“One of the darkest moments in US history was the systematic eradication of the African American midwife from her community, resulting in a legacy of birth injustices.”
“Until the late 19th century, the majority of births were attended by midwives, many of whom were Black, indigenous, or immigrant women. Most midwives, including enslaved women, drew upon traditional healing knowledge and practices passed down through generations. Others learned their practice through apprenticeship, either to local physicians or experienced midwives in their community.
In the early 20th century, however, as childbirth became medicalized, physicians emerged as the primary birth attendants and childbirth moved from the home to the hospital. Midwives delivered about half of all babies in the U.S. in the early 1900s; by 1930, however, that figure had dropped to fifteen percent.
“Until the late 19th century, the majority of births were attended by midwives, many of whom were Black, indigenous, or immigrant women.”
These early decades of the 20th century also witnessed high rates of maternal and infant mortality. Obstetricians and public health and social welfare reformers blamed the midwives, despite evidence from several research studies that midwife-attended births accounted for fewer maternal deaths than those attended by general practitioners, who were typically poorly trained in obstetrical techniques. Public health nurses joined obstetricians in a campaign to eliminate traditional midwives, calling Black, indigenous, and immigrant midwives incompetent, unsanitary, and dangerous.
At the same time, though, some public health nurses recognized that professional midwives in Britain and Europe contributed to low maternal and infant mortality rates in those countries. They worked to establish nurse-midwifery as a new specialty in which nurses (the overwhelmingly majority of whom were white women) would be trained in both nursing and the practice of midwifery. The first nurse-midwifery training programs launched in the mid-1920s and early 1930s, and their growth continued over the ensuing decades.
“Public health nurses joined obstetricians in a campaign to eliminate traditional midwives, calling Black, indigenous, and immigrant midwives incompetent, unsanitary, and dangerous.”
As part of the broader effort to reduce infant and maternal mortality rates, Congress passed the Sheppard-Towner Act of 1921. This regulatory initiative provided federal funding to states to establish midwifery training and licensure and targeted Black midwives in the South, who represented the largest group of unregulated birth attendants. Health departments 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.”
Dominique Tobbell, PhD. “Black Midwifery’s Complex History.” UVA, 12 Feb. 2021, www.nursing.virginia.edu/news/bhm-black-midwives.
Traditional Midwives today are known as Certified Professional Midwifes (CPMs). Most CPMs own or work in private home or birth center based practices. Providing continuous care for women throughout their childbearing cycle, CPMs generally carry a relatively low client load which allows for more personalized and comprehensive care than typical obstetrical practices.
The guiding principles of the practice of CPMs are to work with their clients to promote a healthy pregnancy and provide education to help them make informed decisions about their own care.
In partnership with their clients CPMs carefully monitor the progress of the pregnancy, labor, birth, newborn, and postpartum period. They recommend appropriate management if complications arise, collaborating with other healthcare providers when necessary. The key elements of this education, monitoring, and decision making process are based on evidence-based practice which includes thoughtful integration of the best available evidence, coupled with clinical expertise, and the client’s values and needs.
The CPM credential was developed in the late 1980s and was first issued in 1994 by the North American Registry of Midwives (NARM) to midwives with specialized training and expertise in providing safe, skilled maternity care in community birth settings.
A CPM is not a nurse and she/he does not practice nursing or medicine. While 35 states recognize the CPM credential and skill in caring for low-risk pregnant women in pregnancy and birth, many states, including Illinois and Georgia continue to lag behind. To learn more and see a more detailed map visit pushformidwives.org.
In 14 states CPMs are at risk of criminal prosecution for “practicing medicine or nursing without a license,” which drives the practice of midwifery underground and creates barriers to access for women seeking maternity care.
When Europeans brought African people to the United States and enslaved them in the early 1600s, there were among them African women who were trained and practiced as midwives, and who continued to do so and train others to do so during their lives as slaves. During this time in the colonies, midwives were still the primary source of care in birth for all families. As slavery grew, African midwives served both other African women as well as white women in birth. In the mid to late 1700s, obstetrics was introduced into America and by the early 1800s, the male physician had largely replaced the role of the midwife, particularly among upper and middle-class white Americans. However, in rural America and particularly in Black communities, midwives continued to serve in birth.
The terms midwife, granny-midwife, and granny were used to describe traditional Black midwives, who were well respected by their community and who still attended up to 75% of births in the 1940s in the Southeastern United States. Beginning in the early 1800s, many states created laws that prohibited lay midwives. From that time to the mid-1900s, all lay midwives, including Black granny-midwives, were systematically ousted until there were none left at all.
