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Update and Corrections to Our Spotlight
This month’s spotlight on anti-racism has been updated due to language and inaccuracies that understated the role that descendants of enslaved Africans played in bringing midwifery to the North American continent, and to white women’s role in the displacement of Black midwives for their own financial and social gain. We at CNMA would like to apologize for the use of the offensive term “Granny” in the original piece, as well as for our incomplete narrative that failed to fully represent the significant work done by the Grand Midwives or the level of oppression they were subjected to by members of our own profession.
We would like to thank the ACNM Midwives of Color Committee (MOCC) and Michelle Drew, CNM, MPH, FNP, DNP for taking the time to edit, correct, and addend our original post. Dr. Drew has brought to light additional history we were not aware of and helped us see more clearly how we can do better. We appreciate all that Dr. Drew brings to midwifery, and the wealth of knowledge she has and that she shares.
We acknowledge that the history of nurse-midwifery is steeped in racism and eugenics. ACNM and CNMA have a lot of work to do to atone for that legacy, and to course-correct the path that led to today’s racism-based disparities in healthcare. Our antiracism work as an affiliate is a work in progress, to which we are humbly dedicated.
This post is now housed in Quickening, and the language is available for you to read below.
Black History Month: Honoring Black Grand Midwives and Supporting Black Midwives Today
This Black History Month, The ACNM Midwives of Color Committee (MOCC) and Black Midwives Caucus want to uplift and celebrate the importance of Black Grand midwives and the important roles they played in both caring for their communities and keeping midwifery tradition and skills alive in the United States. We encourage you to learn about Mary Coley, Onnie Lee Logan, Margaret Charles Smith, Biddy Mason, and Gladys Nichols Milton. These midwives and the legions of their unnamed counterparts are directly responsible for helping to establish and sustain the science and art of American midwifery. We acknowledge, celebrate, and thank their spirits for their contributions to midwifery and their perseverance and dedication to serving their communities in the face of disruptive, racist, and xenophobic attacks.
In colonial times, reproductive health care was provided primarily by midwives. Notably, midwifery was practiced by Indigenous people native to North America; and midwifery practices were brought to the United States by enslaved peoples of African descent. Trained through apprenticeship by generations of experienced family members or peers, these midwives provided safe and affordable care to pregnant people in their communities. For many years, the practice of medicine did not encompass the work of reproductive health care; however, in the early 1800s the medical field of obstetrics began to develop, and white male physicians often recognized midwives as competition, an impingement on profit and stature.
A concerted anti-midwife campaign developed, playing on racist and xenophobic tropes that painted foreign-born and Black midwives as illiterate, careless, lazy, incompetent, unclean, and dangerous. This resulted in the 1921 passage of the Sheppard-Towner Act, a federally funded statute intended to support and improve outcomes for infants and birthing people, and which required states to regulate their midwifery workforces. The statute funded white male obstetricians and white female public health nurses to “educate” community midwives in normal birth and act as gatekeepers to determine which community midwives were deemed appropriate care providers. As Danielle Thompson notes, “This meant that, in one of the most racially charged eras in American history, the livelihoods of many women of color were placed directly in the hands of White actors already negatively disposed toward them for both social and competitive reasons.”1 Despite these concerted attacks on midwifery and Black midwives, Black Grand midwives continued to serve their communities. As of 1918, almost 90% of Southern Black births were attended by Black midwives. They also attended many births of poor white women who couldn’t afford the fees of white physicians.
Only 21 years later, Mary Breckinridge founded the American Association of Nurse-Midwives (AANM). An active white supremacist, she did not allow membership of African American midwives nor did she educate a Black nurse at the Frontier Graduate School of Midwifery from 1939 until her death in 1965, despite being in direct violation of Brown v Board of Education from 1954 onward. This organization became part of the newly created American College of Nurse-Midwives. Midwifery education programs from Tuskegee, Flint Goodridge, and Tuskegee Movable School (located in Macon County) during the 1930s prepared the 41 Black nurse-midwives that were practicing at the time, but unfortunately, the effects of the medical establishment’s racist and xenophobic smear campaign and the racist foundation of midwifery persisted and continues still today.
The midwifery profession today is over 90% white; midwives attend only 11% of births in the United States, with 45% of those births being to Black, Latinx, and Indigenous mothers; and clients of color, especially Black birthing people, suffer hugely disproportionate disparities in health outcomes. As midwives, we must learn about, acknowledge, and make reparations for the specific role anti-Black racism has played in the history of our profession as well as current educational, certification, and practice environments. Either through apathy, implicit bias, or structurally racist policies, many of the 20th and 21st century midwifery leaders and educators have contributed to the oppression and exclusion of racialized people from modern professional midwifery. Whether these past oppressions were intentional or not, there is a growing understanding of the need to respectfully align with racialized midwifery students, educators, and leaders. Truth, healing and reconciliation in our profession must begin with uplifting and celebrating the Black Grand midwives who were foundational in the persistence of midwifery in this country. It is difficult to engender trust and professional collegiality without first removing barriers to diversification of our profession, ensuring that every Black aspiring midwife is aided and supported along their professional pathway.
