Posts Tagged ‘RN’

Looking Through You: How a Kaiser Permanente Nurse Transformed Health Education

posted on May 4, 2017

Transparent woman on cover of 1967 Kaiser Foundation Medical Care Program report.

Lincoln Cushing, Heritage writer


In 1967, wife and husband Bobbie and Morrie Collen toured Montreal’s Expo 67 and were transfixed by a pair of transparent mannequins that rotated and lit up to reveal organs and display physiology. They later purchased the figures and shipped them back to Oakland to become the centerpiece of a major Kaiser Permanente health education program led by Bobbie.

Frances Bobbie Collen (née Diner, 1914-1996; always called Bobbie, never Frances) was an accomplished professional as well as being the wife of Morris “Morrie” Collen, MD. She was a nurse with a master’s degree in health education, and was the force behind the groundbreaking Health Education Research Center at the Kaiser Permanente Oakland hospital.

Bobbie graduated from Winnipeg (Canada) General Hospital as a Registered Nurse in 1937 and worked at the University of Minnesota Hospital where she met her future husband, Morrie. They wed secretly when he was a medical student because the university hospital would not hire married nurses. Later they moved to Chicago where he interned at Michael Reese Hospital and she was the evening supervisor at the Meyer House patient wing. While there she also a graduate student at the University of Chicago in Nursing Education.

Bobbie Collen, RN, circa 1980.

In 1939 the Collens moved to California where Dr. Collen began his residency at Los Angeles County Hospital. When World War II began, Dr. Collen’s 4-F status due to asthma kept him from serving in the military, but the Permanente health plan was ramping up to care for defense industry workers. Dr. Collen was one of the first ten physicians hired by Kaiser Permanente’s founding physician, Sidney Garfield, MD.

Bobbie was a founding member of the Permanente Medical Wives in Oakland, an important support group during the challenging postwar years. Dr. Collen’s oral history credits the group as a key factor in the success of Permanente medicine.

But it was Bobbie’s role in patient education that would be her lasting legacy in the advancement of health care. Dr. Garfield asked her to be the Director of the Educational Research Center in the spring of 1967: “Start with the development of a Health Exhibits Theater as an adjunct to our planned health care program for the healthy in our Health Plan membership, because this first step will be the easiest.”

Dr. Garfield with transparent man in Health Education Center

In May 1967 Bobbie submitted her thesis “Factors Associated with Continuing Education of Adult Women” for a Master of Arts in Education at U.C. Berkeley. Then the Collens toured a dozen facilities on the East Coast, including the Cleveland Health Museum and the Lankenau Hospital Education Center in Philadelphia.

Her field work in reviewing health education displays led her to this conclusion:

In my opinion, they have all missed one important feature which is a further step forward in preventive medicine, and that is, to demonstrate not only what the body looks like on the inside, and how it functions, but also how to care for it to keep it healthy. Here I think exists the potential which, when materialized in the shape of a Health Exhibits Theater, will provide a service to our membership that is unique in the country.

The Health Education Research Center at 3779 Piedmont Avenue in Oakland (next to the Kaiser Permanente Oakland hospital) opened its doors in January 1969 as a supporting function for Dr. Collen’s Multiphasic Health Testing Services.

The Principal Investigator for the demonstration research project was Krikor Soghikian, MD, and Bobbie Collen was the Education Director. The U.S. Public Health Service partially supported the Center through the Kaiser Foundation Research Institute because of the research component and its potential application elsewhere in the nation.

One key feature of the Center was the Health Education Library which opened July 1969, equipped with 24 individual projection booths for viewing films, slide-sound programs, and videotaped TV programs.  A patient would visit the library with a physician’s “prescription” to see a specific program.  Adjacent to the Library was an exhibit area that featured the transparent man and woman, a variety of health exhibits, and a children’s area with educational games, toys, and play figures. Later, when the Center was relocated, the children’s section included a doll with leg braces, a stuffed elephant with a hearing aid, and a monkey in a wheelchair.

Caren Quay, MLS, started as the Center’s first librarian in 1970. She recalled that from the beginning visitors requested more information, so she began to build an extensive collection of books and audiovisual materials, with every title reviewed by Permanente Medical Group physicians.

