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Midwives' Collaborative Activism in Two U.S. Cities, 1970-1990

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Midwives' Collaborative Activism in Two U.S. Cities, 1970-1990 University of Pennsylvania ScholarlyCommons Publicly Accessible Penn Dissertations 2013 Midwives' Collaborative Activism in Two U.S. Cities, 1970-1990 Linda Tina Maldonado University of Pennsylvania, [email protected] Follow this and additional works at: https://repository.upenn.edu/edissertations Part of the History Commons, and the Nursing Commons Recommended Citation Maldonado, Linda Tina, "Midwives' Collaborative Activism in Two U.S. Cities, 1970-1990" (2013). Publicly Accessible Penn Dissertations. 896. https://repository.upenn.edu/edissertations/896 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/edissertations/896 For more information, please contact [email protected]. Midwives' Collaborative Activism in Two U.S. Cities, 1970-1990 Abstract ABSTRACT MIDWIVES' COLLABORATIVE ACTIVISM IN TWO U.S. CITIES, 1970-1990 Linda Tina Maldonado Dr. Barbra Mann Wall, PhD, RN, FAAN This dissertation uses historical methodologies to explore the means through which activist midwives in two northeastern cities collaborated, negotiated, and sometimes conflicted with numerous stakeholders in their struggle to reduce infant mortality. Infant mortality within the black community has been a persistent phenomenon in the United States, despite a growing dependence on advancing medical technologies and medical models of birth. Studies in the early twentieth century typically marked poverty as the dominant factor in infant mortality affecting black communities. Refusing to accept poverty as a major determinant of infant mortality within marginalized populations of women, nurse-midwives during the 1970s and 1980s harnessed momentum from the growing women's health movement and sought alternative methods toward change and improvement of infant mortality rates. Utilizing a grassroots type of activism, midwives formed collaborative relationships with social workers, community activists, physicians, public health workers, and the affected communities themselves to assist in the processes of self-empowerment and education. Negotiating with hospital administrators and powerful physician groups, these activists were able to improve substandard medical and institutional treatment of marginalized pregnant women while pushing for alternative deliveries of obstetrical care that included the integration of nurse-midwives. Through their work with communities of marginalized women, nurse-midwives and their collaborative partners were able to improve the consistency of prenatal care by building strong networks of advocacy and social support. As a result, communities became engaged in their health as well as self-empowered to make positive change in the health of pregnant women and infants. Equitable healthcare and persistent infant mortality in the black community are relevant and contentious concerns today. The history of nurse-midwives and health activists sheds important light onto these enduring societal problems. Furthermore, a historical understanding of successful nurse activist models is essential as the country undertakes healthcare reform that will necessarily involve nurses to improve access to care. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Nursing First Advisor Barbra Mann Wall Keywords activism, advocacy, collaboration, community, midwives, social justice Subject Categories History | Nursing This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/edissertations/896 MIDWIVES’ COLLABORATIVE ACTIVISM IN TWO U.S. CITIES, 1970-1990 Linda Tina Maldonado A DISSERTATION in Nursing Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy 2013 Supervisor of Dissertation Signature_____________ Dr. Barbra Mann Wall Dr. Barbra Mann Wall, PhD, RN, FAAN, Professor of Nursing Graduate Group Chairperson Signature_______________ Dr. Barbara J. Riegel, PhD, RN, FAAN, Professor of Nursing Dissertation Committee Dr. Julie Fairman, PhD, RN, FAAN, Professor of Nursing Dr. Damon Freeman, PhD, Professor of History Dedication To Jacob and Joshua ii ACKNOWLEDGMENTS I have had the honor of being guided by an amazing dissertation committee and readers. To my dissertation chair, Barbra Mann Wall: thank you for your patience, encouragement, and spirit during every step of my progress. I am forever grateful that you took me under your wings. To Julie Fairman: thank you for seeing the abilities you helped nurture well before they were ever visible. Dr. Freeman: I thank you for teaching me how to approach race critically and thoughtfully. Your expertise sharpened my ability to consider nursing, community, and health through the multiplicities of race, class, and gender. Thank you