A Labor Without End

Ruth Lubic, a champion of midwifery, surrounded by some of the children born through her D.C. Family Health and Birthing Center. (D.A. Peterson)

In 1982, a Federal Trade Commission study concluded that the doctors opposed to the Childbearing Center were seeking to maintain a competitive monopoly on delivering babies. The FTC report praised the center for forcing hospitals to think about how to "humanize the delivery of obstetric care." By then, birth centers were opening across the country, and hospitals were responding by hiring nurse-midwives, creating welcoming birthing rooms in their maternity wards and offering classes in natural childbirth. Ruth had won.

Now she turned attention to a new cause: opening a birth center in the South Bronx, one of the poorest neighborhoods in New York City. In some ways, a Bronx birth center would be a tribute to Ruth's parents, who instilled in her a desire to care for those in need. Her father, a pharmacist, often gave medicine to the needy, and, during the Great Depression, her mother hocked her canary diamond ring to help others.

Once again, Ruth encountered opposition and suspicion, some of it based on race and class. During one meeting with the board of a health clinic already operating in the Bronx, a minister asked Ruth and her Maternity Center Association colleagues: "What do you think you white people are trying to do, coming in here and telling us how to take care of our babies?"

But Ruth believed that poor women in particular would benefit from the personal attention that midwives provide. And once again, she prevailed. The Morris Heights Childbearing Center opened in 1988, providing prenatal care to hundreds of women who hadn't had access to it before.

Five years later, on a June evening, Ruth and Bill came home from dinner to a voice mail from someone at the John D. and Catherine T. MacArthur Foundation. When Ruth returned the call, a giddy person on the other line told her that she had been named a 1993 MacArthur "genius." At 66, she would receive $375,000 over five years.

"We just whooped and hollered," Bill remembers. "You hug, and you kiss, and you say, 'Oh, my God.'" The next morning, Ruth's thoughts turned to Washington. She was considering trying to establish a birth center in the nation's capital, where the infant mortality rate was double the national average. Better prenatal care for poor women was desperately needed there. And if federal lawmakers could visit a clinic a cab ride away from Capitol Hill, maybe they would fund centers like it across the country. Now, Ruth realized, she could take her MacArthur money and make it happen.

PLYWOOD BOARDED UP THE WINDOWS AND SHATTERED GLASS LITTERED THE PARKING LOT of the old supermarket in Northeast Washington. Inside, thick wire cables dangled in the darkness. The building had been vacant for years, as the neighborhood around it deteriorated and businesses moved to the suburbs.

Ruth remembers standing outside the chain-link fence that surrounded the building in 1994 alongside Dolores Farr, a longtime activist who ran the Healthy Babies Project, which counseled teenage mothers. Ruth recalls marveling over the vastness of the space, and her head spun with possibilities. She turned to Farr, who had brought her to see the building, and said, "We could even have a day care in there."

It turned out that the building was owned by hardware store magnate John W. Hechinger, and he wasn't interested in parting with it.

The District was a tough town, even tougher than New York, in which to get a birth center up and running. Ruth had to go through city officials to get a permit for a health facility, but the District was so broken that Congress had ordered a takeover of the municipal government by a financial control board. Nobody could promise her anything but more meetings. "I'm in my 70s," Ruth told city officials. "You've got to hurry."

She knocked on doors and networked her way around Washington. Through a friend of a friend, she had breakfast with Louis Sullivan, a former U.S. secretary of Health and Human Services. He became a major supporter of the birth center, raising $470,000 to help the clinic qualify for a $785,000 federal grant administered by the city.

Meanwhile, Ruth continued to pelt Hechinger and his real estate manager with letters and phone calls. She got nowhere until she contacted Donna Shalala, then Health and Human Services secretary for the Clinton administration. Shalala knew what Ruth had accomplished in New York and agreed to try to help her win over Hechinger.

Finally, in 1997, after three years of being hounded by Ruth and her supporters, Hechinger offered a deal: The center could lease the supermarket from Hechinger Enterprises for $1 a year, for up to 20 years. Ruth turned him down. Babies were dying, and Hechinger was a rich man, she said. Why couldn't he just donate the property?

Basil Henderson, a lawyer helping Ruth, tried to persuade her to accept Hechinger's proposal. "I thought it was a victory," recalls Henderson, still astonished at the way Ruth refused one of the city's most powerful business leaders. "I told her 20 years was a long time. But she didn't want something that wasn't going to be permanent for the community."

