Delivered by Midwives: African American Midwifery in the Twentieth-Century South by Jenny Luke (review)

Jenny Luke’s Delivered by Midwives is a significant addition to the literature on this subject and on midwifery in general. Although a slim book, it provides an excellent history of midwifery in the South from the days of the “granny midwife” to the expansion of nurse midwifery in the United States. It is also a recommendation for how to improve maternal health care in the United States. Luke begins with definitions of the “macro” and “micro” elements of health care: macro elements involve medical professionals, scientific medicine, hospitals, and state and federal regulations, while micro elements are community-based, culturally sensitive, and holistic. Luke then demonstrates how both are necessary and depicts African American lay midwifery from the late antebellum period through the Jim Crow South. The African American lay midwife was empirically trained and usually understood her work as a spiritual calling, thereby personifying micro elements.

Luke draws from historical scholarship on midwifery, medical and scientific essays, professional journals like the American Journal of Nursing, autobiography and memoir—including the excellent Motherwit: An Alabama Midwife’s Story by Onnie Lee Logan and Katherine Clark (E. P. Dutton, 1989)—and personal interviews. She takes care to note the persistent and institutional racism that affected African Americans. In the South, for example, white doctors did not attend African American women who, until after World War II, typically gave birth in their homes.

In 1921, the U.S. Congress passed the Sheppard-Towner Maternal and Infancy Protection Act to respond to revelations about deplorable rates of maternal mortality and morbidity. Administered by states, the act resulted in public health departments creating midwifery programs. Students who successfully completed the training became certified lay midwives. These programs emphasized asepsis to reduce puerperal infection and the importance of prenatal care, which lay midwives facilitated by creating prenatal clinics. White public health nurses who worked with African American lay midwives found much to admire: Katherine Hagquist, the supervisor of midwifery control in Texas, wrote in 1924, “almost without exception [the African American midwives] were eager to attend classes of instruction” (35). Few went on to attend nursing school to become registered nurses, however, because their education in the segregated public schools of the South was so deficient that some could not even read.

A few black women, northern and southern, underwent training by the Maternity Center Association (MCA) of New York City to become certified nurse midwives (CMNs). Physicians on its board began a school for professional nurse midwives who would practice under a physician’s supervision at the MCA’s neighborhood maternity center. Immediately, however, a number of physicians protested on the basis of well-circulated, but largely untrue, stories about the ineptitude of midwives. In 1945, Tuskegee University, founded by Booker T. Washington in 1881 to prepare African American youth for various trades, expanded its goals and programs over time and opened the Tuskegee School of Nurse-Midwifery.

By the second half of the twentieth century, more and more women of various backgrounds chose to give birth in hospitals because they believed it was the modern thing to do. States increased regulations for certified lay midwives, which eventually included a retirement age and, in the 1970s, an outright ban on them. Gradually, African American midwives were out of a job. Also in the 1970s and 1980s, more women—mostly middle and upper income white women—were interested in birth at home or in a birth center. The number of medical schools that included certified nurse midwifery training increased, as did the number of (usually white) CNMs. Their track record was quite good.

Luke explains the sometimes hostile relationship between obstetricians and certified nurse midwives, but she strongly recommends cooperation. In her epilogue she hopes that this historical perspective will encourage the medical community to “visualize the components of modern maternity care not as a balancing scale, but as onion layers, layers of micro...