Spiritual Care Practices of ‘Granny Midwives’ in the South
African spiritual traditions of healing are present today in a variety of nuanced ways across the globe. A perhaps unexpected place where these diasporic traditions exist is within the field of U.S. midwifery, founded by enslaved African midwives trusted for their wisdom about birth. As a white woman working in the birth field today, it is complex to both acknowledge the foundations of my own practice as stemming from African healing traditions and to simultaneously recognize the ways that memory of these traditions has largely been erased from U.S. medical history as Black midwives have been illegitimated and dislodged from modern medical systems. There is an urgency to reclaim the diasporic histories of early African American midwives, particularly in the 21st century in which midwifery has been shown to improve incidence of maternal mortality and in which significant racial disparities among birth outcomes are present in U.S. medicalized systems. Unfortunately, due to a lack of written history, an explicit erasure of midwife practices by 20th c. white medical practitioners, and shame of poverty or regression among present-day African American descendants of midwives, this history is difficult to observe. Researchers Christa Craven and Mara Glatzel notice a hesitation among African American women to disclose the oral histories of their midwife grandmothers as they attempt to separate themselves from “racialized stereotypes” of ignorance attributed to their communities by white people. Even so, a recent social interest in the history of Black midwives has led to the publication of several interviews, memoirs, and nonfiction accounts related to early African midwifery practices. Such publications reveal that early African midwives, or ‘granny midwives,’ offered spiritual care to birth mothers through holistic attention to the body, community-centered procedure, and the establishment of rituals—all practices of care that influence the American Midwifery Model of Care today.
The earliest midwives in the United States were older Black women known as ‘granny midwives’ or ‘grannies.’ These women shared their midwifery expertise from birth attendance practices of Central and West Africa, including community-centered care, herbalism, cosmology, and ritual. ‘Grannies’ were seen as healers, often taking on medical roles outside of birth attendance. From the 17th-early 20th centuries, ‘granny midwives’ delivered most babies for both Black and white women. ‘Grannies’ had years of experience attending birth, held leadership roles within their communities, and maintained a sense of spiritual authority that fostered healing relationships between members of both Black and white communities. They viewed birth as a healing process “rooted in religious and symbolic ritual. For centuries, their wisdom was contrasted with the limited birth knowledge of white, male doctors. ‘Granny midwives’ were considered experts of the world of birth work and practiced without regulation in the United States until the early 20th century.
However, as birth became more medicalized from 1900-1940, the ‘granny’ was portrayed by medical practitioners as dangerous or invalid. Physicians began to claim that ‘granny midwives’ were uneducated to the modern birthing instruments and procedures which improved maternal and infant outcomes. By the 1920s, the Progressive Era women’s movement for maternal and child health established the Children’s Bureau of Health. Seeking to improve maternal and infant care, this organization explicitly denounced midwives and erroneously argued that their practices were contributing to increasing maternal mortality. Traditional lay midwife practices were invalidated and midwives were deemed to be “superstitious.”Anti-midwifery legislation increased from here, differing from state to state. In some states like North Carolina, midwives were disqualified by local county boards of health through the administration of health code violations. In others, physicians became supervisors of midwives, removing them as community-centered care providers. Some ‘granny midwives’ were eager to learn new modern techniques for birth and share their own traditional healing practices. These changes to midwifery were rooted in racism and profitability. While nurses working to train midwives in the early 20th century thought they were helping mothers and midwives alike, their medicalized instruction denied the values of “traditional skills and folk healing.” Midwifery became a medical profession of its own with the establishment of the Nurse-Midwife, situated within the nursing profession. However, this program was not accessible for Black women in the early 20th century and only became popular as interest in midwifery grew among white women toward the end of the 20th century.
In the 21st century, midwifery in the United States is still regulated from state to state, with no federal uniformity of standard of practice. Traditional ‘granny midwives’ are no longer the primary birth attendants in the United States. In fact, midwives only attend about 8% of U.S. births, with most of these midwives Certified Nurse-Midwives rather than traditional lay midwives. Even so, midwife popularity continues to rise as birthing families desire more personalized, continuous, and relational care than obstetricians typically provide. The midwifery profession of 2021 and the Midwifery Model of Care practiced by U.S. midwives is part of an African diasporic healing tradition which has been seized from its original progenitors—the ‘granny midwives’ who worked from the knowledge of their own Central and West African grandmothers. Those who were once thought to be the only members of their communities with the practical and spiritual skills necessary for attending a childbirth were now condemned for malpractice.
To better understand the care practices of ‘granny midwives,’ it is important to situate them within the methods of traditional African religions. For Africans, all life is considered to be sacred and interconnected. Practices of healing honor this understanding by engaging with the body, earth, and cosmologies together through herbalism, ritual, and communal prayer. For Africans, healing is not only directed toward the physical body, but also toward the community and the cosmos, assuming an understanding of interrelationship between the ancestors and life in the physical realm. The body is seen as a “spiritual reality” which must maintain harmony with unseen realities. Ritual facilitates this connection, not only on a day-to-day basis, but also in significant moments of transformation, such as birth. Practices of health or healing, therefore, such as midwifery, are deeply spiritual practices guided by ritual.
