board free of charge. Over time, and with expanded access to community and hospital health facilities across Cuba, the numbers, activities, modalities and criteria for admission also changed. In particular, in addition to geographi-cal considerations, expectant mothers with defined risk factors were prioritized. For example, during the 1990s economic crisis, the maternity homes' role in healthy nutrition became paramount. The purpose of this essay is to provide a historical perspective of this process, describe the changes and results during the 55 years examined, and take a critical look at the challenges to suc-cessful implementation of this model, a mainstay at the primary healthcare level of the public health system's Maternal-Child Health Program. KEYWORDS Maternal health, maternal-child health, obstetrics, pregnancy, Cuba.

Over the past decade historians have explored the rise of the mid-twentieth-century population/family planning movement on both the international and the local levels. This article bridges the gap between these studies by exploring the work diaries of Dr. Adaline Pendleton ("Penny") Satterthwaite, a midlevel technical advisor who traveled to over two dozen countries for the Population Council from 1965 to 1974. Penny's diaries draw our attention to a diverse network of advocates who mediated between international population activists, state actors, and local communities while also acting as conduits for the transnational spread of strategies and resources. Her experiences also provide evidence of the coercive practices, gendered tensions, and political conflicts shaping the movement while illustrating the resistance and engagement of local actors, the existence of health- and women-centered approaches even during the high period of population control, and the many structural and social barriers shaping family planning projects in practice.

This paper is about the clinical principle of informed choice-the hallmark feature of the midwifery model of care in Ontario, Canada. Drawing on ethnographic history interviews with midwives, I trace the origins of the idea of informed choice to its roots in the social movement of midwifery in North America in the late 1960s and 1970s. At that time informed choice was not the distinctive feature of midwifery but was deeply embedded what I call midwifery's feminist experiment in care. But as midwifery in Ontario transitioned from a social movement to a full profession within the formal health care system, informed choice was strategically foregrounded in order to make the midwifery model of care legible and acceptable to a skeptical medical profession, conservative law makers, and a mainstream clientele. As mainstream biomedicine now takes up the rhetoric of patient empowerment and informed choice, this paper is at once a nuanced history of the making of the concept and also a critique of the ascendant 'regime of choice' in contemporary health care, inspired by the reflections of the midwives in my study for whom choice is impossible without care.

This paper examines the effect of variable reporting and coding practices on the measurement of maternal mortality in urban and rural Scotland, 1861-1901, using recorded causes of death and women who died within six weeks of childbirth. This setting provides data (n = 604 maternal deaths) to compare maternal mortality identified by cause of death with maternal mortality identified by record linkage and to contrast urban and rural settings with different certification practices. We find that underreporting was most significant for indirect causes, and that indirect causes accounted for a high proportion of maternal mortality where the infectious disease load was high. However, distinguishing between indirect and direct maternal mortality can be problematic even where cause of death reporting appears accurate. Paradoxically, underreporting of maternal deaths was higher in urban areas where deaths were routinely certified by doctors, and we argue that where there are significant differences in medical provision and reported deaths, differences in maternal mortality may reflect certification practices as much as true differences. Better health services might therefore give the impression that maternal mortality was lower than it actually was. We end with reflections on the interpretation of maternal mortality statistics and implications for the concept of the obstetric transition., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Nurses struggle with conflicting priorities regarding the care of women during childbirth and the expectations of physicians and employers. Nurses are expected to perform technologically sophisticated interventions that were once performed by physicians, which can affect the perception of comfort that nurses traditionally offered. In this historical overview, I suggest that scientific childbirth advances have contributed to soaring cesarean rates and identify the role of the nurse as a contributor to this trend., (Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

In June of 1866, the empress Carlota founded the Maternity House in the Department of Secret Births at the Hospice of the Poor. Upon the reinstatement of a republican government, Dr. Ramon Pacheco was appointed director of the Maternity House. Shortly after, in February of 1868, Dr. Luis Fernandez Gallardo established a pavilion for sick children in the Hospital of San Andres. After realizing this pavilion didn't have the adequate conditions to operate properly, and in the need of a children's hospital in Mexico City, Dr. Pacheco merged both institutions in April 2, 1869 -with the help of Ms. Luciana Arrazola- and founded the Maternity and Childhood Hospital, the first institution for the care of ill children in the independent Mexico. Ever since it was founded, Dr. Eduardo Liceaga was in charge of the children's health. Later, with the help of the presidents Juarez, Lerdo de Tejada and Díaz, he was able to consolidate the hospital in academic and health services aspects. This noble institution closed its doors on February 5, 1905, upon its incorporation to the General Hospital of Mexico, after 36 years of working for the welfare of Mexican children., (Copyright © 2017 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.)

