MIDWIFERY 
IN THE 
KENTUCKY MOUNTAINS 
AN INVESTIGATION MIDWIFERY IN THE KENTUCKY MOUNTAINS 
An Investigation 
In the late summer of 1923 I undertook an Investigation of 
midwives in certain selected mountain counties of Kentucky# 
Leslie, Knott and Owsley were chosen for this purpose# Their 
area is 373, 348 and 216 square miles respectively, and their 
population is 10,097, 11,655 and 7,820. The largest places in 
each are the county seats — Hyden with 313 souls, Hindman with 
467 and Booneville with 243, respectively. None are on a rail- 
road and in none have the coal mines, the vast industrial power 
in Kentucky, yet been developed. On one edge of Knott county 
only (the Carr!s Fork section) have a few mines been opened up 
and a branch railroad has penetrated about eight miles. Nor are 
any of these counties connected with the outside world as yet by 
automobile roads — but in Leslie and Owsley such roads leading-to 
their county seats are actually under construction. The customary- 
mode of travel, and often .the only possible one, is on horseback 
over such roads or trails as exist, through the creek beds, up 
the branches, over the gaps and ridges of the mountains. 
The topography of all three counties is somewhat similar. 
Leslie and Owsley have each a fork of the Kentucky River travers- 
ing their length, and Leslie and Knott are both more walled in, 
with steeper mountains and narrower valleys, than any part of 
Owsley but the eastern end. It has been said that there is not 
enough level land in Leslie for a tennis court, but a golf course 2 
might conceivably be located in the western part of Owsley. 
Although this region has been robbed of its most lucrative crop, 
in parts to its irreclaimable destruction, its vast primeval for- 
ests, some thousands of acres still remain and enough other natu- 
ral beauty to make a summer's traveling on horseback a not unenvi- 
able experience. 
The population is that homogeneous American stock so associa- 
ted with the Southern mountains as to need no special description 
here. The 1920 census lists 2 foreign born in Leslie (1 male and 
1 female) and 1 female in Owsley — but I never found them. Of the 
4 foreign born listed from Knott I met one—the wife of a retired 
soldier of the regular army. There are over one hundred and fif- 
ty negroes in Knott, descendants of slaves of the white population, 
and a few negro families in Owsley, who are well regarded as old 
respectable citizens, and favorably contrasted with the "foreign” 
negroes brought into the mining camps in adjacent counties. 
Fifty-three midwives were included in this investigation, 
which extended from early in July until mid-September. In order 
to see them in their surroundings and to get into natural conver- 
sation with them, all were visited in their homes. Of course 
this whole time was not spent in talking with the midwives, or 
even in locating them. A vast deal of it was taken up in talk- 
ing with the young mothers they served, as a check upon their 
statements, with the doctors and pseudo-doctors, of whom there 
are unfortunately a number, with the county judges, the school 
teachers; in speaking at picnics, in the courthouses, and to lonely 
little schools. It is impossible for a public health nurse to 3 
keep within the limits of an investIgation* A feeding case here, 
a crippled child yondert an eager young school teacher, a despair- 
ing young mother—time is consumed with all these, as well as by 
such emergencies as a miscarriage, a newborn baby bleeding from 
the umbilicus and many more* 
But the finding of the fifty-three midwives themselves 
took up more actual time than any one can realize who is not fa- 
miliar with the country* Only four lived in the county seats, 
and only five or six of the remaining forty-nine were found on 
the principal waterways. They mostly lived on the smaller and 
rougher creeks, on the forks of those creeks, up the branches 
above the forks, and at the gaps where the branches headed up. 
To see one midwife would sometimes require a detour of five or 
six hour!s riding, and then again one would meet up with four in 
less than a day. Sometimes they were not at their homes and 
thrice I rode miles out of my way to locate them with patients, 
but was never so lucky as to find them actually functioning. 
Three of the midwives in Knott county were away from home alto- 
gether and their histories gotten from married daughters whom they 
had attended* I got to the neighborhood of one * notable old mid- 
wife in Owsley only to find she had been buried the day before. 
During the summer I traveled approximately 650 miles, reck- 
oned on a basis of three miles to the hour, which is conservative 
as on some roads and with some mounts I made four* I rode in 
f 
all thirteen different horses and three mules* Among some of them 
existed every variety of sore, ringbone, kidney disorder and 
other equine complaint* Only two were even fairly good sad- 
dlers* The bridles had sometimes been pieced out with rope and 4 
the girths tied on with wire or string. The blanket was often a 
meal sack. The question of horseshoes is a burning one. In so 
rocky a country a horse should not travel after he has cast a shoe. 
But blacksmiths and forges are few and far between. I soon found, 
however, that nearly any one can put on a shoe if it has been 
turned, so I made it my custom to carry in my saddlebags a couple 
of shoes of the size worn by my horse of the hour, and turned to 
fit him. 
In much of my travel I was alone, but occasionally a fellow 
worker went out of her way to keep me company for a day, and for 
six days in Leslie county I was accompanied by Miss Caroline Whitney, 
a fourth-year medical student at Washington University, spending 
the summer at the Pine Mountain Settlement School and sent with me 
through its courtesy. Six of the midwives were visited by us to- 
gether and one by her alone, and her suggestions as to framing 
questions as well as her companionship were of great value. During 
the last two weeks I combined forces with Miss Ella Woodyard of the 
Institute of Educational Research of Teachers College, Columbia 
University. Through all of my journeyings I met with the kindest 
cooperation and cordiality from the people, official and private, 
whom I encountered. The hospitality and inspiration of the Hindman 
and Pine Mountain Settlement Schools in Knott and Harlan counties, 
the Wooton Community House, Hyden Presbyterian Center in Leslie, and 
the Presbyterian Center on Lower Buffalo in Owsley, are especially 
unforgettable. Nor must I fail to add my appreciation for the 
invariable welcome I received at many firesides, from the little 
old log cabin on a lonely creek where I stopped at sunset to the 5 
now frame houses of the more prosperous farmers in the bottom 
lands. It would not have been possible to track my midwives to 
their remote homes could I not have counted on a shelter wherever 
there was a house when falling night overtook me. Of this I was 
always assured among my fellow Kentuckians. 
