The Cauling of Midwife… A historical journey of Midwifery through the hands of midwives of African descent
by Mama Sarahn Henderson
http://www.birthinthetradition.com/

Hebrew Midwives in the Old Testament


Two Granny midwives who practiced here in Georgia during the 1930's Photo provided by GA. Archives

The earliest documentation of African midwifery can be found in the book of Exodus I verses; 15-21 dated 1500 BC; ... And the King of Egypt spoke to the Hebrew midwives, of which the name of the one was Shiphrah, and the name of the other Puah. And he said, "When ye do the office of a midwife to the Hebrew women, and see them upon the stools; if it be a son, then ye shall kill him: but it be a daughter, then she shall live". But the midwives feared God, and did not as the King commanded them, but saved the men children alive. And the King called for the midwives, and said unto them, "Why have ye done this thing, and have saved the men children alive"? And the midwives said unto Pharaoh, "Because the Hebrew women are not as the Egyptian women; for they are lively, and are delivered before the midwives come in unto them." Therefore God dealt well with the midwives: and the people multiplied, and waxed very mighty. and it came to pass, because the midwives feared God, that he made them houses.

Unlike the history of Anglo- midwifery, midwives of African descent have an origin and a story of her own. A history that is deep rooted in the culture of her ancestors of hundreds of generations from across the waters, which survived the middle passage of slave trading, bringing with them their knowledge of birth and medicinal botanical roots. In many African villages there was not just one particular woman who was known as the Midwife of her village. That is why it is difficult to find an African translation to the word midwife. Birthing was looked on as being women's work and older women who had given birth before assisted another during labor. Oftentimes it would simply be the birthing woman's mother or grandmother and other women to help. Only if there were difficulty would someone else be called in, (usually the medicine man). Other than him, it was considered a taboo for a man to be in the hut of a birthing mother (including the father). It wasn't until slavery on the plantation, that women were appointed as midwives based on their knowledge and familiarity of woman craft.

Maude Callan, one of the first formally educated midwives in S.C.

Midwives During Slavery
There are documentations written that the slave midwife became a highly important member of the slave community within the Southern Plantation, the French and English Caribbean and South America. She was elevated in the slave hierarchy occupying positions just below that of the top slaves, the head overseer and housekeeper. Their skills in Midwifery and herbology were similar throughout the Diaspora. Not only did she deliver the babies of slaves, she also delivered the plantation owners wife and other local white women. The Midwife was the keeper of women's business, knowing which herbs to enhance fertility, to sustain pregnancy, and to abort. She was the root doctor among the slave quarters; maintaining the health of other slaves on the plantation. Pregnancy and childbirth folklore, beliefs and rituals that originated in Africa, were practiced and passed on from generation to generation. Many midwives regardless whether they lived in the U.S.South, West Indies, South America or the Gullah Sea Islands, shared similar beliefs regarding the protection of pregnancy and childbirth. Common beliefs are documented and still practiced among midwives today regarding the Caul or "veil", umbilical cords, the burying or burning of the placenta, easing the pain of labor, and what the pregnant woman is exposed to during pregnancy that could jinx her pregnancy. Although many people today may call these beliefs superstitions, if thoroughly researched one will find that there are origins to these sayings. For instance, the burying of the placenta or the umbilical cord is to remind the child where he was born. Usually a fruit tree was planted over the placenta to assure the child that he will never go hungry. It was believed that a baby born with the caul "veil" over its head will have super natural abilities, have the ability to see spirits and talk to them, or will become a healer. These two beliefs are commonly heard from other traditional cultures. Another practice is the placing of an axe under the bed of a laboring woman to cut the pain and length of the labor. Many granny midwives carried axes to births with them if the mother did not have one herself. The origin of this practice has not been documented, however the Ibo Midwives of Nigeria would sometimes place a metal object used for cutting close by the laboring mothers hut. The axe (which is one of the symbols of the Orisha Ogun) represents the warrior aspect of the deity, thus the axe representing cutting a potentially lengthy or dangerous labor or keeping evil spirits from the birthing process.

