by Judith Kegan Gardiner
Cut, no. 17, April 1978, pp. 3-5
In her reaction to THE CHICAGO MATERNITY CENTER STORY, released by Kartemquin Films in March, my 10-year-old daughter shared the enthusiasm of the 400-member audience with whom we saw its Chicago premiere. Like her, many audience members focused on the film's first part, which shows the birth of one of the last babies to be delivered at home through the Center. After the one-hour-long documentary, a panel of the filmmakers and women health activists answered questions centering on the "how-to's" of home delivery. In the audience, nurses training to be midwives supported home delivery, and about 20 women volunteered that they had had home births. The film shows home birth and informs the viewer of its advantages. However, as women health activists and natural childbirth advocates pointed out, the film is not up-to-date concerning today's primarily middle-class home delivery practices. It is not intended to provide guidance for prospective parents. Today, the panelists said, home delivery is an expensive option available to only a few women, not the inexpensive community service which was once provided by the Chicago Maternity Center.
As the title indicates, THE CHICAGO MATERNITY CENTER STORY is the case study of an institution — its history, its positive results, its opponents, and the unsuccessful organizing attempt to keep it alive. The second half of the film provides the political analysis of why the Northwestern University School of Medicine closed the CMC. The first part seemed the more emotionally charged, easier for the audience to respond to; they clapped when Scharene Miller's baby was delivered. Yet involving as the first part is, it is intellectually incomplete without the second part. The film is a socialist-feminist documentary. The first part should appeal to any woman who feels she should control decisions about her body and reproductive life. The second half goes beyond the presentation of home delivery as an alternate service to criticize the American system of health care for profit. This part makes the film an effective organizing aid, capable of generating careful strategic analysis by committed activists and capable of moving a working-class or middle-class audience toward thinking about the need for collective action on behalf of women and people's health. The film's analysis is convincing and persuasive. The film as a whole successfully taps the feminist enthusiasm generated by the first half and leads it in the second part to anti-corporate anger.
The Chicago Maternity Center film began in 1972 as a short documentary to help save the Center, which was fighting to remain open. But by 1974, before the Kartemquin Collective could finish the film, the CMC was closed. Moreover, a fire in Kartemquin's studios burned much of their working print of the film. Instead of discarding the project, however, the filmmakers broadened their scope to produce the present film as a statement about women's health needs and the way dominant medical institutions fail to meet them.
In the first section of the film we hear from several black, white, and brown women about their support for home delivery. These women were all clients or prospective clients of the Center. One black woman contrasted the harsh, impersonal care she received at Cook County Hospital, the city's large public hospital for the poor, where she gave birth to her first child, with the warm attention she received from the CMC for her second delivery. A Latina speaks of the alienation experienced by the women who can't express their pain or anxiety in a language that will be understood by the hospital staff; home delivery, when a woman is surrounded by her family and friends, is far better. These are the poor women whom established society accuses of stupidity and apathy toward its children. Instead, we see that the women are articulate and actively concerned with their own and their children's welfare in a setting that gives them opportunities for participation and expression.
Much of the first half of the film focuses on Scharene Miller, a young black woman in her first pregnancy. She comes to the Center for a prenatal checkup. Scharene is cheerful and casual. The male intern who asks her questions seems a little ill at ease before the camera, but his questions are friendly and thorough. Scharene listens to her baby's heartbeat through the doctor's stethoscope. We see that the care at the Center is humane.
Some background about the CMC intervenes between our first view of Scharene and her delivery: we wait, as Scharene does, for the pregnancy to advance. For 78 years, the CMC provided over 100,000 Chicago women with a low-cost home delivery service. Because of a commitment to its patient population and its special techniques and staff training, insisting on and providing adequate prenatal care for all of its patients, the CMC's safety rate exceeded that of most hospitals and was far better than the Chicago minority maternal mortality rate. We see scenes from a melodramatic 1939 movie by Pare Lorenz called FIGHT FOR LIFE, designed as public relations for the Center. It has an all-male, all-white cast of professionals, even though the Kartemquin narrator tells us that Beatrice Tucker, M.D. was then co-director of the Center. In the old film a serious middle-aged physician tells a young man that he can serve people by working in the Center and learning sterile techniques. The need for the Center is emphasized by a scene of a woman dying under anesthesia in a hospital that has not taken proper precautions. (This section of the film frightened a four-year-old boy with whom I attended the performance. The movie is not designed for presenting the "facts of life" to very young children.)
