Birthing a Slave: Motherhood and Medicine in the Antebellum South (review)

This engaging and well-researched study of enslaved women's reproductive health in the antebellum South adds considerable detail and a new emphasis to what is now a growing literature about daily lives under slavery. Marie Jenkins Schwartz of the University of Rhode Island builds on her earlier study of enslaved children (Born in Bondage: Growing Up Enslaved in the Antebellum South, 2000) to focus here on women—from fertility and pregnancy, through childbirth, to postpartum gynecology, and at the end, cancer. She uses slaveholders' records, physicians' case records, and accounts by slaves, former slaves, and their descendants to uncover individuals' struggles with illness. The stories that fill the pages of the book are vivid and poignant and reveal some harsh aspects of life under slavery that have not elsewhere been so fully described. Schwartz is most concerned with examining the different perspectives of slaves, their owners, and their health-care providers. She emphasizes also that slave women, who were both workers and reproducers of the enslaved work force, sometimes had points of view and needs that differed from those of enslaved men. She pays attention to both indigenous practices and regular medicine and understands how various systems of health care often acted together. She repeatedly demonstrates that physicians worked within the slave system, and even bolstered it when slave owners hired (and often constrained) their medical services for blacks. The book ends with a chapter demonstrating that emancipation drastically changed the health care available to the freedwomen.

Schwartz's framework complements the work of Todd Savitt, Steven Stowe, and Sharla Fett. Slaveholders' need for women to "breed" created particular points for medical encounters, including at conception (why were some women not getting pregnant?), during pregnancy (why could some women not carry to term?) and childbirth (why did some women have difficulty with or find it impossible to effect a vaginal delivery?), all of which carried significant economic implications. The physicians' role was generally to solve the medical problems and return the women to production and reproduction. Slaves often resisted medical treatments or secretly substituted their own traditional practices, which Schwartz explores, setting up a health-care dialectic that expands our understanding of the period.

Schwartz engages many issues of interest to medical historians. She provides a quotidian, ground-level view of medical practice, and she addresses the perennial question of southern medical distinctiveness with a new eye. Rather than seeking to understand whether or how the medical theory or therapy of southern doctors differed from that of their northern or western colleagues, she finds a distinctiveness in the common southern practices particular to enslaved women. Because physicians often attended their first childbirths at the bedsides of slaves, and because they often tested new therapies and surgical techniques on the same women, medical men learned on bodies that were not equally accessible to northerners. Antebellum physicians worked within the particular system of slavery, often bending to its needs, believing (or acting as if they believed) that a black woman's destiny was to serve her owner. Thus southern medicine was distinctive in the repeated collaboration that physicians offered to slaveholders to maintain the economic value of black women. When Dr. E. R. Mordecai of Mobile, Alabama, surgically repaired a postpartum perineal tear in sixteen-year-old Sally, for example, he took credit that she thus became able to resume her duties under bondage.

The book is a compendium of powerful stories of women affected by the combination of slavery and medical practice. Sometimes the stories overtake the thematic analysis, but as a whole they work to open a window onto a subject of great historical importance. The book is readable and accessible to student and...