xt7pg44hnw9v https://exploreuk.uky.edu/dips/xt7pg44hnw9v/data/mets.xml The Frontier Nursing Service, Inc. 1984 bulletins  English The Frontier Nursing Service, Inc. Contact the Special Collections Research Center for information regarding rights and use of this collection. Frontier Nursing Service Quarterly Bulletins Frontier Nursing Service Quarterly Bulletin, Vol. 60, No. 2, Autumn 1984 text Frontier Nursing Service Quarterly Bulletin, Vol. 60, No. 2, Autumn 1984 1984 2014 true xt7pg44hnw9v section xt7pg44hnw9v uunsnv
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 US ISSN 0016-2116
FNS Is Given Nation’s First Endowed Chair of Nurse-Midwifery 1
Barbara Sonnen Assumes Expanded Nursing Directorship at FNS 2
Nurse—Midwifery: A Profession, An Art, A Commitment 3-34 .
The Art of Nurse—Midwifery
by Ruth Coates 4 vu
Birth Centers and the Art of Midwifery {
by Eunice KM. Ernst 8
'I`he Politic Nurse-Midwife and the Shaping of Health Policy
by Ruth Watson Lubic 14
Nurse—Midwifery Education: Present and Future Perspectives at FNS
by Sr. Nathalie Elder 19
The "FNS Demonstration" —— Where Has It Led? 25
Mary Breckinridge Festival — 1984 35
Beyond the Mountains
by Ron Hallman 36
In Memoriam 38
Memorial Gifts 39
FNS Opens New District Clinic at Yerkes, Kentucky 40
Notes from the School 41
Field Notes 42
Courier and Volunteer News 44
Urgent Needs Inside Back Cover
Alumni News Inside Back Cover
Front Cover: Lower Left: A portrait of Mary Breckinridge, founder of FNS. Clockwise from
top: Eunice l<.M. Ernst. Ruth Coates Beeman, Sr. Nathalie Elder. Ruth Watson Lulnic.
Comments and questions regarding the editorial content of the FNS Quarterly Hu//erin 5
may be addressed to its Managing Editor. Robert Beeman, at the Frontier Nursing Service,
Hyden. Kentucky 41749. i 
US ISSN ()0lG·2ll($
Published at the end of each quarter by the Frontier Nursing Service, Ine. _
Wendover, Kentucky 41775 §
Subscription Price $5,00 a Year L
Edit0r's Office, Wendover, Kentucky 41775 Ll]
Secondelass postage paid at Wendover, Ky. 41775 and at additional mailing offices l
Send Form 3579 to Frontier Nursing Service, Wendover, Ky. 41775 Z
Copyright 1984, Frontier Nursing Service, Inc. I l

i 2*  “’ = ·¥v: ·   , ,
  Q     FNS IS GIVEN   .  H  
.   { , "  .  
I     NATION’S FIRST   s   2’R    _V · 
            '_=    I    L     
  `V   ‘/     2   E at ,7 t `_.,    ’ 
_,; .\    V; NURSE-MIDWIFERY   % ~  
l   ~ re  
Kate Ireland Marvin Patterson
Thanks to the great generosity of Mrs. Jefferson Patterson and Miss Kate
Ireland, the Frontier School of Midwifery and Family Nursing now has the
nation’s first endowed chair of nurse—midwifery education. This is a
I development of great importance. It materially strengthens FNS in its
I continuing efforts to provide the best possible education for the professional
nurse-midwives that the nation and the world so badly need.
The new chair became possible as a result of two gifts from Mrs.
Patterson, FNS’ national chairman from 1960 to 1975, whose generous
support of the Frontier Nursing Service goes back to the days when it was
founded by her father’s first cousin, Mary Breckinridge, and from Kate
Ireland, who since 1975 has been FNS’ national chairman and whose
I generous outpouring of her time, energy, and financial assistance have
I been crucially important to FNS over the years.
’ The new Mary Breckinridge Endowed Chair of Nurse-Midwifery is to be
I filled by nurse—midwives whose education, experience, and personal
A attributes have brought them distinction in the field of nursemidwifery
I practice and education. FNS Director David M. Hatfield has announced
, that Mrs. Ruth Coates Beeman, dean and director ofthe Frontier School of
  Midwifery and Family Nursing, will hold the first appointment to the new
_   chair. Mrs. Beeman’s long career as a nurse-midwife and nursing educator
I' I has encompassed positions ranging geographically from the Belgian
A. Congo (now Zaire) to New York to Arizona and has included faculty
, I appointments at Indiana University, Maternity Center Association, Grad—
L uate School of Nursing of New York Medical College, and Arizona State
if University. She has also been a consultant to the New York State
{ Department of Health, and from 1977 to 1982 she was Maternity Care
Nursing Consultant to the Bureau of Maternal and Child Health, Arizona
i Department of Health Services, Tempe, Arizona. In 1980, she was given a
  Distinguished Citizen’s Award by the College of Nursing, University of
  Arizona. Mrs. Beeman has been dean and director ofthe Frontier School of
Y Midwifery and Family Nursing since January 1982.