In planning my tours through the three counties I tried to 
cover a substantial part of every section and this I succeeded in 
doing rather more fully in Leslie and Owsley than in Knott, \tfuich 
is larger. The midv/ives visited were thus a fair sampling of 
the counties as a whole, including old and comparatively young, 
clean and dirty, capable and shiftless. Twentv were in Owsley, 
seventeen in Leslie and fifteen in Knott. If reference is made 
to the accompanying table it will make clearer an analysis of the 
data obtained. (Table inserted at end of report) 
Fifty-two of the midwives are white and one is colored. All 
are natives of the mountains, as followss 
Knott county 15 
Owsley n 12 
Leslie ” 10 
Perry ,T 4 
Harlan 51 2 
3reathittn 2 
Jackson 1 
Lee ” 1 
Flovd ” 1 
Bell " 1 
Clay 1? 1 
North Carolina 1 
East Tennessee 1 
Virginia __1 (colored) 
53 
Their ages range from 30 to 90 years. The total age of the 53 
is 3193 years. Their median age is 57 and their average age is 
50.3 years. All have been married, five of them twice and one 6 
throe times. Eighteen are widows. These are living with their 
married children or alone on their own lands. The husbands of all 
the midwives but one are farmers. One is a storekeeper as well 
as a farmer, and one cl preacher. One is a deputy jailer, the 
midwife herself being the county jailer, elected on an independ- 
ent ticket. She lives in the county seat and keeps a boarding 
house of sixteen beds. One other midwife in another county seat 
also kept a boarding house, of eleven rooms. One, the youngest, 
aged 30, was the wife of a pseudo-doctor. She was the only one 
in whose family farming was not the primary if not the only occupa- 
tion. Of these 52 farming families all but 7 were living on their 
own land—"poor, ill-favored,” often, but their own. Farming with 
the women is as much a matter of course as with the men, so that 
practically all these midwives are farmers themselves. I found 
the preacher’s wife out hoeing another man’s land while her preach- 
er husband sat under a shade tree reading (he could read but not 
write), and the children were out of school getting wood and' water. 
One old soul of 68 on a remote creek in Knott county came down out 
of a corn patch, at an angle of 40 degrees, where she was hoeing, to 
sit with me in her log cabin and tell me the one event of her life— 
the time she had gone with her husband and sons to Ohio for a year 
and the men had worked in a tobacco factory. ”What did you do?” 
I asked. ”Nuthin’, jest kep some boarders and tuk in washin’.” 
All but 2 of the 53 midwives have had children and the num- 
ber per midwife ranges from 1 child to 16. The 51 who are moth- 
ers have had a total of 448 children, a median of 9, and an aver- 
age of 8.5. Of these they have ”raised” 332, the median raised 7 
"being G and the average being 6.3. By children raised are meant 
those reaching maturity and not necessarily those surviving to- 
day. Two midwives were not sure just how many children they had 
lost. One said she ’’didn’t rightly-know whether there were 7 or 
8 of them dead,” and one that she ’’had raised 8 and lost about as 
many.” 
Their homes vary from the windowless one-room log cabin to 
the modern frame house which has often replaced it, but generally 
speaking their homes are poor as v/ell as inaccessible. This does 
not mean that they are not often tidy, and gay with flowers. At 
least 15 homes of the 53 visited looked exceptionally neat and 
clean, although six of them were windowless log cabins. Their 
mistresses, in ages ranging from 30 to 79, matched the homes. 
Ten midwives, In age from 37 to 89, were filthy. So were their 
homes. The rest fitted in between. 
Their native intelligence appears to vary as widely as 
their houses and persons and ranges all the way from the extreme- 
ly stupid to the keenly alert. One aged 70 who could not read 
or write confided to me that she had always longed to be a doctor. 
.She was one that had no children, but two of her nephews are doc- 
tors—graduates of the Medical School at Louisville—and one is 
now specializing in dermatology at the University of Pennsylvania. 
It cannot be too strongly emphasized that the question of literacy, 
especially with the older women, has no bearing v/hatever upon 
their relative intelligence. One remarkable old woman of 86 
who had been the daughter of a schoolmaster at Booneville could 
read and write and I found her reading her grandchildren’s school 8 
books without spectacles* Another of 70 claimed that she had 
been a ’’pure scholar” in her day and ’’knew all the words in the 
blue backed speller*” Two in their sixties could both read and 
write, while a third could only read print® However, with these 
five exceptions, none of the midwives over 60 were literate. But 
12 of all the 53 midwives could read and write, 4 could read but 
not write, and the claims of 3 others to read I judged doubtful. 
The expression of one that she ’’reads print tolerable well” de- 
fines perhaps the limits of achievement of all but some 7 or 8 of 
the younger ones. One aged 72 who could not read said proudly 
that she could ’’figger”. One aged 54 who was illiterate begged 
for the state literature, anyway, as her children were all ’’schol- 
ars.” A number of them wore spectacles and I asked how they came 
by them. One, aged 59, was using a pair that had belonged to her 
father. Another a pair she had gotten from a neighbor, and a 
third told me that they could be bought now ’’from a man in Chicago 
if you sent him your age.” 