The health librarian would retrieve the prescribed audio-visual program from the files and play it on the projector in the individual’s booth. The list of educational videos grew to over 250 titles; a notation on one of the librarian’s catalogs records that the most popular subjects were stress, nutrition, birth control, breast self-examination, headaches, lifestyles, and high blood pressure.

Health Education Library for Patients, librarian Caren Quay at desk, circa 1974.

The program was quite successful. Audio-visual requests grew from 98 in 1969 to almost 8,000 by mid-1973. Attendance for women was triple that of men. Dr. Collen reflected on how well it reached members of the community:

They would bring in schoolchildren from all over Oakland, who would come in and go through this health education center. They would look at the exhibits—there was a normal lung and a smoker, smoker’s black lung, and I think that helped a lot of kids realize what smoking can do.

After Dr. Garfield and Mrs. Collen passed away (1984 and 1996, respectively) the education display lost its primary advocates. The grant money ran out and the Oakland hospital needed the space. The transparent man and woman went to U.C. Berkeley’s Lawrence Hall of Science. But what continued was an expanding role for health educators and the growth of health education centers at the Kaiser Permanente medical centers for patients and members of the community.

Health Education Library, 1978.

Ms. Quay later became the health information specialist in Northern California’s department of Patient Education and Health Promotion, and recently reflected on the legacy of the program:

The Health Library broke ground as the first library I know of in the U.S. to provide health and medical information to the lay person. It was the model and inspiration (and then flagship, resource, and consulting lead) for health education centers that provided health information (and more) for the Kaiser Permanente Medical Centers throughout Northern California and, eventually, for the other regions of the Medical Care Program. The library served as a model for Planetree in San Francisco and for others throughout the country.

Dr. Collen lamented in his oral history that “[Bobbie] doesn’t get enough credit . . . for all the things she contributed.”

On this Nurses Week we thank Bobbie Collen, RN, for improving public health through education.


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Henry J. Kaiser’s healthy competition – encouraging ‘ideas in overalls’

posted on June 2, 2014

Lincoln Cushing, Heritage writer


One of Henry J. Kaiser’s effective approaches to industrial productivity was his encouragement of nonpunitive competition. He believed that people perform their best when tested against peers, and the evidence suggests that he was right.

"Ideas in overalls" headline, Fore'n'Aft, 10/9/1943

“Ideas in overalls” headline, Fore’n’Aft, 10/9/1943

While building Grand Coulee Dam on the mighty Columbia River during the Great Depression, Kaiser divided the project into two parts.

Two work teams were pitted against each other to see who could finish first and most efficiently in constructing their part of “the largest block of concrete in North America.”

The workers in the seven Kaiser World War II West Coast shipyards saw competition of all kinds as a standard feature. One account of the time described the jockeying:

“Who will eat turkey? Who will eat beans?” Kaiser Swan Island shipyard, June 1944, photo courtesy Oregon Cultural Heritage Commission. Pictured: T-2 tanker USS Nickajack Trail, which ran aground 1946 in Eniwetok Harbor.

“Who will eat turkey? Who will eat beans?” Kaiser Swan Island shipyard competition infographic, June 1944. Pictured: T-2 tanker USS Nickajack Trail.

“Yards were set to competing with one another, and scoreboards showing competitors pulling away in ship deliveries had the effect on output per man-hour of a shot of Benzedrine.

A graveyard-shift crew bet that it could lay a keel faster than its swing-shift competitor and, to win a kitty of $600, reduced the operation from hours to minutes.

“Welders bet burners pints of blood for the Red Cross that they could do it better. But the chief prize was the right to christen a ship. Proudest launcher was an aged Chinese woman, who christened her ship in Chinese and cherished the same silver tray souvenir accorded such sponsors as Mrs. Eleanor Roosevelt.” [i]

The Kaiser shipyard newsletters – Fore ‘n’ Aft in Richmond, and Bos’n’s Whistle in the Northwest – actively documented and promoted news of these competitive challenges. The rewards were often in the form of War Bonds, reinforcing the social good and patriotic nature of the goal.

Outlaws shipyard baseball team photo, sports section of Fore 'n' Aft magazine, 9/24/1943

Outlaws shipyard baseball team photo, sports section of Fore ‘n’ Aft magazine, 9/24/1943

Since Kaiser’s approach to building ships – like products in an assembly line – was new and evolving, there was a legitimate need for innovation and shop-floor creativity. Workers were always coming up with – and rewarded for – more effective and efficient approaches to their jobs. And, as at Grand Coulee Dam, crews and yards competed for top honors and bragging rights.

