03/03/2026
She delivered over 3,000 babies. Never lost a mother. The state said she was unqualified.
Long before there were hospitals in the rural South, long before a Black family could walk through the front door of any clinic that would see them, there was a woman in the community who knew what to do when a baby was coming.
She was not called a doctor. She did not have a medical degree framed on her wall or a stethoscope around her neck. What she had was knowledge, passed down through generations of women who had learned to bring life into the world under the most difficult circumstances imaginable.
They called her the Granny Midwife, and for more than two centuries, she was the backbone of maternal care in Black communities across the American South.
Her roots run deeper than the rural farmhouses where she worked.
When enslaved African women were brought to the Americas during the transatlantic slave trade, they brought their knowledge with them. West African healing traditions included sophisticated practices around pregnancy, labor, birth, and the care of mothers and infants, and those practices did not disappear when ships crossed the ocean.
They survived in the hands and memories of enslaved women who became the primary birth attendants on plantations, because the plantation owners needed them to be.
Enslaved women on plantations served as what one historical account described as the sole matron, midwife, nurse, physician, surgeon, and servant in their communities.
Physicians were expensive, plantations were remote, and labor did not wait for a doctor to arrive from town. So it was the enslaved midwife who answered when a laboring woman called out in the night, for Black mothers and for white ones.
Some enslaved midwives were hired out to neighboring plantations, permitted to travel to attend births across the county, which in a world designed to trap and immobilize them represented a rare and carefully protected form of mobility.
After emancipation, the granny midwives did not disappear. They became more essential than ever.
With no hospitals serving Black communities, no physicians willing to make the journey to rural areas, and segregation ensuring that what medical care existed was largely inaccessible to Black families, the granny midwife was often the only qualified birth attendant within miles.
She attended labor and delivery. She counseled mothers through breastfeeding. She returned in the days after birth to monitor the mother and infant. She watched for postpartum complications. She was nutritionist, counselor, doula, and community anchor, not because she was expected to wear all of those roles, but because no one else in her community was coming to do it.
She served everyone.
White families in rural areas, just as isolated from physicians as their Black neighbors, relied on granny midwives too, which made the knowledge these women carried a community resource that crossed racial lines even inside a society structured entirely around maintaining them.
Around 50 percent of all births in the United States were attended by midwives in the year 1900. By 1930, that number had dropped to approximately 15 percent.
What happened in those three decades is not simply the story of medical progress. It is the story of a deliberate campaign.
In 1859, the American Medical Association designated obstetrics as one of four core branches of practical medicine, a move that set the stage for physicians to claim authority over childbirth and position midwives as their competitors.
Julius Levy, a physician and researcher at the Bureau of Child Hygiene in New Jersey, found through documented research that the lowest maternal mortality rate in American cities was found in the city with the highest percentage of births delivered by midwives.
The data did not slow the campaign.
In 1921, Congress passed the Sheppard-Towner Maternity and Infancy Protection Act, legislation framed as an effort to reduce infant and maternal mortality by funding midwifery training and licensing programs across the country.
On the surface, it sounded like support for the granny midwives. In practice, it was the mechanism of their removal.
The act targeted Black midwives in the South specifically, who represented the largest group of unregulated birth attendants in the country. States established midwifery training classes taught by public health nurses, many of whom had considerably less experience attending actual births than the women they were being sent to instruct.
A Black woman who had delivered thousands of babies across decades of practice was now required to prove herself acceptable to a state that had never once asked her community whether she was doing the work.
Many of the granny midwives were elderly, poor, and rural, unable to travel to certification classes, unable to meet the paperwork requirements, and unable to navigate a bureaucratic system designed without them in mind.
In 1941, the Tuskegee School of Nurse-Midwifery opened in Alabama, explicitly designed to increase the number of Black nurse-midwives. It closed five years later, in 1946, due to a lack of funding, before it had trained enough graduates to replace what the regulations were already eliminating.
