The Legacy of the Black Birth Worker
In the United States it’s estimated that more than 10,000 babies are born each day and in a hospital setting overseen by an OBGYN, but in the context of human history this is a relatively new trend. It was just 100 years ago that 80% of babies were born at home with the help and support of a birth worker. Birth workers have performed a number of functions over the years and in the last century have seen massive changes in how they are viewed and utilized in the US.
For many people today, there is a perception that having a birth worker is a luxury reserved for people who are wealthy, live in cities, and are White. The doula and midwife are trending in certain socio-economic classes and natural births are making a comeback among the privileged. But the truth is that there is a long, proud legacy of birth work rooted in the African American community that grew out of the rural south and was inherited from Africa. It’s these ancestors who have literally helped birth America and as we remember and celebrate their legacy, birthing People of Color are reclaiming these traditions for ourselves.
Who are Birth Workers and What Do They Do?
Over the years birth workers have gone by many different names and performed many roles in their communities relating to childbirth – all important. Today’s birth workers include lactation consultants, midwives, labor and delivery doulas, postpartum doulas, counselors, health educators, and much more. Simply put, a birth worker is a person who supports birthing people at any stage of their maternal journey, not just the labor and delivery stage.
Two of the more commonly known types of birth workers are doulas and midwives. The role of a doula is to support you emotionally and physically during your pregnancy, delivery, and/or postpartum period. The word ‘doula’ comes from a Greek origin that means “female slave for the child-bearing woman,” and thankfully we’ve evolved past that to today’s more modern, and less problematic definition of “one who mothers the mother.” A midwife today, by contrast, is a birth worker that provides medical care for the birthing person during pregnancy, birth and the time immediately following delivery. While midwives have various levels of medical training, a certified nurse-midwife has many of the same abilities as a doctor and is able to deliver babies in hospitals, health clinics, and at home.
Photo by Dahlak Tarekegn from Pexels
Growing, delivering, and caring for a life is taxing in every way imaginable. A doula is there to ensure that the birthing person is cared for, supported, and advocated for, and a midwife is there to provide healthcare and to ensure that the person and the baby are medically safe. These are only two of the many kinds of birth workers today that support birthing people, and their work honors a long legacy and history of people who have done just that throughout human history.
The Ancient History of Black Birth Workers
Midwifery (the practice of being a midwife) has been around as long as our species has been around, helping birthing people bring new life into the world safely. Anywhere people have been born, birth workers have played a vital role in history. According to the Book of Exodus, ancient Egyptian midwives assisted in saving many Hebrew children that the Pharaoh had ordered to be killed. In West Africa the act of giving birth was rooted in spiritual and medical practices facilitated by midwives who were respected, sought out, and performed a range of duties that went beyond delivering babies. These traditional midwives worked as counselors, nutritionists, lactation consultants, and spiritual advisors. In fact, the word “midwife” in many African languages means spiritual healer. When a person in West Africa was giving birth, they would be surrounded with female relatives and midwives who would build altars to protect the new spirit and create drumming circles to honor its arrival. Traditional West African traditional midwives brought the part! According to Shafia M. Monroe, a certified midwife and educator, this ancient ritual of labor and delivery was about love and celebration.
“The historical role of the African American midwife was one of hope and health; whose expertise helped define cultural perceptions of motherhood, protected, uplifted and empowered women and men, and improved maternity care in communities across the nation.”
It’s in these traditions that the roots of African American midwifery grew out of, brought to the United States by enslaved people. African slavers sought out midwives with these skills for capture because the knowledge they had of birthing and medical support was valuable to American plantations for both their White owners, wives, and for other slaves. These African midwives brought with them the culture, hopes, and practices of African midwifery which benefited the majority of people born in the United States, not just Black people. To preserve these healing traditions, secret societies were set up to help newly arrived enslaved people learn the practices of midwifery and healthcare so more people would be able to support the communities they were being brought to.
The Legacy of Granny Midwives
Midwife in Greene County, GA in 1941. (Jack Delano / Library of Congress)
This new generation of African American midwives that was taught and apprenticed by the first generation of African midwives to arrive in the US became known as Granny Midwives or Grannies, so called because they were typically older women. Granny Midwives attended to the birthing needs of all people which for the White plantation owners meant descendants for their own families and more generations of enslaved people to build the wealth of those descendants. As was the tradition of American enslaved people, Granny Midwives found ways to subvert their oppressors using their knowledge of women’s reproductive health to regulate the timing of delivery based on the needs of the mother, not the slave owners.
Once they were emancipated (post-Civil War), the role of the Granny Midwife became even more important to Black communities of the South who were mostly left to fend for themselves. Healthcare was either not accessible or segregated completely for much of the next 100 years. The healthcare that Midwives provided started early in a person’s pregnancy by helping a mother to prepare for labor, delivery, and motherhood and continued all the way through postpartum. Midwives would sometimes walk miles to a person’s home to monitor their health, act as a spiritual counselor, and stay for longer periods of time to help with delivery or even care for other children while their patients were on bed rest. Midwives like Lucrecia Perryman, were vital and respected members of the community not only because of the medical care they gave during the Reconstruction Era, but also because they stepped into many roles. They would garden so that people had nutritious food to eat and clean houses for people on bed rest. Whatever the community needed, Granny Midwives did it, just as their African ancestors had.
Image courtesy of Jack Delano / Library of Congress
Granny Midwives helped to support and birth rural and poor southern communities of people of all colors who also had limited access to healthcare. Mrs. Pearl M. Finley Henry, a Midwife in Florida is said to have helped to deliver more than 90% of the babies born within 3 counties during her career; the Midwife Mary Coley delivered more than 3,000 babies in her lifetime. Their skills and knowledge were invaluable and laid the foundation for modern day midwifery and brought entire generations into the world.