 » xg_..·’:;,.     `
BARBARA SONNEN   ._{      V_ A    
ASSUMES EXPANDED     5      ;  ,
NURSING D1REcToRSH11>    Q     
AT FNS   »`;_,—   3.      f;
      SRSS   S  
In keeping with the objective of expanding and giving increased emphasis  ;  
to its nursing services, FNS has redefined and broadened the position of ` 
FNS Director of Nursing and has appointed Barbara Sonnen to this ·  
enlarged function. Ms. Sonnen assumed her new duties in November. I  
Barbara Sonnen received her BSN from the College of St. Teresa, _?   l
Winona, Minnesota in 1960. Subsequently, she earned two master’s 2 3
degrees, an MS in Adult Education from the University of Wisconsin in 7  
1973, and an MSN, also from the University of Wisconsin, in 1980. She is I  
currently a doctoral candidate in adult education with a minor in nursing ,   ,
at the University of Wisconsin. Her professional career has included a X    
number of key positions in nursing and nursing education. Most recently,  .  
she has been program coordinator, Department of Continuing Education    
in Nursing, University of Wisconsin (Extension).
The nursing directorship, as newly redefined, entails increased respon-
sibilities, including the nursing programs of the Mary Breckinridge
Hospital, the Hyden Clinic, the district clinics, the continuing education Q.
program, and the Home Health Service. Mary Weaver, RN, ADN, CNM, ir
and CFNP, will continue in the important function of Director of Nursing  
for the Mary Breckinridge Hospital. 5
The redefinition of the nursing directorship is intended both to reempha· '_··
size the importance of nursing in FNS’ concept of health care and to assist  
FNS in adapting its program of care to meet new requirements that result ·
from changes in the economy and in government regulations. The latter
include recent Medicare decisions that encourage the early discharge of  '
patients from the hospital to their homes, thereby increasing the need for j
decentralized nursing services. In addition to bringing her experience to f
bear on these specialized problems, the new director will be in a position to »
contribute to FNS’ ongoing efforts to define the health needs ofthe 80’s and  »
to continue to update its programs to meet those needs. ·

