Yale Bulletin and Calendar

April 16, 2004|Volume 32, Number 26

Helen Varney Burst

Burst devoted career to expanding
role of nurse-midwives

When Helen Varney Burst began studying midwifery at the Yale School of Nursing (YSN) in 1961, it was illegal in Connecticut and Massachusetts to provide information on contraceptives or to buy and use any form of birth control.

Planned Parenthood would transport women in Connecticut to a Port Chester, New York, clinic where they could obtain birth control pills or diaphragms. During their summer experience at King's County Hospital in Brooklyn, students would take a Planned Parenthood pamphlet, circle the address of the location closest to the patient's home, and then hide it under the bed sheet.

"Our only exposure to family planning at the time was a one-day trip to the Margaret Sanger clinic in New York," says Burst, who is retiring from YSN this year after 41 years of teaching and practicing nurse-midwifery. (See related story.)

Burst didn't know anything about nurse-midwifery when she arrived at YSN as a new graduate of the University of Kansas School of Nursing. She had traveled to New Haven to study maternal newborn health nursing with Ernestine Wiedenbach, founder of the master's program in nurse-midwifery at Yale.

"Miss Wiedenbach asked if I wanted to take the midwifery courses, which at that time were optional, and I said, 'What's that?' Then as I learned more, I realized midwifery incorporated three of my areas of interest -- maternity nursing, community health nursing and mental health nursing," says Burst.

Over the course of her career Burst has often been witness to some of the pivotal moments in this country's history. She was working in the infertility clinic at Yale in 1961 on the day Dr. C. Lee Buxton, chair of the Department of Obstetrics and Gynecology at the Yale School of Medicine, deliberately had himself arrested for distributing contraceptives. The plan was to force a U.S. Supreme Court review of Connecticut's law since efforts to change the statute were consistently voted down in the legislature.

"I was there when Dr. Buxton came back to the school," she recalls. "Everyone was clapping and cheering. They told me he had just returned from the police department where he was arrested and arraigned."

The U.S. Supreme Court later ruled in Griswold v. Connecticut that states did not have the right to legislate what was happening in the bedroom. By that time, Burst was teaching maternity nursing at the University of Wisconsin at Madison during another watershed period in the nation's history, the Vietnam War protests. The chemistry building on campus was bombed.

After five years in Madison, Burst enrolled in an internship at King's County Hospital in Brooklyn to refresh her skills as a midwife. It was 1969 and Robert Kennedy had recently returned home from a swing through the south, including the Mississippi Delta. He didn't like what he saw -- abject poverty and children's small bodies swollen with malnutrition.

Burst was recruited to work in a federal project in Mississippi to provide services to African-American women, who were denied access to hospital care, and to train nurse-midwives in an attempt to reduce the shockingly high infant mortality rate.

She and four other nurses went to Jackson to help establish an educational and service program. Two other nurse-midwives were assigned to Holmes County to work directly with the women in the area. The project included money to purchase access for their patients in the small, rural hospitals.

"Home birth is fine, but doing home births in shotgun shacks with no water and no screens was not a safe place to be doing births," Burst says.

There were other problems, too, she recalls. One of the two nurse-midwives assigned to Holmes County was black, and the other white. They planned to find housing together, but were told by local residents if they did so they would be shot. It was in the aftermath of the civil rights movement, but some things had not changed, notes the YSN professor.

Despite the hurdles, the nurse-midwives managed to reduce infant mortality in their designated area by half, Burst says. Noticing that infant deaths spiked at about six months of age, rather than declining after the first week as was customary, the women realized the increase represented preventable deaths -- most from pneumonia and diarrhea and a small number due to burns sustained from falling into open fireplaces, the only source of heat.

"The children were dying because the women didn't know how to get their children in early for care when these things happened, and for years it didn't make any difference anyway because they couldn't get into the hospitals," Burst says.

The nurse-midwives began visiting homes regularly after the women gave birth. They gained the women's trust over several months and asked them to let the midwife know if the children developed any symptoms that might signal a life-threatening condition, she notes.

At the same time, says Burst, the nurse-midwives saw their service program expand from maternal and infant care to routine health care. They began conducting physical exams, and through family planning, were made aware of other problems, such as sexually transmitted diseases and mental health issues. In many cases, the nurse-midwives were the only medical care the women had ever had, notes the midwife.

The experience also highlighted the need to revise the midwife curriculum to reflect the expansion of practice to meet health care needs, says Burst. She and her colleagues adopted the principles of "mastery learning," where the curriculum is adapted to the students' learning patterns, for their adult learners. This had never been done in nurse-midwifery, she notes. The units of study and learning were incorporated into modules and made available for educational programs in other areas of the country.

Burst decided that a textbook was needed, too. The only texts available to midwives at the time were an English book on midwifery, American texts on obstetrics, and journal articles, she recalls.

After five years in Mississippi, Burst was hired as a part-time faculty member at the Medical University of South Carolina College of Nursing and began work on her book. The first edition of "Varney's Midwifery" appeared five years later. The first edition as well as the recently published fourth edition of "Varney's Midwifery" were given the Book of the Year Award by the American Journal of Nursing. Burst has turned over future editions to her co-authors.

By the time the book first appeared, Burst had returned to Yale as a member of the faculty and chair of YSN's nurse-midwifery program."It felt good to come home," she says. "The battles I had been fighting elsewhere were accepted ideas here. The ideas sprang from here." She is currently conducting research to document the history and contributions of YSN and its faculty and alumni for a book on the history of nurse-midwifery in the United States.

Despite some reports to the contrary, Burst says, nurse-midwifery and midwifery are thriving. The scope of the practice of nurse-midwifery has expanded from the maternity cycle to the primary care of women from puberty through old age. And there are more nurse-midwives today than ever before, she notes.

When Burst began practicing she was the 401st member of her national professional organization, the American College of Nurse-Midwives. Today there are more than 7,000 members. Four decades ago, one-tenth of 1% of all births were assisted by nurse-midwives, says Burst, but today, 10% of all babies are delivered by nurse-midwives.

"I would like to see that number reach 85%," she says, "because 85% of all births are 'normal,' if you let the process go on without intervention."

In honor of the Yale professor, the YSN is creating the Helen Varney Chair in Midwifery. For more information on the campaign, contact Lisa Hottin at (203) 785-7920 or lisa.hottin@yale.edu.

-- By Jacqueline Weaver

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