A Labor Without End
THE PREGNANT WOMEN IN THE POWDER-BLUE WAITING ROOM PAY NO ATTENTION to the worried, white-haired grandmother walking through the Family Health and Birthing Center in Northeast Washington. They have no idea who Ruth Lubic is, and she doesn't stop to introduce herself. Nor does she pause to admire a large bulletin board that overflows with photos of cooing, drooling, napping babies, all of whom were helped into the world by the center's midwives. These babies -- born to low-income parents in a city with one of the country's highest infant mortality rates -- are part of Ruth's legacy, the culmination of her decades of work to transform the way American women give birth. The babies have defied the odds and are healthy and thriving. It is the birth center that is struggling to survive.
The birth clinic has operated precariously ever since Ruth used a $375,000 MacArthur Foundation "genius" award to open it in 2000. More than once, she and her husband have put up their own money to pay the center's midwives. Two years ago, the clinic nearly shut its doors when it was short a malpractice insurance payment of $22,000.
Now, on this mid-December morning, another crisis hits. In an office next to the waiting room, the clinic's director, Diana Jolles, hands Ruth a piece of yellow note paper. Jolles has written nothing on the note but a number: $248,000. Ruth doesn't have to ask what it means. This is the estimate of the malpractice insurance the clinic must pay for 2007. The bill is double last year's. Another spike is expected next year.
Ruth stares at the note for a few seconds. Under her thick glasses, her blue eyes harden. Without a word, she pockets the note and walks out of Jolles's office to deal with the problem the only way she knows how: Keep working; keep raising hundreds of thousands of dollars; keep publicizing the benefits of using midwives; keep lobbying Congress for liability reform that would help birth centers.
Ruth is not afraid of fighting. She has been doing it her entire life and winning. But now she is nearing her 80th birthday. And she knows that she is running out of time.
WEARING BRIGHT GREEN SLIPPERS AND BROWN CORDUROYS, Ruth moves quickly around her sunny condo in Southwest Washington. It is mid-morning, and she has been up since 5 a.m. Papers and notebooks are stacked neatly on her desk, where she does much of her work. Two calendars hang from the wall, and a pocket diary lies open. The laptop computer was turned on as soon as she got up. She has already sent out a barrage of e-mail.
She downplays her computer skills -- at her age, she says with a chuckle, "I'm lucky to be able to turn on a computer" -- and her packed schedule. She just returned from Boston, where she accepted an award for her service to mothers and children from the American Public Health Association. This weekend, she will ride the train to New York, where her husband of 52 years, Bill Lubic, lives in their rowhouse on the Upper West Side. The couple alternates weekends between New York and Washington, a long-distance marriage that would test couples half their age.
Bill, who is a month younger than his wife, has thought about retiring but continues to work at his law firm part time because Ruth is so busy. He's not complaining, though. Over the years, Ruth's crusade to make childbirth an intimate "low-tech, high-touch" experience for women of all backgrounds and income levels has become his crusade, too. He serves on the birth center's board, accompanies his wife to conferences and meetings and provides pro bono legal work. Ruth calls him "Father," which she has done since their son, Douglas, was young. The clinic's staff members call him that, too. He has come to believe that his wife's mission is of such great importance that it often has to come before him. Even family celebrations with their two grandchildren are scheduled around Ruth's work. "Whatever has to be done, has to be done," Bill says.
Whatever has to be done usually involves Ruth. Though she no longer runs the birth center day to day, she remains its driving force, its public face and its most relentless advocate. It is, she says, the only birth center of its kind in the country, founded as part of the DC Developing Families Center, an ambitious haven that offers poor women health care, family support services and child care, as well as prenatal care and a homey place to deliver babies. The birth center's six midwives and two nurse practitioners have attended and cared for more than 550 babies since the center opened, with far lower rates of C-section delivery and premature birth than the city as a whole.
The clinic's midwives have never attended a birth that resulted in an infant death, Ruth says. One baby, however, suffered brain injuries in 2004 after the mother had an emergency C-section at Washington Hospital Center, which serves as the clinic's backup and where many of its expectant mothers give birth. The incident prompted a lawsuit by the baby's family that was settled out of court this year for an undisclosed amount of money, according to court documents. Ruth says it is the only malpractice suit ever filed against the birth center. But the clinic's malpractice costs are soaring anyway, part of a nationwide liability crisis that has prompted some ob-gyns to stop delivering babies and has forced birth centers around the country to shut their doors.
Locally, the Takoma Women's Health Center, a clinic run by midwives in Takoma Park, closed last month. The Maternity Center in Bethesda shuttered its birthing rooms this month, although the midwives will still attend births at Shady Grove Adventist Hospital in Rockville. Both clinics served a mostly middle-class clientele but couldn't escape the same financial problems that are threatening the D.C. birth center.
Reimbursements from Medicaid and other health insurance plans cover only about half the center's $1 million budget. The city provided $250,000 in 2006, but trimmed that to $200,000 this year. The rest comes from foundation grants and individual donors -- funds that are scrounged together by Ruth. What would happen to the birth center if Ruth got sick? How long would it be able to survive without her?