Chicago Maternity Center: 77 years of home deliveries...Will this be its last?
(Editors Note: The Chicago Maternity Center was a unique clinic that allowed women to give birth in their homes. Long a landmark on Chicago's impoverished Westside, it had served generations of women. In 1972, it was threatened with closure by powerful financial interests. The CWLU organized a campaign that delayed, but could not halt the closing. This article was written as the campaign to save the Chicago Maternity Center was just beginning.)
In June of l688, the Queen of England was about to give birth. Her husband, King James II, wanting the child to be (naturally) male gave these directions to the midwife: Midwife, since it depends on you, put the pieces of a boy into it.
This story was recorded by the royal midwife who, fortunately for her, delivered a boy to the King. The ignorance of the King was probably not unusual. At that time, men knew almost nothing about childbirth. Until 100 years ago childbirth was in the hands of women, midwives who knew from practical experience how to help nature along. These woman were very capable of handling most deliveries. But some complications, such as a breech birth usually meant death for mother, child, or both.
Modern Medicine Begins
In the beginning of the 1800s the science of medicine in Western Europe shared the fate of all science: it consisted of a few theories formulated by ancient Greeks and some practical knowledge gained by secretly (in violation of Church law) inspecting dead bodies. It was not until the Industrial Revolution, the growth of factories in Europe and America; that science became modern industrial science, and medicine along with the other sciences was applied and practiced on a widespread basis.
This historical development of medicine in the nineteenth century was a necessary step in the development of capitalist economies. As more and more wealth was being produced by the workers in expanding factories, the factory owners (capitalists) needed ways of preserving and replacing the population of workers. This meant they had to care about both the number of people available to work and the health of workers with special skills. Unlike the Catholic Church which used to forbid scientific experimentation, and unlike the kings and barons, who couldnt care less about it, the capitalist rulers encouraged scientific development since it could be profitable to them.
Modern medicine is young in terms of human history. It wasnt until after 1860 that Louis Pasteur established the connection between bacteria and disease. That discovery drastically changed the scope of medicine. The causes of such communicable diseases as malaria, typhoid fever, diphtheria, and gonorrhea were all discovered within a few years after Pasteurs breakthrough.
From Midwives to OBs
Modern obstetrics (obstetrics: medicine concerned with the care of women during pregnancy and childbirth) began around the same time. But not without complications. When men first replaced women in the delivery room and began to use forceps and make frequent examinations during labour, there was a notable increase of a disease called childbed fever. Childbed fever began with a chill about the fourth day after the babys birth and nearly always resulted in the death of the mother. In 1846 a doctor named Semmelweiss began practicing in the First Obstetrical Clinic of Vienna a clinic run by professionals, men who were doctors or medical students. Nearby was another clinic staffed by midwives. The men soon found that their clinics rate of childbed fever was much higher than that of the midwives. As a result, expectant mothers often demanded to be delivered by the midwives. This situation caused great embarrassment to the new profession of obstetrics. It was particularly upsetting to Dr. Semmelweiss who was very proud of his medical degree. He investigated the causes of childbed fever and discovered that the medical students often went directly from dissecting dead bodies, cadavers, into the delivery room without washing their hands. The midwives, who did not touch cadavers in the course of their work, did not spread infection. Semmelweiss began requiring his physicians to wash their hands after touching cadavers. One year later the rate of childbed fever in his clinic had dropped from 12% to 3%.
Semmelweiss colleagues demonstrated the traditional reluctance of the medical profession to accept new ideas, particularly when the new ideas meant admitting doctors had caused countless unnecessary deaths. Semmelweiss was fired from the clinic. Not until 30 years later were his ideas about the prevention of childbed fever put into widespread practice. It was during this period that the Chicago Maternity Center began its curiously unique existence. (It is curious that the CMC is unique. Although the need for such an institution is widespread, the CMC is one of a kind Its beginnings correspond roughly to the beginnings of obstetrical science.
Dr. DeLee, the doctor who founded the Chicago Maternity Center had gone all the way to Semmelweiss clinic to learn to deliver babies. In 1895 he established a center to provide safe home deliveries in Chicago. Most of his patients were poor, immigrant women. DeLee also founded the first maternity hospital in the midwest, Chicago Lying-In Hospital. It began in 1910 with the purpose of training obstetricians.