The slaves living along the coast of South Carolina (Gullah) and Georgia (Geechees) arrived here during the slave trading period. Because of the climate and the make up of the soil, indigo and rice were the resources for the plantation economy. Malaria was a major health concern along the Sea Islands; therefore to protect themselves from the disease and isolation, the plantation owners lived off the islands on the mainland (Savannah, Darien, and Beaufort) leaving a white overseer and a few head slaves in charge. Doctors did not come over to deliver babies; therefore the midwife was kept busy delivering babies on her island and sometimes close neighboring islands. Because of the lack of white influences on the island, the slaves along the coast have maintained many of their African culture including birthing customs and traditions. The Penn School located on St. Helena's Island, is noted for being the first vocational school in the south to teach trades (to former slaves and descendants to slaves) such as midwifery. It wasn't until after World War I when all midwives were required to become licensed, that midwifery among African American started to change.


."Old Sibby" a slave midwife in rural Georgia. Photographer unknown: Georgia Historical Archives

Post Slavery
Midwives during slavery time were a necessity. On many plantations there was no one else to deliver the babies of slave mothers. When slavery was over, those families who did not remain on the plantation as sharecroppers left the land to build homes and communities. Because many Blacks were either sharecroppers or farmers, money was not plentiful. They knew how to survive with what they had, but what they had was not always enough. There was a social structure, which was acceptable and workable among the Black community. A structure of sharing and caring for one another. A sense of community, no matter how close or how far one lived from one another. Midwifery multiplied across the south. Thus began a new chapter in African American Midwifery. Although there was a plan in the makings to change midwifery care in the south, midwives were delivering thousands of babies. Midwives were being "called" either by a spiritual awakening, or led by a female relative or neighbor. Local clinics were being built and midwifery training was eventually established.


Grand Midwife Ms. Margaret Smith Age 98 year young

Many midwives shared a common belief about what inspired them to become a midwife. Although it has historically been regarded as being "woman's work", not all women are cut out to be a midwife. However those who became midwives were often led to their path either answering a "call ", followed a family tradition or took up an interest in serving women during pregnancy and childbirth. For some people being called to midwifery came in a dream, others a vision and for some through prayer. For these women, it is a common belief that they were chosen by God to do this work, therefore it means something not only special but spiritual as well. Other midwives followed the tradition in there family, especially in cultures where midwifery and birthing at home was (and still is) the norm. It was not uncommon for a young woman to apprentice and follow her Grandmother, Mother, or Aunty, to assist in a delivery. However a midwife was led to this path, (in most instances) there was a period of training and grooming before doing any hands on.


Me and Margarat Smith talking traditional midwifery lore

Within the African Diaspora a common way to learn midwifery skills was to follow and apprentice with a female kin or neighbor who happened to be a midwife. In this apprenticeship type of training, she learns of the usage and preparation of herbs, what foods to eat and avoid during pregnancy and birthing, she learns what advises to give an expecting and laboring mother, she embraces common cultural beliefs surrounding pregnancy, labor and birth, and equally as important, she learns the skills of the hands. Other midwives were inspired through interest. Either they knew someone who was a midwife; perhaps they attended a friend's birth, or simply wanted to help birth babies. Usually these women had a knack for aiding during stressful moments and came equipped with patience.

During those days a black woman who worked was a teacher, nurse, or midwife. The midwife's pay was usually a nominal fee.Often she bartered for chickens, pigs, vegetables, or a service. This was an acceptable system of exchange and did not keep the midwives from performing her duty. There are plenty of stories told where midwives came to births on foot, mule, during a stormy blizzard, or during a thunderstorm on a hot summer day for miles and miles until she reached the doorsteps of a laboring mother. Often she stayed with the new mother for days or even weeks to assist the mother with the care of her family and home while the mother adjusted to mothering and got her strength back.

Regardless how Midwives became inspired, it is agreed upon that this is their life purpose, and they are doing what they are suppose to do. It is woven into their daily lives like a tapestry, and to many it is considered a way of life. Not only was she the first one to lay hands on a miracle, often times it was she who kept her community healthy with her knowledge of herbs and other homemade remedies. She aided the elderly and was sometimes called on to midwife the sick in their death until their final calling. In the south she was often called the doctor. Because of her knowledge and skills in woman craft, she is respected as "Wise Woman".

The Elimination of the "Granny Problem"


A graduation class of midwives in Georgia, 1930's. GA. Archives

They didn't have a license when they first began, as far back as I can remember. I didn't know of 'em havin' t'have 'em until up later years. Then thet got t'where if they delivered babies, they had t'have a license. And then they were finally just completely cut out of th'job at all. Weren't allowed to'do th' job at all. Cox, "Midwives and Granny Women," 286.