Healing in African traditions is not an individual process, but rather, profoundly communal. Health is thought to be the most important quality that a community can maintain. Without communal health, there can be no personal sense of well-being. Qualities of peace and happiness are not available where tempers of jealousy, pride, anger, or other forms of ill will are present. Shrines often serve as a central source for spiritual power within communities. Diviners or healers spend time in these spaces and disperse their spiritual power among the community. Older individuals as well as infants are thought to be on the edges of this physical world and close to the unseen world. Birth is a time then, not only of significant transformation, but also a of connection to the unseen world out of which the infant is born. ‘Granny midwives’ brought these African understandings of health and the body with them to the United States, perceiving birth as an experience of connection.
‘Granny midwives’ offered spiritual care of the physical body by connecting the birthing mother to both Earth and cosmological realms. Traditional herbalism was used to support the body throughout the pregnancy and postpartum period. Massage was also used to support a woman’s body, decreasing pain and increasing safety. Care of the body during pregnancy included the discouragement of certain practices. For instance, in rural Virginia, ‘granny midwives’ did not allow pregnant women to wash their hair because it was thought this would lead to open pores and increase exposure to germs. Likewise, certain foods were to be avoided during pregnancy. ‘Grannies’ even considered it dangerous to speak directly about one’s pregnancy in public spaces. Unwanted attention toward the mother or fetus could summon harmful spirits that might negatively affect the baby. ‘Granny midwives’ also helped women maintain a particular disposition during pregnancy which avoided “evil,” thus preventing birth defects or malevolent personality development of the child.
When it came to the birth itself, ‘granny midwives,’ much like midwives today, tended to intervene in the natural birth process as little as possible. Often referred to as “baby catchers,” they focused primarily on supporting the woman morally and physically while she labored at her own pace. ‘Grannies’ helped women position their bodies into traditional birth positions which allowed for an easier and less painful delivery. They used massage to soothe, to turn the infant when necessary, and to facilitate delivery. To hasten labor, ‘grannies’ may have prescribed particular remedies such as buttermilk, gun powder, black pepper, red onions, or tea made from a dirt-dauber’s nest. Sometimes, they would engage with the woman’s emotions, intentionally saying something to make a mother angry in order to progress her labor. In the event of hemorrhage, ginger tea was prescribed, or cobwebs soaked in vinegar were applied on the abdomen or birth canal.
After delivery, midwives began to care for the bodies of both the mother and the newborn, often working with the understanding that the mother and baby’s bodies were connected. For example, midwives would squirt newborn’s eyes with mother’s milk to prevent infection or “sore eyes.” They cared not only for the physical body, but also the physical spaces—cleaning the house, preparing meals, doing laundry, watching other children in the family, and offering moral support. ‘Grannies’ encouraged mothers to rest during the postpartum period, often insisting that they stay inside for a “lying-in” period.
Within their communities, granny midwives were thought to have an innate understanding of the body, so much that many women entrusted their midwives to know exactly when the baby would be born, to the hour. However, this trust began to crumble as medicalized birth was popularized and midwives were touted as uneducated and dangerous. Unfortunately, around this time, many holistic spiritual care practices of the body were lost and replaced with practices which focused solely on physiology. As a result, it is nearly impossible to historically investigate the ways that physiology interacted with culture and cosmology for Black and white women giving birth with a granny midwife before the 20th century.
While physicians of the early 20th century often argued that midwives did not understand human anatomy, Lamp argues that midwives’ connection to rhythms of the body shows just how much they did understand, even if their understandings were obscured by ritual metaphor or secrecy. In fact, midwives were happy to learn more from anatomy books when they became available in the 20th century. Lamp highlights the complex “cosmologies of the body” engaged by granny midwives. Their cultural practices and interpretations did not necessarily negate their physiological understandings of the body. Even so, as they gained access to medicalized trainings on topics like sanitation and new instruments, they were quick to incorporate the new information into their practices.
In addition to holistic care for the body, ‘granny midwives’ facilitated a sense of wider communal and cosmological belonging for pregnant mothers. Midwifery was deeply relational. ‘Grannies’ not only formed relationships with the pregnant woman and families but were often already related to them. If the midwife was not family by blood or marriage, she became like extended family through her intimate role as birth attendant and advisor. Consequentially, midwife care was personalized and continuous. In addition to individual families, ‘granny midwives’ were known by their whole communities. Not only were they responsible for birth, but they also often cared for the sick and sometimes dressed and cleaned the dead. ‘Grannies,’ themselves often older in age, connected the young and old within communities. Some argue that their disappearance can be connected to the rupture of these communal links. ‘Granny midwives’ were central figures of autonomous African American community, facilitating not only birth of new life, but also maintenance of traditional African identity related through kin-bound systems of meaning. Even more, ‘grannies’ facilitated community beyond African American families. They were deeply trusted by white and Black families, serving as “an intimate contact between the races and across social class.”
