WEBVTT 00:00.000 --> 00:04.800 [HMD African American History Month Lecture: “Called To Practice"] 00:04.800 --> 00:09.400 [LHC Auditorium February 25, 2010 Not for Public Dissemination] 00:16.566 --> 00:20.432 [Dr. Elizabeth Fee:] I'd like to welcome you to this celebration 00:20.433 --> 00:23.666 of African American History Month. 00:23.666 --> 00:26.566 You might have noticed that we've had 00:26.566 --> 00:35.199 several celebrations. A couple of days ago very nice program, organized by Jill Newmark. 00:35.200 --> 00:39.000 We have two exhibitions and about about one of them 00:39.000 --> 00:44.300 more in a moment and now we have our African American 00:44.300 --> 00:47.666 History Month Lecture by 00:47.666 --> 00:53.699 presentation by Sheena Morrison. Now I'll introduce Sheena 00:53.700 --> 00:56.600 for a minute or two. 00:56.600 --> 01:01.100 She-- Sheena has an excellent training 01:01.100 --> 01:04.233 both in history and public health. 01:04.233 --> 01:10.266 She holds a Master's degree in history from Columbia University, 01:10.266 --> 01:16.399 and she's currently finishing her dissertation in the history of public health and medicine, 01:16.400 --> 01:21.800 also at Columbia University. Her master's in public health 01:21.800 --> 01:26.800 comes from Hunter College, New York, where she specialized in 01:26.800 --> 01:33.466 community health education. She then worked in the Office of the 01:33.466 --> 01:36.799 Public Health Historian for four years, 01:36.800 --> 01:39.933 where she was responsible for archival 01:39.933 --> 01:46.366 research for running an oral history program. And for assisting researchers want both 01:46.366 --> 01:49.232 inside and outside the Public Health 01:49.233 --> 01:54.166 Service who wanted to do research. 01:54.166 --> 02:00.032 Now, sadly, that office is now defunct. 02:00.033 --> 02:04.066 So Sheena worked for a while as a 02:04.066 --> 02:07.432 contractor for the History of Medicine 02:07.433 --> 02:12.933 Division and did a terrific job for us. 02:12.933 --> 02:19.766 She, among other things, has worked on an exhibition, 02:19.766 --> 02:23.632 and the exhibition is currently just outside 02:23.633 --> 02:29.799 and inside the history of Medicine Division. It's called Nothing to Work With 02:29.800 --> 02:34.300 but Cleanliness: African American Grannies, 02:34.300 --> 02:38.700 Midwives and Health Reform. 02:38.700 --> 02:44.333 So I hope if you haven't seen it yet, you will come and see it. 02:44.333 --> 02:49.699 And today's lecture is on a similar a project, 02:49.700 --> 02:53.066 Called to practice: African American "grannies", 02:53.066 --> 02:56.199 midwives, & health reform. 02:56.200 --> 02:59.800 Let me take just a moment to tell you about 02:59.800 --> 03:02.966 the next Women's History Month lecture. 03:02.966 --> 03:08.632 It'll be on 25th of March and the the topic is: 03:08.633 --> 03:13.399 Reproductive Technologies and the Post Human Future. 03:13.400 --> 03:19.500 Are we there yet? It's by Professor Valerie Hartouni of the 03:19.500 --> 03:25.600 University of California at San Diego. And it's here in the Lister Hill Auditorium, 03:25.600 --> 03:31.100 also at 2 o'clock. Now, if you would please join me 03:31.100 --> 03:34.233 in welcoming Sheena Morrison. 03:34.233 --> 03:39.433 [Applause] 03:39.433 --> 03:43.666 Oh, there's one thing I didn't neglected to tell you about Sheena, 03:43.666 --> 03:46.966 and she is the H1N1 historian. 03:46.966 --> 03:50.499 She is situated both in the National 03:50.500 --> 03:53.966 National Library of Medicine and also in 03:53.966 --> 03:59.632 the Office of Preparedness and Response. So she has two mentors, 03:59.633 --> 04:05.099 supervisors, one in each place, and she travels back and forth. 04:05.100 --> 04:12.000 And is doing a wonderful job for that office of recording history as it's happening. 04:12.000 --> 04:18.900 [Sheena Morrison:] Thank you Liz. Good afternoon. 04:18.900 --> 04:28.533 [Presenter preparation] 04:28.533 --> 04:31.299 [Called to practice: African American "grannies", midwives, & health reform] 04:31.300 --> 04:37.866 Prior to the 1920s, most African American midwives in the South became midwives 04:37.866 --> 04:43.366 either by apprenticeship, usually with the familial relation 04:43.366 --> 04:48.099 or because they believe they were called to do so by God. After the 1920s, 04:48.100 --> 04:53.033 the only way to become a midwife was through recruitment to one of the 04:53.033 --> 04:58.666 state sponsored midwifery training programs by a public health nurse. 