As a professional historian, I cringe every time someone utters that horrible phrase about history repeating itself. It does not. But there are echoes of the past in the present, and some of them are ominous. One that comes to mind is the maternity care crisis in the Philadelphia area.

For much of the 19th century, poor women needing assistance in childbirth got it at the Philadelphia Almshouse Hospital, while the better-off were attended to in their homes by relatives, midwifes, and physicians. Maternal and infant death rates were high, and childbirth was viewed with fear as well as joy. Until the advent of techniques to control bacterial infections, hospital births remained dangerous.

After the development of new methods of pain control and infection prevention - as well as, later, antibiotics for halting postpartum infections - hospital births became safer and increasingly common over the course of the 20th century.

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Dangerous direction

Now, in the 21st century, we seem to be moving in a different and dangerous direction. By early next year, we'll be witnessing the 19th shuttering of a maternity ward in the region since 1997, according to the Maternity Care Coalition. And with low reimbursement rates and high costs for maternity services, we could be witnessing even more closings in the coming years.

And then what? Will women be shunted to poorly funded charity wards or forced into debt to pay for attendants at their births? Or will we see, even more tragically, higher maternal and infant death rates?

Evidence-based medicine - a phrase that's very popular with today's health-reformers - taught us long ago that prenatal care, births assisted by trained care-providers, and careful monitoring and follow-up lead to healthier babies and mothers. Healthy People 2010, which contains the federal government's "science-based 10-year national objectives for promoting health and preventing disease," suggests reducing maternal deaths and increasing the proportion of pregnant women who get early, adequate prenatal care. That should be our goal in the Delaware Valley.

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Reversing course

With many women losing their jobs due to the economic crisis, as well as the health insurance that went along with those jobs, the demand for unreimbursed care is likely to grow. Meanwhile, low rates for Medicaid services and high malpractice-insurance costs may well lead even more practitioners to stop providing obstetric services to those in need.

It's time to reverse course and make sure all women receive quality care before, during, and after birth. Achieving this goal doesn't require scientific breakthroughs. It means providing adequate reimbursement for prenatal care and birthing services - at rates that support both the institutions and the health-care workers providing that care. Instead of using the 19th century as a model, we should aim to learn from history and make the 21st century one in which quality maternity care is available and affordable in our community.

Janet Golden is a professor of history at Rutgers University in Camden and a member of the Maternity Care Coalition's Panel for Evaluation and Research Review. She can be reached at jgolden@camden.rutgers.edu.