Document 5: Anne A. Stevens, "An Experiment in Maternity Protection: Report of the Work of the Maternity Centre, of the Women's City Club of New York City," Unpublished paper, Biannual meeting of the National Nurses Association, Cleveland, May 1918, WCCNY Papers, Archives and Special Collections, Hunter College, New York, N.Y. (WCCNY microfilm, reel 20, frames 205-07).Introduction
In this paper Anne Stevens, who headed the Maternity Center, described the clinic's operations to her professional colleagues. She identified institutions and groups who were cooperating with the Center, and reported fully on the Center's work.
Editor's note: The original document was in poor condition. Some words were cut off or missing all together. The missing words were reconstructed as much as possible. Words which were either partially cut off or missing are indicated in brackets, [ ].
An Experiment in Maternity Protection.
Report of the Work of the Maternity Centre, of the
Women's City Club of New York City.I have called this report of the New Maternity Work being done in one section of New York City, an experiment, because it is an effort to completely meet the need for Maternity Care, Prenatal, Delivery, and Post Natal of every woman within a given community, by providing adequate Medical and Nursing care from the beginning of her pregnancy until her baby is one month old. This effort is being made, not by providing another medical and nursing agency but by establishing a Centre, 1. thru which all the maternity work of every hospital, midwife, Doctor and nurse may be coordinated and developed to its fullest extent, 2. a Center at which there will be on file a record of every pregnancy in the district, 3. A Centre thru which all the members of the community may be educated to demand for all the mothers of the community adequate Medical and Nursing care.
It is not then an experiment in prenatal clinics, many of which have been conducted in New York and elsewhere and the value of the pre natal nursing fully demonstrated, but it is still an experiment in it's effort to give adequate Medical and Nursing care to every women in a community and to do it thru a thoro coordination of all the work of all the agencies in that community.
This experiment is being carried on as a result of suggestions made by a committee, called into being by Dr. Emmerson, then Commissioner of Health, to make an analysis of existing obstetrical conditions in the city. This the committee, Dr. Lobenstein, Dr. Cragin and Dr. Van Ingen, did thru an exhaustive survey of hospital facilities as related to numbers of births per year. This committee received valuable help in their work from the New York Milk Committee. Their survey showed hospital beds for approximately 30% of the births.
As a result of this survey it was suggested
1.That the city be divided into ten zones, each zone to have a Maternity Centre which would be a clearing house for all the maternity work in that zone, directing to hospitals those patients most needing hospital care and providing adequate home care for those patients to be delivered at home.
2. That the Maternity Hospitals be encouraged to restrict their ward patients to women living within prescribed area instead of, as heretofore, admitting patients from any part of the city.
Two advantages of these suggestions appear at once,
1. The available hospital beds will be used by the patients who most need them.
2. Better supervision of all registered ante partum patents will be made possible by eliminating the great distances it was necessary for nurses to travel in order to visit the homes of patients who did not attend the Clinics regularly.
The Women's City Club, an organization of about 2000 women formed for the purpose of enabling women with civic interest to work together for the good of a community, became interested in the question of maternity protection at the [insistence] of Mrs. Irene Osgood Andrews, then the Executive Secretary of the Club. [The] Maternity Protection Committee was formed, with Miss Goodrich as Chairman. [After] many meetings and much discussion it was decided that the City Club would [develop] a Centre in one of the Zones into which it was suggested by Dr. Lobenstein's [committee], that the city be divided. This Maternity Centre is now directed by [an Administrative] Council of forty women of the Club of which Mrs. Eugene Myer, Jr., is Chairman, an executive committee of which Miss Goodrich is chairman, and Mrs. Andrews secretary and a Board of Medical advisors of which Dr. Lobenstein is Chairman.
In August 1917 a house was rented in the geographical centre of the Zone, a Graduate Nurse put in charge of the work of getting in touch with the pregnant women in the zone, and a clinic, with an expert obstetrician in charge, established for the purpose of providing Medical Supervision for those patients who had never engaged a Doctor or made definite hospital arrangements, also for the purpose of providing a free consultation clinic to which the neighborhood doctors and midwives might bring their patients for examination by an obstetrician. This examination includes heart, lungs, abdominal, vaginal, pelvic measurements, [Blood] Pressure, urinalysis and where indicated vaginal smears and Wasserman.
It is one thing to establish a Centre in a zone, quite another to get the patients to use it. Previous to the formal opening of the Centre the various agencies meaning Settlement Houses, Day Nurseries, Hospitals, of which there are about forty in the district coming in contact with pregnant women, were visited by the nurses of the New York Milk Committee, generously lent for the purpose, and the Maternity Centre explained to their workers who were asked to refer all pregnant women to the Maternity Centre.
