Linda Janet Holmes is an independent scholar, writer, and women’s health activist with a longstanding interest in the historical and cultural value of traditional African American midwifery. During a recent Virginia Humanities fellowship, Holmes conducted research on midwifery in Albemarle County for a chapter in her forthcoming book from Ohio State University Press. Her work at Virginia Humanities is possible thanks to the support of Sentara Martha Jefferson Hospital.
In the Q&A below, Holmes explains her project and the ways she had to change her research methods because of the Coronavirus pandemic. Read on to learn about midwifery’s holistic approach to pre- and post-natal healthcare and the changing status of the midwife throughout Virginia’s history.
To start, tell us about your fellowship topic. What are you researching?
I have a Fellowship from Virginia Humanities to focus on the historical practices of traditional African American midwives in Virginia, previously licensed as lay midwives and sometimes referred to as “granny” midwives. I’ve been looking at how these women somehow managed to continue traditions and a model of care that in many ways reflects traditions among midwives on the [African] Continent. I’ve been very interested in the survival of these cultural retentions, sometimes modified, in the American South.
You’ve worked on this subject previously, having published an oral history, Listen to Me Good: The Story of an Alabama Midwife, back in 1996. What’s the story behind your enduring interest in African American midwifery?
That’s right. In 1981, I was able to talk with African American midwives in Alabama, a Deep South state, about their practices and their recollections. I was interested in seeing if there were parallels, if there were differences, and putting their stories within the context of Virginia.
My whole interest in this began with my own childbirth experience forty-five years ago, in New Jersey. I was part of a relatively new movement among women to want to be awake and aware during their birth experience, to want to participate in decision making, to have support persons with them, including other women, and to have choices about place and who is caring for them. However, many of the things that I hoped for actually did not occur at that time. That’s what led me to midwives in the first place. Their specialty is in minimizing interventions and providing ongoing support as well as respecting culturally-based traditions. And that’s what, I think, connects the practices of midwives across cultures.
How does Virginia’s history of midwifery differ from or overlap with Alabama’s and other Southern States’?
If one dives deeply, it’s 400 years of women’s history, midwife history, and birthing history, which makes Virginia a very unique state. It’s safe to say some of the earliest practices of African American midwives in colonial America can be documented in Virginia.
In addition to that, what is different about this work in Virginia from the previous work that I did in Alabama is that I’m not only looking back at African American midwifery practices and traditions, but I’m also looking at the present and the future. I’m looking at what we can learn or understand better about their ways of caregiving that might be applicable today—particularly in a time when we’re still struggling with issues like health disparities, access to care, birthing justice, and equity.
Here’s some important background history: In the 1970s, as federal legislation made hospital-based, obstetrical maternal care far more accessible than it ever was during Jim Crow segregation, there was simultaneously legislation being passed across the South to terminate centuries of African American midwifery practices. As a result, mothers who wanted to have a home birth with a midwife could no longer choose that option. So, there’s been this huge gap in time from when the law was passed ending historic African American practice in Virginia and when I began doing the work here. That’s why in Virginia I was talking to midwife descendants and women delivered by midwives, while in Alabama, I was talking to women who only recently stopped practicing as midwives.
What did you learn from talking to midwife descendants in Virginia?
In Albemarle County, the midwife descendants I spoke to recalled the ways midwives were seen as being more than midwives. They were trusted and respected in their communities as extended caregivers. Midwives care about overall, holistic well-being, and not just what’s happening at the time of birth. So, I learned that in Virginia, African American midwives offered the benefit of providing community- and woman-centered care that encouraged communication and understanding, and respected the culturally-based traditions of the mothers they served. The midwives I met in Alabama and later in Africa followed similar traditions.
What I found in Virginia, particularly from research focusing on African American newspapers published in Virginia, is the appreciation, the celebration, and the respect for the midwives who were being phased out in the 1970s. Many churches would have ceremonies for them. In North Hampton near where I live, is the only marker that I know of in Virginia that tells the story of an African American midwife’s contributions to promoting the well-being of mothers and babies in the neighborhood where she once lived.
Since you mention the newspapers you were looking at, can you share some of the ways that you conduct research? How did you find the descendants that you talked to?
Well, I had to adapt my original research plan in the midst of a pandemic. I was originally going to be in Charlottesville for three months, but that turned into less than two weeks. I was hoping to have a workspace at the Jefferson School African American Heritage Center in order to develop community inroads, but the pandemic made that impossible. Churches are also really great for finding midwife descendants or for meeting families who remembered midwives, but churches were not open! So, newspaper articles have been a helpful resource for finding midwife stories and helping me to formulate some of the questions that I asked the midwife descendants.
