Forgotten History: How White Ego Drove Black Women Out of Childbeds

10 min readAug 24, 2020

Americans drop more cash on health care annually than any other industrialized nation, but more of our babies and mothers die as a result of childbirth than almost any other wealthy country in the world.

On the list of 36 OECD countries we rank 33rd, with only Turkey, Chile, and Mexico logging more childbirth related deaths. Our black moms are also 3x more likely to die of birth complications than their white peers, which means a disproportionate percentage of lives lost are women of color. Part of the reason? Our country’s two oldest, baddest habits:

Racism, and labeling gifted women “witches.”

To truly appreciate this forgotten story of human fuckery, consider that midwifery is the healing art upon which the human race is built. Practiced in some form or another since before the ancient Egyptians depicted it in art, it’s still a thriving, very effective branch of women’s medicine today. In modern Denmark, France, and Sweden, midwives deliver about 75% of all babies born. In Britain and Ireland it’s close to half. In the United States, however, only 10% of babies and new mothers are tended by midwives.

Why?

Because in the 1800s black midwives were outperforming America’s white medical doctors at successful childbirth, so our domestic doctors threw an epic, industry-wide Chadfit about it.

[Disclaimer: Side effects of United States history may include facepalming, high blood pressure, cursing, despair, and/or desire to live off-grid. Reader discretion is advised.]

So let’s set the scene. We’re in the Antebellum South and slavery is at its peak. There are a LOT of mosquitos. Our developing nation is being built and cultivated by thousands of enslaved people of color. Wealth is measured not just in money, but also by how many slaves a man possesses. Slaves who birth healthy babies — and don’t die in the process — increase their master’s net worth exponentially. Imagine a $100 bill duplicating itself every 9 months…that’s how owners saw enslaved women of childbearing age.

For this reason, medical care for pregnant women was a thing most slave-owning men were surprisingly okay with. Affluent white men didn’t know much about delivering black babies, however, nor did they want to. So midwives, some of them free women of color but the majority other enslaved women, got the gig. And they were pretty damned good at it.

Too good, it turns out.

EGO VS. ETHICS

Traditional African and indigenous medicine, the primary tools of enslaved midwives, approached healing bodies more holistically than 19th century “western medicine.” Midwifery — admittedly hindered by the unsanitary conditions slaves and poor people were forced to deliver in — focused on nurturing healthy pregnancies likely to produce thriving mamas and babies. During the delivery process plant medicine, massage, and body positioning were used to reduce pain, infection, and hemorrhage. Midwives educated new mothers on proper nutrition, techniques for newborns who didn’t want to feed, healthy sleep schedules, and proper care of post-delivery ladyparts. They were also keepers of knowledge about birth control, menstrual cycles, and pain management.

Doctors, by comparison, leaned on patent/prescription medicines, medical devices like forceps, and surgeries. Many of these “medicines” and devices were creations of the doctors, which sounds okay…but keep in mind this was the 1800s. So these creations had little valid research behind them, and zero professional oversight to make sure they were, you know, not deadly. With safe caesarean sections still decades away and Germ Theory not yet accepted by all doctors, mothers in the care of MDs were regularly exposed to unsterilized medical tools, toxic chemicals, and rough treatment at the hands of “men of science” who were still 100 years away from researching how the female body works. Medical professionals who did not work in obstetrics wrinkled their noses at it all, criticizing gynecology/obstetrics as “messy” and “immodest” work.

(Because the vagina is so gross even doctors should avoid it.)

Unsurprisingly, mothers working with black midwives tended to fare better than those allied with doctors. This isn’t to say they never lost a patient — childbirth was, and still is, a leading cause of death among women of childbearing age. In the 1800s as many as half of all children died before age 5, and 25% didn’t make it to their first birthdays. Mothers, with a death rate of between 25–40% depending on the year and location, didn’t fare much better. But midwives traumatized their surviving patients significantly less than allopaths, and boasted fewer complications. This was contrasted starkly by “childbed fever,” the post-delivery infection which killed thousands of women who delivered in formal hospital settings.

