Tuesday, April 11, 2006

Early Midwives ...


(text taken from brochure)

Beginning in the late 1600s and continuing today, the African American midwives played an important role not only in the birthing care of millions of mothers and babies, but also as keepers of tradition in the provision of general health care, the communication of vital information, and the maintenance of community.

Despite on-going assaults and condemnations from the medical establishment, African African midwives sustained a long uninterrupted history of crucial care giving. Thousands of African American women show up on early 20th century midwife rolls. As recently as 1950, these midwives cared for as many as 50 percent of all black babies born in some southern states. As midwives, these women were much more than birth attendants; they gave extended care as herbalists, helped with domestic chores, took care of children, and provided sick care. Patients and the general public valued a midwife's counsel and advice and respected her as a wise woman and leader in her community.

Over time, however, cultural shifts, medical innovation, regulations, and deliberate efforts to eliminate midwives from the practice of their unique system of birthing care took its toll. Theirs is a lost tradition. What remains is only a fragment of a traditional midwifery system that once was practiced and controlled by black women.

Early Midwives

Even in the midst of drudgery and oppression, African American midwives occupied unique and important positions. Because plantation owners often assigned black midwives to care for white women as well as black women, some midwives exercised a degree of mobility, freedom, and independence usually prohibited under the harsh laws of chattel slavery. Midwives, often known as "doctor," "doctoress," or "nurse," traveled from plantation to plantation and became important channels for communication about personal family matters and for transmitting information to others who were legally restricted from travel. Some enslaved midwives eventually used payment for the midwifery services to buy their freedom.

Following the Civil War, efforts to organize a system to provide health care for blacks fell short. Harsh segregation laws and practices shut blacks out of mainstream medical and nursing schools for more than a century, leaving black communities medically underserved. Yet, in both rural and more urban settings, "granny" or "lay" midwives provided birthing and nursing care for their communities for many years and were regarded as a health care "safety net" by their fellow citizens. Because they viewed their practices as a spiritual calling, they were flexible about receiving payment and often received no money for their services. What mattered to them was doing God's work.

New Rules

Beginning in the 1920s, states heightened their efforts to train, control, and regulate midwives; the long-term goal was to eliminate them. Across the South, new public health programs permanently altered the responsibilities of the traditional midwife. To carry out the new maternal and child health programs, southern states required that midwives be subservient to the local public health system and trained nurses. As federal dollars increased to assist states in reducing maternal and infant mortality rates, Congress channeled support to improve the quaity of medical education. Yet providing opportunities for black women to become professional midwives did not receive similar public support.

The flurry of new rules in the 1920s required midwives to register annually with local health departments, to be subject to inspection of their homes for cleanliness, and to have their moral character assessed by nurses. Midwives could lose their permits if they failed to report to the public health nurse the names of mothers for upcoming births. To attend the birth, the midwife needed to obtain an "o.k." approval slip from a doctor. The midwife bags once under the midwife's control now had to be inspected and approved. Often well-intentioned rules lacked sensitivity to culture and environment.

To survive the new rules, lay midwives acted with creativity and cunning. Never completely abandoning the core of traditional practices, midwives found ways to honor their long held sensibilities and hold on to community traditions under the guise of cooperation. Others simply quit.

All My Babies

A midwife training film produced for the Medical Audio-Visual Institute of the Association of American Medical Colleges and the Georgia Health Department in 1952 is an unparalleled exception to the trend to downgrade midwives. All My Babies: A Midwife's Own Story transmits skills to lay midwives in a respectful way. Named in 2002 to the National Film Registry List (Library of Congress),the film features Albany, Georgia, Midwife Mary Francis Hill Coley (1900-1966) and has traveled as far as India to train midwives. In the film Coley is more than a standard bearer for public health officials; she personifies the care and sensitivity of so many great-grandmothers, grandmothers, aunts, and cousins--midwives who folk say "got us here." She transmits confidence and steadfastness to the mothers she helps.

Trained through apprenticeship in the mid-1930s, Coley helped thousands of birthing mothers in the counties of Doughterty, Lee, Mitchell and Worth, Georgia. Never driving, Coley often walked miles to a birth. "Miss Mary," as the community knew her, also made daily walks back to a mother's home, sometimes for weeks, to assist mothers wtih a myriad of chores including helping with the children, bathing the mother, and changing linen. Whether paid her standard fee of $5.00 (later $10) or not, Coley gave continuously of her services; she was also a Sunday School teacher and served as the President of the Women's Auxiliary in the Church of the Kingdom of God. Prior to the civil rights movement rocking Albany at the end of the 1950s, Coley was a powerful bridge between the white-controlled public health system and the black community. Even amid deeply entrenched segregation, Coley asserted her humanity.


By the 1970s, few African American midwives influenced by the traditional system of care remained in practice. In the 1960s and 1970s, black women in the South began turning to obstetrics (the medical field concerned with childbirth), and perhaps inadvertently contributed to the demise of the black traditional midwife. Midwives old enough to recall grandmothers as slaves were few. Yet, they continued telling their stories to daughters and apprentices and in books, exhibits, and new documentary films.

Fortunately for the traditional midwives who survived, a new generation of midwives launched campaigns to celebrate their accomplishments. Organizations such as the International Center for Traditional Childbearing, the Midwives Alliance of North America (MANA), the American College of Nurse Midwives (ACNM), and various schools of midwifery increasingly recognized the importance of traditional African American midwives as keepers of community and practical lore. The challenge remains to translate historical recognition of past midwives into a widespread renewal of African American midwifery--a renewal that sustains traditions and supports family and community care.

Photo: This is our much-loved greatgrandmother, Mammá, whose story is now more complete. Since the visit to the African American Museum in Anacostia (Washington), and seeing the women within whose tradition she so magnificently served, I feel even more closely-bound to her. Seeing her as a "class of women" of her time serves to fleshen out the images I've held for so long. Seeing myself as following her path in my own time and under vastly different circumstances is helpful to understanding myself and my relationship to all that has gone before me. Everyday now I'm acquiring context for the living of my life. This at a time when one would think there would be little left to learn.

Not so, ... surely.

Then came the visit to the Frederick Douglas House. It's hard to realize that he must have been Mammá's contemporary.

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