When it comes to their professional qualifications and prac- 
tices it is difficult to classify my 53 midwives because they have 
in a sense no professional status, and the origin of their obstet- 
rical practices lies in unrecorded time. As to one thing I am cer- 
tain. None give any post natal care whatever, and in that differ 
altogether from the midwives in Europe with whose work I am familiar. 
When the delivery is over and the mother is ’’fixed up” and the baby 
’’dressed” they go away and, unless something goes wrong and they 
are sent for again, or they happen to be near neighbors, they do 
not return. This is universal. Prenatal care is also unknown. 
And no nursing care, as we understand it, is given. In fact, 9 
the mother, if she can possibly do so, unually gets up after 
three or four days.> The results of this are broadcast for all 
who will to hear. 
When I asked them how they happened to begin to practice I 
usually got the same reply: "i.kep gettin* ketched”-”beinI ketched 
at places:”—”l got ketched with a baseborn child”—and one that 
’’somebody just had to be around to cotch the babies.” The econom- 
ic reasons entered in, of course, particularly with some of the 
younger women in their forties—but in the main most of the mid- 
wives did not begin their practice, It was thrust upon them. As 
* 
neighbors in a lonely country they were called upon for this as 
well as for every other emergency. 
None of the 53 had ever had any training in midwifery, and 
such preparation as they received came from other midwives. 
Practically all said that before they attended cases themselves 
they had gone about with older women, and 9 were the daughters of 
midwives. In Knott country I found a woman of 56 practicing, whose 
mother I visited later to learn that she had ’’ketched” her last 
baby the year before at the age of 90, a record she admitted 
almost worthy that of her own mother who also had been a famous 
midwife in her day. In Owsley county a midwife of 58 told me 
with pride that her mother ’’dressed” her last baby the day before 
she died at the age of 90. She had no record of the number of cases 
attended by this old Spartan—but contrary to the usual custom her 
mother had begun the practice ’’before she quit breedin’,” so it 
must have been a lengthy one. Another Owsley county midwife aged 
57 said she had learned the practice from her mother in Breathitt 10 
county, who had it from her mother who was reported to have de- 
livered over 760 babies. Still another told me her mother ’’posted” 
her and that, because of her small hands, she had begun on cows and 
pigs as a child and had ’’saved many a sow.” One said she ’’teached 
herself,” and another that she learned from watching how it was 
done when her own babies came. Several instanced the names of 
older midwives who had instructed them, and the one colored woman 
(who had belonged to a mountain family in Owsley before the war be- 
tween the states) said her mistress had been a midwife and had taught 
her. Two in Leslie, one 72 years old and one, the youngest seen, 
only 30, said that their husbands were doctors and had started them. 
But neither the husband of the older one, dead twelve years before, 
nor that of the younger, were regular physicians. 
One midwife in Owsley said her mother, her sister and her 
husband's mother were all midwives and her father, who had been a 
schoolmaster, bought ”Dr. King’s book and Dr* Brown’s book” and 
”tuk up” being a doctor. In spite of all these advantages she her- 
self had not even learned to read. In only four instances did any 
of the midwives visited profess to have gotten information from a 
book. One 68 years old in Knott county, who could read but not 
write, said she had studied a book an old doctor (?) gave her mother 
who also had been a midwife. Another in Leslie whose claims to 
read were not substantiated, had had a book. Both books were lost. 
One woman 48 years old in Knott showed me with pride a Wine of Card- 
ui advertising circular, and one in Owsley had a ’’book pamphlet” 
from the State Board of Health which a doctor had given her. 
The 30-year old one at the county seat had a Metropolitan Life 
Insurance pamphlet on Child Care. This particular young midwife 11 
stands out from amongst the rest, product though she is of their 
soil, as in some ways the most promising and in others quite the 
most dangerous, of them all. She is young and clean and intelli- 
gent, but married to a man who practices as a physician without 
any justification whatever for assuming the title of one, from 
whom she has learned many bad habits. I found a hypodermic syr- 
inge in her rubberized bag and a box of pituitrin, which she ad- 
mitted giving for retarded labor, without any conception of the 
gravity of her act. She said her husband authorized its use. 
On the title page of a medical book lying on the table she had 
written both her name and her husband’s with the title of doctor 
before each. 
The question of the practice of unlicensed physicians in 
the mountains looms as a very grave one in connection v/ith mid- 
wifery, and may as well be mentioned here. There are many such. 
I came upon five in Leslie alone. Naturally • the midwives do not 
distinguish between them and their qualified colleagues—all'are 
’’doctors” — and so not only unsafe and dirty practices are propa- 
gated as by authority, but many lives are lost because the mid- 
wife sends for a pseudo-doctor instead of a real one. 
One case told me by Aunt Tildy, the midwife who attended it, 
will serve as an illustration. The baby was ”crossed.” She 
could not reach either head or feet, and after trying all day and 
night Friday she sent Saturday morning for two ’’doctors.” From 
then until Sunday morning she and they all tried unsuccessfully to 
deliver the patient, and at last after over fifty hours of labor 
they sent to the county seat for a doctor who ’’could cut.” But 
before he reached the home the young mother had died. Had it not 12 
been for the pseudo—doctors nearer at hand Aunt Tildy would proba- 
bly have sent early Saturday for the real one and there might have 
been one less maternal martyrdom. Aunt Tildy hereself, a touch- 
ingly honest and unassuming pera.cn, seemed deeply affected by her 
loss. She described the despair of the dying v/oman at leaving her 
young family, how she called for her sister and told her to ’’take 
keer” of her little children, and how the terrible ’’miseries” ”kep’ 
up” until they had ’’kilt her.” 