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 5 - w i    F  i
  X "'* ’ >·   by Ruth Coates Beeman, CNM, MPH   I
    R __, __ } · Dean and Director {
    _,  _ Frontier School of Midwifery and Family Nursing
ig;) s ` {
Universally, and from the beginning of time, women have responded  
to the needs of other women involved in the act of giving birth.  W
Birth, with its mystery, its ritual, its promise, and its beauty, @
continues to create emotional responses which defy scientific or  
intellectual explanation, and the art of midwifery, with all its rich g
folklore, has existed essentially unchanged since human life began.  
The term "midwife" as used in the English language came  _
originally from the medewife of Old English and Middle English, or  
mit from Old High German, having the general meaning of "being 3
with woman during birth." The more common definition, as ;
currently used, is "a woman who assists women in childbirth." The {
variety of terms used for the woman who assists at childbirth has  
from the earliest times illustrated her functions and the regard or I
esteem her art has enjoyed — omphalotma, or navel cutter, in the  
ancient Greek, jordmor, or earth mother, in the Norwegian, and  ,
sage femme, or wise woman, in the French, to mention only a few} _;
But what about the art of nurse-midwifery? Webster has defined  r
art as "the conscious use of skill and creative imagination." This
definition speaks most clearly to the art of nurse-midwifery as we i
attempt to teach it at the Frontier School of Midwifery and Family   ~
Nursing. As we see it, this art goes beyond skill and knowledge. It  t
demands sensitive, even intuitive, awareness of the needs of ·
mothers and a capacity and eagerness to respond to those needs in
ways that are knowledgeable, personal, creative, and loving.
Thus we continue to expand Webster’s definition by learning to
explore our feelings, to open ourselves to our intuitions, and to grow ‘
in empathy. We continue to probe for new meanings as we apply our _
art to expanding practice.

; The art of nurse-midvvifery is developed from a solid base of
  nursing and midwifery skills acquired by a combination of study,
2 observation, and experience in all aspects of childbearing. A nurse-
 i midwife refines her art as she learns to center herself on the needs of
 — the pregnant woman and her family. She understands the unique-
 · ness of the totality of experiences that make up the childbearing
{ ' cycle: pregnancy, labor and birth, and the early postpartum period.
{ She practices her art always within the context of a family-centered
» approach; she understands her scope of practice, and she knows her
. ` limitations. She practices her art within a continuum of health care
 , services that assures an individualized level of care as need
 7 Philosophically, the nurse-midwife acknowledges pregnancy as
Q a period in which each woman embarks on a journey of self-
t discovery, of great personal growth and lifestyle reorganization.?
  Pregnancy is a time in a woman’s life when intense feelings come
·€  close to the surface, as the consciousness of life experiences expands
  to give new meaning to all that has gone before. It is a time in which
 . bodily changes can be exciting and wonderful, or uncomfortable
  and disturbing, Pregnancy can also be a time of disappointments,
? as dreams and realities have to be reshaped if unforeseen events
é threaten the planned birth experience. Pregnancy is a time of
if growing vulnerability, as the woman’s body changes from its
  familiar boundaries, and the processes leading toward birth take on
‘ an inevitability beyond conscious control.
  The unfolding events experienced by a pregnant woman provide
 ’ unique opportunities to practice the art of nurse-midwifery. A
  pathway is opened to allow the nurse-midwife to get into a woman’s
l' expanding consciousness, to explore with her the attitudes and
beliefs passed down to her through the multitude of life experiences
i she and her family have shared. It is a time to explore fantasies, to
i ` introduce positive imageries, to replace anxiety with constructive
 i hope. It is a time to help a woman become comfortable and secure in
` her womanliness and her sexuality, to become aware of, and
intimate with, the baby that is growing into personhood inside her.
To meet these challenges, the nurse-midwife needs to be confident
in her knowledge of the psycho-biophysiology of pregnancy as she
‘ guides the pregnant couple through the cognitive and existential
_ experiences that enhance the "wellness" of pregnancy.

