Constructing the Modern American Midwife: White Supremacy and White Feminism Collide

“US exceptionalism in maternity care is marked by the lack of midwives as primary providers. Out of 100 births, only 10 to 12 will be attended by a midwife – and 9 out of 10 of these midwives are white. Yet globally, most childbearing women are attended to by midwives, only turning to an obstetrician if serious complications arise. According to WHO and The Lancet, midwives could help avert roughly two-thirds of all maternal and newborn deaths, while providing 87% of all essential sexual, reproductive, and maternal health services. Midwifery is one of the most ancient of traditions and professions in the world, with roots that can be traced back to the healing traditions of Babylonia, Egypt, Ancient Greece, Vedic India, and the Aztecs. How has this essential role been so obliterated with barely a peep from feminists claiming reproductive liberation and rejecting male domination, pink pussy hats and all? How did we lose our way in this long-standing battle to keep the patriarchy out of our pregnant uteruses? And why is American midwifery so white?

[..] For enslaved African women, the traditions of midwifery traveled with them, as birth was considered the domain and realm of women midwives as community healers. In fact, obstetrics was not taught in most medical schools. However, as the business of medicine grew in the 1800s, physicians began to stake a claim. Childbirth was lucrative – a chance to make money while experimenting with emerging technologies like forceps, episiotomies, and surgery.

Coupled with the creeping privatization of American health was the near obliteration of birthing at home. Part of this was the growing narrative that birth was risky, needing constant vigilance for medical interventions. Bringing birth into the hospital was business strategy 101: bring the customer to you, manage more than one labor at time, centralize care, and create a medical birth monopoly completely controlled by male obstetricians.

[..] the professionalizing project of medicine in the US resulted in rigid laws, regulations, and procedures and concurrently the overmedicalization of birth. In order to address the “midwife problem,” public health nurses were dispatched by order of public health directors – male physicians – to regulate, limit, and surveil these Black “granny” midwives.

[..] Senator Morris Sheppard, the erstwhile father of the Prohibition Act, and Representative Horace Mann Towner proposed and passed legislation that would address the terrible infant mortality by developing a federally-funded public health workforce. They adopted the narrative set by obstetricians that it was midwives, mostly Black, with limited education (ignorant), and poor hygiene (dirty) who were culpable for the high death rate. The twin arms of white supremacy – anti-Black racism and xenophobia – convinced Black women and northern immigrants that midwives were to be bypassed and that a responsible mother would seek out the care of white male physicians, the new arbiters of medical science and experts on the disease of pregnancy.

[..] With the growth of the second wave of white feminism and women’s liberation in the early 1970s, newfound interest in midwifery emerged, with sexual and reproductive freedom as part of its ethos. Though hyperfocused on abortion and contraception, this new movement of self-taught mostly white women, created a renewed image of birth, intentionally distancing themselves from the medical establishment that also shunned nursing. There was little acknowledgment of the ancient, expert, and holistic practices of Black, Indigenous, and immigrant healers that birthed nearly twenty generations of Americans of all ethnicities – with midwives like Onnie Lee Logan, Margaret Charles Smith, Mary Francis Hill Coley, and the few Black nurses who overcame the obstacles white supremacy put in place to become nurse-midwives like Maude Callen.

[..] Of the thirty-nine graduate programs that train certified midwives and nurse-midwives, only two have Black program directors – one permanent and one interim. In 2020, Commonsense Childbirth School of Midwifery founded by Jennie Joseph, a British-trained midwife, was the first certified professional midwife (CPM) education program in the US to be led by a Black woman.

[..] Can midwifery uproot themselves from its ties to misogyny and white supremacy in a workforce that currently identifies as 90% white, in a population that has increased from only 150 in 1955 to 12,000 today? If midwifery is to thrive into another century in the United States – in the midst of a deeply racialized maternal health crisis, where Black women are three to four times more likely to die in a childbearing complication – then we need to start looking for a way to invest and support the growth of Black, Indigenous, and immigrant midwives of color to reclaim the legacy of midwifery that existed well before Mary and Florence.”

Full article, Niles PM and Drew M. Nursing Clio 2020.10.22