H-NET BOOK REVIEW
Published by H-SAWH@h-net.msu.edu (December, 1999)
Gertrude Jacinta Fraser. African American Midwifery in the South:
Dialogues of Birth, Race, and Memory.
Cambridge, Mass.: Harvard
University Press, 1998. ix + 287 pp. Bibliographical references and
index. $39.95 (cloth), ISBN 0-674-00852-9.
Reviewed for H-SAWH by Patricia Evridge Hill, ,
Department of Social Science, San Jose State University
Recalling Midwifery as Both a Source of Pride and a Sign of Deprivation
University of Virginia anthropologist Gertrude Jacinta Fraser
has written an absorbing, provocative account of the gradual
elimination of African-American midwives from a county in
Virginia's Piedmont between 1920 and 1960. Central to the story
is Fraser's exploration of how residents in the 1980s and 1990s
recalled this transition and attempted to make sense of a past
that simultaneously evoked pain, warmth, and nostalgia for a
more interdependent community.
Fraser's study is based on a combination of archival sources and
fieldwork, including more than 100 interviews with African
Americans in a county of 12,000 residents. Interestingly,
Fraser spoke to only four women who called themselves midwives
and five who delivered babies but rejected the title. The
county's lone public health nurse represents her profession.
The small sample of midwives makes the book more a narrative
about how a community remembers midwifery than a first-hand
history of African-American midwifery in the South. That said,
Fraser's subtitle, which best describes her work, is a
fascinating subject in its own stead.
As a historian, I'm more comfortable with oral history "sources"
than Fraser's anonymous "informants" and with a named place than
pseudonymous "Green River County." Lacking appendices,
transcripts, place names, or the actual names of interviewed
individuals, readers must accept or reject Fraser's
interpretations of her fieldwork without historians' customary
level of documentation. (She proves herself a sound
interpreter of sources in the book's first half, which is
largely based on traditional archival and secondary sources.)
Disciplinary quibbles aside, anthropologists have added a great
deal to our understanding of how people interpret the past, and
medical anthropology in particular has taken the lead in
articulating women's selective compliance with and resistance to
the process of medicalization in the twentieth century.
African American Midwifery in the South is especially strong
on a conceptual level. Fraser highlights the refusal of
southern whites to emphasize environmental and structural causes
of maternal and infant mortality among blacks. Her research
illuminates the unidirectional lines of authority that marked
midwives' relationships with public health nurses and obscured
possible models of health-care delivery that would have blended
access to scientific advances, affordability, and succor.
Fraser correctly points to hospital births as a marker of status
among some African Americans and as an indicator of progress
among others. Characteristic of Fraser's ability to explain
county residents' often ambiguous responses to midwives is her
assertion that "their involvement in birth and death, their
supposed ability to mediate between the real and supernatural
world, and their authority in spheres of knowledge closed off to
ordinary persons meant that midwives had been regarded with what
might be described as awe." As a result, public health
officials' campaigns to discredit midwives "may have overlayered
existing ambivalent attitudes toward these women" (p. 143).
In Chapter Eight, Fraser provides a highly original explanation
of why older women in the county, who still admire and respect
the midwives who delivered their own children, consider the
medicalization of childbirth "inevitable and not necessarily
detrimental" (p. 165). While refusing to condemn the old ways,
"Green River County" residents believe that women's and
children's bodies have changed along with changes in the
community. They don't expect traditional practices to be
salient to a new generation. For example, some women with
knowledge of medicinal herbs refused to treat their
grandchildren with them because "younger bodies did not work
according to the principles with which they were familiar" (pp.