I also modified my research plan to include interviewing midwife descendants outside of Albemarle County. For example, having previously worked as the part-time director of the Portsmouth Community Colored Library Museum, I documented the story of a midwife who practiced in Portsmouth. So I also ended up interviewing a midwife descendant in Portsmouth. Through other interviews, I learned about the community-based practices of a midwife who served mothers in Louisa County. And I interviewed Dr. L. Teresa Church who was delivered by Hubbardsville’s midwife, Mary Simuel Martin Morse, who happened to be Teresa’s own grandmother!
Of course, the pandemic provided more time than expected for reading. There is one book that’s been written, My Bags Are Always Packed: The Life and Times of a Virginia Midwife, about a midwife who worked in the Northern Neck of Virginia. And then Dr. Gertrude Fraser’s anthropological book, African American Midwifery in the South: Dialogues of Birth, Race, and Memory, is truly groundbreaking. It is really important because she was the first to view the practices and traditions of African American midwives in Virginia through a lens that intersects medical anthropology, women’s health, and African American history.
But in the end, my good fortune in finding midwife descendants to interview must be attributed in part to serendipity. A friend of mine who graduated from Hampton Institute happened to have a classmate in Charlottesville, named Theresa Jackson Price who is now in her nineties. She was the first person that I interviewed for this project.
Although Mrs. Price is not a midwife descendant, her roots in Charlottesville go back to the era of enslavement. Her family has a long history of creating opportunities for Black people in Charlottesville. In fact, her decision to seek maternity care at UVA Hospital reflected her commitment to seeking equity and dismantling the segregated health care services that dominated the Jim Crow era. I did not plan to interview Mrs. Price, but I am so glad that I did. I learned from her how having a baby at UVA hospital differed from having a baby at home with a midwife in the l940’s. I am grateful to Mrs. Price for sharing her own birthing story which will be included in the book I am writing. Price, a long-time school teacher and the first Black librarian in Charlottesville’s public school system, also provided me with the contacts that led to my first interviews with midwife descendants in Virginia.
I also did some research on plantation records at the UVA Small Special Collections Library. That’s how I was able to learn about the practices of midwives in the seventeenth and eighteenth centuries. The pandemic meant that I did not have the time that I would have liked to have to explore the community connections, but I found alternatives in the personal contacts, the oral history interviews, and then some of the archival research.
How and why has the standard midwife figure changed since the Jim Crow era, as midwifery has increasingly been incorporated into the public health system?
Well, it’s a great question, because with the professionalization and the standardization of midwifery comes a change in the makeup of the women who are becoming midwives. Today, the overwhelming majority of nurse-midwives practicing in the United States are white. That is a dramatic difference from the past. In the 1920s and 1930s, there were around 10,000 practicing licensed lay midwives in Virginia, and they were predominantly Black women of varying educational backgrounds, varying courses of work—all of the midwives that I learned about also received some training from local and county health departments and several attended classes hosted by Virginia State University and Hampton University, historically Black colleges.
One of the things that distinguishes traditional midwives is their holistic approach to birthing care that sometimes begins with a spiritual call to the practice. And how most often they learn their skills through the apprenticeship model, from following a senior midwife in the community. Their ways of knowing are very different from the ways of knowing of nurse-midwives who enter the profession of midwifery after becoming a nurse and often receive their academic training within a university setting. The connection between nursing and midwifery is a more recent phenomenon compared to the longstanding way of learning through apprenticeships found among indigenous midwives from time immemorial. Traditional midwives in Virginia and elsewhere are strongly bonded, however, by their respect for minimizing technological and pharmaceutical interventions in women-centered or family-centered birthing care as it is sometimes referred to as today.
To wrap things up, let’s talk about the status of midwifery in Virginia today. Why is it important that these traditions be maintained? What might mothers and families gain from midwives reclaiming traditional practices?
In recent years, Virginia has opened the door to increasing access to midwives of African American descent as well as midwives in general. That’s what’s exciting about the project in Virginia, and that’s what really separates it from the work in Alabama. Because in Alabama when I was there, there was kind of this sense of the door being closed. There was no pathway for a Black woman in Alabama to become a midwife without first becoming a nurse. So that’s a really exciting change!
I think that it’s hard sometimes to imagine what a midwife birth looks like because the images we see on TV can be misleading. What’s unfortunate is that it’s still not a familiar mode of care. But there have been some great changes in the legislation about making it easier for a nurse-midwife or any midwife to get licensed in Virginia, and a lot of it’s about expanding access and choice. There’s a lot of research going on now around cultural competency and the importance of communication. The work that I did also included interviewing doulas and an array of birth workers who promote some of the traditions sustained by past community-based African American midwives in Virginia.
For more, listen to “Giving Birth While Black,” a With Good Reason episode that touches on racial disparities and the need for increased access to specialized maternal health care.
Learn more about Linda J. Holmes.