According to the Mississippi State Board of Health, from 1920 until the mid-1960s midwives were at the heart of Mississippi’s public health work. In a 1994 Nursing History Review article, Susan Smith wrote, “Nurses, most of whom were white, and midwives, most of whom were black, worked together to implement the modern public health care system in Mississippi.” Paradoxically, the state regulation of midwifery that brought public health nurses into close contact with lay midwives led to the formation of an unforeseen cadre of public health workers. Beginning in the 1920s Mississippi endorsed limitations on the practice of midwifery as health officials alleged that midwives failed to maintain sanitary surroundings and used unscientific and therefore hazardous folk medicine. Nevertheless, health officers and public health nurses quickly realized that midwives afforded indispensable assistance in applying health policy in African American communities.
In the 1920s, in an attempt to regulate the practice of midwifery, the state developed an outline that dealt with the fundamentals of midwifery. Because most midwives lacked a great deal of formal education, public health nurses gave simple directions. Small groups of midwives met monthly with instructors, who provided information and demonstrated proper techniques. The public health nurses focused primarily on two areas: sanitation (cleanliness of utensils and of the midwife and future mother and her home) and the need to call a doctor for any irregularity before, during, or after delivery. Record cards documented a full history of each midwife and included confirmation of her attendance at conferences and readiness to follow directions, a log of her equipment, and notations regarding her advances in her work. By 1947, 58 percent of Mississippi’s births were still taking place in the home, and midwives attended 36 percent of those women. That year Mississippi had 2,192 midwives, all but 35 of them African Americans, and they played a pivotal role in upgrading maternal well-being in the state. The guidelines, instruction agenda, and certification of midwives by the State Board of Health helped bring about a 47 percent decline in the maternal death rate from 1920 to 1947.
In Mississippi, black midwives were the most prominent and honored members of their communities—the female equivalent of preachers. They were at the core of the time-honored healing networks in rural African American communities and served as counselors and spiritual leaders. Although already held in high esteem by their own communities, midwives rose in status among whites as a consequence of state certification.
Black mothers-to-be and some of their white counterparts favored midwives over physicians for monetary and cultural reasons. Midwives were less expensive than doctors and were willing to journey to isolated areas. They offered reassurance and assistance for expectant women before, during, and after delivery. Many midwives cooked and cleaned as well as cared for the mother and newborn.
Many African American midwives believed that they were doing the work of the Lord and thus did not insist on compensation, although a few dollars or payment in kind was standard. One woman whose husband had no money gave a cow to the midwife. In the 1920s Mississippi midwife Bessie Sutton received around $1.50 for a delivery, and when she retired “in 1962 the fee had increased to $20.” She worked because she loved people, not for the money: “If I’d a stopped ’cause they didn’t pay me, I’d a stopped a long time ago.”
Even though many nurses remarked in their reports on the indispensable public health work achieved by lay midwives, the Board of Health eventually eradicated the practice of midwifery. In an attempt to hasten the removal of midwives, Nurse Supervisor Lucy E. Massey in 1948 introduced a retirement program initially recommended by her district nurses. The arrangement promoted the retirement of elderly midwives by notifying them and their relatives that they were too old to renew their licenses and then honoring them with ceremonies. Massey suggested that these “occasions be marked by as much ceremony as possible so that the retirement would be taken more seriously.” A retirement badge was presented to midwives who were perceived as too old to practice. Any midwife who obtained this badge was known as a Mary D. Osborne Retired Midwife. When she obtained this badge, the midwife was required to return her permit and pledge that she would no longer practice, and she would wear the emblem to community gatherings and to church for the rest of her life.
Today, midwifery is still practiced in the state by two types of midwives. The first, direct-entry midwives, are often self-educated or trained through apprenticeship, attend births in out-of-hospital settings, do not have to be state-licensed, and are exempt from state medical practice laws. The second, nurse midwives, are both registered nurses and certified as midwives. Nurse midwives can deliver babies in hospitals (often in collaboration with a physician), in medical clinics, in birthing clinics, or in out-of-hospital settings such as the home. In 2012, 0.38 percent of all babies born in Mississippi were home births, delivered primarily by either direct-entry midwives or nurse midwives.
- Mississippi State Board of Health Papers, Mississippi Department of Archives and History
- National Center for Health Statistics, Trends in Out-of-Hospital Births in the United States, 1990–2012
- Laurel Lane Noel, “Midwives of Mississippi” (master’s thesis, University of Mississippi, 2012)
- Susan L. Smith, Nursing History Review (January 1994)