“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.”
The history of Midwifery in America has been fraught with oppression and racism. Up until the late 19th century, most births were attended by midwives, many of whom were Black, indigenous, or immigrant women. They carried with them traditional healing knowledge and practices passed down through generations. This holistic birthing care changed drastically as clinical obstetrics arrived on the scene and forced women of color to integrate. Today traditional Midwives are known as Certified Professional Midwifes (CPMs) and in 13 states they are still not legal to practice the intimate care so many birthing people need.
What is a CPM?
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.
common questions
The CPM credential was developed in the late 1980's 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.
"The main purpose of a certification program is to establish entry-level knowledge, skills, and abilities necessary to practice competently. A Certified Professional Midwife’s (CPM) competency is established through training, education and supervised clinical experience, followed by successful completion of a written examination. The goal is to increase public safety by setting standards for midwives who practice “The Midwives Model of Care” predominately in out-of-hospital settings."
A CPM is not a nurse and she/he does not practice nursing or medicine.
Check out this useful Comparison Chart to learn about the differences between CNMs, CMs, and CPMs in America.
While 35 states recognize the CPM credential and skill in caring for low-risk pregnant women in pregnancy and birth, many states continue to lag behind. To learn more visit pushformidwives.org.
In 13 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, grand-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.
Star August (President of HBC) is the proud great great grandaughter of Georgia Madison who was a Grand Midwife (or Granny Midwife) in Bastrop, Texas in the 1940’s. Madison was born about 1893. Georgia Madison’s picture is seen on the left.
Mary Coley was among the last generation of granny midwives providing care to pregnant women across the rural South. These women were indispensable at a time when hospitals were often out of reach, and they have a history of service to their community. Thanks to a 1952 informational documentary filmed for the Georgia Department of Public Health, we can observe Coley at work, delight over the new lives she so carefully brings into the world, and wonder– how did this tradition become completely eradicated?
Star August (President of HBC) is the proud great great grandaughter of Georgia Madison (seen above) who was a Grand Midwife (or Granny Midwife) in Bastrop, Texas in the 1940’s. Madison was born about 1893.
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.
Mary Coley was among the last generation of granny midwives providing care to pregnant women across the rural South. These women were indispensable at a time when hospitals were often out of reach, and they have a history of service to their community. Thanks to a 1952 informational documentary filmed for the Georgia Department of Public Health, we can observe Coley at work, delight over the new lives she so carefully brings into the world, and wonder– how did this tradition become completely eradicated?
Midwives gather on the steps of the Canton, Miss., courthouse in the 1920s. Caroline H. Benoist Collection at UVA’s Bjoring Center for Nursing Historical Inquiry.
“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.
Three generaions of midwives in one family. Caroline H. Benoist Collection.
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.
“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.
Seen left: Group of lay midwives at county meeting in front of county court house, Canton, Mississippi, 1920s. Also: Three generations of midwives in one family. Caroline H. Benoist Collection at UVA’s Bjoring Center for Nursing Historical Inquiry.
“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.
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.
“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.
“I’m aiming to reflect the resurgence of midwifery in the United States and show a US and UK audience how healing and beautiful the midwifery model of giving birth is.”
– Mia Harvey
Mia Harvey, student at National Film & Television School (and BBC Scholorship Awardee) has been following Star August Ali, President and CoFounder of HBC, through her patient visits, advocacy efforts, and everyday life. The documentary, set to release later this year, will chronicle Star and several other Chicago-area women’s experience and intimacy that women experience while planning and giving birth — and the realities of working with a community based homebirth provider.
“I’m aiming to reflect the resurgence of midwifery in the United States and show a US and UK audience how healing and beautiful the midwifery model of giving birth is.” – Mia Harvey
Mia Harvey, student at National Film & Television School (and BBC Scholorship Awardee) has been following Star August Ali, President and CoFounder of HBC, through her patient visits, advocacy efforts, and everyday life. The documentary, set to release later this year, will chronicle Star and several other Chicago-area women’s experience and intimacy that women experience while planning and giving birth — and the realities of working with a community based homebirth provider.
“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… She carried valuable information, passed on by predecessors across generations, that positively impacted the social health of the family structure and overall health of the community.”
-Shafia Monroe
“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…She carried valuable information, passed on by predecessors across generations, that positively impacted the social health of the family structure and overall health of the community. With her eradication, so was her guidance.”
-Shafia Monroe
