You are the ones they’ve been praying and crying for: The history of midwifery in the United States
Jan 18, 2023
Written by: Becca Williams, SBT Copywriter
Cover art from this article.
Have you heard the tale of the Sumerian Goddess, Inanna? This story is one of our earliest recorded, dating back nearly 5,000 years. Numerous lessons can be gleaned from this very long story, but one of the most salient is the power of empathy, compassion, and of being seen. In summation, the goddess Inanna decides to visit the underworld where her sister, Ereshkigal, Queen of the Underworld resides. Ereshkigal is mourning the loss of her husband. Inanna and Ereshkigal do not have the most solid relationship, due to Inanna’s role in her brother-in-law’s death, so Inanna concocts a safety plan with her friend, outlining what powers to conjure should Inanna not return. Sure enough, when Inanna arrives in the Underworld, she is killed by a few Underworld judges and her body is left out to decompose. Above ground, Inanna’s safety plan goes into action and her friend calls upon some small, nearly invisible and genderless winged creatures, called “gala” to fly down there and see what’s going on. When they arrive, they notice Ereshkigal deep in labor pains, about to birth her dead husband’s child. As the story goes, “Ereshkigal groaned, ‘Oh! Oh! My belly!’ They [the gala] groaned, ‘Oh! Oh! Your belly! She sighed, “Ah! Ah! My heart!’ and they sighed, ‘Ah! Ah! Your heart!’
Ereshkigal is so grateful and overwhelmed by their compassion, their presence, their ability to be with her in this critical moment that she offers the winged creatures a blessing, and a gift: Anything they want. They ask for Inanna’s body, and take it back to the Aboveworld, where they bring her back to life. The story continues on, but that point lingers: How crucial and how beautiful it is to have community, support, and love during the birthing process. And, how that should be accessible to everyone. Midwifery is one of the earliest known professions, and midwives and doulas have long been at the forefront of providing this care. This post will delve into the history of midwifery and the integral role that Black midwives and doulas have played for centuries.
(Engraving of Ereshkigal, titled "Queen of the Night".)
Firstly, what is a midwife? That definition has changed as the field of obstetrics and gynecology has become rigidly medicalized and largely dominated by cis gendered white men. Midwives, as defined by this video, support people during pregnancy, in labor, and in the post-partum period. They offer education and support and are medically trained to make decisions. They are licensed providers (there are multiple tiers of licensing) there to support healthy birth outcomes, deliver babies, make medical recommendations, and manage emergencies. When midwifery is integrated into broader systems of healthcare, there are reduced infant and maternal mortality rates, reduced rates of preterm birth, cesarean births, low birth weight babies, and overall reduced neonatal death rates. Often, midwives are conflated with doulas. Both midwives and doulas support people throughout prenatal, labor and postpartum. Doulas, however, do not receive medical training and their main role is to support, provide education, information, advocacy, and physical comfort throughout the birthing process. An alternative, more holistic categorization of midwifery helps us further understand the contributions that Black women have made to this field. In this definition, midwives do more than “catch babies”. They represent a group of supportive folx who provide spiritual guidance in all phases of life and who are part of the community. They are healthcare providers, healers, and help people through their life journey from menarche to menopause.
As the story of Inanna demonstrates, midwives and doulas have been around for a very long time. There is something very specific and unique about the history, erasure, and presence of Black midwives, however. As this incredible timeline details, Black midwives have been around since the Biblical times, and likely before that as well. Many of us know the story of Moses, and the Pharoah’s order to kill all newborn Hebrew males. Shiphrah and Puah were the Nubian (an ethnic group indigenous to northern Sudan and southern Egypt) midwives who refused that order. Nearly 3,000 years later, in 1619, the first enslaved Africans arrived against their will. On that boat, according to Sharon Robinson in the Journal of Nurse-Midwifery, was the first Black lay midwife. During the time of enslavement, Black midwives served a critical purpose, as enslaved people didn’t have access to a doctor. Midwives not only delivered babies (and were thus important to enslavers as a way to ensure the reproduction of their enslaved laboring force), but they also healed and offered support and assistance with a wide variety of ailments among enslaved Black folx. In the early 20th Century, after enslavement ended, Black women continued to care for their communities. Granny midwives operated in the rural South, providing care for both Black communities and poor white folx during labor and delivery when hospitals were either hard to reach or denying treatment and access to Black folx. Granny midwives provided a whole range of care outside labor and delivery, including lactation consulting, advocacy, and nutrition support. Lacking formal education, they learned primarily through apprenticeship and traditions. Mary Coley, Ms. Arilla Smiley, Margaret Charles Smith, and Maude Callen are a few famous granny midwives. You can learn more about them, and others, here and here.
