"Go to Ruth's House": the social activism of Ruth Lubic and the family health and birth center.

Abstract. This case of the work of Ruth Watson Lubic, an internationally known nurse midwife and women's and children's health care activist, provides a modern-day example of the intersection of forceful individual personalities, nursing as a type of activism in itself, and grassroots and local actions that produce larger movement-based activist organizations. Her work as a nurse midwife, in partnership with other nurse midwives, physicians, and community members, illustrates how the efforts of individual actors at a grassroots community level can be as significant as larger traditionally situated activist movements on the lives of everyday citizens. If I could leave you with the single most important prescription to address the tragic and seemingly intransigent phenomenon known as infant mortality it would be this: Go to Ruth's House. 1 So testified physician Ronald David in his address to congressional staffers in 2007. David, a neonatologist, was cochair of the 2005 National Commission on Infant Mortality of the Joint Center for Political and Economic Studies. 2 "Ruth" is Ruth Lubic, an eighty-year-old (in 2009) internationally known nurse-midwife who has over decades worked on issues of social justice, and in particular for the improvement of women's and children's health across all races, ethnic groups, and classes. "Ruth's House" is the freestanding Family Health and Birth Center Lubic opened in northeast Washington, D.C., in 2000, an area with one of the highest infant mortality rates in the country. The center is, as Ruth calls it, "the glue that holds together social support and child care services" that were long inadequate in this area populated by immigrant and low-income families. 3 Lubic is the glue that holds together the whole enterprise-the center's philosophy and its services-and she provides a modern-day example of the intersection of forceful individual personalities, nursing as a type of activism in itself, and grassroots and local actions that produce larger movement-based activist organizations. Her work as a nurse midwife, in partnership with other nurse midwives, physicians, and community members, illustrates how the efforts of individual actors at a grassroots community level can be as significant as larger traditionally situated activist movements on the lives of everyday citizens. 4 Nursing, as a female-gendered profession with social and cultural mandates to provide a broadly defined array of care services, is situated at the fulcrum where health disparities and social justice movements intertwine. Its history illustrates this nexus through its long tradition of focusing on the issues of children's and women's health, and interceding between the dominant power of local and national governments and medical men and women, and disenfranchised groups and populations. We see this in examples such as the settlement house movement and Lillian Wald's work with others to establish the Children's Bureau in the early twentieth century, midwife Mary Breckinridge and the Frontier Nursing midwifery service and school, the clinics and nurse midwifery programs of the Maternity Center Association in New York City, as well as the later school nurse movement. 5 There are, of course, other professions that work from a foundation of social justice, and other areas of focus for nursing activism, but nursing's involvement with children and women represents a century-long continuity for practice and policy. Until the early twentieth century, women traditionally gave birth in their home surrounded by friends and family. 6 But in the late nineteenth and early twentieth centuries, as childbirth became medicalized and paternalized and pregnancy was reconceptualized as a kind of pathologic state, childbearing women gradually lost control of the process, birthing in institutions controlled by medical practitioners and characterized by a rising caesarean section rate. The unique contribution of women's social support before, during, and after births was deprioritized in favor of scientific methods, technology, and institutionalization of medical expertise. …