A few months later, Hechinger relented. Ruth could have the building outright. She was delighted, but she asked Hechinger to pay for a new roof. He gave in to that request, too.

At the groundbreaking of the $2 million DC Developing Families Center in 1999, volunteers handed out buttons that said "Listen to Women." Hechinger refused to wear one, telling the crowd that he didn't listen to anybody, not his wife, not his kids. But, he acknowledged, "I do listen to Ruth Lubic."

In a newspaper interview at the time, he said it was hard to ignore Ruth. "She can soften you up because she's so intellectually and emotionally sure of the rightness of her cause," said Hechinger, who died in 2004 at age 84. "When she's through with you, you have this guilt feeling."

Besides, he was tired of hearing from her: "Things were constantly cropping up where I'd say, 'Oh, no, Ruth Lubic again.'"

STANDING UNDER A GOLD CHANDELIER, Ruth sips white wine and scans the reception room. The stately Sulgrave Club in Dupont Circle is holding a panel on politics this evening. Ruth is a member of the elite women's club, though she looks a bit out of place. Many women are wearing suits from St. John's or Chanel and carrying designer purses. Ruth sports wool pants and a sturdy blazer from L.L. Bean.

As Ruth circles the room, hardly anyone acknowledges her. Then she catches the eye of a tall, elderly gentleman in a pinstriped suit. She has no idea who he is, but she shakes his hand and introduces herself as a MacArthur Fellow and nurse-midwife. And what about him?

He is an economist who quickly finds himself listening to Ruth's spiel about the birth center. Though she doesn't ask him outright for a donation, she tells him about how the birth center has cut the rate of women who need C-sections and who deliver prematurely. He says that he wants to tell his wife about her.

During the question-and-answer period of the program, Ruth raises her hand first and launches into a mini-speech about the clinic and medical malpractice premiums. She asks the panelists for their opinions. She's off topic. The discussion was mostly revolving around partisan politics and Iraq.

Wherever Ruth goes, she turns the talk to birth centers. All her handbags have an outer pocket from which she can whip out brochures. She name-drops constantly. One of her oldest friends in Washington is Supreme Court Justice Ruth Bader Ginsburg. Their husbands once worked together in the same law firm, and they were the only two wives who worked outside the home. On Ruth's advice, Ginsburg delivered her second child without medication. Of the 1965 birth of her son, Ginsburg says, "I felt so satisfied, even triumphant." Ginsburg, just the second woman to sit on the high court, marvels at Ruth's accomplishments and how hard she is willing to fight for her cause. "I could never do what she does," Ginsburg says. "She could probably do what I do if she goes to law school."

Ruth isn't shy about invoking Ginsburg's name when she's trying to drum up donations. And, she'll add, did you know that Alma Powell, the wife of Colin Powell, has visited the birth center?

Ruth loves that a favorite opening line among Washington professionals is, "What do you do for a living?" "Then I get to talk about the birth center," she says.

During a vacation cruise along the Danube last fall, Ruth spent much of the time telling passengers about the birth center. Just before Christmas, a check arrived for $50,000. "We were just drawn by her passion," says Bob Wilson, a developer from Southern California, who, with his wife, Marion, sent Ruth the check. "She's obviously very genuine about it. She's not doing it to benefit Ruth. She's been doing it to benefit people who are totally in need."

Her passion is so great that some find it off-putting. She makes anti-doctor remarks that cause her colleagues to squirm. One friend who said she could no longer donate to the center because other charity work was taking precedence stopped hearing from Ruth.

Lucy Holmes, a longtime friend, says she wishes Ruth could lighten up a little. Once, she invited Ruth to a dinner with a wealthy relative -- with specific instructions to Ruth not to eye the woman as a pile of money. Ruth didn't listen. She gave a speech about the birth center and the need for donations, offending Holmes's relative. Another time, during a vacation to Aruba with Holmes, Ruth left the resort to look for needy maternity clinics. When she found one, she went back to the resort and started fundraising around the pool until the resort's managers told her to stop.

"She's become almost rabid in the past few years. I think she feels her mortality," says Holmes, who helped Ruth set up the birth centers in New York. "I can't take her anywhere anymore to dinner because she tries to recruit everybody to help the poor."

Ruth, a self-described "stubborn old woman," doesn't apologize for her relentless fundraising. "If you're honest and well motivated and not self-serving, some people will understand that," she says. "You just have to stick with it, and something will happen. Something will come along."

Jolles isn't so sure. As the birth center's director, Jolles wants to put the clinic on better financial footing by applying to become a federally qualified health center, which would eliminate its need for private malpractice insurance. Its Medicaid reimbursements also would increase.