After the clips from the older film, we return to Scharene's delivery. We see her house, with its pictures of King and the Kennedys, and the bed from which she is helped onto the dining room table, which becomes a delivery table. (The panelists later told us that now home deliveries use the mother's own bed for deliveries.) The film picks up the birth from the point at which Dr. Tucker arrives, though the narrator tells us that medical students and attendants have been waiting with Scharene for some time. Scharene's labor is long and difficult. She groans and cries while her friends hold her hands and try to comfort her. The attendants and the family prepare for delivery. Dr. Tucker briefly and efficiently tells them how to roll up newspapers and prepare a sterile field. All wait, sipping water, offering Scharene some, during the hours of her labor. At the time of the film Dr. Tucker was about 75 years old, but she seems tough and capable, not "motherly." "On your knees, Doctor," she orders a male resident physician. Later she tells him to "get your fingers out of there; you've been in there long enough."
We see the delivery itself clearly, both in close-up and from a middle range, as though we were one of the watching family members or friends. A young boy is present. One of the women interviewed earlier in the film said that she wanted home delivery so that her children would know about life; she didn't want them thinking that babies grew in the cotton patch.
Scharene's baby is not in the usual position; finally Dr. Tucker takes over from the resident, though she continues to instruct him throughout the delivery. She makes an episeotomy, and delivers the baby with forceps. As soon as the child appeared, the audience cheered and sighed with relief.
Some viewers criticized the delivery for being too difficult. They thought that a film in favor of home birth should show the far more normal easy delivery instead of a rare, long and painful one. Forceps were used in only 1% of CMC births. Current proponents of birth without violence wanted to see different techniques used and wanted the film to show a delivery without instruments. On the other hand, the film shows a safe home delivery even in that rare case of "complications" so often used to frighten women away from home and into the hospital. The film avoids the goody-goody tone of commercial medical education material, and Dr. Tucker's tough humor contradicts the Marcus Welby stereotype of the ideal physician. The Chicago audience, for whom Dr. Tucker is already a legend, cheered when she first appeared; and they clapped even louder later when a panelist announced that Dr. Tucker, now about 80 years old and no longer able to make home deliveries, was learning Spanish so she could speak better with her patients in a neighborhood health clinic.
Having established that the CMC delivered high-quality maternity care to many of Chicago's poor women, the film fills us in on the statistics of the Center's operation. We need to know whom the CMC served and at what cost to understand why it was closed down. At the time the film was being made, an entire CMC home delivery cost a poor woman only $50, whereas a hospital delivery might run anywhere from $600 to $1200. At the time of the Center's closing, its clientele was 50% black, 35% Latina, and 15% white. By the time the film was finished, Northwestern University Medical College had already withdrawn the residents and medical students that had rotated through the CMC as part of their obstetrical training. A physician I interviewed who had worked in the Center 10 years ago said that the kind of care shown in the film accurately represented the service as she had known it then, too. The departure of the Northwestern staff meant that Dr. Tucker was the only physician still making deliveries when the Center closed.
The second half of the film describes the losing struggle of patients, staff, and community groups to keep the Center open. First, mostly through stills, the film prepares us to understand the struggle by a history of the CMC and its funding. Originally a charity sponsored by the wives of Chicago's industrial magnates, the Center then became a peripheral arm of those same magnates' financial interests. Pictures of CMC board members change from socialite Mrs. Potter Palmer to B.D. Searle, head of the drug company. The final trustees of the CMC board are introduced in still pictures with captions showing their corporate positions. Many of them are also board members of the new multi-million dollar Prentiss Women's Hospital, built by Northwestern Medical College, which was taking over the CMC. The films show us promotional material for Prentiss Hospital, promising that Northwestern will continue to operate the unique home delivery service from its new site. However, as the new hospital is built, the CMC is closed, and home delivery is not resumed at Prentiss.
The film's narrator tells us that modern corporate medicine is designed to produce profit, not to answer people's needs. As visual corroboration of this idea, the film shows many graphics, chiefly ads and cartoons: in one cartoon a hospital board of directors smoke their cigars through dollar signs instead of heads. Such cartoons are not likely to change the minds of staunch defenders of free enterprise, though other evidence is more convincing: a Norman Rockwell-like sentimental picture of the old family physician with a worried mother and a small boy illustrates an earlier, simpler health care delivery system, whereas a fast flash of brassy ads represents the present. In one ad, nurses ludicrously ride golf carts because their rounds are too long to walk. Other ads display distraught, depressed women who "need" tranquilizers. Still others show people connected with so many medical tubes and machines that they look like robots. Graphs show rising health care costs and profits. Health care is now a $100-billion-a-year business, an industry larger than defense, with enormous profits made through selling technological equipment, expensive new facilities, and drugs. According to the narrator, profit is not the only question: the new technology is also designed to keep control in the hands of a limited class.
In contrast to our system, there is one quick still of a Chinese patient under acupuncture anesthesia. This visual allusion is not adequate to introduce the possibility of a health care system designed to serve human needs and keep decision-making in the hands of patients and providers. The film gives only the CMC as an example of humane health care and does not indicate that socialist priorities would make institutions like the CMC part of the fabric of everyday life and care, instead of the doomed anomalies they are under capitalism.