04:58.666 --> 05:03.166 The programs were intended to improve 05:03.166 --> 05:07.166 maternal and infant care in the rural South and range from the minimum basic 05:07.166 --> 05:12.999 instruction to expansive preparation. From simply providing midwife permits and 05:13.000 --> 05:17.600 birth registration to more structured training in the form of annual midwife 05:17.600 --> 05:22.166 institute and monthly club meetings. Training programs for midwives in the 05:22.166 --> 05:26.532 United States were only meant to be a temporary solution to meet the needs 05:26.533 --> 05:30.433 for maternal and child healthcare services in areas where hospitals 05:30.433 --> 05:37.066 and physician services were scarce. But in the South, racial segregation and a weak Southern 05:37.066 --> 05:43.132 economy sustained the social conditions which expanded the role of midwifery and maternal and care, 05:43.133 --> 05:48.533 even as reformers sought to eliminate the practice of midwifery. As a result, 05:48.533 --> 05:52.699 midwifery persisted in the South for more than five decades 05:52.700 --> 05:58.466 beyond the campaign to eliminate midwives. The material for this talk is drawn 05:58.466 --> 06:03.932 mainly from the National Library of Medicine's American College of Nurse Midwives collection and is 06:03.933 --> 06:09.133 based on an exhibit that I created, which is now on display outside the History of 06:09.133 --> 06:16.033 of Medicine reading room here at the library. Called to Practice is just one of many narratives about 06:16.033 --> 06:20.333 granny midwives that can be culled from the material in the collection. 06:20.333 --> 06:24.266 The focus of my talk will be on the state and local training programs 06:24.266 --> 06:31.066 designed to educate the granny in the rural South from the 1920s through the 1960s. 06:31.066 --> 06:36.499 I will begin with an overview of the context in which training programs for midwives first emerged. 06:36.500 --> 06:42.666 Followed by a description of the two primary modes of instruction, 06:42.666 --> 06:48.166 clubs and institutes that were used to teach African American midwives in the South. 06:48.166 --> 06:54.166 To conclude, I will show 4 short clips of the film All My Babies. The film was commissioned by the 06:54.166 --> 06:59.199 Georgia Department of Public Health and directed by George C Stoney in 1952 06:59.200 --> 07:04.833 to educate local midwives. The clips I have chosen illustrate key concepts 07:04.833 --> 07:09.099 taught in midwife training programs throughout the South. 07:09.100 --> 07:14.800 For over 3 centuries, African American midwives delivered 07:14.800 --> 07:20.033 babies and practice folk medicine in rural counties throughout the South. 07:20.033 --> 07:24.499 Without any formal training but with a good deal of practical experience, 07:24.500 --> 07:30.066 the granny midwife treated pregnant women, their families, and other members of her community. 07:30.066 --> 07:36.466 And freedom as in slavery, African American midwives worked under the most difficult conditions. 07:36.466 --> 07:42.099 There was little improvement in the overall standard of living for most African Americans in the 07:42.100 --> 07:46.366 decades following the Civil War. Black families in rural South and 07:46.366 --> 07:52.532 the rural South still lacked clean water, adequate housing, and nutrition. As a result, 07:52.533 --> 07:58.233 many of the communities were beset by endemic and epidemic disease. Midwives were one of the many 07:58.233 --> 08:03.699 different kinds of healers. Their residents, black and white, relied upon for care and treatment 08:03.700 --> 08:11.600 when they became ill, and they were held in high esteem. 08:11.600 --> 08:15.400 The practice of midwifery came under 08:15.400 --> 08:20.766 public scrutiny during the 1910s, when progressive reformers collected birth and death-- 08:20.766 --> 08:24.999 death statistics that show mortality among women and infants in the United 08:25.000 --> 08:30.200 States was significantly higher than in some Western European countries. 