03/10/2026
In Celebration of Women's History Month
The History of Black Midwives in America
The history of Black midwives in America is a story of survival, skill, resistance, and care—deeply intertwined with slavery, freedom struggles, and community health. For centuries, Black midwives were among the most trusted and essential healthcare providers in Black communities, especially in the rural South, long before hospitals were accessible or welcoming to Black families.
Roots in Enslavement and African Knowledge
Black midwifery in America began during slavery. Enslaved African women carried with them extensive knowledge of childbirth, herbal medicine, and spiritual care from West and Central African traditions. On plantations, these women were often forced to assist in births for both enslaved women and white women. Despite brutal conditions, they preserved and adapted their medical knowledge, laying the foundation for a distinctly Black American midwifery tradition.
These early practitioners were more than birth attendants—they were healers, counselors, and protectors. Their work was communal and holistic, centered on the well-being of mothers, babies, and the wider community.
The Rise of the “Granny” or grand midwife
After emancipation, Black midwives—often called “granny midwives”—became the backbone of maternal care for Black families in the late 19th and early 20th centuries. The term grand midwife reflected both age and wisdom: these women were revered elders who learned through apprenticeship, observation, and experience rather than formal schooling.
Operating in an era of segregation, when Black people were barred from or mistreated in hospitals, grand midwives delivered the majority of Black babies in the South. They traveled on foot or horseback, carried handmade tools, used herbal remedies, and provided postpartum care that extended well beyond birth. Their maternal outcomes were often as good as—or better than—those of white physicians at the time.
Regulation, Racism, and Decline
In the early 20th century, the professionalization of medicine and midwifery brought major changes. Public health campaigns, influenced by racism and eugenics, portrayed Black midwives as dirty, ignorant, or dangerous. New laws and licensing requirements were introduced that many elder midwives could not meet, not because of lack of skill, but because of barriers like literacy tests and racial exclusion.
Government programs trained and supervised some midwives, but overall, these policies dramatically reduced their numbers. By the mid-1900s, hospital births became the norm, and Black midwives were pushed out of practice. This shift coincided with the loss of culturally competent care and, eventually, widening racial disparities in maternal and infant health.
Legacy and Modern Revival
Despite their decline, the legacy of Black midwives endured. Figures like Margaret Charles Smith, who practiced for decades in Mississippi, preserved stories and practices that might otherwise have been erased.
Today, Black midwifery is experiencing a revival. Modern Black midwives and doulas are reclaiming ancestral knowledge while also navigating medical systems, working to address the ongoing Black maternal mortality crisis. They often point to history as evidence: when Black communities controlled their own birth care, outcomes were better.
Why This History Matters
The story of Black midwives is not just about the past—it is about justice, autonomy, and health today. Understanding the role of the grand midwife helps explain both the resilience of Black communities and the structural harms that disrupted effective, life-saving care. Honoring this history means recognizing Black midwives as medical professionals, cultural stewards, and agents of resistance whose impact still shapes American healthcare.