By 1950, midwives attended only 5 percent of all births in the United States, though they still attended approximately 25 percent of all non-white births, an imbalance that reveals exactly whose communities had been abandoned by the medical establishment the regulations were designed to protect.
Through all of this, some granny midwives held on.
Maude Callen was born in Florida in 1898, trained as a nurse-midwife, and arrived in Pineville, South Carolina in 1923. Over the course of her career she delivered an estimated 600 to 800 babies and trained hundreds of other midwives across the region. LIFE Magazine photographer W. Eugene Smith followed her for a landmark photo essay published in 1951. She practiced until her retirement in 1971 and was inducted into the South Carolina Hall of Fame.
Margaret Charles Smith was born in Alabama in 1906. She became a licensed midwife in Greene County, Alabama in 1949, and over her career attended nearly 3,000 births. She never lost a mother. She co-authored her autobiography, Listen to Me Good: The Life Story of an Alabama Midwife, at the age of 91.
Onnie Lee Logan was born around 1910 in Alabama, the daughter and granddaughter of midwives. She practiced for most of her adult life while also working as a maid to make ends meet, delivering the majority of her patients for free because most of them had nothing to pay her with. Her autobiography, Motherwit: An Alabama Midwife's Story, published in 1989, became an immediate classic.
These women did not just deliver babies. They held communities together at their most vulnerable moments, and they did it across decades of being told by the medical establishment that they were the problem.
The consequence of erasing them is not theoretical.
Researchers and public health advocates have drawn a direct connection between the decline of Black midwives in the mid-20th century and the persistent rise in Black maternal and infant mortality rates that followed.
The communities that lost their granny midwives did not replace them with physicians who showed up at 2 a.m. on dirt roads. They replaced them with nothing.
Today, Black women in the United States die from pregnancy-related causes at two to three times the rate of white women.
Today, the number of Black midwives in the United States remains critically low.
Those two facts are connected. The historians, the researchers, and the data say so plainly.
The granny midwife carried the knowledge of generations in her hands. She walked through mud and crossed rivers and showed up in the dark without being asked twice.
Teach this. Teach the granny midwives alongside Florence Nightingale. Teach the Sheppard-Towner Act alongside the progress narratives of 20th-century medicine. Teach the names Margaret Charles Smith, Onnie Lee Logan, and Maude Callen to every generation that comes after this one.
They built the foundation that modern midwifery stands on. The foundation deserves to know its own name.
SOURCES
TIME Magazine — The History That Explains Today's Shortage of Black Midwives
Used for: midwife birth percentages, Tuskegee School, Julius Levy finding, maternal mortality link
Santa Clara University — The Decline of Southern Black Midwifery in the 20th Century
Used for: AMA 1859 obstetrics claim, enslaved midwives serving white families, plantation context
Weitzman Institute — Continuing the Legacy of Granny Midwives
Used for: Sheppard-Towner Act details, licensing campaign, midwife roles as counselor and doula
UVA School of Nursing — Black Midwifery's Complex History
Used for: Sheppard-Towner targeting Black midwives, untrained supervisors overseeing experienced women
South Carolina ETV — Maude Callen: SC Hall of Fame
Used for: Maude Callen career, 600-800 births delivered, retirement 1971
Frontier Nursing University — Celebrating Black Grand Midwives
Used for: Margaret Charles Smith, nearly 3,000 births, never lost a mother, autobiography 1996
We Are DTI — A Brief History of Black Midwifery in the US
Used for: Onnie Lee Logan biography, family midwifery lineage, Motherwit autobiography
PMC / American Journal of Public Health — Black Maternal and Infant Health: Historical Legacies of Slavery
Used for: Black women dying at 2-3x the rate of white women, structural racism in obstetrics
SF Community Health — The Importance of Black Midwives
Used for: West African birthing knowledge carried through the slave trade
Black Midwifery Collective — History of Midwifery
Used for: End of legal lay midwifery by 1970s, state-by-state permit removals
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