The First Crisis
By 1929 DeLees center was delivering about 2000 babies a year at home. The doctors and nurses staffing the center came from Chicago LyingIn. But when the Depression came, the Hospital which had been created to meet the staffing needs of the Maternity Center, decided to close the center down as an economy measure.
Fortunately DeLee understood the Maternity Center was more important than the Hospital and took it upon himself to run it without benefit of hospital support. Since no one could afford to pay for a delivery, DeLee also had to raise separate funds.
In 1931 Dr. Beatrice Tucker joined the staff as medical director of the Maternity Center. She has held that position ever since. Dr. Tucker put together a board of directors to manage the Centers finances and fund raise since the Center could not be supported by the patients fees. Between 1929 and 1941, the Maternity Center home delivered am average of 360 babies a month.
Recognizing the need for a place to bring patients in case of complicated deliveries, Dr. Tucker sought the backup support of several Chicago hospitals. An agreement was finally made with Wesley Memorial whereby the Hospital would require its residents (a resident is an M. D. who hasnt finished training in a specialty) and fourth year medical students to spend time working for the Maternity Center.
The growth of the Chicago Maternity Center in those years paralleled a general shift from midwifery to obstetrics. As more and more babies were being delivered by doctors, in or out of hospitals, states around the country were passing laws about midwifery. In some states (Illinois) it became illegal for a midwife to practice. In others she was restricted to delivering in a hospital under a doctors supervision.
Medical practice was changing quickly during this period. Scientific discovery was still a major cause of change, but its role was becoming secondary to that of medical economics. Today it is this aspect of medical care which determines what happens or doesnt happen when one sees a doctor. Modern medicine, first developed to serve the needs of capitalist enterprise, has become a major capitalist enterprise itself. Hospital construction, health insurance, and drugs to name a few components are all big businesses, with the goals of big business: to make profit.
The Present Crisis
Obstetrics is no exception. The Chicago Maternity Center has provided women with critical services for 77 years, but today its existence is being threatened. The overwhelming majority of the women who use the center are poor. Statistically, they are 140% Latin, 45% black, 5% white Appalachian and 5% white middle class. The Center charges $200 for a delivery, but the fee is adjusted according to ability to pay and almost no one pays the full $200. 30% of the Centers cases are emergencies women who have not seen a doctor before delivery or who have just delivered unattended. The Center is threatened not because it is less needed today the need has increased but because all the forces of medicine as big business operate against it: it is not profitable.
Recently the gold coast hospital complex, consisting of Wesley Memorial, Passavant, Northwestern Medical School and its clinics, announced a new hospital will be built in their area. This hospital, scheduled to open in about 2 years, will be called the Womens Hospital is supposed to house the present Chicago Maternity Center among other things. Management of the new hospital appears to be planned in a peculiar way. Different services have been contracted out to the other two hospitals and to Northwesterns clinics. The net effect is that so far no one group is taking public responsibility for the Hospitals planning and policy. All advance public relations insist the new Hospital will not phase out the Chicago Maternity Center and will continue home deliveries. But recent decisions place these promises in doubt.
The Chicago Maternity Center is totally dependent upon its medical staff since that is all it has. Last year Northwestern Medical school stopped requiring its fourth year students to work for the Center. Wesley presently sends only one resident. This means the CMC operates with only two obstetricians (Dr. Tucker at age 75 is one of them) and one resident. Since one obstetrician must be on call at all times in case of complications, they are seriously overworked. Wesley and Northwestern have caused critical staff problems; the question is, why?What Is To Be Done?Increasing numbers of men and women are beginning to understand some things about health care in America: on the one hand quality health care is necessary to live; on the other hand the quality of the health care provided most people keeps them struggling to survive. This situation must end.
For example, the Chicago Maternity Center, which for some women is the only alternative to delivering at Cook County Hospital and for others is simply THE only alternative, must not be allowed to die. Likewise, the new womens hospital must not be permitted to practice the kind of medicine, common to hospitals, which scorns or ignores the health needs of most women.
The new hospital must meet peoples real health needs. Any women interested in working toward this goal call Womankind.