Slave masters noticed…and so did the women in their lives. Some affluent white wives went so far as to hire “Negro midwives” to handle their own pregnancies, whispering in their sewing circles about the “almost mystic” abilities of enslaved healers.

Now, if there was one thing that medical doctors did not have, but veeery much craved at this point in history, it was respect. Medicine during this century looked more like the movie Saw than TV’s Grey’s Anatomy. Doctors prided themselves as scholar scientists, but accidentally tortured and killed SO MANY PEOPLE in the pursuit of knowledge that they were feared more than trusted.

Having these black midwives, most of whom were illiterate, outshine the medical community was a bad look for Team 19th Century Docs. And Negro women undermining them to the point of being preferred by white elites? Oof. Potentially disastrous for a group of men still looking to rise to the top of American society.

So, rather than hiring or training with the “grannies” to learn why their birth outcomes were better, medical professionals began working together to destroy the good reputation of “negress midwives,” using propaganda as their primary tool.

With their fistfuls of herbs and granny aprons, midwives were easy to label “witches,” “voodoo queens,” and “superstitious fools.” Doctors wrote pearl-clutching articles complaining about the “unsanitary conditions“ midwives exposed mothers to…leaving out, of course, that Germ Theory was discovered in part because of new mothers contracting infections and dying in their own filthy hospital wards. (Seriously…Google “Dr. Ignaz Semmelweis,” and why he started demanding hand washing become a thing.)

Obstetrician Joseph DeLee decried midwifery as a “descendant of barbarism.” One Alabama internist wrote “negresses” had “fingers full of dirt.” A pair of Southern white essayists warned that herbalism — using ginger root for morning sickness or antibiotic herbs on infections — was “occultism.” (Doing so while unironically selling patent medicine versions of ginger medication for nausea in their own practices.) Novelist Charles Dickens even put white elites’ growing disdain for female healers in print, creating the character of Sarah Gamp, a drunk and incompetent nurse who underscored the dangers of letting a mere woman handle health, in his novel The Life and Adventures of Martin Chuzzlewit.

WHEN FAKE NEWS KILLS

These loud critics conveniently omitted that the “unsanitary conditions” midwives worked in were frequently the result of slave owners refusing to make purified water or fresh linens available to the humans they owned. They dismissed how black mothers, even the rare few who were free and/or wealthy, faced such extreme discrimination in hospitals they had no choice but to hire midwives for home births. And they DEFINITELY didn’t mention the experiments surgeons like Dr. Francois Marie Prevost and Dr. James Marian Sims were doing on black bodies, testing genital reconstruction surgery and cesarean sections without pain killers or sedation.

“Witchery” and “voodoo” were demonized from the pulpits of churches to the front pages of local papers, but not a word was said about the sadism of cutting women open like a pot pie while they were awake.

This anti-midwife campaign didn’t have hashtags to help it spread, but it did broadly nonetheless. Outraged legislators began the work of making it illegal for anyone but a licensed medical professional to perform home births. Midwifery wasn’t made illegal, but obstacles to becoming certified in it — expensive membership dues and licenses, for example — were put in place to make sure few women of color could actually practice it. Funding for schools teaching midwifery was cut. Programs to teach freed people of color how to read were abolished.

These combined efforts eroded and then eradicated midwifery. By 1900, white male physicians or their nurses were tending more than 50% of all births in the United States, and 95% of white middle-and-upper-class births. But as midwives were driven from their profession, neither infant nor mother survival improved much.