Adapted with permission from the California Affiliate of ACNM (CNMA), with contributions from ACNM’s Midwives of Color Committee (MOCC) and Michelle Drew, chair of ACNM’s Black Midwives Caucus.
References:
Further Learning:
Constructing the Modern American Midwife: White Supremacy and White Feminism Collide by P. Mimi Niles and Michelle Drew
ON SALE IN FEBRUARY! Into the Light of Day: Reflections on the History of Midwives of Color Within the American College of Nurse-Midwives by Linda Janet Holmes, MPA – proceeds go to The A.C.N.M. Foundation’s Midwives of Color Scholarship Fund
ACNM’s Diversity, Equity, Inclusion and Belonging efforts, including our Anti-Racism Roadmap for Change
Eliminating the Racial Disparities Contributing to the Rise in U.S. Maternal Mortality: Perspectives from the American College of Nurse-Midwives (ACNM), Black Mamas Matter Alliance (BMMA), and International Confederation of Midwives (ICM)
Racism, Antiracism, and Racial Equity article library in the Journal of Midwifery & Women’s Health
A HISTORY OF MIDWIFERY IN AMERICA (original post)
CNMA is working towards becoming an antiracist organization. In 2019 new bylaws were approved that recognize CNMA’s responsibility to actively address racism and the resulting health inequalities suffered by communities of color. Importantly, we must actively support efforts to increase racial diversity in our profession while engaging actively in self-education. “Spotlight on Antiracism” is a new section of the newsletter where you will find a monthly educational offering. We encourage our membership to check it out and share widely in your workplaces.
For Black history month we are going to take a moment to uplift and celebrate the importance of Black Grand midwives and the important roles they played in both caring for their community and keeping midwifery tradition and skills alive in the United States. We encourage you to learn about and celebrate: Mary Coley, Onnie Lee Logan, Margaret Charles Smith, and California’s own Biddy Mason. These midwives and the legion of their unnamed counterparts are directly responsible for helping keep the science and art of midwifery alive in this country. We celebrate them and thank their spirits for their contribution to midwifery. Their perseverance and dedication to serving their communities in the face of racist and xenophoic attacks on midwifery intended to denigrate them and eradicate their role in the community is an inspiration.
In colonial times, reproductive health care was provided primarily by midwives: Midwifery was practiced by Indigenous people native to North America, and midwifery practices were brought to the United States by enslaved peoples of African Descent and by European immigrants. Trained through apprenticeship, by generations of experienced family members or peers, these midwives provided safe and affordable care to pregnant people in their community. For many years the practice of medicine did not encompass the work of reproductive health care; however, in the early 1800’s the medical field of obstetrics began to develop and white male physicians recognized midwives as competition, an impingement on profit and stature.
A concerted anti-midwife campaign developed; playing on racist and xenophoic tropes painting foreign-born and Black midwives as illiterate, careless, lazy, incompetent, unclean and a danger. This resulted in the 1921 passage of the Sheppard-Towner Act. The federally funded statute intended to provide funding to improve outcomes for infants and birthing people required that states regulate their midwifery workforces. The statute funded the white male obstetricians and white female public health nurses to “educate” community midwives in normal birth and act as gatekeepers to determine which community midwives were deemed appropriate care providers. As Danielle Thompson notes, “This meant that, in one of the most racially charged eras in American history, the livelihoods of many women of color were placed directly in the hands of White actors already negatively disposed toward them for both social and competitive reasons.” Despite these concerted attacks on midwifery as a profession and Black midwives in particular, Black Grand midwives continued to serve their communities. As of 1918, almost 90% of southern Black births were still attended by Black midwives.
Only 21 years later, Mary Brekenridge founded the American Association of Nurse-Midwives (AANM). An active white supremist, she did not allow membership of African American midwives. This organization became part of the newly created American College of Nurse-Midwives founded by Hattie Hemshemeyer with the aim to create a professional midwifery organization open to all nurse-midwives regardless of race. Unfortunately, the effects of the medical establishment’s racist and xenophoic smear campaign and the racist foundation of nurse-midwifery persist today. As of this writing, the midwifery profession is still over 90% white; we attend only 11% of births and our clients of color, especially Black birthing people, suffer hugely disproportionate disparities in health outcomes. As nurse-midwives we must learn about, acknowledge, and make reparations for the specific role anti-Black racism has played in the history of our profession. We must uplift and celebrate the Black Grand midwives who were foundational in the persistence of midwifery in this country. We must remove all barriers to diversification of our profession ensuring that every Black aspiring midwife is aided and supported along their path.
In honor of Black History Month and in celebration of Black Grand Midwives, we offer the following readings to learn more about the history of midwifery in the United States.
Constructing the Modern American Midwife: White Supremacy and white Feminism Collide by P. Mimi Niles and Michelle Drew