But Ruth hates the idea and has fought it. She fears losing control of the center to federal bureaucrats, who could demand that midwives see more patients and reduce appointment times. The entire ethos of the birth center would change, Ruth argues. "I don't want to become more of the same," she says. "The system doesn't work. It just doesn't work, I tell you."

Last year, much to Ruth's chagrin, the birth center's board of directors voted to forge ahead, a process that could take a few years. Ruth isn't making it easy. When she and Jolles attend meetings about applying for the federal program, the older woman often mutters under her breath, "It won't work."

Jolles says she is still intent on the idea. Yet part of her wonders if Ruth is right. Maybe another solution to the center's long-term survival will come along. "She really does believe in things that seem impossible," Jolles says. "That's the only reason that she's gone as far as she has."

Larry Mirel, a former District insurance commissioner, agrees that it is a mistake to underestimate Ruth. Three years ago, she persuaded Mirel that the city ought to extend its malpractice insurance to cover nonprofit community health centers, which would solve some of the birth center's financial problems. (The city finally put money aside for the program in this year's budget, but more bureaucratic hurdles have to be worked out.)

Mirel left his city job in 2005, but he is still working on the project on his own time. "I'm doing it because of her," says Mirel, an attorney in private practice. "She believes strongly in what she's doing, and she makes you believe in it, too."

LEANING DOWN, RUTH COOS AT THE BROWN-EYED BABY GIRL IN A PINK KNIT CAP. "Do you want to be involved?" she whispers. "Would you like to be a lobbyist? Yes?" She wiggles her fingers at a baby boy nearby, who is sporting a blue bib that says "I Love My Mommy." She'd like to recruit him, too.

It is January 18, Ruth's 80th birthday, and she is presiding over a meeting in a downtown conference room. She has convened a group of midwives, health advocates and lobbying experts to brainstorm ideas for saving birth centers. The Manhattan birth center that Ruth founded closed in 2003. The birth center in the Bronx still operates, but as part of a larger community organization. Ruth believes the midwives are no longer in control and says the original spirit of the center is gone. She doesn't want the D.C. birth center to suffer the same fate.

Ruth picked her birthday for this brainstorming session, figuring that those invited, no matter how busy or far away, would feel obligated to attend. About 20 people have shown up, including her always supportive husband and two mothers who delivered at the birth center.

One of them, Aree Plunkett, gets up to describe her experience with the birth center. A tall, heavy-set woman with cropped black hair, she shifts her restless curly-haired son Mosha from arm to arm. As she starts to speak, her voice quivers, and she apologizes for getting emotional.

"This," she says, holding Mosha, "is sort of like my miracle baby." Plunkett, 32, had a history of ovarian problems, and didn't realize she was pregnant until after her first trimester. She heard about the birth center from a cousin who had received care there.

The midwives and staff, she says, were better than family. Plunkett's first child had been delivered in a hospital 12 years earlier, where the extent of breastfeeding education was a pamphlet laid on her bed. At the birth center, the midwives told her how breast milk provided better nutrition for newborns. Plunkett was skeptical that she could endure the pains of natural childbirth, but the midwives assured her that she could do anything she put her mind to.

During Plunkett's labor, her mother, best friend and a cousin burned incense, sang songs and cheered her on. "A lot of things I failed at in life," Plunkett says, "but delivering that baby that day was all me." Her voice gets louder and clearer. "Nobody could take that away from me. I had no medical assistance, no epidural, nothing . . . You know, I feel like I can do a lot. It's not too much that gets me down after delivering a baby like that."

When she finishes speaking, the conference room is quiet. Ruth pulls out a tissue and wipes her eyes.

A FEW MONTHS AFTER RUTH'S BIRTHDAY, the clinic receives a $150,000 grant from an advocacy group for community health centers. It's not to shore up the clinic's shaky finances. It's for the future. The advocacy group wants to see if it's feasible for the birth center to offer primary care in addition to prenatal care. Ruth is thrilled by the idea and has scheduled a visit by an engineer to explore adding a second floor to the building. She seems puzzled when asked why she would consider expanding the clinic when it's in danger of closing.

"There are elements who are more fragile than we are," she explains. "We have to try to help them. You can't stop [pushing] while you're waiting for good things to happen."

Then she gets back to work.

Phuong Ly is a freelance writer. She can be reached at phuongyenly@gmail.com. She and Ruth Lubic will be fielding questions and comments about this article Tuesday at noon.