As the woman moves through the cycle of childbearing, labor * 
and birth offer her a journey into the unknown. This journey is at g·
the same time an end and a beginning; it ends a lifetime of one set of  A
experiences and begins a new and deeper understanding of life. A .
woman needs to experience this journey through labor within a  
mind-body connection that centers on herself. Anxiety, self—con- {
sciousness, doubt, fear —— all tend to block the spontaneity and flow . `
of labor by setting up an outpouring of neurohormonal agents that F
are inhibitory to these natural forces.3 A woman needs to free   _
—— herself to the timelessness of natural rhythms that miraculously l
bring forth new life. As she accomplishes this, she will be engulfed  l
by body messages and sensations in labor that are strong and ‘ 
powerful- they can be frightening or they can be exhilarating, but  i
she will be changed forever by these experiences. Q
The nurse-midwife learns to have an abiding reverence for, and ·
trust in, the natural processes of labor. The presence of this ,
knowledgeable, competent, caring, and skilled practitioner helps E
reassure the laboring woman that she will have "safe passage" in f
her journey through the unknown. The nurse-midwife provides for  —
her basic nurturing needs through her ministrations and her  
presence. The nurse-midwife knows that the massaging of tension- r
weary back muscles, the proffering of ice chips to a thirsty mouth,  .
the pressure of a hand against the aching sacrum, the light  
effleurage of the abdomen during uterine contractions are all  I
actions that renew spirit and energize the woman giving birth. ·
Because a laboring woman is so sensitive to external stresses and {
stimuli, the nurse-midwife assures a place for her that protects the  ~
privacy and intimacy of the birth experience: a place that is calm,  2
quiet, warm, comforting, and comfortable. , V
The nurse-midwife’s presence also provides boundaries for pain,
fear, fatigue, and anxiety. Her presence assures protection from
abandonment or entrapment and brings comforting reassurance ,`
that all is as nature planned in the intensifying rhythms that
culminate in birth. The nurse-midwife confirms a reality to all that
is happening.
To be cared for in labor, to be assured of a sympathetic presence
when vulnerable, is to know that one is valued. To be valued frees up Qi
a woman’s energy for bringing forth new life.  I

i Once the baby is born, a woman is launched into her new
 A identity. The sound, the touch, the sight, the nuzzling of a new baby
? evoke strong ecstatic response in a woman that help bond her to
. that child forever. A whole new self-concept and heightened self-
  esteem come in taking on this new role. Now the mother, who has
g been nurtured and protected in labor, becomes protector and
_ ' nurturer for another helpless, very vulnerable being. She is
E energized, excited, and fatigued. She welcomes the sleep of renewal
i _ that comes after the work of labor.
1 The nurse-midwife understands the mother’s continuing need to
._ restore her body and spirit, to replenish spent energy. She guards
* the new mother during the early period of rapid and dramatic
' physiological adjustment to the nonpregnant state. Her presence
~ frees the mother to sleep and be renewed.
In time, she helps the mother reconstruct events, to review and
Q summarize, to fill in voids, to make a "cognitive map"" of the
.— totality of her birth experience. This then allows a new mother to be
finished with the "business” of pregnancy and birth and to move on
. to constructing new family relationships.
. Thus, nurse—midwifery, as it has evolved, is an attempt of the
professionally prepared nurse to blend her scientifically disciplined
: learning with the intuitive aspects of the "earth mother" or "wise
. woman" in responding to the needs of women caught up in the
i mystique of childbearing. This instinctive, intuitive, quality of the
Q nurse-midwife who never loses her awe in witnessing the miracle of
; creation assures the continuation of nurse-midwifery as a profession
I to meet the needs of all mothers to come.
1. Ruth Coates, in Can Maternity Nursing Meet Today’s ChaIlenge?, Ross Round-
table on Maternal and Child Nursing, Jeffries, J.E., ed. Columbus: Ross
_ Laboratories, 1967, p. 41.
~ 2. Noble, Elizabeth. Childbirth Without Fright. Boston: Houghton Mifflin Co., 1983.
~ 3. Klaus, M.H. and Kennel], John H. Parent—Infar1tBondiiig. 2nd ed. St. Louis: C.J.
Mosby Company, 1982.
4. Rubin, Reva. Maternal Identity and the Maternal Exp0rimzc¢·. New York, Spring
  Publishing Co., 1984.

