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

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.