Blog: Continuing the Legacy of Granny Midwives

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Authors: Angela Taylor, MPH, Tonantzin Juarez, MS, Brandon Azevedo, MPH

In the United States (U.S), the maternal mortality rate is higher than that of other high-income countries. In 2020, the maternal mortality rate in the U.S. was 24 deaths per 100,000 live births compared to 1.2 deaths per 100,000 live births in the Netherlands (the lowest out of all high-income countries). Further, Black women are three times more likely to die from birth complications than White women. Midwives are trained healthcare professionals specialized in pregnancy, childbirth, postpartum, sexual/reproductive health, and gynecological health, whose model of care is associated with reduced maternal mortality and positive birth outcomes, such as a decrease in the use of birthing interventions and an increase spontaneous vaginal births. However, Black women often lack access to midwives, especially Black midwives, who historically have been integral in Black communities. In fact, 80% of Black births were attended by midwives in the 1930’s, compared to only 9% in 2020. This Black History Month, we are highlighting the midwives of the Deep South who were instrumental in Black maternal health, including Mary Coley, a “granny midwife” who helped rural women in Georgia for 30 years.

Who Were Granny Midwives?

The terms midwife, granny midwife and granny largely describe the Black midwives that cared for pregnant Black women in the rural South. Their origins come from enslaved individuals brought from West Africa who were experienced midwives and continued to practice and train other women. These women became the primary source of birth care among enslaved individuals and were respected members of their communities. After Emancipation, the work of granny midwives continued in rural and remote parts of the South, as Black women had at home births to avoid discrimination at hospitals and avoid monetary costs, as granny midwives at times accepted food or even chickens as payment.

Even though the introduction of obstetrics in the early 1800s largely replaced the role of the midwife in rural America – and in particular, in Black communities, – granny midwives remained essential. However, policies enacted in the 20th century removed granny midwives from being primarily involved in maternity care and increased surveillance on the profession. Part of the Sheppard-Towner Maternity and Infancy Protection Act of 1921 required midwives to be licensed and trained. This regulation echoed a common stereotype that Black women weren’t clean, thus responsible for infant and maternal deaths. The Hill-Burton Act of 1946 gave grants and loans to hospitals and other healthcare facilities, which led to the rise of women, including Black women, giving birth in hospitals, further alienating granny midwives. The impact of surveillance resulted in a decline in the workforce, especially in Georgia, where there were 3,000 registered midwives in 1930 and 1,322 in 1950. The decline has also continued over the past 80 years in the U.S. In 1940, there were 115,000 midwives and informally trained nurses, and as of February 2022, there are only 13,524 midwives.

Mary Coley 

Mary Francis Hill Coley is a significant figure in the midwifery movement. She was born on August 15, 1900 in Baker County, Georgia. After moving to Albany, GA in 1930, she became interested in midwifery and was trained via apprenticeship by Alabama midwife Onnie Lee Logan. During her 30-year career, “Miss Mary” delivered more than 3,000 babies and is recognized for crossing racial lines, helping both Black and White mothers deliver their babies, as well as helping those underserved and most in need. Mary would also help families beyond the delivery of the baby by helping with cooking, cleaning, and completing and submitting forms to the county health office.

Mary Coley was the focus of a 1952 documentary titled, All My Babies. The film followed Mary for four months and showed the preparation and delivery of babies in rural and poor conditions in collaboration with local nurses, physicians, and community members. It is well-known within the midwifery community and has been used for midwife training. In 2002, the Library of Congress selected the film for the National Film Registry as “a culturally, historically and artistically significant work.” In March 1966, Mary Coley died, but her legacy of being an advocate for healthy babies and connector between community members and the traditional healthcare system lives on today.

Midwives Are Needed For Black Women

Granny midwives understood the importance of a community model of midwifery and its role in saving Black women and babies. Continuing the legacy of Mary Coley and the granny midwives of the Deep South means allowing Black women to have more diverse birthing options and access to midwives in order to improve maternal health outcomes. Integrating midwives into the healthcare system is one solution suggested to improve maternal health outcomes, especially for Black women. States that have a higher integration of midwives have better maternal/birth outcomes, such as lower cesarean rates, higher spontaneous vaginal births, and lower preterm births. Further, states that have a high proportion of Black births, have the lowest integration of midwives.

It is essential that there is policy alignment across federal and state laws in this area. Currently, there are different laws regarding licensure of midwives. For example, Certified Nurse Midwives (CNMs) can be licensed in all 50 states; however, certified professional midwives (CPMs) can only obtain licenses in 30 states. State laws must allow all midwives (CNMs, certified midwives, CPMs, lay midwives, and registered midwives) to practice to the full extent of their respective training and federal policies are needed to improve the midwifery workforce. In a field that is currently dominated by White women, and often leaves out Black women, we owe a historic debt to the granny midwives who paved the way for modern-day midwifery and must recognize their role in today’s current efforts for birth equity.