Before closing the subject of the lack of preparation of mid- 
wives for their work it is pertinent to mention the instruction being 
given them today by nurses under the State Bureau of Child Hygiene in 
conjunction with the county health officers. Ten of the midwives 
among those I saw in Leslie and Knott had attended these conferences 
and several professed changes of method as a result. But I had 
every reason to think from inquiries among the young mothers that 
their unhygienic practices of many year’s standing had not been sup- 
planted by a few hours’ instruction. The only midwives I found 
who appeared to have benefited by instruction were those that phy- 
sicians had taken about and had made a special effort to teach. 
This was notably the case in Owsley and particularly so in connection 
with one physician who has unquestionably saved many lives he never 
personally reached. I found three midwives where he used to live 
whom he had had out with him over and over, who described without 
any promptings from me and with graphic illustrations how they 
scrubbed their hands, ’’trimmed and scraped” their nails, how they 
held the fundus, and one even told me how she used a ’’cheap tin pan” 
for a bedpan, as Dr. showed her to do. With the younger women, 13 
in their forties and fifties, changes are possible with pains- 
taking bedside teaching—and this would be even more the case were 
not bad practices already acquired* All of the real doctors I met 
in these counties were emphatic in urging the need there for mid- 
wives* ”We absolutely cannot do without them,” said one in Owsley — 
and ”the midwife is a necessity here,” said another. 
The length of practice varied from those who were just begin- 
ning to those who wore retiring after over forty or fifty years. 
But few felt certain in estimating their years of practice, and the 
figures they gave, like the ages of many of the older ones, are 
often approximate* The total for all 53 is 1022 years, median 
length of practice is 18 years and the average 19.3 years. 
Except only in the vaguest way none of the midwives had any 
idea of how many mothers they had delivered before birth registra- 
tion began. Many shov/ed mo the stubs of their certificate books and 
explained that the registrar had filled out the papers for them. 
Occasionally some other member of the family had done this for the 
midwife who could not write, but none had kept reliable records 
before registration. One midwife is Leslie aged 78 and on crutches, 
but still sought after, said that in her forty odd years of prac- 
tice she had ’’dressed” over 800 babies and had ’’never had to have 
a doctor yit.” Another aged 50 said she had had nearly 100 in 
eight years. Still another aged 76 was more explicit. She had 
always kept marks in a ’’day book” and when a neighbor had counted 
them up for her there were 337 in her practice of 27 years. One 
in Knott county aged 73 and with 40 odd years’ practice behind 
her had also kept marks in a book, and had over a thousand to her 14 
credit years ago when a little grandchild, who is now married and 
has three children of his own, tore up the bookc After that she 
kept no record until she began the report officially and she showed 
me the stubs of the four certificate books which the registrar 
filled out for her. That Leslie county midwife aged 72 who could 
"figger” and had practiced over 50 years was positive she had 
"dressed” exactly 590 babies. None of the others pretended to have 
any record at all of the number of their cases. 
The proportion of midwives to doctors reporting births in 
these counties is shown by the following figures for 1922 from the 
State Board of Health. 
Leslie 
1 doctor reported 41 births 
43 midwives ” 265 ” 
Knott 
5 doctors ,T 37 ” 
55 midwives " 396 n 
Owsley 
3 doctors ” 66 ” 
30 midwives " 163 ” 
An annual permit for midwife, with regulations, a-copy-of 
whieh-i-s-app-ended-t-e-tfel-s-report, had been given to those 10 of my 
53 who attended the classes of instruction under the Bureau of Child 
Hygiene and the County Health Officers. All the midwives sending 
in birth certificates are registered with their local registrars 
in accordance with the act regulating and licensing midwives in 
Kentucky which was passed by the 1920 legislature and adopted July 
12, 1920. 15 
The ten instructed midwives claimed to be using the silver 
si’-rate solution provided by the state, and two others said they 
were using it, one stating that a doctor had given it to her. None 
of the others had ever seen the solution although a few had heard 
of it. A number of them recalled cases of baby’s sore eyes, and 
one in Knott county said she made ’’yellowroot tea” and put it in the 
baby’s eyes. Two of the health officers told me that cases of oph- 
thalmia neonatorum were rare in their counties—but that many evi- 
dences of venereal disease appeared in the mountains with the open- 
ing of the mines. 
Equipment is a minus quantity in mountain midwifery. Among the 
ten who had been instructed by the Bureau of Child Hygiene Nurses 
seven claimed to carry bags, but of these two could not produce the 
bags because they were "worn out.” One of these began graphically 
describing the articles that hers contained as we sat at her cabin 
door, but when I asked to see them the brush was lost, the oilcloth 
left somewhere, she was out of lysol, and did not have any eye drops. 
Of the remaining five midwives one had a small, old, dirty leather 
handbag with silver nitrate in it, one a similar equipment plus a 
paper of straight pins; a third the same plus a bottle of ergot and 
ono of lysol, a fourth had a clean bag of striped washable cloth 
with her birth records, the silver nitrate, and a clean white 
apron in it, and a fifth was the young woman of 30 (wife of a 
pseudo-doctor) whose rubberized bag with flowered lining had the 
hypodermic syringe and pituitrin in it, as well as bottles of 
iodine, ergot, bichloride, the silver nitrate and some cotton. 
One of the midwives taken about by Dr. aforementioned 16 
bold me she had a handbag with her own scissors, thread and 
scorched rags (folded in), all wrapped in ’’white silk paper.” But 
I found her in the woods gathering brush, after visiting her empty 
homo, and did not like to ask her to return so far with mo, and so 
could not verify her statement. Still another midwife pulled 
some roots out of.her apron pocket and said she took those. None 
of the rest of my 53 pretended to any equipment v/hatever—counting 
on finding at the patient’s home the hog grease which is their one 
almost universal requisite. 
