About 6,000 babies a year come into the world at Kapiolani Medical Center for Women & Children. Since 1890, when it opened, it’s estimated that more than 400,000 babies have been born there.

In the last century there have been vast improvements in children’s health care in Hawaii. The advent of antibiotics and vaccinations in particular has shifted the field from disease treatment to prevention.

That’s a good thing for families, but it pushed the two local hospitals that focused on children to an economic cliff. It’s an interesting story. Two stories, actually.

One begins in 1890 — 124 years ago — with Queen Kapiolani, when she opened a maternity home with $8,000 she personally helped raise through bazaars and luaus over a 10-year period.

It was called the Kapiolani Home of the Hoolu and Hoola Lahui Society (Society to Propagate and Perpetuate the Race). It occupied a five-bedroom house at Makiki and Beretania streets named Ululani, which had belonged to the queen’s sister, Princess Kekaulike, who died six years earlier.

At the time, women would spend two weeks at the maternity home, delivering their baby, then learning how to care for it. The cost was only $1.75 a day. It wasn’t immediately successful; Hawaiian women were suspicious of doctors, and only six babies were delivered in the home’s first year.

By 1929 the home was more successful and needed more space. It moved to the former home of Dr. John Whitney at Punahou and Bingham streets, where it is today, and was renamed the Kapiolani Maternity and Gynecological Hospital in 1931. President Barack Obama was born there in 1961.

The second hospital had a different beginning. It was conceived by former Gov. Sanford Ballard Dole and Dr. James Robert Judd in 1906.

Judd was the grandson of Gerrit P. Judd, whom I wrote about a few weeks ago.

Dole met James Judd walking on the street one day and asked about the health of the community.

Judd told him he had just found something shocking: The infant mortality rate in the islands was more than 28 percent, and another 20 percent of children died between their first and fifth years. Dole was appalled, and both pledged to form a group to take action on it.

The group decided Hawaii needed a hospital just for children. In 1909 the first children’s hospital in Hawaii and one of the first in the world opened its doors on Kuakini Street.

Kauai resident Albert Wilcox contributed more than $50,000 to build the hospital, and it was named Kauikeolani Children’s Hospital after his wife, Emma Kauikeolani.

In 1910, 354 children were admitted to Kauikeolani Children’s Hospital, spending an average of 19 days at a cost of $1.08 a day.

The first president was Dole, who ran the hospital until his death in 1926. Harold Garfield Dillingham, the son of Benjamin Franklin Dillingham, took over and was president for three decades until 1958.

Another interesting aspect of the story is that Kauikeolani Children’s Hospital gave birth to two other hospitals.

The Rehabilitation Center of Hawaii was started at Children’s Hospital in 1953 for disabled people residing in Hawaii, including polio-stricken children. The center became the Rehabilitation Hospital of the Pacific in 1975.

The Honolulu Shriners Hospitals for Children was originally established as a ward of Kauikeolani Children’s Hospital. It moved to the former Dowsett Mansion on Punahou Street in 1930 and has worked collaboratively with Children’s Hospital since then.

Dr. Calvin Sia, a senior board member and pediatrician at Kapiolani, said he imagined that a bridge over Punahou Street or a tunnel underneath it might one day connect the two children’s hospitals, but it never happened.

It’s paradoxical to me that healthy children became a challenge for hospitals, but I can see that a decline in admissions also meant a decline in income for children’s hospitals.

At first Children’s Hospital considered developing a university medical center at Queen’s Hospital (now the Queen’s Medical Center), Sia said, but it feared it would be absorbed and disappear into the larger general hospital.

It made more sense for a pediatric hospital to merge with a maternity home, said John Walker, who joined the board of trustees of Children’s Hospital in 1973.

"If a child was born with a problem, they’d just have to change floors rather than have to be driven across town,"he said.

At first there was a great deal of resistance from the doctors and staff. They argued about their new name and location. Kapiolani had more room on Punahou Street than Children’s Hospital had on Kuakini Street, it was decided.

"The staff of each wanted autonomy," Walker recalled. "The doctors were fiercely independent. When we finally merged in 1978, the Children’s Hospital doctors insisted on a separate entrance from the porte-cochere.

"So at a cost of $35,000 — and money was tight back then — two doors were created, 10 feet apart! One said Kauikeolani Children’s Hospital over it, and the other said Kapiolani Maternity and Gynecological Hospital over it. Both opened to the lobby."

Sia recalled that "for the first five years, we had two boards of trustees, two nursing staffs, two medical staffs and two entrances, on one property. … We shared administrative functions, but the chief of staff alternated yearly between to two legal entities."

Walker added:"The hospitals came together in this building in 1978, but we really didn’t merge completely until 1984.

"Dean Witt, who was a trustee of Children’s Hospital from 1957 to 1984, said to me one day in 1982, ‘We’ve been living together five years. Isn’t it time we got married?’ He meant it was time to be one organization, not two.

"When Witt, trustee Frank Damon and I approached the Kapiolani board with the idea of a complete merger, two of the trustees were so upset they quit," Walker recalled. "Over time the boards and staff saw the wisdom of having just one entity."

"The really tough task, however, was when the three of us had to meet with the Children’s doctors with the same message," Walker said. They weren’t happy. "We somehow managed to live through it!"

"Kapiolani Medical Center is unique in being the only maternal and child health center in Hawaii and the Pacific," Sia said, "and this stand-alone combination is also one of the few in the nation."

In the last 25 years, Kapiolani bought Pali Momi Medical Center and merged with Straub and Wilcox Health System to form Hawaii Pacific Health, making it the largest health care system in the state. Each of the hospitals retained its individual name and identity.

Bob Sigall, author of “The Companies We Keep” books, looks through his collection of old photos to tell stories each Friday of Hawaii people, places and companies. Email him at Sigall@yahoo.com.