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The Waring Historical Library Digital Archives Program Black Maternal Health Week Highlight: African American Midwives

by Tabitha Samuel on 2023-04-17T16:23:00-04:00 | 0 Comments

 

Midwives Blog Post Header Graphic

 

A Group of African American Midwives of the Charleston County Health Department Training Program Pictured Outside Building

A group of African American midwives in the Charleston County Health
Department Training during the 1940s. Click image to view in digital collection.

This year, we mark the 2023 Black Maternal Health Week (April 11-17th) by honoring midwives (also known as granny midwives and grand midwives) and their contributions to healing, wellness, and birthing in African American communities throughout South Carolina.

For African American communities in the South in the late nineteenth and well into the twentieth centuries, midwives were trusted and well-respected health care practitioners that were relied upon for general healing for the family as well as for providing maternal and infant care during labor and delivery. Often lacking access to hospitals and physicians due to a lack of means and location and, if accessed, subjected to racism, discrimination, and substandard care in segregated facilities, obtaining care from trusted members of the community as granny midwives instead was vital for African Americans. According to Morrison and Fee (2010),

Few physicians—white or black—were willing to attend births for the two or three dollars per delivery that midwives would accept. (Indeed, midwives would sometimes be given a chicken as payment or not be paid at all.) African American mothers also preferred home births to hospital deliveries because they could avoid the prejudice and discrimination they often experienced in White society.1

Midwifery had also been practiced centuries before enslavement, of course, and carried over during middle passage. The Smithsonian’s National Museum of African American History & Culture (NMAACH) notes

Experienced midwives were among the many enslaved individuals who survived the middle passage and continued to practice and train others as the primary source of birth care throughout the country. Early African American midwives were important members of their community, even among enslaved individuals. Slave owners used these medical practitioners to ensure the health of their reproducing enslaved women and their newborn infants to expand their labor force. It was also common for midwives to attend to the slave master’s wives during birth as well. A good midwife might receive pay for their labor and be allowed to journey long distances to work, granting them a level of mobility that was rare for most enslaved individuals.2
African American midwife in the Charleston County Health Department training program observes staff examining African American expectant patient.

African American midwife in the Charleston County Health Department training program observes staff examining African American expectant patient.

Following enslavement and in the Jim Crow South, midwives were often the primary health care practitioners for African American communities although hospital physicians were displacing them in northern cities at the turn of the century.3 This was certainly the case in South Carolina. In Pineville (Berkeley County), South Carolina, Maude Callen worked as a midwife and health care practitioner from 1923 through 1986.4 During her career, she not only provided general medical care to the community and care during labor and delivery, but she trained other midwives and brought immunizations to churches, schools, and other community gatherings for over 60 years.5 World War II photographer, W. Eugene Smith published a photograph essay focusing on Callen’s work in the 1951 issue of Life magazine, featured in the Waring’s collection.

With the medicalization of childbirth in the early twentieth century, there is a dramatic shift away from out-of-hospital births as physicians and public health professionals labeled midwives as unlicensed and ill-trained, concluding that they were to blame for the rise in maternal mortality rates that occurred as more families opted for hospital births. According to NMAAHC,

...as privatized medicine grew in popularity in the United States, out-of-hospital births fell from nearly 100% to 44% by 1940. Unfortunately, this change was mostly fueled by general medical practitioners whose inadequate obstetric education, general lack of hygiene, and unsafe delivery practices created high maternal mortality rates. The rise in mostly preventable deaths compelled the government to intervene, subjecting midwives and physicians alike to state health regulations.6

As a result of the pushback from physicians and public health professionals, the Sheppard-Towner Act was passed by Congress in 1921 to fund states’ efforts to provide training and licensure to midwives, particularly in the South. Health Departments, such as the Charleston County Health Department, “established midwifery classes taught by public health nurses—many of whom had far less experience attending births than the midwives they were training. To be licensed, midwives had to undergo this training and submit to supervision by public health nurses.”7 Photographs of the trainings provided by the Charleston County Health Department to midwives during the 1940s are featured in the Waring’s Charleston County Health Department Photographs Digital Collection.

Midwives continued to provide care through the middle of the twentieth century for African American communities across the south, but hospital and physician care soared as a result of increased regulation, which has included nurse-midwife educational programs. Today, midwives serve in “birthing centers, hospitals, and private residences to care for and support healthy mothers and newborns before, after, and during childbirth." 8

Footnotes

[1] Sheena M. Morrison and Elizabeth Fee. “Nothing to Work with but Cleanliness: The Training of African American Traditional Midwives in the South,” American Journal of Public Health, 100, no. 2 (2010): 238-39, doi: 10.2105/AJPH.2009.

[2] National Museum of African American History & Culture, “The Historical Significance of Doulas and Midwives,” 2023, National Museum of African American History & Culture, https://nmaahc.si.edu/explore/stories/historical-significance-doulas-and-midwives.

[3] Morrison and Fee, “Nothing to Work with but Cleanliness,” 238.

[4] Emma Whalen, “Rural SC Health Clinic Home to Midwife Maude Callen Seeking National Recognition,” The Post and Courier, January 2, 2023, https://www.postandcourier.com/news/rural-sc-health-clinic-home-to-midwife-maude-callen-seeking-national-recognition/article_cdc4a742-7a4c-11ed-afcf-1b2a6f4bf3fd.html.

[5] Whalen, “Rural SC Health Clinic.”

[6] NMAAHC, 2023.

[7] Dominique Tobbell, “Black Midwifery’s Complex History,” University of Virginia School of Nursing, February 12, 2021, https://www.nursing.virginia.edu/news/bhm-black-midwives/.

[8] NMAAHC, 2023.


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