Globally and locally, whether pregnant women have the right to choose who attends them during pregnancy and birth is a lively and often contentious topic. There is a strong belief in today’s midwifery community that, in the past, women once had total control of birth and their bodies without interference from the church, government, or medical men. It is true that women generally gave birth in their homes with the local midwife, often of their choice, but full bodily autonomy was neither desired nor granted. The medicalization of childbirth shifted authority over birth to male doctors and the locus of birth became the hospital; a change first available only to affluent women and then to the working-class mothers as well.
When and how did this shift in childbirth take place? During my time at the Library of Virginia as a Virginia Humanities fellow, I focused on understanding midwifery from the Civil War to the twentieth century. This period lies between the antebellum world with the seeming dominance of Black midwives and the twentieth century with the assertion of control by physicians. Black women still plied their trade, but now in freedom, and doctors seemingly coexisted with traditional midwifery. Was this a Golden Age of women’s birth autonomy?
Until a little over one hundred years ago, midwives were the universal attendants of pregnant women. Having seen birth from start to finish many times, they were empiricists. From numerous observations passed down through generations, midwives understood how things would go, why they were going that way, and what skills could bring about the desired outcome. As part of the community, the midwife knew the laboring woman before her and applied her skills within the cultural context of the community and family. The historical Virginia midwife might be white or Black, free or enslaved. Midwives served women of all races and socioeconomic conditions.
Most midwives in early Virginia were probably white, as there were fewer Black people in the seventeenth-century colony. These women often acted as instruments of the state during a period of tight control over sexuality. Midwives extracted the names of fathers from laboring women, turned young couples in for premarital sex when babies were born too early, sat on courts to determine witchcraft and infanticide, and swore to paternity as testimony in inheritance cases.
The end of the Civil War brought this world crashing down. My research on the post-Civil War era caused me to ask the question: Did emancipation and a relative lack of outside interference create a rare moment of autonomy for women and midwives?
The two women in the top right are Lucy Hudson Crawley and Ruth Hudson Galford, relatives of Sarita Bennett, a friend of the author. They represent a line of midwives going back to the late 1790s in Augusta County and Pocahontas County (now WV). Today, their granddaughter and great-niece Sarita is a retired Virginia midwife who served women in both states.
Black women continued to work for prominent families after the war, and women chose to employ them. With the south in turmoil and repair during the Reconstruction Era, midwives practiced with previously unknown freedom. Lynchburg midwife Margaret Jones, who was born into slavery, was said by her community to be “a woman of the highest respectability, loved and honored by all who knew her, both white and colored.”
Image courtesy of Lynchburg Legacy Museum.
It is usually supposed that Black women dominated the ranks of traditional midwifery after the Civil War, but white women continued to practice, especially in rural areas of western Virginia. Orleana Hawks Puckett is perhaps the best known of these women. She served more than 1,000 mothers without a loss. Her cabin still stands on the Blue Ridge Parkway.
I was surprised by the numerous white midwives I found in the urban centers, especially Richmond and Norfolk. White women like Fanny Stewart can be found in city directories well into the late nineteenth century. Others who possessed the resources took out advertisements in newspapers – including a preponderance of ethnically European names, such as Lafon and Dresse – and typically had full-blown practices.
Midwives, white and Black, continued to enjoy community approbation and support, even from physicians. In 1871, a doctor complained to the Richmond Dispatch that forces were lobbying the legislature to establish a Board of Examiners for midwives. He noted with feigned astonishment and no little sarcasm that medical doctors, looking for business, believed that
“hitherto so many thousands of valuable lives (Virginia’s greatest and best) have been imperiled at the very threshold of their existence because our mothers and grandmothers would trust themselves to uneducated old women in accouchement.”
Moreover, he pointed out the significant burden on the poor who could not afford a physician.