Fraser positions her work as an alternative to narratives of "great men"
and those of "midwifery on the rebound." Such interpretations portray
midwives as retaining or regaining their autonomy despite public health
officials' denunciations. Some also promote a romanticized image of
cooperation between black midwives and white doctors and nurses. Fraser
advocates a third strategy that "stresses the gradual destruction of the
African American midwifery tradition over the first half of the twentieth
century" (p. 40). Although she recognizes that these approaches need not
be mutually exclusive and includes a study of Virginia's influential state
registrar, William Plecker, in Chapter Three, Fraser's historiographic
preference for the "suppressed midwifery" narrative is clear and a bit
strident. This may be the result of her focus on a particular county in
Virginia and the public health personnel involved at both the state and
county level. Certainly, Fraser's descriptions of Plecker, a eugenicist
who directed midwives to maintain racial distinctions and "basically
controlled public health in Virginia through most of the first half of the
century," and "Mrs. Stewart," the county's long-time public health nurse,
who thought black women "ignorant" for relying on older women from their
own community, make anyone contemplating a top-down study pause (pp. 38,
Still, individual policy makers and medical personnel made/make a
difference. For example, the value of a study of public health leadership
in South Carolina shifts considerably after 1940 when Dr. Hilla Sheriff, a
liberal committed to the use of federal funds to improve health care for
African Americans despite a recalcitrant and racist state legislature,
took over conservative James Hayne's bureau of maternal and child health.
Similarly, accepting Fraser's caveat concerning the unidirectional lines
of authority between public health nurses and midwives, one can much more
easily imagine nurses who were more open-minded than "Mrs. Stewart," such
as South Carolina's Laura Blackburn, Maude Callen, Eula Harris, and
Eugenia Broughton, designing a midwife-training program that "allowed
midwifery to continue as a birthing alternative" (pp. 41-42). My point
here is that although Fraser's choices served her well in the case of
Virginia, a variety of narrative strategies may be appropriate given
different historical actors throughout the South.
Fraser sets forth some of her most compelling conclusions in Chapters Ten
and Eleven. Interview subjects spoke in detail about African-American
women's efforts to define and control risks during pregnancy and midwives'
influence and admonitions during the postpartum period. The interviews
demonstrate that midwives' models for the delivery of the placenta and
treatment of the umbilical cord differed from those of public health
officials. According to Fraser, "incidents of resistance to the
educational agenda of medical personnel often occurred over these
explicitly noninvasive methods of treating the body or maintaining its
health" (p. 235). In contrast, interview subjects had very little to say
about the actual delivery of a child--a situation in which a midwife's
abilities, traditional practices, or the exigencies of a medical emergency
might require that she put her hands into the birth canal. Both older
women and older men interviewed by Fraser knew of the legal prohibitions
against midwives doing so. The subjects' unwillingness to describe
techniques used by midwives or recall details of deliveries are
insightfully interpreted by Fraser as less obvious signs of resistance.
As a fourth-generation midwife told Fraser on the subject of entering the
birth canal, "They [midwives in her grandmother's time] knowed how. . . .
I know how too. But I am not allowed to do it. And I wouldn't do it for
nothing cause its against the law.'" This insight, along with county
residents' silence on the subject, indicates that Fraser is correct to
read between the lines (p. 155).
In conclusion, Professor Fraser treats readers to a well-written study,
impressive both conceptually and in its execution. Her ability to
interpret her subjects' silences, as well as the information they provide,
makes this volume useful to historians and social scientists studying
women's health, southern history, African-American communities, and
professional rivalries among practitioners. In addition, Fraser's
intellectual honesty when the residents of "Green River County" refused to
tell her what she wanted to hear confirms her credibility and provides an
excellent model for graduate students.
. See, for example, Margaret Lock and Patricia A. Kaufert, eds.,
Pragmatic Women and Body Politics (New York and Cambridge, England:
Cambridge University Press, 1998) and Robbie E. Davis-Floyd and Carolyn F.
Sargent, eds., Childbirth and Authoritative Knowledge: Cross-Cultural
Perspectives (Berkeley: University of California Press, 1997).
. See my profiles of Maude E. Callen and Hilla Sheriff in Lois N.
Magner, ed., Doctors, Nurses, and Medical Practitioners: A
Bio-Bibliographical Sourcebook (Westport, Conn. and London: Greenwood
Press, 1997). Susan L. Smith analyzes the complex relationships between
Mississippi midwives, public health nurses, and state officials in Sick
and Tired of Being Sick and Tired: Black Women's Health Activism in
America, 1890-1950 (Philadelphia: University of Pennsylvania Press,
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