Radical Figures in Health History: Margaret Charles Smith and Grand Midwives

Posted on 9.14.2012 by Kelly

“I'd have sometimes 4 babies a night...I'd wade in water up over my knees to get to people's houses.”

So Margaret Charles Smith described her work as a midwife, catching 3,500 babies in Greene County, Alabama throughout the early to mid-twentieth century. Margaret was part of a tradition of primarily black healers called “granny” or “grand” midwives who attended to pregnant people in the southeastern United States. As described in a recent article from Insight Magazine, “According to chattel records, the first African (Black) Midwives arrived in America in 1619, bringing with them centuries of healing wisdom from diverse African cultures and their rich traditions of pregnancy care for women. Their knowledge allowed them to continue to care for African and white women in this country and extend this care to include the entire family. African (Black) Midwives not only provided prenatal care and 'caught' babies, but provided primary care for women, pediatric care for newborn infants and children, and medical care for men when necessary.” Grand midwives worked for very little pay and sometimes accepted trades for their services. While maternal mortality rates were high in the early part of the 20th century, there is evidence to suggest that grand midwives had exceptional records. Margaret Charles Smith, for example, did not have anyone in her care die during all her years as a midwife. However, doctors were quick to demonize grand midwives due to their lack of formal education and status as lower class women of color.

While the American Medical Association (AMA) was founded in 1847, professionalization of medicine in the United States did not truly occur until the early 1900's, influenced by studies such as the Flexner Report (1910) which set standards for medical education. Prior to this time there were many quack doctors and snake oil salesmen, but there were just as many lay health practitioners who were knowledeable and competent such as grand midwives, herbalists, and homeopaths. Indeed the treatments preferred by these lay practitioners were often less invasive than those used by the “regular” doctors who were “taught to treat most ills by 'heroic' measures: massive bleeding, huge doses of laxatives, calomel (a laxative containing mercury) and, later, opium.” (Witches, Midwives, and Nurses: A History of Women Healers). A Popular Health Movement in favor of these alternative healing philosophies thrived during the 1830's and 1840's. However, the dominance of the medical model we have today was established by events such as the founding of the AMA, the passage of medical licensing laws favoring “professional” doctors, and the previously mentioned Flexner Report, which was funded by the wealthy Carnegie foundation.

Initially, grand midwives were not seen as a threat to the burgeoning medical profession as the communities they served were largely poor people of color. However, as maternity care moved into the hospital these same low-income people were needed as subjects upon which to train new doctors. Racist and sexist attitudes about the abilities of grand midwives supported the push to limit, and eventually outlaw, their practice. Over the first half of the twentieth century, grand midwives were increasingly required to undergo training and receive supervision from state health departments.

This fascinating movie called All My Babies...a Midwive's Own Story was a training film for grand midwives produced by the Georgia Department of Health in 1952. Through the thinly veiled emphasis on cleanliness and hygiene the movie tells the interesting story of “Miss Mary” Coley and the families she served. Unfortunately many of the older grand midwives were either unable or unwilling to go through the required training and licensing requirements of southern states and were forced to leave midwifery. Eventually many of these states outlawed non nurse-midwives or pushed them into a legal gray area that made it nearly impossible to practice. Margaret Charles Smith was prohibited from practice in Alabama in 1976, when her and “about 150 other black traditional midwives were told they would be jailed if they continued to work as midwives.” (Alabama Women's Hall of Fame)

Today, non-Hispanic black pregnant folks face a maternal mortality rate nearly four times higher than that of white pregnant people. In working to address these health disparities we should look to the model of care that was provided by grand midwives of the past and gain inspiration from amazing people such as Margaret Charles Smith who dedicated their lives to the healing and care of their communities.