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Seventy-five years ago, two-thirds of American women gave birth at home with no painkillers, often attended by a family doctor, as the tradition of relying on midwives and practical nurses was falling away. The practice of modern obstetrics was on the rise and the trend toward the majority of births occurring in hospitals was just around the corner as the American Medical Association met in Kansas City in May 1936 and hotly debated the benefits of new childbirth analgesics and how far to go in relieving the pain of childbirth.
Part of the tumult over the issue had been provoked by articles in the press describing these new drugs and their use.
We could fast-forward to the 1950s when hospital childbirths had become the norm, the pain of the experience was reduced by epidural anesthesia and women relinquished control over the process to the physician. Formula was seen as a convenience, especially for many women who remained in the workforce after World War II, and it allowed fathers to take part in infant care. Ironically, it was the “liberated” women of a later era who demanded a more natural approach to childbirth and support for breastfeeding.
The baby-in-the-drawer configuration allowed a mother to pull the baby into her room to nurse and hold her child as long as she desired. Around 1961, when he took over as chief of service at Harbor City Hospital, Sharzer made a couple of bold moves. Sharzer questioned the long-held “once a cesarean, always a cesarean” policy after he observed countless women scheduled for cesarean arrive at the hospital late in labor and give safe births.
Doctors feared that the vertical incision made through the large uterine muscle would rupture during contractions and for years women who had had a cesarean were discouraged from having subsequent vaginal births. A five-year study of vaginal births after cesarean deliveries in multiple hospitals showed that reverting to a natural birth process could be successful for many women. Sharzer recalls:  “A doctor had to be present all the time and there was a lot of resistance” among the general obstetrical crowd, but at Kaiser Permanente, vaginal birth after cesarean, known as VBAC, was easier to implement because a doctor was always on duty in the maternity ward. In those years, Sharzer also helped establish the first program in Southern California for training nurse practitioners at Cal State Los Angeles and when they graduated, he hired them to work under supervision assisting the doctors with prenatal care.
Next time: How Kaiser Permanente responded to member demands for shorter postpartum hospital stays. In 1933 nurses were not expected, or even allowed, to perform such a task as starting an IV (tube to introduce liquid intravenously). Looking back from 2011, it seems absurd that nurses – usually women – weren’t entrusted with a task that is now considered routine.
Nursing history is also punctuated with challenges related to the nurse’s evolving role on the medical care team and with major changes in technology, including medical equipment and use of computers to record medical notes.
In the 1960s, 1970s, and 1980s care of patients shifted away from the hospital to outpatient settings. These changes spawned the same day surgery program that allowed patients to have a procedure without staying overnight.
With KP’s emphasis on preventive care, its nurses have been called on to create outpatient education programs to help members manage their own health in partnership with their medical care team. Tom Debley, director of Kaiser Permanente Heritage Resources, is author of a new biography of Dr. Between September 8, 1944, and March 30, 1945, a comic strip named Supermac ran in Fore ‘n’ Aft.