By 1930 changes were well on their way and much to the disadvantage of the granny midwifery population. Strategies were in place to eliminate the "Granny Midwife problem." Although this historical account took place in Georgia, this story is told throughout all of the southern states. And this is what bridges the similarity of the Anglo-American midwife and the African-American midwife's history. When the first granny midwives volunteered their names in for a license, little did they know there was a plan in store for the discontinuation of their midwifery practice? Like the white midwives in the north, she thought that becoming licensed would legalize and legitimize her lifelong work. She was told that taking classes in midwifery would give her more prestige and status. Whereby, encouraging midwives to enlist their names was a deceiving method of the State Department of Health to track who was practicing and where so they could be closely monitored and eventually retired. This encouraged more (young) women to apply for licenses (between the ages of 25-45). Some were not given a license either because of age, lack of practice, or failure to submit recommendations from two doctors. However midwives in the most rural areas where there was no threat of competition were allowed to continue their practice without licensure. Of course, these areas were populated by predominantly blacks. Courses were being taught in the county clinic for midwives with the intentions of encouraging the midwives to practice one way and to discontinue practicing the ways of the older midwives, which the state viewed as unsafe and superstitious.


A granny midwife attended regular midwife classes provided by the county clinic. These midwives were instructed by the Nurse Midwife sitting on the ground. Photo provided by GA. Dept. of Archives 7. Ms. Lola Coleman, Auntie Dinah (a certified nurse midwife who formally practiced in Accra) and myself in Ghana. Ms. Lola and myself happened to be in Ghana during the same time. It was this occasion that I finally met Ms. Dinah. We had corresponded a few time over ten years before. Ms. Dinah ran her own maternity home.

Upon completion of their course and at graduation, the midwives were issued black bags and in it they carried scissors, a scale, strips of gauze, string for the umbilical cord, silver nitrate for the babies eyes and a birth certificate, all of which the state provided. Doctors and nurses thought it was difficult to train the midwives claiming they were ignorant and unclean. Illiteracy made it difficult for some midwives to fill out birth certificates and other documentations. Birth outcomes were being documented and statistics were showing that there was a high number of infant mortality and maternal morbidity. Tetanus being one cause of this, made it so that midwives were then forced to take shots and chest X rays. This was largely due to the fact that most people raised livestock close to their homes, which created an environment for disease. Childbirth fever claimed the lives of some women because of unhealthy living conditions. However it is also documented that childbed fever was higher in the hospitals largely due to the fact that hospitals housed the sick and dying and that doctors used unsanitized foreign objects (such as forceps and needles) during birth. A bad image was being painted of the granny midwife. A lot of negative attention was given to their home remedies (which were passed down from slave midwives), cleanliness of birth supplies, personal hygiene and superstitious ways. Local nurses were attending home visits. Their view of poverty was classified as dirty, which in most cases was not true. Most homes, although they did not have the appearances and the comfort of the other neighboring homes across the tracks, were kept clean and tidy even if newspaper was used to fill cracks in the wall. Courses on hygiene were implemented into their training program, particularly the cleansing practices of their hands and the sterilization process of their scissors. The calling of midwifery was working its way to endangerment. The state was finally reaching its long-term goal to phase out midwives completely. Although the midwives skills showed improvement from the educational programs, the ultimate plan to get rid of midwives was the original focus and finally reaching reality. The measure of the program's success was not in the refinement of the midwife's skill but in her decreasing numbers. In the 1960s with the availability of health care funds (welfare) to the poor along with desegregation legislation, black women were now permitted to deliver their babies in the hospital. With the addition of federal subsidies for maternity care to the poor, many of the midwife's clients became aware of the welfare benefits that offered to pay all medical costs for those who qualified. Total reimbursement of federal monies would be made to recognize care-givers-the midwife not being one of them.