The fees charged varied, apparently at random, in all but two 
cases, from two dollars to five dollars. Several midwives said 
they made one charge for neighbors and another for people farther 
off, and some said they asked more when the confinement was a 
long one. Only one mentioned as small a sum as $1.50, and only 
one charged over $5. That is the wife of the pseudo-doctor afore- 
mentioned who had a hypodermic and gave pituitrin; she charges 
$10. From $3 to $5 were the usual fees. 
I come now to a description of the obstetrical practices of 
these midwives as they went over them with me sitting on the splint- 
bottomed chairs or the steps of their homes* From some of them I 
learned nothing because they were frightened or shy or extraordi- 
narily reticent. Others poured out their experiences spontaneous- 
ly. A very few, like Aunt Tildy, described some of their worst 
cases and asked what they should have done. Several talked con- 
stantly of other midwives and their mistakes. ”1 never had a 
woman with childbed fever—but Mrs. K. has ’em.” I never lost a 
woman but Aunt Nora has lost throe” —”I never sent for a doctor 
yit, but Beck has to send for 'em”—and so on. 17 
In reply to my questions ns to when they send for a doctor 
I got frequently a protest against the very idea* "Never had to 
call a doctor yit" is a common phrase, spoken proudly by women pro- 
fessing to practice from 20 to 40 years„ Only 18 spoke as if they 
ever recognized the need for medical assistance in any but cases so 
exceptional as to stand out above the rest* They sent without dis- 
crimination for real or pseudo-doctors but the ones readiest in send- 
ing were on the whole the ones who could reach real medical assist- 
ance—and I think most of the pride in getting along without it 
came from those who had never known it. One said she never sent 
for a doctor because there were not any within reach. Several spoke 
of the cost as prohibitive—30 or 35 dollars—because of the distance. 
Only 7 had ever seen forceps applied. Several of the older ones, 
who had had hundreds of cases, said they had never had one where the 
woman could not deliver herself, with their assistance. Seven mid- 
wives had had a doctor, or a pseudo-doctor, on only one occasion- 
one in Owsley to get an afterbirth that had "growed to the womb,” 
one in Leslie because "the baby was dead, and had growed to her 
backbone, and the doctor had to put her to sleep and pull it loose." 
Still another because the woman had "fits"—thirteen before the doc- 
tor arrived and one after. Baby and mother lived, she added, and 
two other babies have come since without convulsions. 
Three other midwives sent upon one occasion each for doctors 
because of the woman1s advanced age for having the first baby. 
One said the mother was "right old" and added she had passed her 
twehty-second birthday. Questioned as to why she called that old 18 
she replied "they calls it old." Another said her patient had 
been an "old girl" when she married and was twenty-two or three 
when the baby came and "wouldn't mind her noway.” Asked for fur- 
ther explanation she said that sixteen or seventeen-year old girls 
"don't have much trouble" but a women of twenty-two has "settled by 
that time." The third midwife frankly called her patient an "ole 
woman" (in her thirties) and said the doctor used "faucets". She 
added as we sat in the open space of her double log house, that 
this hardly won baby was dying now of "flux" in its second summer 
from eating cucumbers. 
One midwife in Leslie said that the reason her own daughter 
had died a few days following childbirth was because she could not 
get the afterbirth—and had called Dr. (naming a pseudo- 
doctor) who "pinched off the cord" instead of "peeling hit”—and 
so "mortified" her daughter that she died. 
All of the midwives make examinations, some of them over and 
over, and always, so far as I can ascertain, with greased hands. 
One described reaching into the uterus to grease the baby's shoul- 
der. Asked why they examine they usually make some such reply as 
nto see if the baby is cornin' straight"—"to see if the womb is 
open" — "to see if its heads an' front"—or else they give no rea- 
son. One said she did not examine if when she got there the baby's 
head was "even with the world." Some of the mothers told me they 
had been examined ten or twelve times during a brief and normal 
labor. When I asked one midwife if she washed her hands she re- 
plied: "Cou'se I don't wash ’em—I greases 'em." But most of the 
midwives said they washed their hands first, one adding "with pot- 19 
ash soap not lye soap.1' She said she used a clean towel and lard 
and had her hands ’’like I was goin’ to make up a mess of biscuits.” 
Those midwives in Owsley county who had been taken about by the doc- 
tors described scrubbing their hands. 
One cannot be sure of the extent of childbed fever, but it 
seems not to be frequent. Only two cases were reported in 1922 for 
Knott county, and none for Leslie or Owsley. The midwives are most 
uncommunicative on that subject. One in Leslie said there was not 
much fever but she ’’sends for a doctor if they have it.” One in 
Owsley said she gave winter fern for it and another that she ’’sends 
to a doctor for medicine or they die.” She had had it herself. 
One voluble midwife declared she had seen childbed fever ”a heap of 
times.” Another told me she had never had a case, but that very day 
a few miles farther on I dined at the house of a young woman who had 
been poorly since her last baby was born four years ago because she 
'’lay in bed two months with childbed fever.” She had been attended 
by this same midwife. 