    A · » A   — _  , l
      A   =   IQJII  l, ____   "  12.1RTH CENTERS i
    " .   ` `   ‘ AND THE ART l
 A   J :4 ar
~ s · »       
    I S A ~ _ , _ ,, i
**1;;   ’ _,_ · LA by Eunice K. M. ( Kitty ) Ernst, CNM, MPH
fj. ‘   £»‘   ‘$¢~“’ T Administrator
      h     National Association of Childbearing Centers I
The freestanding birth center is bursting into the arena of ¥
American health care. It is a daring demonstration of an alterna-  
tive to the conventional view of pregnancy as an illness, and birth  
as a medical event. What precipitated the entrance of this concept
of health care delivery for childbearing families? Why is it
gaining momentum? And what impact will it have on maternity i
Ifone accepts the principle that for every action there will be a I
reaction, the birth center is a reaction to our concentration on the
medical problems of pregnancy and birth, overlooking the fact g
that the vast majority of women experience a pregnancy and birth  
totally free of medical problems. There is no question that during
the early decades of this century too many mothers and infants
died in childbirth. There is no question that the medical problems `
which left children without mothers, and mothers without child- I
ren, had to be brought under control. There is no question that any Q
plan for change in providing care to childbearing families should gi
recognize the great gains that have been made through organized  
programs for prenatal care; improved socio-economic conditions  
for women that promote better health, hygiene, and nutrition; the H
control of reproduction through family planning; and scientific C
advances in medicine, surgery, pharmacology, nursing, and y
public health. There is also no question that we cannot ignore the A
problems of today that are at least as complicated as those of 1
yesterday: inadequate preparation for pregnancy, birth, and ‘
parenting; inadequate "high-touch" care and inappropriate "high- I
tech" care; abuse of children and women; and the bottom line of 1
escalating cost. l

l When birth moved into the acute care setting of the hospital, it
  seemed like a good idea. It certainly brought sick women and
i newborns to a place where antibiotics, blood transfusions, and
  improved diagnostic and surgical procedures transformed poten-
  tial tragedies into pregnant triumphs. But no one studied what the
T impact ofherding all women into the acute care setting was doing
· to the normal process of childbirth and the delicate dynamics of
family interactions. Only in the last couple of decades has
scientific investigation raised serious questions about the routine
' procedures of the hospital, such as the use of drugs in labor, the
separation of mother and baby, the flat-on-the-back position for
i delivery, and the promotion of artificial feeding.
{ Only in the past few decades have women had access to
s medical information that has caused them to be concerned, to
E question, to become informed, and to reclaim responsibility for
their own health and childbirth experience}
T During the fifties and early sixties, women organized into
  childbirth education groups, nursing mothers, and parent support
i groups to change the way they were cared for in the acute care
setting. The presence of husbands in labor, rooming in, and
{ family-centered care came into being as a result of consumer
_ pressure. But for some, the changes were too little or too late
  (babies don’t wait). During the late sixties and early seventies,
i frustrated with their inability to bring about uniform desired
£ changes, a few women began to take matters into their own hands
` and stayed at home, often unattended by professional practi-
T tioners.
, In the early seventies, Maternity Center Association, in New
if York City, concerned that dissident women would "throw out the
Q baby with the bath water," so to speak, perceiving the growing
T desire among childbearing women for a safe, satisfying alterna-
 ’ tive to the conventional maternity care, began to explore alterna-
tives. Even during the three years of investigation and planning
. for the demonsti ation of the freestanding birth center, the desire
Z was changing to a demand. The health planning systems that
were established nationwide under federal legislation to develop a
4 regionalized system for health services were confronted with
g articulate women advocating for the inclusion of alternative
  programs, providers, and practitioners. As a result of their efforts,