New York City was ahead of its time in recognizing the issue of maternal death and the need for proper statistics. New York has also documented since the 1950s the enormous public health challenge of racial disparities in maternal mortality. This paper addresses the history of the first Safe Motherhood Initiative (SMI), a voluntary program in New York State to review reported cases of maternal deaths in hospitals. Review teams found that timely recognition and intervention in patients with serious morbidity could have prevented many of the deaths reviewed. Unfortunately the program was defunded by New York State. The paper then focuses on the revitalization of the SMI in 2013 to establish three safety bundles across the state to be used in the recognition and treatment of obstetric hemorrhage, severe hypertension in pregnancy, and the prevention of venous thromboembolism; and their introduction into 118 hospitals across the state. The paper concludes with a look to the future of the coordinated efforts needed by various organizations involved in women's healthcare in New York City and State to achieve the goal of a review of all maternal deaths in the state by a multidisciplinary team in a timely manner so that appropriate feedback to the clinical team can be given and care can be modified and improved as needed. It is the authors' opinion that we owe this type of review to the women of New York who entrust their care to us., (Copyright © 2016 Elsevier Inc. All rights reserved.)

This paper is a biography of a great Soviet paediatrician, Professor Georgy Nestorovich Speransky, known as the founder of Russian neonatology. He was the organizer, Director and scientific leader of the first State Research Institute of Maternity and Infant Care in the USSR which later was reorganized as the State Research Institute of Paediatrics of the Academy of Medical Sciences of the USSR. He organized the first Russian medical department of childhood diseases at the Central Institute of Continuing Education for Medical Doctors, where he and his colleagues taught physiology and pathology. He was one of the initiators of a free state system of maternity and infant health care and infant mortality was decreased tenfold., (© The Author(s) 2014.)

Historians have long used maternity records to understand the evolution of maternity services. More recently, epidemiologists have become interested in obstetric hospital records as a source of data (e.g. birth weight, social class), to study the influence of early life on future health and disease: life course epidemiology. Edinburgh and Aberdeen are unusual in holding detailed records from several maternity institutions. The records of 1936 are of particular interest because all children born in this year and at school in Scotland at age 11 sat a cognitive ability test, the Scottish Mental Survey 1947. This study aims to describe the maternity services in Edinburgh and Aberdeen in 1936, between the First and Second World Wars. Understanding the richness of data in birth records, the manner in which they were recorded, and the context of the institutions in their community is essential for interpreting life course epidemiology studies.

This article examines how the Frontier Nursing Service (FNS) utilized nurse-midwives to respond to antepartum emergencies such as preterm birth, eclampsia, malpresentation, and hemorrhage in the women of Appalachia in the years 1925 to 1939. Particular attention is given to the preparation that nurse-midwives received during their midwifery education to prevent and respond to emergencies. Using traditional historical research methods and primary source material from the FNS papers in the Special Collections, University of Kentucky Libraries, Lexington, Kentucky, this article describes the nurse-midwives' experiences and how they implemented skills they had learned during their training in Great Britain. Working in the isolated mountainous area of Leslie County, Kentucky-for the most part without direct assistance from physicians-FNS nurse-midwives decreased maternal and neonatal mortality rates. During their first 2000 births, they had only 2 maternal deaths, whereas the national average maternal mortality rate was approximately 7 deaths per 1000 births. The nurse-midwives performed external cephalic versions on a routine basis. For pregnancy and birth emergencies, they administered sedation, gave general anesthesia, and performed invasive lifesaving techniques in order to protect the lives of the women in their care. During these 14 years, their cross-cultural engagement, assessment skills, clinical judgment, and timely interventions improved maternal and child health throughout the region., (© 2015 by the American College of Nurse-Midwives.)

This article deals with the main features of the emergence and first ten years of the Centros de Higiene Infantil, facilities run by the Departamento de Salubridad Pública from 1922 on in Mexico City with the goal of providing care for mothers from pregnancy onwards and children from birth to two years of age. It reviews the actions that gave rise to this project and how it became established. It analyzes the structure of these centers, the characteristics of the mothers and children seen there and the functions performed by doctors and nurses, stressing the notion of preventing childhood illnesses, and ends with a first assessment of the effects and limitations of these centers.

