Birth of Birth Justice - Birth Justice Origins

Black Midwife Herstory

Common ancestry

Black midwifery in America today is a tapestry woven from the stories of Black people from diverse backgrounds. Black midwives have shared legacies and histories, bonded by the richness of African ancestry and the Afro-experience, whether they identify as Black, African, African American, Afro-Caribbean, Afro-Brazilian, Black British, Afro-Latinx, Melanated, or African descended: Africa.

This is where our story begins.

Traditional knowledge of childbirth precolonial context

Traditional knowledge about attending to birth existed in Africa for thousands of years, like in many cultures across the world. Wherever there have been birthing people, there have been birthing attendants–for millenia. The beliefs, ideas, rituals, tools, approaches, and methods that African people devised for birth are as varied as African identity itself, ranging across region, ethnicity, and historical experience. These traits were passed down from generation to generation, adjusting, evolving, and adapting with time, context, innovation, and change; but there are some key threads that tie traditional African birth practices together: the use of plant medicines, the value of rituals, a strong sense of spirituality, and participation of community in pregnancy, birth, and postpartum care.

transatlantic slave trade

(Ma’afa: Swahili word for disaster, terrible tragedy)

The first Black midwives in the Americas and on American soil were among the African people that were captured in the slave trade, forced against their will, and transported to colonies in the Americas where they were enslaved. They would have brought with them knowledge and ideas about birth and healing from their own cultures. Most of them came from regions across West and Central Africa, places that include areas in Senegal, Mali, Angola, Ghana, Nigeria, and the Democratic Republic of the Congo.

africans in america

Our ancestors also brought nuances, customs, and attitudes unique to their culture with them as well as a variety of trades and skills. They were blacksmiths, artists, griots, priests, priestesses, warriors, woodworkers, weavers, herbalists, storytellers, cooks, and midwives.

passing down traditions

MANY OF THESE ASPECTS OF OUR ANCESTORS’ IDENTITIES HAVE SURVIVED IN US. AND CAN BE SEEN THROUGHOUT THE DIASPORA, IN FOLKTALES, MUSIC, RITUALS, LANGUAGE, AND FOOD.

Passing down African-based cultural knowledge is one of the primary ways enslaved people participated in resistance and in retaining a sense of their identity in the context of trauma.

honoring black midwives in enslavement

During chattel slavery in the United States, enslaved midwives, or grannies as they were called, fulfilled an important role, particularly on plantations in the South and attended the births of both Black enslaved people and white families.

MIDWIVES' ROLE ON THE PLANTATION

Elsey is a midwife who was enslaved on the Thorn Island Plantation in South Carolina. Enslavers customarily kept detailed records of activities on plantations. While many of these records are sparse, they illustrate details about the important status of midwives. The rules on the left, excerpted from a Thorn Island plantation record, are an example. Although these words cannot tell us Elsey’s experiences in her own words, we get a tiny glimpse of her.

A DUAL ROLE

Enslaved midwives had a complex and dual role. They both performed a sacred practice and served as a supportive resource to those they looked after, but also had to serve the reproductive and labor interests of enslavers, who were interested in profits associated with exploiting the Black body and breeding enslaved people.

Some enslaved midwives also participated in acts of resistance, however, such as providing abortions*1, giving updates that would delay a postpartum person’s return to work in the fields*2, or deliberately using birth healing traditions that were scorned or forbidden by whites around them.

HEALER & RITUALIST

The other types of support enslaved midwives gave, beyond the physical aspects of birth, included both practical advice and spiritual guidance.

Some practices included “covering the umbilical cord of each newborn with a piece of scorched linen,” wrapping “the mother’s abdomen in a white “belly band,” and disposing of the placenta, “so that it could not be mishandled for ill purposes.”

The midwife was also attentive to unique circumstances, for example, when an infant was born with portions of the amniotic sac on its face. This was called the “veil” and signified a child gifted with spiritual sight. Enslaved midwives also sometimes participated in the naming of the child.

PASSING DOWN HEALING KNOWLEDGE

Enslaved midwives, like other healers, folk practitioners, and “root doctors,” exchanged their knowledge with other members of the plantation community and also taught women who apprenticed with them during birth. Members of the community also sought the help of spiritual healers if they had specific concerns or requests. This sharing of knowledge contributed to the survival of certain beliefs andpractices. For example, in South Carolina, where many Africans from Central Africa were brought, “slave communities […] fostered the Angolan/Kongo belief that the spirit/soul and the body are joint entities.