many state health plans now include a mandate for alternatives
such as birth centers or nurse-midwives.? ,
Resistance to the concept of birth occurring anywhere except  
in a hospital was, and still is, enormous.3 Leading members of the I
Medical Advisory Board of Maternity Center Association in New {
York resigned in protest to the proposed demonstration of a Y
freestanding birth center. The American College of Obstetricians z
and Gynecologists, joined by the Academy of Pediatrics and later ,
by the American Academy of Family Practice, took a position ll
against out—of-hospital births. This made it almost impossible to § `
obtain funding for the project. But the Governing Board of l
Maternity Center Association (MCA), with the support of a few j
courageous nurse-midwives, obstetricians, and pediatricians, i
forged ahead to address the needs of a small but determined
segment of childbearing families. ,
Anyone who has read Wide Neighborhoods by Mary Breckin- _
ridgei will see the parallel ofthe effort to establish the demonstra-
tion of the Frontier Nursing Service and the effort to establish the .
demonstration of the freestanding birth center.  
The desire/demand of parents caused MCA to define the need
for an alternative. In 1975 the Childbearing Center was establish- i
ed as a demonstration model. In 1978 MCA sent a consultant ;
across the nation to look at fourteen other birth centers. In 1979, g
with support from Jane Leigh Powell, who serves on the Boards of I
the FNS and MCA, eleven birth centers were studied? In 1981,
under a grant from the John A. Hartford Foundation ofNew York, Y
MCA designed a program for networking information on birth yi.
centers. In 1983 MCA, with renewed funding from the John A.  
Hartford Foundation, established the National Association of if
Childbearing Centers (NACC).6 The Network, and then NACC,  _
worked at a policy level, a provider level, and at the public level to _
identify the need for maintaining quality services. These efforts F
promoted the drafting of Guidelines for Licensing Birth Centers '
that were subsequently adopted by the American Public Health
Association in 1982.7 i
Eighteen states now have licensure in place, and seventeen =. 
states are working on licensure. A pilot program, partially funded
by the Pew Memorial Trust of Philadelphia, is now under way to

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  { I i .  
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  A typical room in a birth center. This one is in a center in Reading,
‘ Pennsylvania, whose director is Diane Lytle, an FNS graduate.
, set standards of excellence and establish a mechanism for
  certification by self—evaluation, site visit, and Board review.
l Assurance of safety in care of mothers and babies in birth centers
[ is a sine qua non!
b Market research conducted in parts of Florida, Texas, Alaska,
_ Pennsylvania, upstate New York, and Minnesota show that more
E than 50% of women would consider using a freestanding birth
i center? Increasing numbers of childbearing women seek care in
i birth centers. The satisfaction of users of birth center services is
  displayed in a fourfold increase in operating centers since 1978,
  but the real force in the development of the concept is economic.
" Birth centers are now reimbursed by most major insurers. Blue
y Cross has written contracts with birth centers in 27 states. HMO’s
V (health maintenance organizations) and Medicaid are paying for
l l services. CHAMPUS (the benefit program for military dependents)
l is withholding pay until certification is in place. Business,
industry, and labor unions have included birth centers in their
l health benefit packages, and some insurers are offering cash or
discount incentives for users of this low-cost service.
2 The average charges for birth centers in 1982 were 47.7 percent
  of charges for normal birth in the hospitals serving as back-up for
i the birth centers reporting. The factors that contribute to cost
containment are these:

1. The program is designed to be education intensive, to promote
responsibility in parents for preventive health and appropriate
use of medical services. i
2. The facility is of ordinary construction and equipped to initiate  t
emergency procedures and implement transfer. High tech is
reserved for the acute care setting. *
3. The birth center, as an ambulatory care facility, is staffed only ·
when a family is in-house. 2
4. The nurse-midwife subsumes part of the role of the nurse, V,
obstetrician, and pediatrician in high-touch care of mother,
anticipating a normal pregnancy and birth. *
5. Home follow-up eliminates the need for costly hospital stay. .
It is important to view the birth center as a new approach to p
pregnancy and birth. It is not a cheaper rendition of the program ;
offered by the acute care setting. It represents an opportunity to ‘
_ separate the 75% of women who will experience a problem-free ‘
pregnancy and birth and provide a place and program more V
appropriate to their needs at lower cost; a program that defines I
midwifery as individualized, personalized "with woman" care,
regardless of the education and training of the practitioner.
It is acknowledged, even by those who initially opposed the  
concept, that the birth center is changing the delivery of maternity .
services to childbearing fam