This article documents the historical factors that led to shifts in mission work toward a greater emphasis on community health for the poor and most vulnerable of society in sub-Saharan Africa after 1945. Using the example of the Medical Mission Sisters from Philadelphia, Pennsylvania, and their work in Ghana, we challenge the conventional narrative of medical missions as agents of imperialism. We assert that missions-particularly those run by Catholic sister physicians, nurses, and midwives-have changed over time and that those changes have been beneficial to the expansion of community health, particularly in the area of improvement of maternal care.

In the beginning of XX century health care of the Yakutskaya ASSR characterized by low level of development due to lacking and shortage of medical manpower, illiteracy of population in issues of prevention of various diseases. In those times, by virtue of timely applied new normative documents, health personnel training, organization of medical educational institution for Yakutia and preventive activities the first results in further development of obstetrics service were achieved. In the beginning of XX century in Yakutia high birth rate, high infant and maternal mortality were marked. The present study was carried out to analyze development of obstetrics service in Yakutskaya ASSR (at present the Republic of Sakha (Yakutia)). The study established that to the end of XX century birth rate decreased and extra genital morbidity increased. The indicators of perinatal and maternal mortality, quality indicators of dispensarization of pregnant women, prevention and diagnostic of diseases ameliorated. According implemented analysis no grounds are tracked to expect any increasing of birth rate. However, possibility is not inconceivable that in perspective percentage of women having two and more deliveries up to the end of reproductive cycle will decrease. The effectiveness of actual "stimlulating" measures of public policy will be under the threat in future because of "Russian cross" of 1996. In the Republic, aggregate birth rate level of 1.7 deliveries counting upon one woman has no perspective. The other mechanisms and public policy are needed to be worked out.

The Fort Lewis maternity project begun in Tacoma, Washington in 1941, was considered a pioneering project that met the identified maternal/child health care needs of enlisted military families. From the outset, local medical leaders as well as Children's Bureau advisors intended that the project would provide physician-managed pregnancy as well as hospital births and that public health nursing would play a critical role in this maternal/child initiative. The project proved so successful that the model of care established under this program was reinterpreted to meet similar needs for military families in other states as America entered World War II.

This study employed historical methodologies to explore the means through which the Maternity Care Coalition used grassroots activism to dismantle the power structures and other obstacles that contributed to high infant mortality rates in Philadelphia's health districts 5 and 6 during the 1980s. Infant mortality within the black community has been a persistent phenomenon in the United States. Refusing to accept poverty as a major determinant of infant mortality within marginalized populations of women, activists during the 1980s harnessed momentum from a postcivil rights context and sought alternative methods toward change and improvement of infant mortality rates.

The Office of Economic Opportunity-Population Council program is an example of a mid-twentieth-century federal government/private foundation cooperative effort to place family planning and maternal health at the center of a fight against entrenched poverty. These joint efforts were the trend in family planning and maternal health provision by the 1960s and had two overlapping but also contradictory goals. The first was to provide contraceptive services to poor women to reduce the numbers of poor children, thus relieving the poor of added mouths to feed. Popular fears of a population explosion, mounting welfare rolls, and an increase in the numbers of African Americans receiving welfare fueled this goal. The second aim, however, was to expand comprehensive maternal health services to help reduce poverty by increasing poor women's involvement in and control over the health institutions that could have significant impact on their lives. While the first goal pivoted on encouraging poor women to bear fewer children, the second sought to integrate poor women into community healthcare delivery systems.

Primary maternity units are commonly those run by midwives who provide care to women with low-risk pregnancies with no obstetric, anaesthetic, laboratory or paediatric support available on-site. In some other countries, primary level maternity units play an important role in offering equitable and accessible maternity care to women with low-risk pregnancies, particularly in rural and remote areas. However there are very few primary maternity units in Australia, largely due to the fact that over the past 200 years, the concept of safety has become inherently linked with the immediate on-site availability of specialist medical support. The purpose if this paper is to explore the various drivers and barriers to the sustainability of primary maternity units in Australia. It firstly looks at the historical antecedents that shaped primary level maternity services in Australia, from the time of colonisation to now. During this period the space and management of childbirth moved from home and midwifery-led settings to obstetric-led hospitals. Following on from this an analysis of recent political events shows how Australian government policy both supports and undermines the potential of primary maternity units. It is important that researchers, clinicians and policy makers understand the past in order to manage the challenges facing the development and maintenance of midwifery-led maternity services, in particular primary maternity units, in Australia today., (Copyright © 2013 Australian College of Midwives. All rights reserved.)