Rarely ever did I feel that the statements given me regarding 
maternal deaths and stillbirths were accurate. A number of the mid- 
wives who had been practicing for years declared that they '’never lost 
a mother or a child.” One who said she had had ’’upwards of a thous- 
and” deliveries had only lost two mothers. The one in Leslie who 
could ”figger” and who had counted 590 babies in over 50 years admit- 
ted but two stillbirths and said she had lost ’’nary woman.” One in 
Knott who delivered 265 cases admitted ”two or three” stillbirths 
only. A neighbor where I spent the night told me of three recent 
stillbirths which the midwife had not mentioned. A favorite ex- 
pression is that they have ’’always been blessed with good hack.” 20 
Ono dirty old soul in Knott county told me she ’’took the Lord with 
her” and that was why she had such good luck* In her practice of 
over forty years with over a thousand cases she had never lost a 
mother and mighty few babies.” One in Leslie told me voluntarily 
that she had had a maternal death from hemorrhage within the 
year. Another in Knott, who has the reputation of losing many 
mothers, and lost one of her own daughters from hemorrhage, men- 
tioned without questioning and as though it were a complex with her, 
that ’’everybody lost women.” 
The midwives described several ways of getting the placenta 
if it did not come normally. Several said they ’’went in after 
hit.” One said she reached for them and ’’they just come out.” 
One aged 47 who was just beginning said with pride that she had 
not had but two cases and in both ’’the afterbirth was stuck” and 
she reached in and ’’pulled them out as good as anybody-” Another 
said she had only had to go in after one, and that was with a woman 
where baby and everything had ’’rotted,” and came out in pieces. 
This had happened to the same woman four times before. Several 
say they get the afterbirth by ’’peeling and working the cord” 
and bringing pressure on the fundus. 
It is the almost universal custom among the older women to 
deliver their patients sitting on some one’s knees—usually those 
of the patient’s husband—’’her man.” Two told me they preferred 
her to sit in a chair without a seat, and one said she sometimes had 
her stand up- Perhaps the expression Scotching the baby” arises 
from this custom- None of the midwives admitted that they got worse 
tears than with the patient delivered in bed. In fact one old 21 
soul, she who ’’found” over a thousand babies years before regis- 
tration began, had the face to tell me she ’’had never had a tear— 
but the doctors has ’’em.” 
Several even of the older women now say they let the mothers 
choose and will deliver them in bed if they prefer. As one in 
Owsley expressed it ”l lets ’em take their pleasure, but can wait 
on ’em better sittin’ up.” But one in Knott frankly said she did 
not like this new way of ’’ketchin* babies in bed.” Another, the 
midwife who never got a tear, told me she let her patients choose. 
But I ascertained from a sixteen-year old mother just delivered of 
her first baby that she had ’’cried” to stay in bed and Aunt Jane 
made her get up. With the younger women and with those in touch 
with the doctors the custom of delivery in bed seems rapidly super- 
seding the older one. 
From a number of midwives I learned of cases of eclampsia 
bub rarely did they report them as having happened among their own 
patients. They called convulsions ”fits'1 and no one had any reme- 
dy to suggest. The experience of the older ones has included a 
few cases of abnormal presentations and of these they usually boast 
because of their skill in handling them, either by external version 
or ’’turning” the baby from within. Some of them seem to have gotten 
very dextrous and the whole neighborhood says of these that they 
have ’’good luck.” When I asked those of more limited practice 
what they would do if they had certain complications to meet I found 
that rarely had they decided beforehad on a plan of action. 
’’Never had hit happen yit” was the usual answer and with it they 
appeared satisfied. 22 
Several of the midwives told me of cases where the "afterbirth 
had come first*" and one said she herself had been in bed five 
months because of that. A young mother with her second baby had 
died from hemorrhage due to this just a few hours before I rode 
through her neighborhood. One of the doctors told me he had been 
called in for seven cases of placenta previa in hi$ mountain prac- 
tice of only a few years. 
Of all obstetrical complications a hemorrhage was the most 
frequent, calling forth the fullest information and concerning 
which there seemed to be the greatest variety of superstitious 
practices* Only three of the midwives I saw in Owsley county, one 
i 
in Leslie and one in Knott had learned from doctors how to hold the 
fundus, and the one in Knott added "raise her hips and stuff her 
with cotton." But she had not tried this method herself. She had 
heard of cording the leg (a custom mentioned in all 3 counties by 5 
of the midwives, 2 specifying the left log and hand, 1 the left leg 
and arm, 1 the right leg, and 1 not specifying) but she did not be- 
lieve that was much use. What she had found most helpful v/as just 
to lay her hand on the woman and repeat a verse from the Bible, 
which a preacher had given her. Word for word as it came from her 
lips I found it in Ezekiel 16:6. "And when I passed by thee, I saw 
thee polluted in thine own blood. I said unto thee when thou wast 
polluted in thine own blood, live. Yea, I said unto thee when thou 
wast in thy blood, live." This she said she had also tried 
fully on a dehorned steer which was bleeding to death. 
Remedies to be taken for hemorrhage nearly all were home- 
made* Two midwives in Leslie and Knott suggested ergot, one in 23 
Knott advised paregoric and another (she whose mother had had a 
book from an old doctor) said laudanum was the best thing but you 
could not get it now. As a substitute she suggested a remedy 
volunteered by several—cold cloths applied locally. She added 
that o. tea to ward off miscarriages could be made of ’’black gum 
bark mixed with sweet apple tree bark, and peeled one piece up and 
one piece down”. Teas of this general character were recommended 
by several for severe bleeding. A midwife in Owsley said to use 
black gum bark from the north side of the tree mixed with the bark 
of a sweet apple tree. Some endorsed either one without the other. 
Yellow root tea was recommended by a midwife in Knott county, 
rattleweed root or sarvice bark tea by one in Leslie, tea from ”com- 
frey” roots by another, pepper tea by several, assafetida by one in 
Owsley, nutmeg by one or two others, and the ’’leaves” (needles?) 
of the white pine in a tea by another. 
