The Legacy of African American Midwives in America

Jul 27

The Legacy of African American Midwives in America

Written By: Neha Suresh, Intern

The coronavirus pandemic has given a new life to the field of midwifery, as home births surge due to insufficient access to hospitals. At the end of March 2020, Google searches in the US for “home birth” were at their highest level in the past six years. However, midwifery has been frowned upon in the US for decades. This sudden switch is overwhelming the midwife community in the US. Midwife Robina Khalid explained in an open letter on behalf of the New York City Homebirth Collective, “If a pregnant person originally chose a hospital because they believed it to be the safest location in which to give birth, that belief continues to make the hospital the safest place for that person to give birth.” We take a look back to the racial origins of midwifery and the evolution of this craft to give expectant parents in the pandemic some perspective with which they can choose wisely.

During chattel slavery in the 1600s, African midwives served both other African women as well as white women in birth. Obstetrics was introduced in the late 1700s and midwives were replaced by male physicians. In the early 1800s, many states created laws that prohibited lay midwives, and they were all mostly ousted by the mid-1900s. The practice of midwifery came under public scrutiny during the 1910s. Physicians tended to attribute high infant and maternal mortality rates in the United States to the “unsanitary and superstitious” practices of traditional midwives. The 1921 Sheppard–Towner Maternity and Infancy Protection Act provided matching funds to state health departments for midwife training programs. By the 1950s, a vast majority of women gave birth in hospitals due to a nationwide campaign to undermine midwifery and the efforts of some midwives to integrate themselves with the hospital system to remain relevant. The 1970s reintroduced midwives, except this time most midwives were mostly white women. The erasure of Black midwives’ practice from South was the precursor to the erasure of their contributions to the natural birth movement of the seventies.

As of 2015, Washington State had the most midwifery integration and North Carolina had the least. The maternal mortality ratio in Washington in 2015 was 9.0 deaths per 100,000 births. In comparison, North Carolina had a maternal mortality rate of 27.6 deaths per 100,000 live births. In tandem, the infant mortality rate in Washington was 4.8 deaths per 1,000 live births, compared to 7.2 deaths per 1000 live births in NC. Hospitals that incorporate midwives have a 74 percent lower rate of labor induction and a 12 percent lower rate of cesarean deliveries.

Many factors contribute to overall maternal mortality in the US, from underlying conditions to inadequate health insurance, but midwife integration has shown largely positive outcomes. In the UK, Scandinavia, and France, more than half of the deliveries are done by midwives. In the US, less than 10% of deliveries are led by midwives. Maternal mortality rates in these countries are a fraction of America's. Today, thirty-three states, including North Carolina, require private insurance companies to pay for services provided by Certified Nurse-Midwives (CNMs), and Medicaid coverage for CNMs is required in all states. Integrating trained midwives could help mitigate America’s rising maternal mortality rates.

One of the only educational outlets conveying the learnings of African-American midwives is “All My Babies.” This film, which follows Mary Francis Hill Coley, is a documentary to educate the medical community about midwifery in the black community of rural Georgia. The film aimed to share best practices of the profession and communicated 118 points. These points focused on prenatal care and delivery techniques, incorporating partners into the birthing process, and managing the relationship between the midwife and public health specialists.

A huge part of fixing the maternal mortality crisis is giving birthing people choices. Having said that, birth at home is by no means for everyone. People with underlying conditions like diabetes need to be far more cautious, and a home birth is potentially dangerous; it’s also not an option when a baby needs to be delivered by C-section.

Overall, a larger role for midwives could improve a deficient healthcare system for both mothers and their children, especially during the COVID-19 pandemic. The Southern Birth Justice Network is calling for insurance coverage and support for midwife care as one way to help Black Americans have better birth experiences.

Continued racial disparity is reflected in elevated African American maternal mortality rates. In 2018 the maternal mortality rate for Black women stood at 37.1 deaths per 100,000 births, compared with 14.7 deaths per 100,000 births for white women. This has been further exacerbated by the pandemic. To close this gap and promote reproductive autonomy, consider supporting one of these organizations:

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The Legacy of African American Midwives in America

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