Overcoming Challenges

As one explanation for the longevity and centrality of lay midwifery in southern childbirth culture, chapter 11 focuses on the lack of medical support and hospital facilities available to African Americans in the Jim Crow South. It reaches back to the early twentieth century and examines the challenges faced by black medical schools and hospitals, and the establishment of the National Medical Association. The problems associated with segregated facilities and the consequences of the Hill-Burton Act failed to ease the pressures on the black medical profession. The Slossfield Community Center in Birmingham Alabama is used as a case study to emphasize the both the obstacles faced by black hospitals and physicians, and the benefits of a holistic, interdisciplinary approach to wellness.

African American Nurse-Midwives

With the greatest need for improvements of maternity care in the south, this chapter returns the focus to the southern states. The National Organization of Public Health Nurses acknowledged the vital role African American nurse-midwives played in the public health education of black women and their families and two schools were established, one of which was the Tuskegee School of Nurse-Midwifery in Alabama. Much of the chapter is devoted to the specific training required to be effective in the isolated, poverty stricken communities of the rural south and shows how cultural sensitivity was central to nurse-midwives’ work.

Cultural Motifs Persist

After a general overview of childbirth’s shift to hospital in the early decades of the twentieth century from a national perspective, the chapter narrows its focus to the Jim Crow South. The cultural motifs established during slavery are highlighted as features of African American lay midwifery. A religious calling, an intergenerational female connectedness, and authority to practice were inherent characteristics of the midwife’s role.

Epilogue

The epilogue brings hope of positive change as the American College of Nurse-Midwives and the American Congress of Obstetrics and Gynaecology work on common ground to solve the pressing issues of American maternity care. A reassessment of the essential inclusion of both macro-level and micro-level components of care leads to the conclusion that Dr. J. Edward Hill subscribes to: good health care is local and when community activism is supported by state and federal funding and integrated into the structures of medicine and politics change will happen.

Problems of Racism and Challenges to Professionalism

Despite their recognized importance to maternity care African American nurse-midwives experienced both racial and professional discrimination. This chapter underscores the unyielding obstacles of racism. Issues of segregation, unequal pay for black nurses, and lack of funding led to the closure of the Tuskegee School of Nurse-Midwifery, and the American Association of Nurse-midwives determined that whiteness was central to its concept of the professional midwife. Physician-centered maternity care was advocated as a solution to what was termed racial dualism in health care and ultimately the implementation of the wartime Emergency Maternal and Infant Care accelerated the shift toward hospital birth.

Establishing the Professional Nurse-Midwife

This chapter returns to the Progressive Era to locate the origins of obstetrics, the economic competition perceived by professionalizing medicine towards midwifery, and contrasts the US to the development of midwifery in Europe. It outlines the establishment and goals of the Maternity Center Association and introduces the new profession of nurse-midwifery.

Working with the State

Beyond their work as maternity care practitioners lay midwives fulfilled a crucial role in public health and this chapter describes their value as an extension of the state board of health. From their authoritative position in the community midwife clubs were extremely influential in organizing vaccination drives and education campaigns. The chapter discusses the state’s reliance on midwives to gather vital statistics, and the importance and consequences of submitting a birth certificate after each delivery.

Midwifery Today and Its Potential for Tomorrow

This chapter explores the strengths of modern midwifery and identifies areas of concern for the future. A strong interconceptual role is vital to improving women’s health but the lack of diversity in the profession is hindering its potential. The chapter focuses on the work of the American College of Nurse-Midwives’ Midwives of Color Committee, the United States Midwifery Education, Regulation, and Association, and the International Center for Traditional Childbirth to explore the ways in which midwifery can stake a permanent claim in the lives of American women and maternity health.

Changing Childbirth Customs

The shift towards macro-centered maternity care was not merely about improved safety in childbirth, a more complex situation is unravelled in chapter 13. Hopes for progress and inclusion and equality of access stimulated black women’s agency for change and micro level childbirth customs were adjusted accordingly. The implementation of Medicaid solidified the shift leaving licensed lay midwives in the distant past, figuratively speaking.