On April 9, 1912, the law establishing the Children's Bureau was signed by President William Howard Taft. The original mission of the Children's Bureau was to "investigate and report … upon all matters pertaining to the welfare of children and child life among all classes of our people." This paper focuses on the transitional years from roughly 1950 to 1969, when the Children's Bureau's investigative mandate was transformed from a set of intramural activities that viewed maternal and child health research as part of a larger effort cutting across investigative, programmatic, and policy goals, and across different domains of the child's life, to an extramural research program focused specifically on maternal and child health. Discussion focuses on the mission of the Maternal and Child Health (MCH) Research Program, housed now within the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA), of the U.S. Department of Health and Human Services.

Julie Kamblijambi-Kep has come a long way from her childhood in the village of Wingi in Papua New Guinea's East Sepik Province. This article explores the support Julie's family provided for her education, her subsequent training as a nurse and her work around the country, including as the coordinator of the maternal health program at the University of Goroka. The article's exploration of various challenges, including the death of Julie's husband and her need to work while raising five children, make it a useful reference point for women in Papua New Guinea, especially those who are committed to helping others by working in the field of maternal and child health.

This article describes the development of our collaborative practice, discusses the barriers and challenges presented by the current health care environment, and identifies factors that would encourage the initiation and strengthening of a successful collaborative model in similar settings. Successful collaborative practice is more than just a practice model, or a set of items that, once checked off, will guarantee success. It is a process that is inextricably linked to the focus and dedication of all our clinicians to provide the best care possible for women., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Collaboration among professional groups is essential for safe and efficient health care. Midwifery care is optimized when allowed to function independently within an integrated health care system of support to address complications should they arise. A formal process for collaboration facilitates a smooth, expedient flow of information and decision making in a time of need, maximizing safety and efficiency. This article describes a successful collaborative model among four midwives and one obstetrician that addresses the impending maternity health care provider shortage, the needs of vulnerable populations, and cost-efficiency through appropriate use of technology and choice of health care provider., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Low breastfeeding duration rates reflect the pain and distress experienced by many women who discontinue breastfeeding in the early weeks and months of life. This paper explores modern key historical events that have significantly influenced Australian breastfeeding education and practice., Method: Relevant literature reviewed from 1970 to 2010 identified key events that appear to have contributed to the decrease in Australian breastfeeding rates and the increase in women experiencing breastfeeding complications, particularly nipple pain and trauma., Findings and Discussion: The rise in institutionalisation and medical intervention in labour and birth has also medicalised midwifery practice. Technocratic intrusion and institutionalised care is contributing to the separation of the mother and newborn at birth. Delayed mother-baby initiation of breastfeeding and interruption of the duration of the first, and subsequent breastfeeds, negatively affects the innate ability of the mother and newborn to establish and sustain breastfeeding. The 'pathologising' of breastfeeding that involve midwives teaching women complicated and unnatural breastfeeding techniques interfere with instinctive sensory and mammalian behaviours and further contributes to the high complication rates., Conclusion: Midwives are encouraged to reflect on their role as 'experts' in the breastfeeding process and give confidence to women so that they utilise their instinctive ability to breastfeed by self-determined techniques that encourage mammalian skills for newborn sustenance and survival., (Copyright © 2010 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

This is a literature-based historical analysis that uses Michel Foucault's technique of tracing epistemological change over time to understand the epistemological changes and their outcomes that have occurred in Nunavik, the Inuit region of Northern Quebec, with the introduction of modern techniques and technology of childbirth in the period after the Second World War. Beginning in 1986, in the village of Puvurnituq, a series of community birthing centres known as the Inuulitsivik Maternities have been created. They incorporate biomedical techniques and technology, but are incorporated into the Inuit epistemology of health, in which the community is the final arbitrator of medical authority. This epistemological accommodation between modern biomedicine and the distinctly premodern Inuit epistemology of health has led to the creation of a new and profoundly non-modern approach to childbirth in Nunavik.