American ‘athletic industrialism’

One scholar suggests that this was a phenomenon of “athletic industrialism” that fused the two chief domains of competition in America: capitalism and sports.[ii]

“. . . Athletic industrialism did not merely rally workers, exploit them in a grand speed-up, or turn work into a game of outwitting management.

“Rather, athletic industrialism focused workers on the overarching goal of maximum output and offered an array of means to that end: attempts to set shipbuilding-speed records, Maritime Commission programs to laud the most productive shipyards, output contests for welders and other craft workers, campaigns to elicit labor-process improvements from workers.

"Queens of the welding machines," Fore'n'Aft, 8/20/1943

“Queens of the welding machines,” Fore’n’Aft, 8/20/1943

“More importantly, athletic industrialism fused workers into coherent units while also pitting groups against others in rules-bound competition.”

Striving for excellence in 2014

Today’s health care worksite may not be the war-driven frenzy of the Kaiser shipyards, but it nonetheless relies on worker wisdom to serve Kaiser Permanente members. The Kaiser Permanente Labor Management Partnership’s unit-based teams continue the tradition of healthy competition to achieve results.

Here are but two examples:

An industrial kitchen can be a danger zone, with its sharp knives, wet floors, grease and hot temperatures. It’s a challenge to be safe and efficient, but between July 2010 and June 2011 the Food and Nutrition Department at Southern California’s Panorama City Medical Center dramatically improved its safety record.

The department divided into two teams and sponsored a friendly competition for a pair of movie tickets. This motivated – and liberated – the staff to approach their colleagues who might be performing a task unsafely and suggest an alternative approach.

In 2010 the number of after-visit summaries given to patients at Southern California’s Kaiser Permanente South Bay Medical Center had slipped, resulting in a high number of patient calls and reduced patient satisfaction. The staff set up a friendly competition to see who could have the best improvement in the rate of after-visit summaries printed.

The Urology and General Surgery Department improved its numbers by 45 percent and the General Surgery Department improved by 56 percent. John E. Chew, director of care experience for General Surgery and Urology, remarked: “The best solutions come from the front-line staff. We’ve always known that, but UBTs give it a structure.”

Unit-based team safety contest poster, 2013

Unit-based team safety contest poster, 2013

Competing for better health

Kaiser Permanente employees and physicians are also tempted to improve their health through competition. Last year Kaiser Permanente launched the Spring into Summer KP Walk! Challenge.

Participants registered online; if they logged at least 150 minutes of walking through the end of June, they were entered in a weekly random drawing for prizes that included a solar cell phone charger, a gym bag, and a 4-in-1 tote bag.

Teri O’Neal, RN, was inspired to start walking by coworkers and joined the challenge to help keep her motivated on her journey to better health.

“When I first started, after half an hour I was so exhausted that I had to go home and straight to sleep. But I kept at it.”

Now, Teri has completed several triathlons, two marathons, and a Spartan race. “When I completed that first triathlon and I got my medal, I felt so proud. And it’s nice to be able to look back and see how far I’ve come.”

This year’s Spring into Summer challenge is team-based, with the teams in the top three places winning prizes.

The Kaiser experience, from Grand Coulee Dam to today, shows that healthy competition, whether among wartime shipyard workers or today’s health care employees, is truly a “win-win” situation.

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[i] The Truth About Henry Kaiser,” three-part series by Lester Velie in Collier’s, July-August 1946
[ii] “Launching a Thousand Ships: Entrepreneurs, War Workers, and the State in American Shipbuilding, 1940-1945,” unpublished dissertation by Christopher James Tassava, Northwestern University, June 2003.


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Kaiser Permanente nurse reassembles Bay Area history in her mosaic art

posted on April 25, 2012

By Laura Thomas
Heritage correspondent

Mosaic artist Tina Amidon is a long-time Kaiser Permanente nurse who works at Oakland Medical Center in Oakland, California. Photo by Ginny McPartland

Most of us who grew up in the Bay Area were affected in some fashion by Henry Kaiser’s legacy: our parents or grandparents came here to work in his wartime shipyards, or we were influenced by the growth and change the massive migration brought. Untold numbers of us received medical care in the health plan that bloomed in the wake of it all.

