January 1980
The Baby Factory
At Houston’s Jeff Davis Hospital, where more than 10,000 babies are born every year, charity, idealism, and bureaucracy confront the ancient instincts of the flesh.
Rafael Villanueva opened his eyes upon a vast field of pink. The nurse who held him made a perfunctory soothing sound and shifted his slight weight to the crook of one arm, leaving her right hand free to change the liner on a baby scale. The infant squirmed and burrowed his head deeper into the nurse’s pink hospital gown. He was fourteen minutes old. There were still a few traces of blood on his face and his deep fetal creases were filled with the mucous coating of birth.
The nurse was a large black woman with auburn hair. Her movements were brisk, economical. She placed the baby on the scale, recorded his weight, then double-checked the data on the ID bracelets that had been placed around his wrist and ankle. When she was through she picked him up again and with her free hand unfastened the locks on the door of a nearby incubator. She laid the baby on his back in the incubator and then, with a distracted motion no more consequential than the closing of a suitcase, snapped the door shut again.
I watched the baby through the clear Plexiglas. He made slow backpedaling motions with his feet, the soles of which were still stained with ink from the footprints that had been taken immediately after birth. He made a strange mewling sound that seemed neither contented nor distressed but had a vague experimental timbre, as if he were gauging the acoustic properties of his new environment. He looked utterly isolated, but in this room—the Transitional Care Nursery, where healthy babies spend the first six hours of their lives—there were at least a dozen other newborns entertaining their simple reveries in the warm, womblike air of their incubators.
Rafael Villanueva was one of the 30 babies born this November day at Jefferson Davis Hospital in Houston, one of the country’s great wellsprings of human life. Like Ben Taub, it is a charity hospital run by Harris County, and its primary function these days is to provide the county’s indigent population with obstetrical care. Almost 14,000 babies were born here in 1979, more than at any other hospital in the United States except the Los Angeles County Women’s Hospital. They were born to the poor and displaced: to thirteen-year-old girls, to Vietnamese refugees, to Northern laborers who had come to the Sunbelt looking for work and had lost their medical insurance in the interim between jobs, to illegal aliens for whom giving birth at JD constituted a pro forma proof of citizenship.
For the average middle-class parent, accustomed to tending the garden of family life with such neurotic devotion, JD can be a frightening place. Certain elemental forces are more obviously at work there than in the stunning tranquility of an institution like the Woman’s Hospital of Texas across town on Fannin Street, where women in labor seem to regard childbirth as hardly more strenuous than a particularly challenging yoga exercise, where the hospital even provides a birthday cake for the new arrival. JD is raw, spare, chaotic; one who enters the county hospital is struck with an impression of having stumbled into the path of a raging natural force.
“The poor folks are really going to be lucky,” County Judge Roy Hofheinz said when Jefferson Davis Hospital was built in 1937. By and large his prediction was not quite borne out. For almost all of its history, JD has been a source of controversy, first as a financial hot potato handed off between the city and the county, then—as conditions there became more apparent to the general population—as a place of unrelieved suffering and bureaucratic apathy. It was chronically overcrowded, understaffed, and unsanitary, if not outright filthy. The situation reached a tragic climax in a staphylococcus outbreak that occurred in 1957 and was not contained until two years later, after 24 infants had died.
The creation of the Harris County Hospital District gave Jeff Davis a reliable, if generally inadequate, financial base, and the construction of Ben Taub in 1964 made possible the gradual conversion of JD into a hospital primarily for maternity cases. Even with such a limited focus, the facilities have frequently proved inadequate. Until the new maternity wing was built last August, women gave birth in a cramped, cheerless hospital addition that had originally been built as a polio ward. On the frequent occasions when the labor rooms were full, mothers were lined up in their beds on both sides of a narrow corridor, howling in pain and fear and pleading for the attention of the harried staff. At one point in 1975 there were so many unexpected births that newborn babies had to be kept in cardboard cribs that were taped together so a misplaced elbow or broom handle would not jostle an infant to the floor.
Conditions are much improved now that the new Winifred Wallace Maternity Center has been opened, though even there it is not uncommon for women in labor to be crowded out into the hallways. The place is pleasant and well lit, but it cannot compensate for the outright agonies of women who are often ignorant about the process of birth. If one stops and listens, what one hears most, beneath the canopy of Muzak, are groans and lonely pining sounds, and the occasional terrible, surprised bleating of a fifteen-year-old girl who doesn’t understand what is happening to her.
I wandered lost through the core of the hospital, trying to find my way to the labor and delivery section of the new maternity wing. The building was a patternless maze, with so many mismatched floors that I found it necessary to ride up or down in elevators just to stay level. It was lunchtime, and a sour, cabbagelike smell emanated from the staff cafeteria. A woman stood near a vending machine, eating with her fingers the contents of a can labeled “cocktail tamales.” The anonymous hallways were jammed with people of every race. Pregnant women, wearing T-shirts printed with the word “baby,” more often than not herded three or four children as they walked along looking for the maternity clinic. Teenage girls recuperating from the delivery of their babies padded down the corridors in fuzzy Day-Glo slippers or waited in line at the pay phones for a chance to plead with their boyfriends or to tell them how much they didn’t need them. In the maternity waiting room, known as “the stork club,” a group of people sat watching a big television with tin foil wrapped around the ends of its rabbit ears.
I walked past the pharmacy waiting room, which was full, and then past the casher’s office, where several people were undergoing “financial counseling” to determine how they would pay JD for its services. Hospital policy dictates that no one can be turned away in an emergency, but otherwise the admission requirements are rather stringent. The fact that JD is a charity hospital does not mean that patients are not expected to pay for the care they receive. Everyone who applies for admission is required to present proof of income, along with some sort of verification that he is a resident of Harris County. How much a patient pays is determined by a sliding scale that takes into account his income and number of dependents. “Overscale” patients are referred to other hospitals, and those who fall “within the code” are given a designation that indicates how much of the hospital fee they are expected to pay. An “A” patient pays nothing, while an “E,” at the other end of the scale, is liable for the entire amount, which for a routine delivery is usually $1200, about half of what it would cost for a private hospital and the services of a private obstetrician.
When I arrived at the maternity wing, a man was stamping about the nurses’ station in a state of barely contained fury. He was very short and compact, with a crew cut, thick black-framed glasses and a glossy black vest that he wore over a T-shirt.
“My wife had a baby at 3:04,” he told me. “It’s now eight o’clock and she still hasn’t seen the doctor. I’m trying to talk to the head nurse. I had her paged a half hour ago and she’s still not here. I’ll never come back here again. When they finally took my wife into the delivery room the baby’s head was showing completely.”
The two nurses on duty were whispering to one another behind their desk, trying to decide how to deal with him.
“Ma’am,” the man called when he saw them conspiring, “ma’am, if you’re going to call me a liar you can say it to my face!”
“I was not calling you a liar, sir,” the nurse said wearily.
Finally he was given permission to go back to the recovery room to see his wife. He put on a pink-striped gown—resentfully—and stormed off down the hall.
The other people at the nurses’ station were more accommodating. A boy of about sixteen mumbled, half-embarrassed, to the nurse, “I’m supposed to see my baby, you know. The one she had this morning.”