08:30.200 --> 08:34.733 American physicians and public health officials tended to attribute the higher 08:34.733 --> 08:40.199 death rates to the unsanitary practices and superstitious beliefs of midwives. 08:40.200 --> 08:46.700 Some reformers advocated for midwives to receive formal training, but most argued that the better 08:46.700 --> 08:53.233 solution would be to replace midwives with physicians altogether. During the next two decades, 08:53.233 --> 08:58.233 reformers campaign unsuccessfully to eliminate the practice of midwifery. 08:58.233 --> 09:01.966 Resolutions to the midwife problem were frequently the subject of 09:01.966 --> 09:06.066 discussion at annual meetings held by professional organizations with an 09:06.066 --> 09:10.232 interest in maternal and child health. But some of the social and economic 09:10.233 --> 09:15.699 barriers to eliminating midwives were not so easily overcome. In Northeastern cities, 09:15.700 --> 09:20.133 midwives have been largely displaced by physicians working in hospitals. 09:20.133 --> 09:25.999 Many women considered hospital births the modern and advanced form of delivery. 09:26.000 --> 09:30.333 But midwifery persisted in southern rural communities, where the majority of African American 09:30.333 --> 09:35.733 midwives practiced. During this period there was simply not enough skilled 09:35.733 --> 09:40.366 physicians or hospital facilities in southern rural communities to replace 09:40.366 --> 09:44.432 the services provided by midwives. African American midwives were 09:44.433 --> 09:49.166 responsible for the delivery of over 50% of all black infants in the 09:49.166 --> 09:56.166 South and 25% of infants nationwide. Moreover, most physicians, white and black, 09:56.166 --> 09:58.766 were unwilling or unable to accept the 09:58.766 --> 10:02.899 meager fees midwives were willing to accept. Often, 10:02.900 --> 10:06.100 midwives would accept livestock as payment 10:06.100 --> 10:10.000 or be forced to receive nothing at all. 10:10.000 --> 10:15.933 In an era of pervasive racial discrimination, few black families had access to or could 10:15.933 --> 10:21.099 afford the cost of hospital deliveries. Poverty and discrimination also made 10:21.100 --> 10:25.466 home births more desirable than hospital deliveries to many African American 10:25.466 --> 10:29.699 women living in the rural South. As a result of these barriers, 10:29.700 --> 10:34.933 training for African American midwives was deemed the most viable solution. 10:34.933 --> 10:40.066 Reformers proposed that granting midwives be trained by public health nurses, certified in midwifery, 10:40.066 --> 10:45.932 and regulated through the state and local health departments. 10:45.933 --> 10:51.733 There were no legal precedents for the care of maternity in the United States prior to the 1920s. 10:51.733 --> 10:54.066 In 1921, Congress passed 10:54.066 --> 11:00.266 the Sheppard-Towner Maternity and Infancy Protection Act, the first piece of of legislation 11:00.266 --> 11:05.599 to address maternal and child health in the United States. The bill, which was administered 11:05.600 --> 11:10.966 by the Children's Bureau, was enacted by a coalition of reformers and public health officials 11:10.966 --> 11:15.532 concerned about the large number of deaths among women and children. 11:15.533 --> 11:20.633 The Sheppard-Towner Act was intended to address some of the commercial, I'm sorry, some, 11:20.633 --> 11:24.733 of the economical barriers to healthcare for mothers and and infants. 11:24.733 --> 11:30.199 Supporters of the bill had hoped that it would lead to universally available maternity care, 11:30.200 --> 11:36.666 but their vision of publicly funded medical and nursing care for every woman was lost in 1927 when 11:36.666 --> 11:42.266 a coalition of medical societies and conservative organizations. Charged that it was a step towards 11:42.266 --> 11:49.999 state medicine and fought efforts to renew it. From 1921 to 1929, 11:50.000 --> 11:55.266 the Sheppard-Towner Act provided matching funds to states for midwife education. 11:55.266 --> 11:59.332 Midwife training programs were only meant to be a small part of the overall 11:59.333 --> 12:05.666 purpose of the act and Southern states, however, instructional programs for midwives 12:05.666 --> 12:12.332 made-up a significant portion. Southern states with large numbers of midwives have and a shortage of 12:12.333 --> 12:18.866 physicians and hospitals invested heavily in regulatory and training programs. 