Oakland Kaiser Permanente medical-surgical nurse and artist Tina Amidon is a product of the Bay Area and draws inspiration for her art from its diverse and dynamic culture and history. Her childhood in North Berkeley was influenced by artistic and outdoors-loving parents. That influence drew her to a nursing career that allowed her the freedom to pursue those pleasures while nurturing the resilience and intuitive powers she uses to create her art.

Recently she found herself immersed in a particular aspect of Richmond history that ties back to Henry Kaiser’s shipyards and Bay Area culture.

Mosaic loveseat tells Richmond’s story

Her years of working in mosaics, producing large sculptural installations, culminated in October with the public unveiling of a commission for the Richmond Museum of History. From ceramic shards she collected along the shoreline that had been dumped by TEPCO, an El Cerrito dinnerware factory, she built a large diner coffee cup as a tribute to the East Bay’s working class tradition.

Fashioned as a love seat, the cup replicates one of the many styles produced by TEPCO in one of its more popular colors, Sunglow. Along with dozens of broken bits from cups and plates used at various eateries and clubs, the chair features photos of TEPCO workers at the old plant, framed by snaps from discarded pottery molds Amidon also found on the shore; and dinner plates from the Red Oak Victory, the Kaiser-built ship converted to a museum and docked at the former Richmond Shipyard No. 3.

Tina Amidon takes a seat in her mosaic coffee mug in the courtyard of the Richmond Museum of History. Photo by Fina Lloyd.

To Amidon, it forms a quilted narrative of the city, the shipyards and the lives of workers who enjoyed their time off in “the local restaurants and cafes where they spent their hand-earned money after work,” she said.

“This piece honors the men and women who not only worked at the TEPCO factory but built the ships and got their health care at Kaiser Permanente… They sipped their coffee at diners all over the Bay Area and at places like Trader Vic’s and Tad’s Steakhouse.”

And so did the rest of us who were around in the past five decades.

Sandi Genser-Maack and husband Lynn Maack, of Richmond, are TEPCO china collectors and can cite more spots that used Tepco: Mel’s Drive-In, Doggy Diner, Rod’s Hickory Pit, the old Villa De La Paix in Oakland; the Milk Farm on I-80 near Dixon, The Broiler in Sacramento, the Lau Yee Chee Restaurant in Honolulu, Louie’s Club in El Cerrito and the Cerrito City Club. Mama’s Royal Café in Albany still does and there are probably others.

Hundreds of commercial and fraternal establishments ordered dishes with customized logos in a selection of TEPCO colors and designs. The old West was a major theme for many eating places in the mid-20th century and the U.S. Navy was a big customer, according to Genser-Maack. During World War II, she said, “all the Liberty and Victory ships that went to sea left with TEPCO.”

The Technical Porcelain and China Ware Co. – TEPCO’s official name – was founded by Italian immigrant John Pagliero and run by the family from 1918 to 1967. It was the largest dinnerware factory in the West and El Cerrito’s largest business to date.

Trash turned into treasure

Throughout the years, imperfect pieces were unceremoniously dumped, like much garbage at the time, along the bay shoreline where Amidon discovered them a decade ago while walking her dog near Point Isabel. It became her favorite collection spot for mosaic pieces, but it wasn’t until she attended a 2007 exhibition of the Maack collection that she saw her first intact TEPCO plate. She was surprised when she learned about the factory and its place in local history.

“I was able to piece together the whole story,” she said. Literally.

Fascinated by how cast-off items can create a narrative, Amidon says everything she creates tells some sort of story. A 2008 piece, “Allegorical Reliquary,” is a 12-foot-high, 8-by-10 foot roofless room that resembles an abandoned Irish chapel. It resides at Annie’s Annuals in Richmond where customers can amble through it as they shop for flower seedlings. The interior, which has water flowing down the walls inspired by the weeping walls of Zion National Park, features a lively pictorial of mosaics from found objects to tell simply of the joys and struggle of everyday life.

Nursing feeds artistic instinct

During her 22 years as a Kaiser Permanente nurse, Amidon has spent a lot of time listening, and what she’s heard has provided the fodder for the metaphorical tales told in her pieces. Currently she works part time in both Peri-op, giving pre-surgery patients vital instructions, and in the Ambulatory Surgery Unit, where she preps them on the day they arrive for the operation.

“There are all these stories you encounter as a health care person,” she said. “We see a lot of life that other people don’t see.”