WELCOME BACK(?) TO THE PARTY

It wasn’t until 1910 that men of power began calling out just how shit the medical profession was, and how it was failing women. This was the year that The Carnegie Foundation for the Advancement of Teaching published Abraham Flexner’s scathing report on medical education in North America. Flexner blasted the majority of our nation’s medical schools as both unscientific and unethical, making such a strong case that many were forced to close. And though he was by no means anti-racist, even Flexner noted how systemic racism was idiocy:

“The physical well-being of the Negro is not only of moment to the Negro himself. 10 million of them live in close contact with 60 million whites. Not only does the Negro himself suffer from hookworm and tuberculosis; he communicates them to his white neighbors, precisely as the ignorant and unfortunate white contaminates him. The Negro must be educated not only for his sake, but for ours. He is, as far as the human eye can see, a permanent factor in the nation.” — Abraham Flexner

Two years later The Federal Children’s Bureau was founded in an effort to improve birth rates. The group also began funding targeted research on women and children’s health. (Medicine had previously treated both as identical to adult men, but smaller, which is not how science works.) By 1914, women in medicine like Dr. Eliza Taylor Ransom began working to force — yes, they had to force — pain management and “twilight sleep” during gynecological procedures, including pregnancy complications.

But even with these seismic shifts in medical culture, and “witches” barred from participation, our mortality rates remained rock bottom. In 1918 the United States ranked 17th out of 20 industrialized nations.

It wasn’t until AFTER women won the right to vote on issues pertaining to their bodies that America got healthier mothers, heavier babies, and fewer deaths. Soon after the 19th amendment was ratified, the Sheppard-Towner and Infancy Protection Acts became laws, providing the first federal funding ever for maternity and child care.

The American Board of Obstetricians and Gynecology was established in 1930 as part of an organized maneuver to push general practitioners/internists out of child birthing. (They’d had 50 years to audition as the keepers of maternal health, but proved themselves to be both tone deaf and uncoordinated.) The ABOG even began welcoming midwives back into the art they developed, cultivating collaborative relationships between practicing gynecologists and midwives.

By the time the baby boom hit in the mid-1940s folks were happy they had — it was all hands on deck in the delivery room. Midwives, OB/GYNs, nurse practitioners, and even the occasional doula started working together on the regular to make sure the country’s Baby Boomers were born safely. The American College of Nurse Midwives was even founded, something which marked the midwifery profession’s official comeback. But black midwives, unsurprisingly given segregation, got few party invitations. The few black midwives in the country were sectioned away from mainstream medicine, seen mostly as a resource for the poorest and blackest people in North America.

Nearly a century has passed since this major landmark on the women’s health timeline, and while our infant and mother mortality rates are the best they’ve been since the nation was founded, our stats on black midwifery are still…well, kind of pathetic. As of 2018, just 1% of America’s midwives were black. Around 11% of practicing OB/GYNs today are BIPOCs, suggesting some women who would have previously pursued midwifery moved to the more celebrated title of “M.D.” But overall, the landscape once dominated by black excellence now pales — literally — in comparison to its origins.

Will any of this information change your life profoundly today? Unless you’re pregnant and trying to choose between a midwife or a doctor, probably not. But we are living through a present where whether equality exists — and where it definitely does NOT exist — is being discussed fervently on a daily basis. And that’s where obscure, forgotten history like this can actually be valuable.

We see in this weird, 100+ year narrative how women didn’t experience changes in their health or birth outcomes until they became legal voters with active roles in government. And we also witness just how long some of our choices effect millions of people. It’s been around 90 years since black midwives were successfully targeted and labeled “witches,” but the consequences — some of the worst birth statistics money can buy — are still very, very much with us.

Human Fuckery Podcast, New Orleans’ favorite dark history show, believes in doing your own homework. To check how we did on this article, you can start with the following list:

America’s Health Rankings; The United Health Foundation

https://www.americashealthrankings.org/learn/reports/2018-annual-report/findings-international-comparison

Birthing, Blackness, and the Body: Black Midwives and Experiential Continuities of Institutional Racism

https://academicworks.cuny.edu/cgi/viewcontent.cgi?article=1422&context=gc_etds

PATTERNS OF CHILDHOOD DEATH IN AMERICA

https://www.ncbi.nlm.nih.gov/books/NBK220806/

Child and Infant Mortality Data

https://ourworldindata.org/child-mortality

“Black Physicians and Black Hospitals”

https://web.archive.org/web/20161002104238/http://medicine.missouri.edu/ophthalmology/uploads/ch06.pdf

“Abraham Flexner and the Historians”

https://pubmed.ncbi.nlm.nih.gov/2179404/