The background material prepares us for the specific fight that develops between the clientele represented by WATCH (Women Act to Control Health Care), an organization of the Center's clients and workers, medical students, and women health activists, and, on the other side, Northwestern University, with the CMC board of "trustees" now acting on behalf of the large medical school complex. The struggle is a prolonged one. At first Northwestern University, which had been providing medical personnel for the CMC, begins constricting its support. Unfortunately, by the time WATCH and the women working for the Center realize what is happening, it is already too late. They do not have a wide enough base in the community; not enough women who are clients of the Center's dwindling services have the time and energy to carry on the fight. Even worse, by the time they organize, they can only negotiate with Northwestern on its terms, rather than mount a wider community fight for other sources of support for the Center. This section of the film provides excellent source material for strategic analysis by groups doing institutional organizing.
We see a meeting of WATCH and some clips of women stuffing envelopes to send out appeals. WATCH members carry posters and hold demonstrations. They meet to decide tactics. Although the board of trustee members are identified for us by captions, the members of WATCH are not. For example, as Barbara Bishop is shown as a WATCH speaker several times, and in one scene, she is wearing a nametag that cannot be read by the audience. It takes a while to figure out that she is a Northwestern University medical student who supports the Center, while being under pressure from the obstetrics and gynecology department at her school to switch her support to hospital deliveries. Perhaps the filmmakers wanted to show WATCH as a collective without specific leaders, but more identification of its speakers would have made this section of the movie easier to follow.
The physician I interviewed said that even 10 years ago the Northwestern obstetrics and gynecology faculty discouraged students from working at the Center and disparaged its level of care. She said the male medical school physicians kept trying to frighten students about what would happen if complications arose. They tried to make the students feel that home deliveries were unsafe. In fact, backup facilities for handling complications were excellent, the nursing staff at the CMC were trained midwives in essence if not in certification, and the safety record of the CMC was exemplary. The film omits such evidence that the medical establishment was in favor of hospitals and against home delivery for reasons independent of the profit issue. Instead, it simplifies the connections between corporate capitalism and medical ideology.
The scenes showing confrontations between WATCH and the CMC board of trustees are the highlights of the film's second part. They provide a parable of powerful liberals faced with feminists' and poor people's demands. "We feel even worse than you do," a suit-wearing, middle-aged white administrator tells a casually dressed, emotionally upset multiracial group. The CMC is a charity, the administrators tell WATCH, and it is too expensive for the university medical center to afford. The women reply that the university has been given huge federal grants for its new hospital, and some of that money can justly go for home deliveries. There is no demand for home deliveries, say the trustees, citing the declining patient load at the Center to only 30 a month. But the women reply that the university has been deliberately constricting the service, cutting down its physician supply. Moreover, as several of the women know from personal experience, the medical school staff either fails to inform women about the CMC services or actively discourages them from using it, saying they will be safer in the hospital. The trustees tell the medical students that they are nice, idealistic young people.
The confrontation ends with the trustees smooth, unruffled, and winning. The audience knows that their arguments are specious and their motives suspect. We can applaud the right-on replies of WATCH speakers that debunk the liberal trustees. But we also must concede that right answers don't transfer power. The board retains the power to close down a money-losing service that helps poor women while raising enormous sums for a prestigious, fashionable new facility that will be called non-profit but will enrich many.
The film ends with an explicit political statement by the narrator — women and health care workers must work together to take control of the institutions that affect our bodies, our children, our lives. We get a pitiful last glimpse of WATCH activists selling rummage on a street corner to raise money for the CMC, after we have seen the slick public relations brochures for the new hospital. Yet the film is instructive and cautiously optimistic rather than discouraging. Unlike SALT OF THE EARTH, BLOW FOR BLOW, or UNION MAIDS, it does not end on the "up" note of a successful popular struggle. On the other hand, it does not show the patriarchal capitalist power structure as inevitably in command. Instead, we get one model of a humane, practical maternity service. We see a struggle in which women work together, learning their own strengths and those of their opposition. Our interest now is in the future," says the narrator, "health care for profit for a few or health care as a human right."
The movie does not paint an overall picture of what good socialized health care for this country would be like; its glance at China does not explain the health care systems of today's socialist societies. The slogan that "health care is a human right" was popularized by health activist organizations like Medical Committee for Human Rights in the late 60s and early 70s. Now, in the absence of a national health movement, organized to lead us toward socialized medicine in a reordered society, the ending of THE CMC STORY may leave us somewhat at loose ends. Despite these limitations, the film is effective. It argues forcefully for the benefits of home delivery. It raises consciousness about health care priorities under capitalism. And it helps generate the anger and enthusiasm needed for institutional organizing campaigns.
Kartemquin Education Films, 1901 W. Wellington, Chicago, IL, 60657 (773-472-4366), produced and now distributes THE CHICAGO MATERNITY CENTER STORY.