The Medicalization of Birth
In the early 1900’s, about half of all births were attended to by midwives and most women were giving birth at home. Things started to change for the traditional midwife as progressive public health reformers began to collect information on and be concerned by infant and maternal mortality rates. These medical reformers blamed midwives, characterizing their practices as “unsanitary and superstitious,” ignoring social determinants of health that were more likely to be the cause in the Jim Crow South. Newly trained White, male doctors saw traditional midwives as unskilled and uneducated, especially in the delivery of White babies. Within 30 years midwives went from being respected and revered to being persecuted and dismissed as taboo – nevermind that they had spent the last 200+ years practicing and passing traditions down from generation to generation.
In the more urban Northeast, midwives had been replaced by doctors working in hospitals, but in the rural South, where the majority of traditional Granny Midwives were, it was harder to eliminate the practices until the introduction of 1921 Sheppard–Towner Maternity and Infancy Protection Act. The Towner Act established and provided funds for state health departments to train and regulate the work of midwives led by public health nurses who in many cases had far less experience attending births than the midwives they were training. This was the beginning of the systematic eradication of Black midwifery in the South. The focus of this training was on hygiene and sterilization which was rooted in the racist perception expressed by reformers that traditional midwives were dirty and unskilled.
“Even as government-funded research in the 1930s continued to document the better birth outcomes achieved by midwives compared to physicians, reformers continued to blame Black, Indigenous, and immigrant midwives for the country’s abysmal mortality rates.”
Twelve African American midwives receive instruction in midwifery. Image courtesy of American College of Nurse-Midwives
As time went on, more and more regulations and licenses were added that prevented many Granny midwives from legally practicing, including literacy requirements and more training than many either could not or would not do. In the state of Georgia, the state eventually stopped certifying direct-entry midwives entirely, pushing many Granny Midwives into an early retirement. The goal was to standardize, professionalize, and medicalize care. In other places the health departments would inspect the midwives’ medical bags to ensure there were no unregulated items like herbs and roots that had been used for generations to help during the birthing process. If found with a non-state-approved item or tool, midwives were subject to a $1,000 fine or 12 months in a chain gang. Despite all of these barriers, Grannies continued to exist in diminished numbers and capacities and were indispensable for Black women in rural, poor areas. By the early 1970’s, only about 1% of births were being attended by midwives in the entire nation.
A Change in the Tide
Courtesy of the Bettmann Archive
Eventually, the American perception toward midwives and natural births started to change during the 70’s, particularly among White, middle-classed women. Social attitudes were undergoing a revolution generally, but particularly in healthcare, which became seen as a “right, not a privilege.” People also wanted more say in the kind of care they received, starting a movement to deregulate and demedicalize life events like childbirth where it was common for women to give birth sedated and alone in what was known as ‘Twilight sleep.’ Middle and upper class birthing people of the 1970’s wanted more autonomy and natural options than their parents had, leading to a resurgence of midwives. But this midwife comeback was almost completely done by White women who were better able to receive the education and navigate the racist laws and restrictions that had systematically erased Black Granny Midwives in the 50 years before.
According to the book Birthing Justice: Black Women, Pregnancy and Childbirth, counter-culture White feminists ‘built’ the “alternative natural childbirth movement” while Black birthing activists were working on Civil rights to address the social determinants of health that contributed to negative maternal outcomes for Black birthing people. They were seeking to desegregate hospitals, set up their own health clinics, and broadly challenge racism in healthcare that was affecting poor People of Color. It’s with this understanding of history that many sociologists and historians who study childbirth among women of color in America challenge the idea that White counter-culture revived the profession of midwifery in America. It is something they embraced, but that was owed to the legacy of the Black ‘Granny’ Midwives.
“The struggle for birthing alternatives is inseparable from struggles for racial, economic and social justice and the fundamental transformation of global maternal-care systems.”
Birth Work in America Today
Photo by Thiago Borges from Pexels
Today the practice of birth workers like midwives, lactation consultants, and doulas remains regulated in most places and requires varying degrees of training and certifications. The legislation put in place in the 1920’s has been built upon to ensure that child birth remains regulated and professionalized, but laws and regulations vary state-to-state meaning there is no widely accepted definition of a “midwife.” Yet recent research shows that the use of birth workers can reduce maternal and infant mortality and the need for medical interventions that increase risk during labor. Another study indicates that states that incorporate birth workers into their healthcare systems have better outcomes. What does all of this mean? That our ancestors and the traditional midwives were on to something, and the research is just now starting to catch up.
We’re moving in the right direction, but the birth worker field is still drastically underrepresented by People of Color thanks to the regulations of the early 1900’s. As of 2018, The American College of Nurse-Midwives reported that “midwives of color represent 5-6% of ACNM midwives ”and only 2% of all midwives in the U.S. are Black. Organizations like the National Association to Advance Black Birth (NAABB) are working to revive the traditional healers, doulas, and midwives in Black and and Indigenous communities to address the maternal mortality disparities that still remain 100 years after progressive reformers of the 1920’s sought to get rid of them.
What a ride birth workers have had, all the while helping to deliver new life into the world and caring for those that give birth. There’s no question that African American midwives have played a huge role in giving birth to America, and we are thrilled to give them the recognition they deserve. It’s an honor to carry on their traditions and legacy to birth the next generation who will, hopefully, do the same.
Interested in working with a doula for your pregnancy? Learn more about our maternal care at Spora Mommas.