SALLY: AN ENSLAVED MIDWIFE IN TOBAGO

An excerpt from an 1829 estate appraisal shows number fifty-five: Sally, a 41-year-old creole woman living on the Invera Estate who is described as “healthy” and having an “appraisal value” of £38. One of three women listed with the same name, we know that Sally was likely born in the Americas and probably gained her skill from another Black midwife as an apprentice.

CHILDBIRTH BEFORE OBSTETRICS IN U.S.

Before the 1760s, male-identified physicians were rarely invited to births, unless it was an emergency. Births of white families were attended by women, either family members or female midwives (which included both white midwives and Black midwives), and the large majority of Black births that occurred in the South, where there was a larger Black population, were attended by Black midwives. In all cases, in this era female midwives were considered the experts of childbirth, while physicians attended to strictly medical matters.

THE FIRST AMERICAN MIDWIFERY COURSES IN THE LATE 1700S

Although birth was at that time considered the domain of women and female midwives, there were physicians interested in midwifery, and one American physician, Dr. William Shippen, Jr., after receiving training in midwifery in London and Edinburgh, began a series of lectures in the States to teach anatomy, surgery, and midwifery education in 1762. Other American physicians soon began offering similar courses and as medical schools were established and developed, they began to incorporate more obstetrical education into their courses. Over time, physicians began to deem the scientific education that they were learning about childbirth as superior to the knowledge of midwives that were not formally educated.

NEW ALLURING BIRTHING OPTIONS & A NEW NARRATIVE OF BIRTH

Developments in medicine gave the field of obstetrics momentum in the 1800s. A new widely accepted thought in obstetrics was that birth was a pathological event and needed to be managed as such. Physicians in the field also asserted that women were too weak-minded and delicate to attend deliveries and continued to mount a campaign against midwives. New medical methods, such as the use of forceps and episiotomies became widely recommended as common practices for an easier birth.*1 These options became alluring to many white women at the time, with their promises of less pain and more comfort. Other interventions included anesthesia, and laceration repair. And they added to the perception of increased safety.*2 However, there was a lot of debate over both forceps and anesthesia. “Improper anesthetic use caused numerous complications, particularly prolonged labor due to decreased ability of the uterus to contract, newborn breathing difficulty, and hemorrhage.”*3

POST-EMANCIPATION

After slavery, Black midwives in the South continued to serve both Black and white birthing people. Young midwives learning the trade, apprenticed with more seasoned midwives, often family members. “The apprenticed girl would accompany her mentor on visits to pregnant women, sew and clean for them, and stay with them after their babies were born.” After many years, she began assisting with deliveries. “When the senior midwife decided to retire, she would officially hand over her practice and patients to her chosen successor. In this way, the traditions of midwifery were passed from generation to generation and continuity in belief and practice were maintained.”

NUMBER OF BLACK MIDWIVES FROM STATE TO STATE 1920S TO 1980S

In 1900, 50% of all births in the US were attended to by Black Midwives who got their training through apparenticeships. In 1918, Black midwives attended 87.9% of Black births in the state of Mississippi. In 1921, in Mississippi, there were 5,000 registered “grannies;” in 1941, about 3,000; in 1961, hardly 1,000; 20 in 1980, and in only one granny “was listed as still practicing with a permit.”

The same pattern followed in multiple states. In Alabama in 1942, for example, “there were 2,200 registered grannies; by 1980, there were only 70.”

LAURA CARR: GULLAH GEECHEE MIDWIFE

“The Waccamaw Neck had a long tradition of lay midwives – indigenous healers and folk practitioners who followed the Gullah root medicine tradition. Although they usually had no formal medical training, midwives treated a variety of ailments in addition to attending births; they maintained a body of spiritual knowledge, and they understood the medicinal uses of regional plants and other substances used to treat and cure ailments. The only known midwife and root doctor at Hobcaw Barony was Laura Carr. Born into slavery in 1844, Carr provided care for the residents of the four African-American villages at Hobcaw Barony. She lived at Friendfield Village until her death in 1935.”

MOTHER GEORGE

“Mother George owned a ranch and practiced frontier medicine in the Grays Lake area. She delivered babies for Black and white families through the gold rush years and later. When Mother George died, her secret was discovered” – She was assigned male at birth and had been living as a woman long enough for this to have come as a shock to her tiny frontier town.

