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78 Dr. Hilla Sheriff Caught between Science and the State at the South Carolina Midwife Training Institutes Patricia Evridge Hill • • • Committed to “scientific” models of modern childbirth but restricted by inequities that denied almost half of South Carolina mothers access to hospitals or physicians, black and white medical women created an alternative form of maternal and infant health-care delivery during the middle decades of the twentieth century. Unlike many physicians and public health officials who blamed midwives for high infant and maternal death rates and sought their eradication, Hilla Sheriff (1903–88) recognized that eliminating lay midwives from a segregated South would deny most African American women access to any form of legal medical assistance during and after their deliveries. Sheriff, who headed the state board of health’s Division of Maternal and Child Health or supervised its director from World War II until her retirement in 1974, chose instead to focus on improving training for midwives as a temporary measure until African Americans could have access to a better health-care system. Beginning in the early 1940s, state law required South Carolina lay midwives to attend a summer institute every four years. New midwives attended every summer for four years, then every fourth year. Most counties also required attendance at monthly meetings with a public health nurse. By the middle decades of the twentieth century, an overwhelming majority of South Carolina’s midwives were black women who served rural African American families in the southeastern portion of the state. These lay practitioners were required to attend formal two-week midwife training institutes. A handful of white midwives from South Carolina’s northwestern counties attended less formal training ses- Dr. Hilla Sheriff 79 sions organized by county public health officers or visiting nurses from the state board of health. Between 1940 and 1965, Dr. Hilla Sheriff institutionalized and modernized the medical training received by the state’s midwives. She enlisted African American nurse midwives Maude E. Callen, Eugenia Broughton, and Eula Harris to design and deliver the bulk of a program that maintained the legitimacy of lay midwives and raised their status among peers and patients. Neither the black nurse midwives who influenced the daily direction of the training institutes nor Sheriff and the other white physicians and public health nurses who offered organizational expertise and state resources considered the institutes an adequate response to the consistently high maternal and infant death rates in South Carolina ’s Lowcountry counties. Their respect for lay midwives should not obscure their preference for hospital births (or “normal” home births with a physician or nurse midwife in attendance). Caught between the requirements of science and those of the state, South Carolina medical women, led by Hilla Sheriff, chose pragmatism as a short-term strategy. South Carolina’s most highly decorated public health official—Sheriff’s accolades included the American Public Health Association’s Ross Award in 1969, the Order of the Palmetto in 1975, and the Medical University of South Carolina’s Distinguished Alumni Award in 1981— is most often associated with the eradication of endemic pellagra, pioneering contraceptive research for the Milbank Memorial Fund, and an examination of toxoplasmosis and other forms of household poisoning. Yet she touched as many lives through a compromised yet workable program to train and license lay midwives.1 Historian Johanna Schoen has noted that health and welfare officials throughout the twentieth-century South operated “within a larger political context of deep suspicion toward any services for the poor.”2 In South Carolina, elected officials had a long history of neglecting the health-care needs of African Americans and poor whites. By working together to create what they perceived to be a transitional alternative to integrated health care, Sheriff and the medical women she supervised both improved maternal and child health and nurtured expectations of social change. Born in Pickens County, South Carolina in 1903, Sheriff remained quite close to her large family throughout her life. The fifth of seven children, she never remembered being steered toward a particular career or directly pressured to live a conventional middle-class life as a wife and mother. Two of Sheriff’s sisters taught school. One also married and raised a family; the other remained single. A third sister married, had children, and devoted a great deal of time Dr. Hilla Sheriff Courtesy of South Caroliniana Library, University of South Carolina, Columbia, S.C. Dr. Hilla Sheriff 81 to medical and educational philanthropy, as had her mother. John Washington Sheriff...


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