The ‘granny midwife’ invited birthing mothers into a wider community of people in addition to facilitating a sense of belonging within the divine realm. Midwives’ power was known to come from “higher authority.” A ‘granny’ would receive divine signs and readily share them with the birthing mother or with the wider community. Readings of divine signs were reinterpreted, affirmed, or discouraged by the community within the seen realm. The midwife cared for the community and for birthing mothers through her facilitation of physical and spiritual community, establishing a sense of belonging for birth mothers situated within both the seen and unseen realms.
A third way that ‘granny midwives; offered spiritual care to new mothers was through the engagement of rituals. ‘Granny midwives’ were known in their communities as ritual experts who facilitated birth and postpartum rites that allowed for connection between the mother and baby, the community, and the unseen realms. While most rituals practiced by ‘granny midwives’ were erased from midwifery’s history with mandated-midwife trainings and heavy midwifery regulation in the early 20th century, there are traces of a few traditional African birth rituals practiced in the U.S. still known through oral history. For example, some midwives tracked pregnancies in accordance with the cycles of the moon, awaiting a particular type of moon before anticipating the start of labor. When a woman began to show physical signs of her pregnancy, it was common for ‘grannies’ to read the cosmological meaning of her body’s signs. While interviewing rural African Americans living in Virginia on granny midwifery practices, anthropologist Gertrude Jacinta Fraser found that community members were hesitant to talk about a particular ritual related to the use of smoke during and after childbirth. Eventually, she was able to uncover the ritual, learning that midwives used to surround a mother with smoke during a prolonged labor to stimulate contractions and hasten the birth. Other rituals were more explicitly undergirded with cosmological meaning. For instance, during the postpartum period, ‘granny midwives’ were responsible for properly burying the placenta and umbilical cord, returning them to the earth and the ancestors. Postpartum rituals also existed which sought to gradually reintegrate the mother into her daily life. By facilitating birth rituals, ‘granny midwives’ provided birthing mothers with a way to make meaning out of their experiences.
In 2021, the Midwives Model of Care is rooted in patient-centered care which is relational, hands-on, and continuous before, during, and after birth. Midwives seek to minimize medical intervention as much as possible while still identifying danger and obtaining proper support as needed. While the model of care does not reference cosmology, it does necessitate attention to physical, psychological, and social components of well-being. This reflects the traditional African healing model of care. With the contemporary resurgence of the field of midwifery in the United States, primarily initiated by interest of white women in the 70s, there is a need to explicitly acknowledge the racism which contributed to the original disappearance of the granny midwife traditions and to talk about race’s role in the contemporary midwifery movement. Christa Craven and Mara Glatzel argue that contemporary birth workers have an obligation to inhibit any further erasure of traditional African American midwifery practices, especially when erasure is a function of racial privilege (source). The reemerging popularity of midwives as a result of the deterioration of hospital birth outcomes comes an opportunity for those who support midwifery to commit to uncovering its authentic history in the United States. Additionally, there is a challenge to acknowledge and honor the African spiritual traditions which served as the foundation for birth workers in this country. Birth workers today have the opportunity to offer spiritual care to their fellow Black midwives by advocating for the validity of their practice. This advocacy is spiritual care not only for the midwife, but also for the wider community.
Granny midwives in the United States south never disappeared completely. The memory of African spiritual birth practices was carried in rural communities by a few courageous midwives. Today, with the resurgence of midwives in general, there is also a movement to provide adequate birth care to Black birthing persons. This care often comes through the form of Black midwifery. Black midwives in states like Georgia are balancing the modern-day medicalized birth system while reclaiming the traditions of their grandmothers. In Atlanta, Certified Nurse, Simone Marshall offers holistic midwifery care that balances certified birth technology with traditional African spirituality. Marshall’s practice is deeply grounded in family-centered care, a relationship between the body and the earth, and her own relationship with the divine. Lay midwife, Sarahn Henderson also practices midwifery in Atlanta, with the tagline, “So you want to birth like your mama ancestors?” Part of the mission of her practice, Birth in the Tradition, is to resurface the practices of traditional pregnancy, birth, and postpartum from Africa, to “reinstate the number of Birth Workers of African descent,” and to recognize the Grandmother Midwives from whom her practice was derived. This renewed attention toward traditional African midwifery practices across the U.S. is reconnecting African American birthing persons to the sanctity of their bodies, renewing a sense of community-centered care, and reconnecting families to cosmological community through sacred traditional rituals. The legacy of granny midwives lives on with each new life born into spaces that honor the sacred and interconnected nature of life. As a white woman working in these sacred spaces, I hope to tell the stories of granny midwives who so influenced my own practices, to remember their rituals, and to relentlessly support the African American voices of birth working today to carry on the traditions of their Grandmothers.
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