There is not much that we know about her, but according to the Idaho State Journal the back of a photo found in the Clyde Anderson photo collection was marked with a note “Mother George who lived at Grays Lake and is buried there. She was a midwife and a successful doctor. Her father was a Negro and her mother was an Indian.”

GRANDMA MASON

Born into slavery in Mississippi, Biddy Mason has left a profound legacy. She is known for winning her freedom in a court case in California, running a successful midwifery business, becoming a wealthy entrepreneur and philanthropist, and co-founding and financing the First African Methodist Episcopal Church in Los Angeles.

Before Biddy obtained her freedom, she was forced to travel west by the Smiths, slaveholders who were joining the Mormon migration to Utah. She walked about 2,000 miles behind a caravan of 300 wagons and was responsible for making meals, herding cattle, and providing midwifery care.

TWILIGHT SLEEP & HOSPITAL BIRTHS

As obstetric science continued to develop in the States, the use of drugs also became popular, such as opium for pain relief. There was also scopolamine and morphine which together erased the person’s memory of the birth and also had an anesthetic effect. It was called “twilight sleep” and made the patient semiconscious throughout labor “with intact contractions.” Although it was controversial in the medical community, there was a contingent of American women that voiced the desire for it. But women under scopalamine, “still experienced intense labor pains, screaming and thrashing so much during labor that they were placed in “crib beds” to avoid accidents” and the “inappropriate use of the drug by physicians had frequently led to adverse events, including maternal delirium and asphyxiation of newborns.” By summer 1915, the popularity of twilight sleep dropped sharply, but it ultimately spurred the continued search for drugs for painless childbirth. Many white women, who would’ve otherwise chosen birth at home with a physician, chose the hospital to avoid complications form drugs administered at home.”

TWILIGHT SLEEP & HOSPITAL BIRTHS

CAMPAIGN AGAINST LAY MIDWIVES

As the medical establishment continued to create a monopoly over birth, county and state health departments also grappled with concerns over infant and maternal mortality rates, which were attributed to a variety of factors.

However, the birthing work of lay midwives came under microscopic scrutiny and physicians began discrediting midwifery care in multiple ways, including lobbying for legislation to either limit the midwives’ practice significantly or to eliminate midwives altogether.

This combined with the negative racial climate and criticism of Black midwives’ healing traditions led to the persecution of lay overall, and Black midwives in particular.

TRAINING FOR BLACK LAY MIDWIVES

In many counties across southern states, medical professionals and health departments began to require lay midwives to attend training seminars. The supervision that was enforced placed authority on local health departments, shifting that authority away from community midwives, many of which chose not to complete the training.

While the older community midwives were being slowly and systematically replaced, there were among them who accepted the mandate of the health departments along with younger recruits eager to serve their community in this way. These new recruits represented a breakaway from the apprenticeship culture among Black midwives, and a mark in a new direction.

MARY COLEY

Mary Francis Hill Coley (1900-1960) was born in Georgia and trained as a midwife under Alabama Midwife OnnieLee Logan. Miss Mary, as her patients called her, was called to, midwifery during a time of scrutiny for the profession. Just between 1930 and 1950, the number of midwives in her state was cut in half. New regulations made it impossible for midwives to practice legally, however, Mary Coley chose to stay up to date with the requirements to continue serving her community. Within her community, Mary Coley was in high demand and was able to charge double what other midwives asked for ($30) this was able to afford her a relatively comfortable life, a sustainable business, and perhaps even the access to continue her education when the state declared that traditional knowledge was not enough

NURSE-MIDWIFERY

The term “nurse-midwife” was introduced by Frederick J. Taussig MD in 1914, to differentiate between nurses trained in midwifery. The first nurse-midwifery education program in the U.S. was established in 1932. As nurse-midwifery continued to develop as a new profession, Tuskegee University, a historically Black university, established the Tuskegee School of Nurse-Midwifery for Colored Nurses. It graduated 31 Black nurse midwives from 1941 – 1946.

BLACK NURSE-MIDWIVES

Although Black midwives that trained in nurse-midwifery had accepted the developing health paradigms trained successfully as nurses and in a medical scope of midwifery, they still faced hurdles related to race in their pursuits towards the development of their careers and to practice to the fullest of their ability.

