The Importance of Black Midwives, Then, Now, and Tomorrow

We see it and read about it in the news a lot these days -- Black mothers are dying around the time of birth three to four times more than white mothers, and Black babies are dying at twice the rate as white babies. This is not a new crisis; but the urgency, the attention, and the collective action that it has prompted from people across all races is new, it's growing, and people are demanding action. 

Midwives, and specifically Black midwives, for centuries have played a critical role in improving the care and outcomes for Black families. At the same time, Black midwives have also faced extra, unnecessary, and often extreme and insurmountable challenges to practicing and serving the families in need of their care. 

In honor and recognition of Black History Month, and in recognition of the work that's done by organizations and individuals that fight for the lives of Black mothers and babies every month, we are sharing information about Black midwives, including – and most importantly -- what you can do to help increase the number of Black midwives in the United States. 

History of Black Midwives

"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."

-Shafia M. Monroe, DEM, CDT, MPH

When Europeans brought African slaves to the United States in the early 1600s, along with them came 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. I encourage you to learn more details about the history of the African American midwife by watching the video presentation by Shafia M. Monroe, renowned midwife, a doula trainer, motivational speaker, and cultural competency trainer.

Common Threads

Over the years, studies and research have been done to determine the cause of the disparity in health for Black mothers and babies. Many believed it was due to poverty and poor lifestyle habits, but time and again, results from studies showed that this was and is not the case.  

"Education and income offer little protection. In fact, a black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth-grade education." 

-Linda Villarosa, New York Times

Villarosa goes on to explain:

"For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions — including hypertension and pre-eclampsia — that lead directly to higher rates of infant and maternal death. And that societal racism is further expressed in a pervasive, longstanding racial bias in health care — including the dismissal of legitimate concerns and symptoms — that can help explain poor birth outcomes even in the case of black women with the most advantages." 

Shafia Monroe, dubbed “Queen Mother of a Midwifery Movement, is a pioneer who has worked since the 1970s to reduce the high Black infant and maternal mortality rates. She writes on her blog about the common threads causing Black maternal mortality:

• Ignoring Black women’s plea for medical attention.
• The unconscious bias against Black women.
• Dismissing the health care needs of pregnant and postpartum Black women.
• Not believing Black women when they say, “something is wrong.”
• Allowing Black postpartum mothers to die.

What Can Be Done - How Black Midwives Can Help

Since the 1960s and 70s, midwifery has seen a resurgence in popularity, growing slowly as a recognized, viable, safe, and good option for most people. Since the beginning of 2000, the number of births attended by midwives has been steadily increasing. Alongside this, several organizations have been working to increase the presence of Black midwives and access to these midwives in order to improve outcomes for Black women and babies. 

There is a well demonstrated need for health professionals who share common bonds with and understand the needs of people of color. Simply put, for example, when Black families are cared for by Black health professionals, like midwives, they are better heard, seen, respected, understood, and get their needs met, which relates directly to health outcomes.  

How You Can Help

If you are a person of color and are called to be a midwife or doula to serve your community, now is the time! To learn general information about becoming a midwife, visit the Midwives Alliance of North America. For a list of scholarships for birth workers of color, check out this list from the Grand Challenge, these scholarships from Mercy in Action, and these resources from the American College of Nurse-Midwives. 

If you are not called to midwifery, there are plenty of things you can do to support the work that’s being done by Black midwives and other midwives of color. Here’s a simple, three-pronged approach:

• Spread the word - The simplest, first step. Get the word out about the problem on social media and in your local and far-reaching networks. Learn and share specific stats on the mortality rates in your area. 
• Support your nearest or favorite midwifery school or program, specifically requesting to support funding or scholarships that benefit midwives of color. If you cannot donate funds directly, consider how you can initiate or support fundraising in your community.
• Support in other ways, like donating to organizations making a difference (see below) or working as a mentor if you are currently a midwife or doula.

For more information on how to support birth workers of color, visit Grand Challenge.

Organizations Making a Difference

This is far from an exhaustive list, but the following organizations are doing incredible work to engage and solve the problems Black families face. If you’re looking for a place to start to engage or send a check, consider one of the following groups.

• National Black Midwives Alliance
• National Association to Advance Black Birth
• Sista Midwife Productions
• Black Mamas Matter Alliance
• Sister Song

References

A Historical Development of Midwifery in the Black Community: 1600-1940. Sharon A. Robinson, CNM, MS. Journal of Nurse Midwifery. 1984.

Why America's Black Mothers and Babies Are in a Life-or-Death Crisis. Linda Villarosa. New York Times. 2018.

African American Nurse Midwives: Continuing the Legacy. Anitra Ellerby-Brown, MS, RN, CNM, Trickera Sims, MSPH, RN, and Mavis Schorn, PhD, RN, CNM. Minority Nurse. 2008.

Specializing in Normal: An Overview of Midwifery in the US. Lucille Tower. Portland State University. 2015.

A Scholarship Solution and Grand Challenge from Mercy in Action. Birth Workers of Color Scholarship. 2013.

Slavery in America. History.com Editors. 2019.

The History of Midwifery. Judith P. Rooks, CNM, MPH, MS. Our Bodies Our Selves.org. 2014. 

Birthing, Blackness, and the Body: Black Midwives and Experiential Continuities of Institutional Racism. Keisha L. Goode. CUNY Academic Works. 2014.

https://journals.sagepub.com/doi/pdf/10.1177/2158244017752220

The Midwife Said Fear Not: A History of Midwifery in the United States. Helen Varney Burst RN CNM MSN DHL (Hon.) FACNM and Dr. Joyce E. Thompson DrPH RN CNM FAAN FACNM. Springer Publishing Company. 2015. 

Lessons From African-American Midwife Traditions. Kristal Brent Zook. NPR. 2005. 

Ending Black U.S. Maternal Mortality. Shafia M. Monroe. 2018. 

America Is Failing its Black Mothers. Amy Roeder. Harvard Public Health. 2019.

Black Mothers Keep Dying After Giving Birth. Shalon Irving's Story Explains Why. Nina Martin. NPR. 2017.