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Profiles Fighting the Battles… and Winning!

“Behold the turtle…it makes progress only when it sticks its neck out.”

Dorothea Lang ’56, who had a poster with this sentiment on it hanging in her office for many years, was never afraid to stick out her neck for what she believed.

For nearly 40 years Lang has worked, advocated and legislated to achieve recognition for the practice of midwifery and quality care for women.

Born the second eldest child to missionary parents in Japan, Lang saw a midwife arrive at home to assist her mother’s delivery of her four younger siblings. In the 1930s, 97 percent of women in Japan were delivered at home by midwives. Only those few with complications went to the hospital.

Lang saw the respect that these midwives received in the community. “People had warm feelings towards them,” she said, “the same feelings you would have for a family doctor.” Intrigued, Lang went on to Albright College with the intention to acquire the science foundation for midwifery education.

However, she could find no information on midwifery education in the United States. By 1950, 88 percent of American women were delivered in hospitals by doctors. Home births delivered by midwives were no longer the norm. So, Lang completed a five-year nursing program at Albright and Reading Hospital School of Nursing.

Not long after receiving her bachelor’s degree, Lang discovered a new program that taught midwifery at Johns Hopkins University Hospital. Excited about the opportunity, she applied and completed her educational and clinical requirements to become a certified nurse-midwife (CNM). However, when she went to find a job, she found that there were no clinical practice employment opportunities for midwives. Lang took a job as an obstetrical head nurse and junior instructor at New York Cornell Medical Center in New York City.

But in 1962, an opportunity arose that would not only change Lang’s life, but the future of midwifery in America.

Lang traveled to San Iku Hospital in Tokyo’s East Side as a consultant-mission associate. While in Tokyo her collegial relationships with obstetrical professors, nurses, midwives and other allied health team members introduced her to the modern type of health care – professional midwifery practice in a hospital setting.

“In Tokyo, midwives were delivering 95 percent of the births,” Lang said. “They were doing such a good job with the Japanese women. The doctors were there in the back rooms doing research and writing textbooks, and the midwives were doing all the work. The doctors only saw the patients when there was a problem.” That experience, said Lang, greatly influenced her pioneering work to integrate the American professional midwife into both hospital and public health-based maternity services.

In 1965, after completing a master’s degree in public health at Columbia University, she went to work for the Maternal-Infant Care project in New York City as a nurse educator. Her goal was to introduce midwives into the system and convince the New York City Health Department that midwives were the key to improving and personalizing maternity care. In 1968 Lang was appointed director of midwifery.

Under her administrative guidance, the number of hospitals that employed midwives went from two to 23, and through her efforts the fullest scope of nurse-midwifery practice was demonstrated in urban settings.

Now, across the U.S., more than 40 universities offer midwifery education and more than 10,000 midwives have been educated to provide the “midwifery model of care” to families of all cultural and socio-economic levels.

That missionary trip to Tokyo in the early 60s taught Lang another thing – midwives shouldn’t be required to have a nursing background in order to practice midwifery. “A doctor doesn’t need to be a nurse before they become a doctor, so why should a midwife need to be a nurse first,” she argued. That argument, and her persistence for more than 20 years, led to a Board of Midwifery in New York State that recognizes certified nurse midwives and certified midwives. The law, established in 1992, stated that prerequisites to midwife education may be nursing education or the academic science equivalent, such as psychology, anatomy, physiology, pre-med, etc. For Lang’s pioneering efforts, she was given New York Midwife License Number 000001.

Honored with the Hattie Hemschemeyer Award in 1986, the most prestigious award presented by the American College of Nurse Midwives (ACNM), Lang’s mandate to midwives sums up her philosophy best: “Do not try to go where things are already great. Go where the individual needs of the women are
the greatest.”

In 2002, the Dorothea M. Lang Pioneer Award was established by the American College of Nurse Midwives Foundation to acknowledge those midwives who have demonstrated why midwifery care could and should be on the health care team. “I’d like to think that maybe my work gives courage to other people to reach beyond what’s existing today.”

Lang hasn’t stopped since retiring in 1998. Today, she remains active at both the local and state levels working toward achieving a friendlier mother-baby environment within the health care system. She’s involved in community-based organizations in central Harlem to help improve maternity care there, and she represents the International Confederation of Midwives (ICM) as a nongovernmental organization at the United Nations.

In addition, she continues her pioneering efforts at the State University of New York– Brooklyn where she is working to establish a doctoral program in midwifery, which she hopes will be available within the next 10 years.

“I still have a lot of energy,” she said. “We haven’t won all the battles yet.”

– Jennifer Post Stoudt

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