BOX 2-2

Case Study: Nurse Midwives and Birth Centers

The Midwifery Model of Maternity Care Gives Mothers Control and Improves Outcomes

When Wendy Pugh delivered her first child at age 30 in a Washington, DC, hospital in 1999, her labor was induced—not out of medical necessity, she said, but because “there was a scheduling issue with the doctor.” She didn’t question the obstetrician’s decision at the time, but when she got pregnant again, she polled her friends and discovered that many had had cesarean sections. When she asked why, few gave medical reasons. She decided she wanted “a more organic process.”

Midwifery teaches you that the woman is the most important person in the relationship and that’s why you should listen to her and try to give her what she wants and what she needs.

—Ruth Watson Lubic, EdD, CNM, FAAN, founder, Family Health and Birth Center

Seven months into her second pregnancy, Ms. Pugh arrived at the Family Health and Birth Center (FHBC) in northeast Washington, DC (, where certified nurse midwives provide pre- and postnatal care and assist with labor and delivery with little technological intervention. Delivery takes place at a homelike freestanding birth center or at a nearby hospital, depending on the woman’s choice, her health, and such factors as whether she is homeless. The FHBC accepts Medicaid and private insurance and offers a sliding-scale fee for those ineligible for Medicaid. No one is turned away.

Ruth Watson Lubic, EdD, CNM, opened the FHBC in 2000 in response to the disproportionately high rates of infant and maternal death, cesarean section, and premature birth among poor and minority women in Washington, DC. In 2009 the infant mortality rate in the city was 12.22 per 1,000 live births, far exceeding that of any state in the nation (Heron et al., 2007). Nationwide, nearly four times as many black as white infants die as a result of premature birth or low birth weight (HRSA, 2006). Dr. Lubic had already founded the first freestanding birth center in the country (in 1975 in New York City) and

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