12:18.866 --> 12:23.432 The midwife programs established under the Sheppard-Towner Act were modeled on the pioneering 12:23.433 --> 12:28.833 work of doctor S Josephine Baker, the director of New York City's Bureau of Child Hygiene, 12:28.833 --> 12:34.333 who was closely affiliated with the Children's Bureau. Baker was among the group of reformers 12:34.333 --> 12:38.333 who saw midwives as a necessary part of the healthcare system and argued 12:38.333 --> 12:42.099 in popular and medical journals that death rates for midwife attended 12:42.100 --> 12:47.300 births were not higher than hospital deliveries attended by physicians. 12:47.300 --> 12:52.300 Others, like doctor Joseph B DeLee, known also as the father of obstetrics, 12:52.300 --> 12:58.300 argued against the midwife having any role in maternal and child healthcare. In his own words, 12:58.300 --> 13:03.833 he was fundamentally opposed to any movement designed to perpetuate the midwife. 13:03.833 --> 13:07.699 Regardless of their stance on midwifery, private practitioners and public 13:07.700 --> 13:13.300 health officials all agree that midwives could not continue to deliver babies without the benefits 13:13.300 --> 13:18.233 of scientific medical knowledge. 13:18.233 --> 13:23.799 As part of the overarching goal to modernize childbirth practices in the South 13:23.800 --> 13:29.666 granny midwives were required to register with health departments to obtain a permit and to attend 13:29.666 --> 13:34.932 a prescribed course of study. The venue for instruction was usually the monthly midwife club 13:34.933 --> 13:40.866 and the annual institute. Some states had literacy requirements and required midwives to undergo an 13:40.866 --> 13:48.299 annual physical examination to remain in compliance with state regulations. 13:48.300 --> 13:53.200 Early state efforts to monitor midwives first began with the campaign to locate 13:53.200 --> 13:58.066 and register all practicing midwives. Registered midwives were then mandated 13:58.066 --> 14:02.099 to attend monthly midwife meetings, usually held in local health 14:02.100 --> 14:08.466 departments or churches. A nurse midwife, charged with 14:08.466 --> 14:13.799 statewide supervision of the midwives, traveled to the different counties, providing a series of 14:13.800 --> 14:19.233 lectures on cleanliness, equipment and birth registration. 14:19.233 --> 14:25.499 To ensure that the women maintain sanitary standards beyond the monthly midwife meeting, a nurse, 14:25.500 --> 14:31.166 midwife or public health nurse also visited the homes of the midwives and sometimes 14:31.166 --> 14:37.932 accompanied them on deliveries. Midwife clubs were initially organized to 14:37.933 --> 14:42.399 regulate midwives and serve as a venue of support for small groups of women. 14:42.400 --> 14:47.033 There is some evidence that the concept of midwife clubs first served as a measure 14:47.033 --> 14:50.999 of control in counties where there wasn't an organized health department. 14:51.000 --> 14:56.366 Little in the way of instruction was accomplished early on. The monthly meeting served primarily as 14:56.366 --> 15:02.499 a means for the local health officer to keep track of the register midwives. 15:02.500 --> 15:06.433 They later evolved into sessions where, in addition to some instruction, 15:06.433 --> 15:11.833 midwives could replenish their supplies. During the mid during the meetings, 15:11.833 --> 15:17.399 midwives could buy the supplies at cost from the nurses. But even at cost, 15:17.400 --> 15:20.600 keeping the bags stocked according to regulations sometimes proved to be 15:20.600 --> 15:27.566 a hardship for many of the midwives who were barely making a living from their practice. 15:27.566 --> 15:31.799 The replenishment of supplies also provided a concrete reason for the 15:31.800 --> 15:37.500 monthly meeting and was a good segue into the bag inspection. 15:37.500 --> 15:41.633 The midwives bag was inspected for cleanliness and content by an assigned 15:41.633 --> 15:47.133 group leader or the public health nurse. Midwife bags often contain herbal remedies, 15:47.133 --> 15:53.566 patent medicines, and in some cases, drugs provided by local physicians. 