Ms. Selorm and myself in front of her home/maternity home. She is a nurse midwife who serves her village in the Ashanti region of Ghana

The welfare program nearly killed midwifery altogether. Two successful plans (tricks) were consistently delivered to retire the midwife, all the way until the last one who was retired in 1987. The first strategy was the volunteer "honorable discharge". The beginning of this process was to allow the granny to assist in selecting a nurse midwife for her replacement. The granny would be encouraged to sell her birth bag to the nurse midwife decreasing the temptation to midwife. After this process was completed, a banquet and ceremony would be given to the granny by her midwife club, at that time she would be persuaded to ask for an honorable discharge and sign a statement promising that she would not accept anymore cases. Then she became an "inactive" official member of the local midwifery club. Supposedly this procedure removed the possibility of hurt feelings. However, when some midwives were interviewed it was quite the contrary. Many of these midwives were still young and capable of their calling. They felt as if they were deceived into retiring and many of their feelings were hurt. The second strategy was the doctor's permit. A pledge card was issued to an expectant mother at her prenatal visit (at the local clinic) with the physicians signature permitting her to have a home delivery providing she was considered "low risk". This was an agreement that was also to be honored by the granny midwife, for the mother had to present this card to the granny showing that she was permitted by the doctor to have her baby delivered at home by the granny. Since the women were attending their prenatal visits at the clinic, a lot of them concluded that they might as well continue their delivery care with the doctor in the hospital.


Ms. Lola Coleman CNM, Auntie Sisi (a traditional Birth Attendant , and myself in Larteh Ghana, W. Africa. 1994

Health officials painted an ugly image of the granny midwife and unfortunately many of the birthing women bought into it. Having your baby in the hospital presumably meant that you were equal to white women. It became a status thing to have a baby in the hospital. Midwives fought for a clean and honorable image, however, the high risk list grew longer and longer and less women were given permits for a home delivery. Eventually, it came to a point of numbers, where a midwife had to deliver a certain number of babies within a two-year period of time. The small numbers ranged from state to state. If the midwife was not able to reach that quote, her license was not renewed. Only in a few small rural communities did you find a granny in practice. In essence, a compellation of desegregation, government regulation, education, certification, sanitation and racism crippled practically the entire population of granny midwives in the south.


Ms. Lola Coleman, Auntie Dinah (a certified nurse midwife who formally practiced in Accra) and myself in Ghana. Ms. Lola and myself happened to be in Ghana during the same time. It was this occasion that I finally met Ms. Dinah. We had corresponded a few time over ten years before. Ms. Dinah ran her own maternity home.

Between the 30's and 40's, most women were having their babies in the hospital. During the twilight of their birth experience ("twilight" was a drug used to put women to sleep while they were in labor and gave birth. While some women were totally unconscious, others were in a hypnotic state of alertness), women woke up finding that they had given birth to their baby, while the husbands patiently waited in the waiting room to hear the good news. Eventually, this method of birthing faded, and the use of anesthesia was employed to take away the feeling of giving birth. Birthing had become a process of medical management and out of the power or participation of the birthing parent. Consequently, two and three generations of mothers have given birth to their babies without having a clue as to how they did it. In the meantime the midwife's calling became fewer and fewer, as some women would tell her there was no need for her service because welfare was paying for the expenses. The granny midwife was not totally erased, just left in the shadows of tomorrow .


A traditional way to labor. Atlanta, Georgia

Today's Midwife
A new generation of midwives have emerged and have taken on a new meaning to midwifery with an appreciation and respect for the past. The Grand Midwives, a term we now wish to honor them with, are still among us. Some are with us in spirit, and a few are still with us today. Two midwives who told their stories before passing on were, Onnie Lee Logan in her book, Motherwit, An Alabama Midwife's Story, and Why Not Me ? The story of Gladys Milton, midwife by Wendy Bovard and Gladys Milton. One midwife of a few still living is Margaret Charles Smith from Alabama. You can read her story in her book titled Listen To Me Good. These three midwives have shared their story with us so that we can understand our history in Midwifery. Midwives can be found throughout the United States and across the sea. In many states Midwifery is still unlawful. Some states have managed to pass laws that have made midwifery a free state to practice in. Those who practice lay midwifery in restricted states do so because they believe that families ought to have the right to birth where they want and to be attended by whom they choose. They believe in freedom and exercise this belief as Harriet Tubman once did. Many midwives today believe they were called to serve the pregnant mother as the midwives of yesterday. They serve with pride and dignity, something that no man will ever take away. As long as there are mothers upon the stool, there will always be midwives.


A traditional way to labor. Atlanta, Georgia Me , Margaret Smith and Marcia Yaquob House of La Matrona Conference