Several advised spices, eaten just so, or in a tea served 
cold, or three grains ground into a powder. A paste of flour and 
cold water was recommended by other midwives and two of them told 
me that they had tried it successfully. One called it ’’flour bat- 
ter dough.” Tea made out of soot was endorsed in all three coun- 
ties for hemorrhage. One in Owsley specified chimney soot. One 
in Leslie specified that it must be taken from under a pot. And 
one in Owsley implied how common must be the use of coal, picked up 
as it is all through the mountains almost by the side of the road, 
when she said it must be wood soot. 
One old superstition that I got in both Owsley and Leslie 
counties from midwives as disconnected from each other as if the 
Seven Seas had flowed between, was that of putting an ax under the 24 
bed, blade up, to stop a hemorrhage. But the Leslie county 
midwife, a sensible appearing woman only forty-five years old who 
was clean and could read, said she knew it "did no good ’cause 
they tried it with her sister who died anyway." And she began to 
"go off into faints" just as the blood soaked through the bed 
and fell on the upturned ax — so that some people even said it 
had helped to kill her. She then said that she advised strip- 
ping the woman and putting on her something dirty that somebody 
else had worn — as a petticoat, for instance — but it must be 
soiled to do any good. 
A variety of things are given for other conditions — 
expecially for protracted or retarded labor. Pepper tea, red 
or black, is a favorite in all three counties. Black gum bark 
comes in use again here, roots of the rattleweed, blueberry, rasp- 
berry, yellow spicewood and bluebell are given, all made into 
teas, and "witch hazel bark boiled into a thick syrup," ginger 
tea, tansy, peppermint, burvine, sulphur in sugar, quinine and 
gunpowder. 
One Knott county midwife said that a tea made from the 
root of the rattleweed would bring on the "miseries” if the 
woman was at term, or check them in a premature labor. One mid- 
wife in Owsley county said the same of blueberry root tea, which 
"looks like rattleweed root." A slovenly younger one of 42 in 
Leslie gets the same effect from a "powder in a box bought at the 
store." Another in Leslie aged 72, says that if a tea made from 25 
’’blueberry rattleweed” is given two months ahead of the date of the 
expected, confinement the woman ’’finds her baby easy.” One in 
Owsley gives ’’spigment” for the same purpose. These were the only 
nnptanc.es T found of prenatal care i 
For afterpains this same midwife gives "angelico root," which 
her mother, another midwife, calls "jellico root." She 3mows a patch 
"hid in the hills" which she won’t let anybody touch. She also 
"gives a yarb called allenkinpane" (elecampane?) as does her old 
mother. Another old midwife gives "a yarb that grows low down on 
the branches." Pepper or ginger tea are sometimes given and penny- 
royal, and "a round bottle of cordial from the store." Pepper tea is 
also used for chilling and to promote flow after delivery if it is 
checked, as is also pennyroyal. One midwife in Leslie makes a tea of 
a mixture of wahoo bark, spicewood and winter fern for this purpose- 
followed by a dose of oil and turpentine. For "risings" in the 
breast, if a midwife is called back on such a case, one in Leslie 
recommends a "catnip poultice," and another "binding the breasts 
tight." Most of them say they never have to meet this condition. 
The care given the babv varies very little among them* Nearly 
all dose it with castor oil, many add catnip tea as well, some give 
sugared milk and some the milk of another woman. All cut the cord with 
unboiled scissors and tie it with several strands of thread twisted 
together. Most of them grease the navel with lard or castor oil 
and then put a scorched rag over it. Practically universal is this 
custom of scorching the rag. One midwife in Owsley said she had 
given it up because the doctors did not do it, and one in Knott 
because it was "oldtimey." To revive a baby some "work its arms and 26 
legs” but generally they put it in water. One in Owsley ’’floats hit 
in cold water.” One ’’washes hits breast.” One in Knott ’’washes 
hit in camphor.” 
Since no postnatal visits are made the midwives claim little 
responsibility for the fact that nearly all the mothers get up three 
or four days after their babies are born. One midwife said she 
thought that was the reason why six of her own babies had died in the 
first month of life-- that and working in the fields up until the con- 
finement period. This last is also quite general. One young woman 
who had worked all summer in the fields and all winter ”sawing wood” 
since her marriage, had had two fairly normal babies, then two puny 
ones, than a bad miscarriage. I mention her case because she was 
the daughter in law of one of the midwives. Similar histories are 
common in all three counties. 