to my dissertation readers: Bill McCool and Anne Teitelman. My work has benefitted greatly from both your insight and unique vantage points. This project also benefitted from several awards and fellowships. The Walter Lear Fellowship Award, The Sigma Theta Tau Research Award, and the University of Pennsylvania School of Nursing Research Award provided various funding for this project. I am also deeply appreciative for incredible groups of archivists: John Pollack and his staff from the University of Pennsylvania’s Van Pelt Library Rare Book and Manuscript Special Collections as well as Steven Novak and Jennifer McGillan from the Archives and Special Collections at Columbia University Medical Center’s Augustus C. Long Health Sciences Library. Their invaluable guidance helped me navigate my way through a host of primary sources. To my family and friends who believed in me when at times, I doubted myself; I love you and thank you. You know who you are. My sons, Jacob and Joshua, bravely ventured on this life-altering journey with me six years ago. It is because of you that I accomplished this goal. Love you dearly and forever. iii ABSTRACT MIDWIVES’ COLLABORATIVE ACTIVISM IN TWO U.S. CITIES, 1970-1990 Linda Tina Maldonado Dr. Barbra Mann Wall, PhD, RN, FAAN This dissertation uses historical methodologies to explore the means through which activist midwives in two northeastern cities collaborated, negotiated, and sometimes conflicted with numerous stakeholders in their struggle to reduce infant mortality. Infant mortality within the black community has been a persistent phenomenon in the United States, despite a growing dependence on advancing medical technologies and medical models of birth. Studies in the early twentieth century typically marked poverty as the dominant factor in infant mortality affecting black communities. Refusing to accept poverty as a major determinant of infant mortality within marginalized populations of women, nurse-midwives during the 1970s and 1980s harnessed momentum from the growing women’s health movement and sought alternative methods toward change and improvement of infant mortality rates. Utilizing a grassroots type of activism, midwives formed collaborative relationships with social workers, community activists, physicians, public health workers, and the affected communities themselves to assist in the processes of self-empowerment and education. Negotiating with hospital administrators and powerful physician groups, these activists were able to improve substandard medical and institutional treatment of marginalized pregnant women while pushing for alternative deliveries of obstetrical care that included the integration of nurse- midwives. iv Through their work with communities of marginalized women, nurse-midwives and their collaborative partners were able to improve the consistency of prenatal care by building strong networks of advocacy and social support. As a result, communities became engaged in their health as well as self-empowered to make positive change in the health of pregnant women and infants. Equitable healthcare and persistent infant mortality in the black community are relevant and contentious concerns today. The history of nurse-midwives and health activists sheds important light onto these enduring societal problems. Furthermore, a historical understanding of successful nurse activist models is essential as the country undertakes healthcare reform that will necessarily involve nurses to improve access to care. v Table of Contents ACKNOWLEDGMENT………………………………………………………………..iii ABSTRACT……………………………………………………………………………...iv LIST OF TABLES……………………………………………………………………...vii CHAPTER 1……………………………………………………………………………...1 CHAPTER 2…………………………………………………………………………….19 CHAPTER 3…………………………………………………………………………….60 CHAPTER 4…………………………………………………………………………….98 CHAPTER5……………………………………………………………………………130 EPILOGUE……………………………………………………………………………142 BIBLIOGRAPHY……………………………………………………………………..147 vi LIST OF TABLES Table 2 vii Table 3 viii Table 4 ix Table 5 x Chapter One Midwives’ Collaborative Activism in Two U.S. Cities, 1970-1990 1 Introduction Successful nursing advocacy often involves unlikely parings of polar opposites working together. Collaborations of extremely different people united toward a cause can make radical changes in nurse, client, and community. This dissertation examines the role of nurses in the women’s health movement of the 1970s and 1980s through the lens of two organizations: the Maternity Care Coalition (MCC) of Philadelphia, Pennsylvania; and the Maternity Care Association (MCA) in New York City. The MCC and MCA provided the institutional frameworks within which nurse actors operationalized their advocacy. This study adds to the multiple meanings of nurse advocacy by placing nurses as
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