Since the inception of the United States, midwifery has been the most customary practice for pregnancy care and childbirth. Today, the primary care for pregnant people in most developed European countries is facilitated by midwives. However, in the United States a divide began to take root in the 1800’s, when white male physicians began to explore childbirth with greater interest. Their approach was based on a patriarchal and colonial framework that was highly experimental and racist, often times using enslaved African to test explicit drug therapies, shock treatments, and surgeries without any anesthesia.
Prior to the creation of formalized medical education in obstetrics and gynecology, midwives were the sole experts in birth work and medicine relied heavily on Native American and African American knowledge of plants and indigenous healing modalities. For millennia, birth work was considered a female occupation or “woman’s work” (Hoch-Smith and Spring, 1978; Leavitt, 1983; Rooks, 1997; Donegan, 1978; Litoff, 1990). The midwifery model of education was a indigenous model of apprenticeship under more experienced midwives that were often grandmothers who also learned from their grandmothers. In the United States midwifery was largely practiced by enslaved Africans who were responsible for women’s healthcare of all enslaved women on the plantation as well as the white women who owned them. A large part of midwifery apprenticeship on the plantation included various forms of training such as herbalism, procedures for dealing with birth complications, perinatal care, and serving as traditional healing.
Once the field of medicine became “professionalized” and legitimized by the legal system with the invention of the American Board of Obstetrics and Gynecology in 1927, physicians sought to dominate the field of birth work as its primary practitioners. Their claim to jurisdiction spurred racist propaganda campaigns depicting Black midwives as caricatures falsely accusing midwives of being “incompetent”, “witches”, “unclean”, “savages”, and “untrustworthy”. These physicians also lured white women to trust them because they offered “innovative” pain relief options such as opioid tampons, and mercury. In addition to the propaganda, because pregnancy began to be viewed as a pathological condition beginning in the late 1800s and continuing into the 1900s, physicians claimed that only legally trained individuals could “treat” this “condition”. Such assertions/claims served as manipulative tools that “pushed the scales” in favor of physician-assisted births versus granny midwife assisted births.
The public perception of midwives began to shift as the midwives who had for centuries in the Americas served as the primary maternal and infant healthcare providers were essentially deemed illegitimate. These smear campaigns were supported by the white male physicians who were founders and members of State Boards of Health which controlled who was able to care for and treat women in childbirth. By the 1900s white male physicians attended approximately half of births, despite having little to no training in obstetrics.
In rural America, however, Black midwives continued to attend births especially for Black folks who lived in the segregated south and had no access to hospitals in their communities. In the Southern states, Black midwives, sometimes called “granny” midwives, attended up to 75% of births until the 1940’s.
Racist laws, educational restrictions, and campaigns against midwifery care led to the dismantling of the practice especially for Black women, for example:
- The 1910 Flexner Report recommended hospital deliveries and the abolition of midwifery. The study has since been recognized for its racist, sexist, and classist approach to medical education.
- “Twilight sleep” was introduced in 1914, an amnesiac given to women by white physicians preventing any memories of giving birth.
- In 1915, Dr. Joseph DeLee – a prominent obstetrician – called pregnancy and childbirth “dangerous” and “evil.” Dr. DeLee promoted the use of forceps, sedatives, ether, and other interventions that needed hospital-level care. He argued that midwives were incompetent.
- The Department of Indian Affairs passed legislation that moved births from the home to the hospital.
- The Shepphard-Tower Infancy and Protection Act became a federal law in 1921. It encouraged states to develop their own maternal and child health legislation. Before these changes, lay midwives practiced mostly without restrictions. The new laws severely reduced their practice in many states. For example, Alabama began requiring all midwives to obtain a license, then later required nurse-midwives to practice only in hospitals. These changes prevented 150 “granny midwives” from practicing across the state practically overnight.
- Public health nurse Mary Breckenridge founded Frontier Nursing Service (FNS) in rural Kentucky in 1925 which led to the more formalized field of nurse-midwifery also developed at this time. Breckenridge’s racist rhetoric impacted Black midwives’ entry into the nurse midwifery route though Breckenridge has been for “creating a pathway for midwifery education and certification.”
The formalization of education and certification ultimately delegitimized apprentice-trained midwives in every community. Today, less than 5% of midwives in the United States are people of color. Disparities in maternal morbidity and mortality rates are striking; Black mothers are 2-3 times more likely to die in childbirth than white mothers. This impact reflects the powers and forces that disconnected midwives from their communities.
Black Midwives that Birthed Communities
Mary Coley was born in Baker County, Georgia. She began training as a midwife under the tutelage of Onnie Lee Logan. She became an advocate for the health of Georgia’s black population and was known for her willingness to work with women regardless of race in a time of segregation. It is estimated that she delivered over 3,000 babies in her career.
Ms. Arilla Smiley was trained by the local Health Department in Brunswick Georgia and apprenticed with her mother-in-law. She received her license to perform midwifery in 1963 and retired in 1987. During her career as a midwife, Ms. Smiley delivered over 1,000 babies in Mitchell County.
Maude Callen was a nurse-midwife in the South Carolina Low country for over 60 years. Her work was brought to national attention in W. Eugene Smith’s photo essay, “Nurse Midwife,” published in Life on December 3, 1951.
Margaret Charles Smith delivered more than 3,000 babies. In 1949, she became one of the first official midwives in Green County, Alabama, and she was still practicing in 1976 when the state passed a law outlawing traditional midwifery. In the 1990s, she cowrote a book about her career, Listen to Me Good: The Life Story of an Alabama Midwife, and in 2010 she was inducted into the Alabama Women’s Hall of Fame.
Abbott, Andrew. 1988 The System of Professions. Chicago: University of Chicago Press.
Donnegan, Jane B. 1978 Women and Men Midwives: Medicine, Morality, and Misogyny in Early America. Westport: Greenwood Press.
Fraser, Gertrude Jacinta. 1998 African American Midwifery in the South: Dialogues of Birth, Race, and Memory. Cambridge: Harvard University Press.
Hoch-Smith, Judith and Anita Spring. 1978 Women in Ritual and Symbolic Roles. New York: Plenum Press.
Leavitt, Judith Walzer. 1987 “The Growth of Medical Authority: Technology and Morals in Turn-of-the-Century Obstetrics.” Medical Anthropology Quarterly 1(3). September. 230-255.
Leavitt, Judith Walzer. 1983 “Science Enters the Birthing Room: Obstetrics in America Since the Eighteenth Century.” The Journal of American History. 70(2). 281-304.
Litoff, Judy Barrett. 1996 “Forgotten Women: American Midwives at the Turn of the Twentieth Century.” Pp. 425-441 in Childbirth: Changing Ideas and Practices in Britain and America 1600 to the Present, edited by Phillip K. Wilson, Ann Dally, and Charles R. King. New York: Garland Publishing.
Pringle, Rosemary 1998 Sex and Medicine: Gender, Power, and Authority in the Medical Profession. Cambridge: Cambridge University Press.
Radcliffe, Walter. 1989 Milestones in Midwifery and the Secret Instrument: The Birth of the Midwifery Forceps. San Francisco: Norman Publishing.
Rooks, Judith Pence. 1985 Midwifery and Childbirth in America. Philadelphia: Temple University Press.