MAUDE E. CALLEN

Maude E. Callen was a nurse-midwife who worked in the South Carolina Lowcountry. Orphaned at age six, she grew up in a physician’s home in Florida. Later she attended the Georgia Infirmary and then Tuskegee Institute in Alabama. In 1923, she set up a nurse-midwifery practice in South Carolina, where she served one of the poorest areas of the state at that time. She practiced out of her home and delivered between 600 and 800 babies in her 62 years of practice, sometimes traveling over difficult terrain to get to her patients, walking through mud and creeks. She also taught midwifery to people in the community. In 1936, Callen trained midwives through the Berkeley County Health Department as a public health nurse. She taught prenatal care, baby delivery, and care for newborns.

Her life was captured by W. Eugene Smith’s photo essay, “Nurse Midwife,” in 1951 in LIFE magazine and brought to national attention.

TRADITIONAL CHILDBEARING GROUP, BOSTON, 1979-1991

The Traditional Childbearing Group (TCBG) was a grassroots home birth and midwifery training organization co-formed in Boston, Massachusetts by Mama Shafia M. Monroe. The group was devoted to providing reproductive and childbirth support and education to Boston’s Roxbury African-American community. Its members not only attended home births, but trained direct-entry midwives and educated the community about breastfeeding, nutrition, prenatal and postpartum care, childcare, and adolescent parenting. Many services were free of charge, and others were a small fee. TCBG passed out pamphlets at laundromats and grocery stores, provided sexuality education for teens, worked in state juvenile detention centers, women’s state prisons, inner city high schools, and at the Boston City Hospital. The group also measured blood pressure and offered family counseling services. The Boston Globe featured Mama Shafia and her work with TCBG in 1990.

AYANNA ADE AND CHILDBIRTH PROVIDERS OF AFRICAN DESCENT, HOUSTON, 1970S TO 1980S

Ayanna Ade was a midwife committed to equity and diversity in birth and midwifery, but overall, for Black liberation. She trained as a home birth midwife in her hometown Houston, Texas in the 70s and also joined the Black Panther Party where she helped run the party’s free breakfast program for school children and taught science to schoolchildren in Oakland, California. Back in Houston, she completed a biology degree, followed by nursing and midwifery degrees, becoming a nurse-midwife so that she could serve in the hospital. She delivered 2,000 babies, and ultimately co-founded The Childbirth Providers of African Descent (CPAD) in 1980, which was the first private national Black midwifery professional association. CPAD held annual meetings and education workshops and created opportunities for Black midwives to support each other.

INTERNATIONAL CENTER FOR TRADITIONAL CHILDBEARING (ICTC), 1991-2016

With the support of Ayanna Ade and other educators, Mama Shafia Monroe, after witnessing a deep void and lack in birthworkers of color in Portland, Oregon where she had moved her family in 1990, founded the International Center for Traditional Childbearing (ICTC) in 1991 to fill the gap. The years of ICTC were a fervor of rich gatherings among birthworkers of color across the country, seeding, watering and nourishing connections, and collective visions. Birthworkers that attended ICTC recall the incredible sense of community and support they felt in their work. With Mama Shafia’s leadership, ICTC’s mission was to increase the number of midwives, doulas, and healers in order to reduce infant and maternal mortality, increase breastfeeding rates, and empower families. “Its vision was that there be a midwife for every community, a healthy baby born to every family and the midwife as the norm for women of color.”* In 2016, Mama Shafia retired and in the following years, ICTC transitioned into the National Association to Advance Black Birth.

JENNIE JOSEPH AND COMMONSENSE CHILDBIRTH, INC. AND SCHOOL OF MIDWIFERY

Jennie Joseph, like so many of our other elders has been a needed voice championing maternal health for people of color. As a British-trained midwife, she moved to the States in 1989. She founded Commonsense Childbirth Inc. in 1998 and created The JJ Way, an innovative “common-sense approach designed for women and children.”

Jennie is owner of the first Black privately-owned MEAC-accredited midwifery school.

BLACK MIDWIVES ORGANIZING WITHIN MIDWIFERY ORGANIZATIONS

Since their founding, major midwifery organizations in the United States have done significant work in advocating for the midwifery model of care that centers clients and families and the natural physiologic process of birth as well as honoring the ancient craft of midwifery. They’ve created a variety of key professional resources for practicing midwives across the country. But like many institutions across the United States, organizations like Midwives Alliance of North America (MANA), American College of Nurse-Midwives (ACNM), and the National Association of Certified Professional Midwives (NACPM) have grappled with racist histories and created hostile environments for midwives of color in the past. Throughout the decades, Black midwives and their allies within these organizations have been persistent, courageous, and clear in their goals to make these spaces truly inclusive for midwives of color.