"Catchin' Babies:" Granny Midwives and Beyond
“I was born wanting to see births and catch babies.” –anonymous midwife (“Know your Florida Midwifery History,” Florida Midwives Association)
Recently, over brunch at Denny’s, my sister, Terri, and I sat down to go over notes about our maternal and paternal lineages based on my interviews with now-deceased family members, my great aunt, Willie Cummings Jackson, and my mother, Catherine Staggers Johnson.
Terri had agreed to help me organize these handwritten entries, scribbled on looseleaf sheets and other scraps of paper, to create family trees based on these tidbits of information about my grandparents and great-great grandparents’ marriages, their children, family births and deaths.
Too often, the challenges, accomplishments, and experiences of our ancestors are lost, forgotten, or never passed on to our youth. For example, on one wrinkled sheet, I had written “Mary Brown Williams was the daughter of Frances Brown, a midwife, who assisted at Juanita’s birth of my mother, Catherine.” For whatever reason, I had overlooked this fact.
Ironically, I was working on a blog about Black midwives in the South, when I learned that my paternal great-great-grandmother had been a midwife in Ocala (in Marion County), Florida, during the 1920s.
I wondered about Grandma Frances’ work as a midwife. (Had she learned midwifery from her mother? Were there other midwives in our lineage? Was she paid for her services? Did she have any formal training?)
My research into the history of Black midwifery in Florida would answer some of my questions about my great-great-grandmother’s work as a midwife.
Granny Midwives
In Mama’s Little Baby: The Black Woman’s Guide to Pregnancy, Childbirth, and Baby’s First Year, Dennis Brown, MD, and Pamela A. Toussaint refute the depiction of southern Black midwives (known as “granny midwives” or “mammies”) as unskilled, uneducated practitioners. “The midwife’s work was more than ‘catching babies,’ they were psychologists, dietitians, loan officers, sex therapists, prayer partners, marriage counselors and friends and sometimes relatives to the women that they served.”
Granny midwives’ belief that God “calls” them reflects their deep spiritual roots. Their practices grew out of African midwifery rituals, traditions, and beliefs, such as squatting (to connect a mother to the earth), salting and burying the placenta and umbilical cord (to heal the womb) and the use of herbs to ease labor.
Before and after Emancipation in 1863, granny midwives delivered babies for Black enslaved women (as well as the wives of plantation owners) and played pivotal roles in assuring healthy pregnancies and births. On the other hand, enslavers’ primary concern was protecting “the health of their reproducing enslaved women and their newborn infants to expand their labor force.”
In an article, “Know Your Florida Midwifery History,” Justine Clegg, MS, LM, CPM, stated, “In addition to offering homebirths for most of Florida’s pregnant women, midwives provided essential medical care and other services to many communities.”
Grandma Francis practiced midwifery during a period when white male doctors believed that granny midwives, who delivered babies for Black and white women in rural and remote areas of the South, were unsanitary and incompetent. Poor women in the southern states did not have access hospitals or could not afford hospital fees.
Midwives frequently dealt with hemorrhage, breech presentations, and the delivery of twins or triplets. Those who fostered a relationship with a local white doctor would consult him in emergency situations.
In the 1900s, Dr. Joseph DeLee, “the father of modern obstetrics,” called midwifery “barbaric” and campaigned to medicalize delivery through “routine use of sedatives, ether, episiotomies [Editor’s note: an incision between the vagina and anus], and forceps (all of which we now know to be harmful when used routinely).”
According to the late Judith P. Rooks, a certified nurse midwife (CNM) and past president of the American College of Nurse Midwives, “Midwives attended approximately half of all births in 1900, but less than 15 percent by 1935. By the early 1930s most practicing midwives were Black or poor-white granny midwives working in the south….
“Where midwifery declined, the incidence of mother and infant deaths from childbearing or birth injuries generally increased … primarily due to obstetrical interference in birth.”
In 1931, Florida passed its first midwifery licensing law, which required that “practicing midwife … be able to read the Manual for Midwives, be able to fill out birth certificates … have attended, under supervision of a physician, at least fifteen cases of labor and delivery, possess a diploma from a school for midwives, and become licensed by the State Board of Health.”
Did the new law affect my great-great-grandmother’s ability to work? Did she ever pursue licensing?
The Present: One Family’s Ordeal
In March 2023, Rodney and Temecia Jackson, a Black married couple made national headlines when they refused to heed their long-term pediatrician’s advice to admit their newborn daughter, Mila, to Children’s Medical Center of Dallas for jaundice treatment.
The parents insisted that they could treat the condition at home under the supervision of Cheryl Edinbyrd, PhD, a Black licensed midwife, who had assisted at Temecia’s home birth.
A few days later, the pediatrician contacted the Texas Department of Family and Protective Services (DFPS), which authorized the seizure of their daughter. When Rodney refused to cooperate, Dallas police officers arrested him. The child welfare agency placed Mila in foster care, thereby denying Temecia the chance to bond with her newborn. A month later, DFPS returned the infant to her family.
In news interviews, Temecia cited her reason for choosing a home birth under the care of Edinbyrd, owner of Tree of Life Birth, Counseling, and Wellness Center in Dallas, TX: She had had two previous Cesarean sections and did not want to undergo another.
Despite the contributions and rich legacy of midwives, the Jacksons’ ordeal illustrates doctors’ lingering mistrust of their competence.
Midwifery Today
As of 2021, the Government Accountability Office reported that 12 percent of births in the United States were attended by a midwife.
Black midwives make up only 7% of the total certified nurse-midwives and certified midwives in the United States, which has the highest rate of maternal mortality among industrialized nations.
Black women have the highest maternal mortality rate and are more likely to give birth by C-section than any other racial group in the country.
The American College of Nurse-Midwives advocates “increasing the number of Black midwives (to) help dismantle the vices that lead to high maternal death rates and negative outcomes in the Black community.”
CNMs and OBs
Many factors—too numerous and complex to discuss here-- affect interprofessional collaborations between CNMs and physicians.
Here are some:
· Some states grant CNMs broad autonomy, while others require some degree of supervision or direction from a physician.
· Physicians argue that patient safety might be compromised if CNMs … are permitted to practice without a doctor's oversight.
· In some states, physicians attending a vaginal birth are reimbursed at a higher rate than midwives providing the same services.
· Restructuring hospital bylaws would allow midwives to be the principal providers for low-risk pregnancies and to collaborate with physicians when risk factors are present.
Can collaboration between CNMs and obstetricians (OBs) assure patient-centered, safe, and comprehensive care for women?
The Physicians and Midwives Collaborative Practice (PMC) in northern Virginia provides an example of successful collaboration. This practice is made up of physicians, midwives, and nurse practitioners. During labor, an obstetrician and a midwife attend to patients. “If a disease develops, the providers, as a team, pursue optimum management.”
Midwives have come a long way since the days of Grandma Frances by vigorously advocating for professional autonomy, subsidized education, diversity, and equitable collaborations with other medical professionals.
2024 Wista Johnson (Reprint by permission only.) Photo: Courtesy of picyrl.com
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