Midwives in the United States assist childbearing women during pregnancy, labor and birth, and the postpartum period.
[3] Town records indicate some well-known midwives including Bridget Fuller (d. 1664) who practiced in the Massachusetts Bay Colony and Mrs. Wiat of Dorchester (d. 1705) who attended over 1,000 births.
While Elizabeth Phillips was trained in London before continuing her practice in Boston, other midwives such as Ann Eliot may have acquired medical skills through their husbands.
[8] While CPMs do not have prescriptive authority, they administer medications, order laboratory tests, and use devices as allowed by state law.
Midwives are skilled practitioners who expertly identify conditions which require referral to or consultation with other health care providers.
CNMs and Certified Midwives (CMs) also provide well-woman care, including annual exams, birth control, infection checks, and pre-pregnancy counseling.
[6] CMs are currently licensed in Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, Virginia, and the District of Columbia.
[10][12] At the start of the 20th century, specifically between 1900 and 1940, the professionalization of obstetrics and gynecology lead to a campaign against all lay midwives by the United States government, but especially the racialized figure of the granny midwife in the American south.
[10][12] In 1921, the Sheppard-Towner Maternity and Infancy Protection Act afforded federal funds for midwifery training programs to state health departments.
[12][15][16] These laws complicated the work of granny midwives significantly, particularly because they lived in rural settings where illiteracy was common and access to registration filing facilities was more limited than in urban areas.
She notes that both the training and regulatory programs and mandatory registration and certificate laws jointly contributed to the diminishing number of midwives in places like Macon County, Alabama.
[17] Another facet of the campaign against midwives and towards greater professionalization and exclusivity in obstetrics was the development and expense of medical technology.
[10] Included in such publications was information equating black midwifery with “witchcraft” and “witch doctors” of West Africa, as well as with uncleanliness and ignorance.
[17] These numbers would drop dramatically over the next six decades, with granny midwives coming to make up a small minority of birth attendants by the 21st century.
Mrs. Smith was licensed to practice midwifery by the state in the late 1940s, after Alabama began to regulate lay midwives.
[18] At the time, becoming a registered midwife in Smith's home of Greene County, Alabama required either a state-run month-long lay midwifery training course or a nurse-midwifery education that could take several years.
[18] In addition to formally recognized training, granny midwives seeking to be registered had to be recommended and supported by two physicians and demonstrate cleanliness and Christian morals.
[10][12][13][14] State-sponsored training and regulation of midwives took many different forms and existed to varying degrees in numerous states from the 1900s onwards.
[12] The state also had regulatory measures which required doctors to check in after every midwife-assisted birth so that they could identify and report any infractions made by the midwives.
[17] In response to this new law, the John A. Andrew Hospital of Tuskegee University organized a training program for midwives in Macon County.
[17] The program aimed to prepare Macon County midwives for the examination and to equip them with some basic formalized medical training.
[11][13] Mississippi's training and regulation program focused on community based large meetings or “clubs” where midwives gathered for instruction by public health nurses.
Wilkie reports that granny midwives had specific procedures for every stage of the maternal process, from pregnancy to delivery to post partum and oral histories of their traditions are confirmed by archeological artifacts from the nineteenth century.
[10][16] To prepare for delivery, the granny midwife might have applied lard or Vaseline to an expecting woman's perineum to lessen the likelihood of tearing and ease the passage of the infant.
Emmenagogues, used to stimulate menstrual bleeding and as abortifacients, such as tansy, pennyroyal, senna, cottonseed, cedar berries, juniper, ginger, turpentine, asafetida, and camphor were known to and used by granny midwives.
[21] Granny midwives were also known to carry castor oil, black pepper tea, goose grease, and other remedies to stimulate labor and aid in contractions.
[10] Scholar Valerie Lee writes that in Florida, midwives registered with the state were mandated to carry such things as baby scales, safety razors, and silver nitrile solution.
[10] However, the midwives supplemented these mandates with their own trusted remedies and tools, such as nail files, aspirin, camphor, Vaseline, and collapsible birthing stools.