Amidon grew up going to art fairs with her mother, a rakú clay artist, and spending a lot of time outdoors (her father was an economist for the U.S. Forest Service). “I would make little clay animals and sell them and that’s how I earned my play money. My mom worked very hard to prepare for all the fairs and I got an early look at the art life.”

In Berkeley High School, she started respiratory therapy training but later realized becoming a nurse would give her both a living and the autonomy to travel for the art education she sought. Over the years the quest for art knowledge has taken her to international museums and sights that inspire her imagery. Before focusing on mosaics in the early 1990s, Amidon worked on drawings and watercolors, lithographs, photography and making floor cloths.

Ideas come from everywhere

“I have tons of ideas. I take classes and figure out how to do things. That how my art always is. I just do it,” she says.

Amidon also relies on the expertise and support of her husband Jim, a mechanical technician at Lawrence Berkeley Laboratory. Married almost 30 years, the couple traveled around the world some 20 years ago and continue to travel, camp, and explore the outdoors. They are known for their travelogue slide presentations given at REI in Berkeley over the years.

Amidon’s first show in 1995 featured wall pieces made from broken china, called “Grandma’s Dishes.” She has since created larger work and has exhibited nationally. The TEPCO chair has been accepted into the Mosaic Arts International 2012, a juried show of the Society of American Mosaic Artists in Kentucky.

Her 2005 sculpture “Passion,” a stylized chair with a heart-shaped back, depicts all forms of strong feeling and is on view at the Stained Glass Garden on Fourth Street in Berkeley. Two wall pieces: “Don’t Smoke in the Garden,” an ashtray the shape of a flower, and “Live Long and Prosper,” a couple sitting inside a hand imitating the split hand sign from Star Trek, are at Snapshot Mosaics on LaSalle Avenue in Oakland.

Bringing art to the people

Not satisfied merely with creating art, Amidon said she is “always trying to draw an audience” and wants to involve more people, particularly the youth in Richmond, where she lives. Amidon enlisted the help of modern dance teacher Jacqueline Burgess and her class at El Cerrito High to choreograph performances that were big hits at both the unveilings of her reliquary (a container for relics) piece and the TEPCO chair.

With Arty Cordisco, the owner of Douglas and Sturgess, an art supply store in Richmond, she is working on a community art space and sculpture garden. Her goal is to pull the large numbers of artists who live in Richmond into a “Bohemian art network” of like-minded folks who can help energize the creative spirit in town.

Amidon encourages everyone to visit her coffee cup in the courtyard of the charming and informative Richmond Museum of History at 400 Nevin Ave. just down the street from the Kaiser Permanente Richmond Medical Center.

Medical Center employees and patients really have no excuse not to pay a visit, she says. Housed in the former Carnegie Library, the museum “is a gorgeous building in itself. You can see the history of Richmond from the native American Indians all the way to farm lands to the Kaiser shipyards,” she said.

“You just go out the back door (of the medical center). It’s two blocks…there’s a park. It’s a great place to bring your bag lunch and have a picnic. You can have your sandwich in my chair. I don’t care.”

YouTube film by Fina Lloyd, Heritage associate


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Maternity care evolves to embrace family

posted on July 1, 2011

By Laura Thomas
Heritage correspondent

Second of two parts 

1978 American Journal of Nursing article authored by KP San Francisco’s then Maternity Coordinator Deloras Jones, RN, BSN.

In the 1970s, Kaiser Permanente responded to the rising influence of feminism and a popular trend calling for home births, drug-free deliveries and family participation by establishing the Family-Centered Perinatal Care Program (FAMCAP) at the San Francisco Medical Center. 

With patients demanding a more natural birthing experience, the Kaiser Permanente family-centered birth program zeroed in on one particular aspect of the trend: Shortening the mother and infant’s postpartum stay in the hospital. KP San Francisco’s then Maternity Coordinator Deloras Jones, RN, BSN, began recruiting participants in 1973 and found many expectant parents were enthusiastic. 

“The parents wanted increased father involvement, less family separation after birth, and treatment of mother and infant as though they were well, not ill,” Jones wrote in “Home After Delivery,” a 1978 article in the “American Journal of Nursing,” after 1,200 families had used the program successfully. 