It Is almost universal among the women who have borne several 
children, to complain of a prolapsed uterus. One of the midwives I 
failed to see in Knott county had gone to visit another of her tribe 
on a far creek and get some medicine for a ’’failin’ womb.” A daugh- 
ter of this same woman had given birth to a baby a month before on a 
Sunday, and on Tuesday was ”up and cookin'” for a family. The sister 
of a midwife upon whom I called because she had a three-weeks’ old 
baby had gotten up only two or three hours after Its birth..” and 
never gone to bed agin until night.” This had been her custom with 
all her babies excepting only with the first, when she ’’stayed in bed 
sixty days with childbed fever.” Such instances could be multiplied 
over and over. 27 
It is not the-purpose of this report to "point the moral” of 
the data collected* I had teen less than human had I not pondered 
the problem, as I unraveled the facts, and sought its solution* 
Finding and applying it will undoubtedly be the work of many people 
and much time. None the less the story of my fifty-three midwives 
will not have ended until that solution has been reached and 
applied. //l /'. /d . * x COUNTY 
AQE BIRTHPLACE 
MARRIAGE 
NUMBER 
NUMBER 
Literacy 
Number 
Cleanliness 
Eye Prophylaxis 
STATUS 
CHILDREN 
CHILDREN 
Years of 
• 
BORN 
REARED 
Practice 
| Kgott 
75 Knott Go. 
53 * ■ 
,Ky 
» 
W 
M 
12 
10 
11 
8 
No 
NO 
c 
25 
10 
Clean 
Fair 
No 
Yes 
3 » 
79 « ■ 
* 
M 
9 
8 
No 
c 
25 
Clean 
No 
4 * 
50 • ■ 
* 
M 
11 
11 
No 
5 
Fair 
NO 
5 * 
70 * * 
• 
M 
10 
6 
No 
c 
20 
Fair 
No 
8 * 
48 • • 
• 
« 
7 
6 
RAW 
2 
Clean 
No 
7 • 
78 » » 
a 
W 
10 
8 
NO 
0 
25 
Clean 
NO 
8 » 
70 • * 
a 
M 
0 
0 
NO 
0 
40 
Fair 
No 
9 • 
68 * * 
a 
W 
4 
4 
R 
0 
30 
Clean 
Yes 
10 • 
68 * » 
a 
M 
10 
5 
NO 
c 
30 
Fair 
No 
11 • 
90 ■ » 
a 
W 
10 
8 
No 
0 
20 
Fair 
NO 
12 * 
48 * • 
• 
M 
13 
9 
R 
8 
Fair 
Yes 
13 * 
56 * * 
a 
M 
12 
11 
R ft) 
12 
Dirty 
NO 
14 » 
68 * • 
a 
M 
8 
5 
NO 
15 
Fair 
No 
13 ■ 
73 ■ • 
a 
M 
5 
4 
NO 
0 
40 
Dirty 
NO 
16 Leslie 
78 Perry * 
a 
W 
5 
5 
NO 
c 
40 
Fair 
Yes (?) 
17 » 
76 ■ • 
a 
W 
8 
7 
NO 
27 
Dirty 
NO 
18 * 
54 * » 
a 
w 
8 
8 
R (t) 
22 
Fair 
Yes 
19 * 
45 Leslie " 
a 
M 
5 
4 
RAN 
8 
Clean 
No 
20 * 
30 * • 
a 
M 
1 
1 
RAW 
6 
clean 
Yes 
21 • 
58 » • 
a 
M 
2 
2 
NO 
c 
30 
Fair 
Yes 
22 • 
47 • ■ 
a 
M 
4 
2 
NO 
4 
Fair 
Yes 
23 • 
87 Harlan ■ 
a 
V 
9 
8 
NO 
32 
Fair 
NO 
24 * 
45 Leslie * 
a 
M 
8 
5 
NO 
18 
Dirty 
NO 
25 * 
89 • » 
a 
V 
11 
4 
NO 
c 
30 
Dirty 
NO 
26 * 
47 Olay » 
a 
M 
1 
1 
R (t) 
18 
Fair 
Yes (?) 
27 • 
57 Bell ■ 
a 
M 
13 
5 
No 
10 
Fair 
No 
28 * 
45 Leslie • 
a 
W 
11 
11 
r m 
0 
15 
Fair 
NO 
29 * 
72 Floyd • 
a 
W 
13 
11 
NO 
0 
50 
Fair 
Yes (?) 
30 * 
42 Leslie » 
a 
M 
8 
3 
No 
4 
Dirty 
NO (?) 
31 • 
50 • • 
a 
M 
9 
8 
RAW 
8 
Clean 
YS3 
52 * 
51 • • 
a 
M 
15 
6 
RAW 
15 
Clean 
Yes 
33 Owsley 
50 Owsley • 
a 
W 
16 
8 
NO 
' c 
20 
Dirty 
No 
34 • 
37 • * 
a 
V 
9 
5 
RAW 
4 
Dirty 
Ho 
35 * 
52 • * 
a 
M 
5 
5 
R 
7 
Clean 
Yes 
36 * 
62 • * 
a 
M 
10 
13 
RAW 
0 
15 
Fair 
No 
37 • 
57 » • 
a 
U 
9 
8 
NO 
8 
clean 
No 
38 • 
88 • • 
a 
W 
8 
5 
RAW 
o 
30 
Clean • 
No 
39 * 
57 Breathitt 
a 
M 
13 
9 
NO 
37 
Fair 
No 
40 • 
49 Perry * 
a 
M 
5 
4 
NO 
20 
Fair 
No 
41 • 
58 East Tennessee 
M 
11 
6 
NO 
20 
Fair 
No 
42 • 
74 Owsley Co. 
Ky. 
M 
4 
2 
No 
c 
30 
Fair 
NO 
43 • 
48 Lee * 
a 
M 
5 
5 
No 
7 
clean 
No 
44 • 
54 JaoXson* 
a 
M 
11 
9 
No 
14 
Fair 
NO 
45 » 
73 North Caroiinia 
V 
0 
0 
NO 
8 
Fair 
No 
46 * 
54 Breathitt 
Co.,Ky 
• M 
12 
7 
NO 
12 
Dirty 
NO 
47 • 
73 Virginia 
a 
w 
7 
7 
NO 
o 
30 
Fair 
NO 
48 • 
70 Owsley Co. 
V 
5 
3 
RAW 
28 
Dirty 
NO 
49 • 
41 * • 
a 
M 
8 
6 
RAW 
0 
18 
Clean 
Yes 
50 * 
86 • * 
a 
M 
12 
11 
RAW 
25 
Clean 
NO 
51 • 
59 • • 
a 
M 
12 
11 
RAW 
18 
Clean 
No 
52 * 
75 • • 
a 
W 
15 
10 
m 
o 
89 
Fair 
Wo 
53 * 
51 Harlan » 
m 
M 
13 
10 
No 
5 
Fair 
No 
Total 
3193 
448 
332 
Total 
1022 
Median 
57 
9 
6 
Median 
18 
Average 
60.3 
8,4 
6.3 
Average 
19.3 
c - Clrcura. 
Subject could not be sure.