Patients reported to the Centre by these agencies, doctors or midwives are visited as soon after the day on which the patients are reported as possible. There-after those less than seven months pregnant are seen every two weeks either at home or the Maternity Centre; those more than seven months pregnant are seen every week either at home or at the Maternity Centre. When a call comes from any other source than a doctor or midwife, the patient is visited, but no advice or care given until the doctor or midwife in charge of the case has been communicated with, by telephone or office call. Patients found to have made no arrangements for medical supervision are urged to come to the Maternity Centre clinic for doctor's examination and advice. They are visited at the regular intervals and are given as much as they will allow in the way of pre natal nursing at each visit, until they do come to the Maternity Centre Clinic. At the Maternity Centre Clinic they are urged to return for doctor's examination every month, up to the seventh month, thereafter every two weeks or oftener as the case demands. Taking into consideration the findings of the examination by the doctor at Clinic and the home conditions of each individual patient, as learned by the nurse during her visits to the patient, the patient is advised as to the best possible arrangements as soon as possible. When it is impossible to persuade the patient to accept this advice the next best arrangement is discussed with her and so on until some plan is discovered which the patient will accept. If the patient is to be delivered at home she is turned over to the nurses of the Henry Street Settlement as soon as she has definitely registered with a doctor or midwife. If she is to be delivered in a hospital, she is urged to register at that hospital as soon as that particular hospital will register her. Until she is actually registered she is visited at the regular intervals and given pre natal nursing care by the Maternity Centre nurse. After she has registered at a hospital, her further nursing care depends on that particular hospital. Some hospitals have the patients report at their dispensary at stated intervals, some send nurses to visit the patients in their homes, others do nothing in the way of pre natal nursing of the patient until she enters the hospital. In the last instance, the Maternity Centre continues the pre natal care of the patient until she enters the hospital.
The prenatal nursing is done by a combination of nurse's visits to the patient in her home and the patient's visits to the nurse at the Centre. The home visits are made by several different nursing agencies, all having accepted the same [standards] of nursing care and using the same records. After the nurse feels that she understands the home condition she urges the patient to go to the Centre on the day on which her next nursing care is due. This plan can be carried out because of the complete interchange of records. The record of every home visit is sent to the Centre. The record of every visit at the Centre is sent to the nursing agency carrying the patient. The advantage of this scheme is that the nurse gains the confidence of the patient in her own home and learns the problems of that home, and then the patient comes to the Centre and has the advantage of seeing the exhibit of a model baby bed and outfit, of buying material for baby clothes at wholesale prices, of getting patterns and help for making those clothes. By this plan also one nurse can care for more patients in a given time because the patient is the one who does the travelling.
The post partum bedside nursing is provided by the nurses of the Henry Street Settlement, in the same way as it has been for years. Mothers and babies are [visited] daily for the first five days, thereafter as the case demands until dismissed. [Babies] are followed for one month and all reported to the Babies Welfare Association. [The] general rule for teaching the family to give as much as the nursing care as [possible] followed in the care of all post partum mothers and their babies, always taking into consideration the home conditions and the intelligence of the family and [the fact] that the nurse is responsible, not only for actual care of the patient [and for] giving as much in the way of instructions as she can in that particular home. [Patients] delivered in a hospital and dismissed are given further care and instruction in their homes, whenever necessary.
The attendance at deliveries in the homes was undertaken by the Nursing of the Henry Street Settlement at the opening of the Maternity Centre, for the purpose of supplying a nurse at time of delivery to assist the doctor or midwife in every way possible and to add to the comfort of the patient. This service does not supply a nurse to watch a labor case, wherefore the nurses do not answer calls unless the doctor is already at home or has been sent for. The nurses answer calls from the doctors on the Outdoor Service of the Manhattan Maternity, private Physicians and midwives.
The routine for delivery nursing were worked out in the consultation with the nurse in charge of the Maternity Centre, and the policies of the Centre cooperated with to the fullest extent.
Three expert obstetricians are on call at the Maternity Centre for consultation with neighborhood doctors or midwives at time of delivery if abnormalities arise.
An effort is being made to further provide adequate care for those patients delivered at home by attempting to meet the need for someone to take mother's place in the home, while the mother stays in bed. So far this is only an attempt as the effort to obtain a staff of working housekeepers has not so far been successful but is still being made.
As a result of the work of Dr. Lobenstine's Committee of Obstetricians, A Maternity Centre Association has been formed for the purpose of developing Maternity Centres in the other zones of the city. Several such Centres are now being developed.
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