He was small and scrawny, and struggled to find privacy in a big public yard when changing into his super persona.
These images are from the digital collection of Fore ‘n’ Afts collaboratively produced by Kaiser Permanente Heritage Resources and the Richmond Museum of History.
Conversation is strongly encouraged; however, Kaiser Permanente reserves the right to moderate comments on this blog as necessary to prevent medical, personal and confidential information from being posted on this site. Finally, we reserve the right to change the posting guidelines at any time, at our sole discretion. Gertrude Nielsen of Norman, Okla., denounced such pain killing innovations as twilight sleep – a combination of morphine and scopolamine – and a synergistic anesthesia accomplished by injecting a mixture of morphine and Epsom salts into the muscles and introducing a mix of quinine, alcohol and ether in olive oil into the rectum. Breastfeeding of infants made a dramatic resurgence,” she said in her testimony against a law to dictate length of hospital stay for new mothers. In the mid-1950s at Permanente founding physician  Sidney Garfield’s behest, the “rooming-in” program began at new facilities in San Francisco, Walnut Creek and Los Angeles. He decided to bring fathers directly into the birthing room, and he began to encourage women to use the “prepared childbirth” techniques. When Sharzer first suggested the notion to his colleagues at the five other Permanente Southern California facilities, he was voted down 5 to 1. But an innovation – the transverse incision made across the lower belly – was introduced that reduced the likelihood of rupture and more doctors began to experiment with allowing women to try vaginal births, under close monitoring.
But women, especially those active in the civil rights and anti-war movements, found themselves relegated to supportive roles to male leadership and many split off and created the feminist movement, founding the National Organization for Women, among others.
Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Sidney Garfield’s sole nurse at the Desert Center Hospital near the construction site of the Los Angeles Aqueduct.
But this fact is indicative of how far nurses have come in 75 years in America and at Kaiser Permanente. Advances in technology made it possible for surgery patients to spend less time in the hospital, and Medicare reimbursement policy revised in 1983 dictated shorter hospital stays. In the 1970s, the nurse practitioner role was developed to perform many of the tasks formerly done by the physicians. Nurses have become specialized in outpatient management of chronic conditions such as heart disease and diabetes, and in providing home and hospice care. The “super” concept character had already permeated popular culture – the iconic Superman first appeared in Action Comics in 1938 – but this Supermac fella was…different. Over the short span of 26 cartoons strips he fearlessly fought German saboteurs and industrial mishaps.
Based on publication credits, “T” might have been either Rose Thompson or Virginia Thompson; the “C” could have been Mary Chapman, Stan Champion, Mary Lou Clark, or Jack Cook. In addition, Kaiser Permanente will remove all spam, personal attacks, profanity, and off topic commentary.
Sidney Sharzer joined Permanente in Southern California in 1956, he became an early proponent of change.


Most of Sharzer’s patients were bombarded “with a lot of propaganda, or advertising, as we call it,” he said, and resisted his advice. In these early “dream hospitals,” the nursery had been built adjacent to the maternity rooms with slide-through drawers for the babies to be passed in from the nursery through a soundproof wall.
Nurses are able to help the new mothers learn better how to care for their infants,” said a Kaiser Permanente newsletter of the era. He was inspired by British doctor Grantly Dick-Read’s book, “Childbirth without Fear,” which advocated the use of breathing techniques to minimize pain and increase the joy of the experience. There was a lot of hostility from both doctors and nurses who assumed the fathers would try to get in the way by second guessing the medical staff, he said.
Health care and childbirth became a major arena in women’s struggle for equality and power over their lives. Runyen, a young nursing graduate from Los Angeles, was just starting out and looking for adventure. A review of Kaiser Permanente’s history reflects the major strides the nursing community has made, bringing them to a place and time where their skills are as varied and as specialized and expert as physicians.
Outpatient chronic condition management – for the benefit of the patient and the health plan – became ever more important to minimize the time patients had to spend in the hospital. For example, the KP multiphasic or annual physical, initiated in the 1950s for the longshoremen’s union and expanded to the general membership, began to be administered by nurse practitioners working under supervision of physicians. Specialized nursing roles have multiplied exponentially over the decades with today’s nurses trained in every aspect of medicine: surgery, intensive care, cardiac care, obstetrics, geriatrics, orthopedics, and the list goes on. He was the empowered spirit of the home front workforce, appearing in an employee magazine with a circulation of 80,000 copies. She started an organization in 1960 – now Lamaze International – that currently focuses less on birthing methods and more on achieving a natural childbirth without drugs or technological intervention. She became bored with her first job helping to birth babies, and sprung at the opportunity to help launch this pioneering hospital in the desert.
He had taught Runyen how to start an IV, and the skill came in handy one day when she received an emergency call that one of the workers had succumbed to heat exhaustion. Changes in maternity care also led to shorter hospital stays and an emphasis on family-centered perinatal practices.
Nurse practitioners were also tapped for well baby care and routine pediatrics visits as medical roles morphed during a critical shortage of medical manpower in America. Nurse midwives, who had all but disappeared from the American health system, became increasingly commonplace.
Fathers were finally allowed in delivery rooms at all Southern California facilities by the end of the 1960s. Garfield was not around, so she drove the ambulance to the job site and immediately inserted a saline IV.




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