In the decades after World War II, the length of stay standard for childbirth had risen to as many as 10 days, keeping mothers away from their families and in the sterile environs of the acute care hospital. A picture in a KP newsletter from the late 1940s shows a new mother preparing to leave the hospital after 10 days of rest and recovery. 

Patient education key in shortening hospital stay

As an essential part of the 1970s shortened-stay program, KP began to offer prenatal classes and encouraged the father’s participation in childbirth preparation as well as in labor and delivery. The hospital experience included rooming-in for mother and infant after 24 hours of observation in the nursery, breast feeding training, and infant care classes. 

With an eye to shortening stay, the program focused on protocols for assessing mother and baby’s health and ability to go home within 12 to 24 hours. A nurse was assigned to visit the family at home for three days and to be available for questions and assistance for up to two weeks. 

In 1976, Jones and colleagues Mark J. Yanover, MD, and Michael D. Miller MD, published a report of their study of the experience in the San Francisco family-centered program. They compared a group of 44 low-risk mothers who delivered their babies along the typical routine with 44 others who elected the early discharge program. The researchers concluded that “this method of perinatal care is as safe as that traditionally provided at our medical center.” 

FAMCAP had a major influence over early discharge standards developed for both the American College of Gynecology (ACOG) and the American Association of Pediatricians (AAP) and marked an acceleration of a trend toward shorter hospital stays for postpartum mothers. 

Kaiser Permanente provides tools to help smooth a new mother's transition to home. Photo originally published in the Permanente Journal, Fall 2005.

The shorter stay phenomenon in the 1970s was wholly embraced by cost-conscious health maintenance organizations, often without the follow-up care that was the hallmark of the Kaiser Permanente approach – and became the source of intense national debate in the 1990s. 

Shortened stays too short?

According to figures that came out in Congressional hearings, the median length of stay for postpartum women across the U.S. had dropped almost 50 percent between 1970 and 1992 – from four days to less than two days for a vaginal delivery. “Within the last three years, stays have declined from 48 hours to 24 hours. Some (women) were even required to leave the hospital in as little as eight hours after delivery,” according to Debra Kuper writing in the “Marquette Law Review” in 1997. 

There were increasing reports of kernicterus, a rare and preventable complication of jaundice, and mental retardation due to failure of postpartum mothers to return for Phenylketonuria testing, amongst other tales of women being kicked out of hospitals before adequate assessment of their or their infants’ readiness to go it alone. 

In response, Congress enacted the Newborns’ and Mothers’ Health Protection Act of 1996 to mandate 48-hour stays for vaginal births and 96-hour stays for cesarean births unless mother and physician agree to a shorter stay. Both the national OB-GYN and pediatricians associations revised their standards to reflect the new mandates. 

Nonetheless, shorter hospital stays with more choice and control over the childbirth experience have become the norm for parents across the country. Expectant Kaiser mothers and fathers are now given a birth plan to fill out that allows them to select the delivery room environment, methods of inducing labor and controlling pain, delivery position and various postpartum procedures. 

Recent national trends show the cesarean section rate for first-time low risk mothers climbing – California rates increased from 20 to 26.5 percent from 2000 to 2005. Statistics also show a retreat from the 1980s surge in women wanting vaginal deliveries after cesareans (VBAC) with California rates for repeat cesareans up from 84.4 to 94.3 percent from 2000 to 2005. 

Kaiser Permanente continues to support women who want to deliver vaginally after they’ve had a C-section, and offers programs and procedures that encourage strong mother-baby bonding practices, including breastfeeding. Today, about 75 percent of American new mothers nurse their newborns. 

Honors for KP “baby-friendly” hospitals

Kaiser Permanente Southern and Northern California regions were honored in 2008 by the California Breastfeeding Coalition for leadership in supporting nursing mothers while medical centers in Clackamas, Oregon; Honolulu; and Hayward and Riverside, California, were all been named “baby-friendly hospitals” by the Baby-Friendly Initiative of the World Health Organization. 

Keeping birth “normal” is still a worthy goal for the organization, Fontana midwife and nurse specialist Iona Brunt wrote in 2005 in “The Permanente Journal.” 

“We must empower mothers with the belief that their bodies are made to give birth and, in most circumstances, will do well. We must dissipate the idea that without our high-technology intervention, babies cannot be born healthy and safe.” 

“It makes sense,” she said. “It’s cost-effective and it’s the right thing to do.”

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