This physician’s skepticism of licensure was undoubtedly derived from his knowledge of the relative skills of midwives and physicians in the birthing room. An 1875 case starkly revealed the limits of “scientific” treatment. The esteemed Richmond physician, Hunter McGuire, treated the seven-month pregnant wife of shoe magnate Stephen Putney for sudden abdominal pain, headache, and nausea with morphine. When the morphine wore off, she was no better, and McGuire was nowhere to be found. Putney called another doctor. Mrs. Putney died in a convulsion minutes after that doctor arrived. He blamed McGuire. At the next meeting of the Richmond Academy of Medicine, arguments were had, sides were taken, fisticuffs ensued, and a penknife was thrown.
While midwives enjoyed considerable liberty in their practices, there were also signs that the medical model of birth was gaining ground in the late nineteenth century. Advertisements for midwives that appeared in newspapers frequently mentioned their association with the “better” physicians of the city to increase their authority. Black midwife Harriet Randolph’s obituary in 1911 said she served “leading families and physicians,” as well as all classes of white and Black people.
Nancy Elliott Obituary
Alexandria Gazette, August 27, 1877.
White women seemed to be moving to a medical model as well. Around 1905, Susan Abigail Roope, a physician, sued a printing company for listing her as a midwife in the Richmond city directory. A native of Massachusetts, she had only recently received her medical degree in her mid-40s. She asserted that the entry damaged her reputation because the term “midwife” was “construed by the public generally as conveying an idea not altogether complimentary.” The Law and Equity Court dismissed her claim.
That same year another court case reflected the increased strictures of midwifery even before state licensure. A Black midwife named Minnie Vann stood before the Richmond Mayor’s Court accused of practicing medicine without a license. The newspaper cryptically noted that the case “aroused interest,” and she was bailed out at the significant cost of 100 dollars. Undoubtedly, public sentiment and the accepted practice of hiring Black midwives caused considerable public comment regarding the case.
Isabella Voss Advertisement
Chataigne's Richmond City Directory, 1881.
The same public ambivalence in which midwifery existed side-by-side with formal medicine influenced the court case of Isabella Voss. Born Isabella Pearl Distradoza in Spain, she migrated to America with her husband, German physician William Voss. She used the terminology of a physician—“doctoress”—as the couple operated a clinic. In 1903, a young man from a “respectable family” brought her an infant to be placed with a family. Voss tried to find a home for the “illegitimate” child but returned it to the young man after failing to do so. The child was eventually found abandoned in an alley near 8th and Marshall, possibly on the site now occupied by the Library of Virginia. Both Voss and the young man were charged with attempted murder. Despondent over her arrest, Voss took her own life by poison. The “respectable citizen” was never named and the case disappeared from the newspapers.
The newspapers were generally sympathetic to Voss’s plight and noted her standing in the community. Family members reported that Voss agonized over the loss of her reputation. Ominously, her prosecution was part of a larger uptick of cases brought against midwives in the early twentieth century, part of a larger movement by progressives and doctors to solve the so-called “Midwife Problem.”
Midwives generally enjoyed autonomy through the late nineteenth century. Doctors fought for their professional lives and sought government protection, however. Sporadic local medical licensing gave way to state statutes beginning in the 1880s, although such laws were largely unenforced. If a woman, who in doctors’ eyes was an illiterate immigrant or African American, could help a woman in her birthing, then it was not medicine.
An article in the 1919 Richmond Times-Dispatch typified this disdain for folk medicine. Under the blazing headline “Many American Women Needlessly Sacrificed,” the article derided the “negro mammy and self-taught midwife” who still held sway in many communities. The article presaged the 1921 Sheppard-Towner Act, which provided government support for prenatal and infant health care, further reducing the agency of local midwives.
Contrary to public health studies of the time, doctors and bureaucrats increasingly blamed midwives for deaths during birth and campaigned for the elimination of folk midwifery altogether. The practice of medicine was also changing. The clinician and country doctor gave way to a science-based approach that diverted the attention away from the patient and towards technology, staging a mechanistic process. Despite this shift, midwives like Harriett Randolph and Isabella Voss would continue to employ a woman-centered, holistic approach.