The paper examines some of the progress and problems encountered during the first two decades of the Safe Motherhood Initiative. Sufficient statistics are cited to identify the immensity of the persisting problems associated with maternal death and morbidity before the study focuses on some of the endeavours designed to enable women to survive their natural function of giving birth. Varying attitudes and approaches that have characterised the initiatives launched in the past 20 years are reviewed and their changing emphases noted. The stress on treating the medical causes of maternal death in the early years have been complemented by increasing attention to social and political issues as time has elapsed. The advent of the Millennium Development Goals (MDGs) has impelled efforts to provide skilled attendance for all women during childbirth; the poor, socially disadvantaged and vulnerable being those most at risk. MDG 5, concerning maternal health, is perceived as pivotal in the context of global development. Maternal death when viewed from the human rights perspective is perceived as a social injustice rather than a health disadvantage and Safe Motherhood is currently considered increasingly as a basic human right. The study offers a synthesis of concepts and actions that are contributing to building Safe Motherhood across the globe in the 21st century. In considering the factors that inhibit the degree of safety associated with giving birth, global efforts that are tackling a persisting buffer zone are identified and continuous action urged in order to strive towards the targets set for 2015., (Copyright © 2009 Elsevier B.V. All rights reserved.)

The subject of this article is the health checks for pregnant women and children in Denmark and Sweden introduced in the 1930s and 1940s. It focuses on how political goals and means have changed up until today. The questions addressed are: Which health issues did the politicians and authorities find relevant to deal with? How should they be dealt with? Who were the interventions targeted towards? It is shown that from the 1970s changes gradually took place in two respects. (1) The scope widened inasmuch as increasingly more aspects were to be included in the examinations and guidance. Not only did they come to comprise the physical, social and mental wellbeing of the children but also the life of the entire family, including efforts to improve the parents' social networks and their ability to handle their relationship with each other. (2) Interventions became increasingly targeted towards those categorised as being in need, either for medical reasons or because they were seen as less capable of caring for their children. Thus, this implied that the universal model of welfare provision was partly abandoned. The categorisations necessitated definitions of normality in more aspects and more surveillance in order to assess whether women and children lived up to the criteria of normality. These two changes were probably inter-related since the urge to target and therefore identify risk groups increased when more resources were invested as a consequence of the widening scope of the activities.

The article describes and analyzes one of the political projects that gained strength in Argentina during the between-war years and remained in place throughout Peronism: government tutelage of mothers and children. It examines how the Dirección de Maternidad e Infancia viewed the mother-child dyad, how this office proposed to address the issue of infant mortality, what type of technical staff was in place, and what limitations were encountered in trying to enforce these ideas. It also looks at what changed and what stayed the same at the office under Peronism.

This paper focuses on the introduction and development of midwifery education and training in Sydney during the last decades of the 19th century. The aim of the training, it is argued, was to displace the lay midwives by trained midwifery nurses who would work under medical control. The lay midwives were one of the largest occupational groups among women and two-thirds of births in NSW were being delivered by them in the late 19th century. It was a period of professionalisation of medicine and medical men laid claim to midwifery as a legitimate sphere of their practice and saw it as the gateway for establishing a family practice. The lay midwife stood in the way of their claim. The training programs were established purportedly to control maternal mortality. From the beginning in 1887 medical men were in control of midwifery nurse training. In addition to training at the Benevolent Society Asylum, three more women's hospitals were established in the 1890s in Sydney making it possible to train a stream of midwifery nurses. The midwifery nurses were charged exorbitant fees for their training; the fees contributed substantially towards running the new hospitals that delivered birth services to the poor and destitute women mostly in their homes. The midwifery nurses worked hard in miserable conditions under the guise of clinical experience required for training. When a critical mass of poorly trained midwifery nurses were in the offing, a Bill was introduced into the Parliament in 1895, restricting registration to midwifery nurses and this would have eliminated the lay midwife if passed. It took more than two decades to get a Registration Bill passed in the NSW Parliament.

This paper uses a feminist interpretation and secondary sources to describe the history of Australian midwifery from colonisation until the 1980s. There have been too few midwife scholars who have had access to or used primary data collections to describe the role and place of midwives in the colonising community. I draw on a range of biography, medical literature and work by sociologists and economic historians to produce a limited picture of the history of professional midwifery. This helps to explain the position of midwives today and the problematic relationship we often have with medicine.