A Life Well Lived: The Legacy of Nurse Midwife Maude E. Callen

Maude Callen 1It is said that a picture is worth a thousand words and it was the photographic genius of the late W. Eugene Smith’s photo essay, “Nurse Midwife” published in a 1951 edition of Life Magazine that grasped my attention and introduced me to the late, great Maude E. Callen, a nurse midwife.

Callen was born almost 40 years after the Emancipation Proclamation in Quincy, Florida and was one of 13 children who would become an orphan by age 6. Quincy is located in Gadsen County and to this very day, has one of the worse infant mortality rates in Florida. It’s a wonder that Callen survived her birth and miraculously ended up in the home of her uncle, William J. Gunn whose story is equally fascinating because he was a former slave and carriage driver that became one of the first African American physicians in Florida. His medical school education at Meharry School of Medicine was paid for by his former employer, Dr. George W. Betton, a white physician.

Callen graduated from Florida Agriculture and Mechanical University (FAMU) the year her uncle died and completed her nursing education at Tuskegee Institute. She later trained at the Georgia Infirmary that was started in 1832 and became the first hospital for African Americans in the nation. It was also one of the first institutions to train African American nurses.

Callen eventually arrived in Pineville, South Carolina in 1923 which was one of the poorest towns in Berkeley County. As recent as 2010, it only has approximately 2,000 people who earn an average of $20,000 a year. Callen was one of only 9 nurse midwives in the entire state that delivered babies and it is estimated that she delivered approximately 600 to 800 babies during her career. She faced challenges most of us can’t imagine such as delivering babies by kerosene lamps although there was clearly electricity by the 1950’s; having patients arrive in oxcarts to her home in the middle of the night and performing home births to women in a 400-square mile radius of muddy roads.

Dr William J GunnHer selfless deeds did not go unnoticed. After Smith’s photo essay was published, people donated $22,000 to her practice and a clinic was built in her honor. When President Reagan invited her to the White House, she allegedly said “You can’t just call me up and ask me to be somewhere. I’ve got to do my job.”Callen did that “job” until she retired in 1971 and continued to volunteer until she died at the age of 91.

Callen may have never made it to the White House as a guest of President Ronald Reagan but she is definitely an American hero.

I encourage everyone to view Smith’s wonderful photographic essay and be inspired.

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Home Birth Midwives are On Their Own

Home Birth Midwives are On Their Own

W. Eugene Smith—Time & Life Pictures/Getty Images

In last month’s “Gray Journal” (aka American Journal of Obstetrician & Gynecologists), Dr. Frank Chevernak and colleagues wrote a response entitled “Planned Home Birth: The Professional Responsibility Response” that was troubling. The authors recommended that an obstetrician not backup midwives when they performed planned home births but “still provide excellent and compassionate emergency obstetrical care to women transported from planned home birth.” Well, there are assumptions that the authors need to clarify. First, they’re assuming that homebirths will require emergency care and that obstetricians should provide “excellent and compassionate” care once these patients arrive. So, if we, as obstetricians anticipate a problem, is it ethical to take a “hands off” approach until it plops on our door step?

I am not an advocate for home births because of my concern for patient safety but as, Chevernak points out, the rate of women who give birth at home as increased by 29 percent which is significant. Instead of addressing the root cause of the problem, these “thought leaders” take a very paternalistic approach which will not solve the problem and as a woman, I find offensive. The attitude is reminiscent of a certain political party who thought they spoke for the values of Americans until the infamous “47 percent” showed up at the polls and proved them wrong.

I wish homebirth moms would deliver in birthing centers if they want to avoid a hospital because of its immediate access to emergency care. A C-Section cannot be done in someone’s home nor can the baby be properly resuscitated. However, our hospitals also have some “housekeeping” to do such appropriately staffing their overworked labor and delivery nurses and making family practice physicians and midwives contact a back-up obstetrician when a baby is having decelerations on a fetal strip rather than waiting until the 11th hour when it’s often too late.

We need to take a more intelligent approach to this issue and have a dialogue with patients, physicians and midwives such as Ina Mae Gaskins, an expert who has a track record of homebirth safety. We need to start thinking outside of the box and use technology and innovation rather than paternalism and fear.

In the words of the great Marianne Williamson: “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us.”

Pregnant Women Die When Providers Don’t Listen

Every month I have the unenviable duty of reviewing federal medical malpractice cases to determine if the physician or midwife was at fault when a baby is born injured, dead or a pregnant woman dies. A panel of high-ranking federal officials listens to my presentation and then decides whether that doctor or midwife should be reported to the National Practitioner Data Bank, a place that essentially collects “data” on providers who have “messed up” or breached the standard of medical care.

After performing these reviews for several years there is a constant theme that keeps emerging: providers don’t listen to patients or nurses about important issues and inevitably harm is done. I suppose we are all a bit more sensitive about maternal death based on the popular TV series, Downton Abby, because of an episode where one of the beloved characters dies in childbirth. So, can anything be done to reduce the risks of pregnant women dying? Yes there is according to The Smart Mother’s Guide to a Better Pregnancy (TSMG) and here are some of its recommendations:

  • Select your provider very carefully and if he or she does not listen or is insensitive to your concerns and complaints, by all means change providers
  • Understand the importance of a fetal monitor strip and understand what and why “decelerations” can predict whether the baby is at risk for dying in labor. This topic is discussed on pages 201 and 202 of the book.
  • Meet the back-up obstetrician of your midwife or family practice doctor during the early part of your prenatal care and make sure he or she is contacted when you are admitted in labor. Why? Because a midwife or family practice physician can’t do a C. Section in the event of fetal distress or if your baby needs to be delivered immediately but an obstetrician can.
  • Trust your instincts. If you think something is “wrong” then it is until your provider or the hospital proves it’s not.
  • If you think something is going wrong while you’re in labor and your provider is not doing his or her job, ask to speak with the hospital administrator and request a second opinion from the chief of the obstetrics department or better yet, a maternal fetal medicine specialist.

Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.