15:53.566 --> 15:57.499 After the Sheppard-Towner Act, they were prohibited from carrying any item 15:57.500 --> 16:04.366 not approved of by the Board of Health. Whereas clubs tended to be more 16:04.366 --> 16:10.999 means of regulating midwives, training was the primary focus of the annual state sponsored institute. 16:11.000 --> 16:16.166 There was more planning involved, and a typical two week institute drew women 16:16.166 --> 16:21.599 from all over their respective states. These were generally held on the 16:21.600 --> 16:26.900 grounds of black colleges or normal schools with overnight accommodations for large groups of women, 16:26.900 --> 16:32.833 and midwives were responsible for paying for their own room and board. 16:32.833 --> 16:37.199 Instruction was carried out through demonstration, role-playing and songs. 16:37.200 --> 16:42.100 Because most midwives had little formal education and many were illiterate. 16:42.100 --> 16:46.633 During midwife training institutes, a nurse midwife or public health nurse 16:46.633 --> 16:50.533 presented the lessons and demonstrations, and she would be assisted by a group 16:50.533 --> 16:57.733 leader chosen from among the midwives. Miss Chase, an anatomically correct life sized doll, 16:57.733 --> 17:02.866 in the 10th month of pregnancy. Was used for lecture and demonstration 17:02.866 --> 17:08.766 during midwife training sessions. Special lectures were also given 17:08.766 --> 17:15.632 by doctors and nurse consultants. Each midwife was then evaluated on her 17:15.633 --> 17:20.733 ability to repeat the demonstration, for example on how to prepare a model 17:20.733 --> 17:27.033 birth room or the proper technique for cutting the umbilical cord. The class curriculum included 17:27.033 --> 17:33.499 principles on pre and postnatal care an what complications midwives might expect. 17:33.500 --> 17:37.266 Role-playing was used to evaluate the midwives understanding of the lesson, 17:37.266 --> 17:39.666 as well as to prepare her for 17:39.666 --> 17:44.032 unexpected or difficult situations. 17:44.033 --> 17:49.899 Songs were often used to convey the significance of of many of the concepts. 17:49.900 --> 17:55.666 Like birth registration for example, or why sterilization of equipment was necessary. 17:55.666 --> 18:01.199 The lyrics to a song written by one of the nurse midwives explain many of the benefits 18:01.200 --> 18:06.166 [Silence] 18:06.166 --> 18:12.032 of birth of having a birth certificate throughout one's life cycle, from school registration 18:12.033 --> 18:18.999 to Social Security benefits. For the smaller institutes, county health departments, 18:19.000 --> 18:24.933 churches, and African American schools were used as venues. There were even institutes that 18:24.933 --> 18:28.499 provided on the job training. Like the one held in Denmark County, 18:28.500 --> 18:31.766 South Carolina from 1926 to 1929. 18:31.766 --> 18:37.332 It was held at an African American school affiliated with a small hospital. 18:37.333 --> 18:41.333 The classes were held continually for three months during the summer and 18:41.333 --> 18:48.299 each midwife attended for one month. Classes were held in a clinic like fashion and the and the 18:48.300 --> 18:53.066 midwife performed all the work, including the deliveries. The Denmark County Institute was 18:53.066 --> 18:58.599 a unique situation, however. During institutes, midwives characteristically demonstrated 18:58.600 --> 19:04.833 their competency without the benefit of real patients. And both venues, however, 19:04.833 --> 19:10.366 the midwives professional obligation to her patients mother and child was emphasized throughout the 19:10.366 --> 19:14.332 event and permits were renewed upon the successful completion 19:14.333 --> 19:20.999 of the Training Institute. The practical application of lessons 19:21.000 --> 19:25.433 taught during the annual institutes and reinforced during the monthly clubs 19:25.433 --> 19:29.499 were not always possible however. Conditions under which midwives 19:29.500 --> 19:35.000 practice in the field were often not sterile. Most homes were without adequate lighting, 19:35.000 --> 19:40.000 heat, proper ventilation or running water, and expectant mothers were unaware 19:40.000 --> 19:44.300 of the sterile birth techniques that they would later come to expect. 19:44.300 --> 19:47.900 [Portions of lecture are missing due to faulty original disc]