(Statue in Montgomery, Alabama titled "The Mothers of Gynecology", representing Anarcha, Lucy, and Betsey [see below].)
As this story progresses, it’s important to remember how the white medical community used Black women in medical trials and experiments without their consent. Think back to Henrietta Lacks, and the women who underwent forced sterilizations, known as Mississippi Appendectomies. In the 1840s, gynecologist Dr. J Marion Sims, sometimes referred to as the “father of gynecology” conducted experimental surgeries on enslaved Black women in order to develop a treatment for fistulas. While we don’t know the names of all the women he conducted surgeries on, we do know the names of three: Anarcha, Lucy, and Betsey. Not only is it important to recognize and uphold the contributions that granny midwives made to our society, we must also see and understand the many known, unknown, and nonconsensual contributions that Black women have made to the overall field of obstetrics and gynecology.
By the mid-20th Century, the field of labor and delivery had become highly medicalized. This meant more births were happening in hospital rooms, with the birthing person often separated from a community of care that included doulas and midwives. People often gave birth alone or relatively isolated in a clinical environment that then pushed them out without a structure of support around them. Many of us have had less-than-great medical experiences that have left us feeling unheard and as though we are an amalgamation of body parts measured up against insurance rates. This separation of our bodies from our emotions, and the movement away from holistic person-centered care is absolutely rooted in white supremacy, and in the 1960s we saw this in the way Black midwives were pushed into obscurity. Doctors began a campaign that focused on Black midwives as unsanitary, uneducated, and unsafe, and introduced a litany of burdensome medical licensure requirements. Between 1936 and 1938, for example, Black midwives were the majority care providers in their communities, and there were 1600 midwives in Tennessee alone. In 2021, there were less than 900 Black midwives in our entire country. Between 6-8% of certified nurse midwives are Black, and out of the 360 birthing centers we have nationwide, only 13 are owned by Black folx.
Today, there remains heavily engrained racism within the medical structures of our society. White supremacy’s demand for bodily control has left our country with the worst birth and maternal mortality outcomes of any other developed nation. Midwives participate in less than 10% of births here, compared to much higher rates in Western Europe where their presence is more integrated into their healthcare system. Those countries have significantly lower maternal and infant mortality rates, and yet the US spends more per capita on health infrastructure than any other country in the world. Black women are 3-4 times more likely to die during or after childbirth than their white counterparts, and the studies that show this often control for socioeconomic conditions – meaning, a wealthy Black woman with access to resources is still that much more likely to die than a poor white woman. Look no further than the story of Serena Williams’s serious birth complications.
(How Black Midwives Can Help Our Broken Maternal Health System, Dr. Nikia Grayson)
There are people, communities, and lived experiences behind these numbers, though, and we lose a lot of nuance when we approach any issue with a monolithic lens. Black women and birthing people are often ignored, with their concerns going unheard. This represents a massive issue within the fabric of our culture. Black doula and activist Andrea Little Mason (who verbalized the titular quote for this post) speaks about the danger in treating Black birthing people as a monolith, “You say you love me but when you come to me everything you tell me is about how frail I am.” If we shift the conversation away from looking at Black birthing folx as victimized or traumatized by the system, we can turn toward a more liberatory perspective, one encapsulated by the principle of birthing justice: When birthing people recognize their innate power to make the best health decisions for themselves and for their families, that power will have a transformational impact on their family and community.
Additional Resources:
Check out this wonderful website and article regarding Black Maternal health.
There are many organizations supporting Black midwives and mothers, including the Black Midwives Alliance, Black Mamas Matter, and the National Birth Equity Collaborative.
