Read our first post on Community Doulas and Early Learning.
The role of midwives and doulas has been integral to childbirth across cultures and centuries. For women of color, particularly Black women in the United States, the midwife role was not just a profession but a legacy—one deeply intertwined with community care and cultural traditions. Historically, midwives and doulas in African American and Indigenous communities provided essential support to pregnant women, often facing barriers to mainstream medical care. However, over time, systemic racism and policy changes systematically marginalized these women, forcing them out of the spaces they had long occupied.
The Role of Black Midwives and Doulas in History
Black midwives and doulas have a significant history in the United States, dating back to the 1600s. Enslaved African women brought midwifery knowledge to the Americas, where they cared for both enslaved and white women (National Museum of African American History and Culture, 2022). These women were often the sole providers of maternal care for their communities. Their knowledge and skills were indispensable, especially given the lack of access to formal healthcare in rural and underserved areas.
After the abolition of slavery, Black midwives continued to play an essential role, particularly in the rural South, where they became prominent figures in their communities. Known as “granny midwives,” these women were trusted community healers who provided comprehensive care, including prenatal, delivery, and postpartum services. The granny midwives operated at a time when many rural communities had limited access to doctors or hospitals. They were often the only source of healthcare available, particularly to Black families and low-income households (Library of Congress, 2024). Despite their crucial role, granny midwives faced increasing opposition from the medical establishment, which sought to standardize and regulate childbirth practices.
Medicalization and Marginalization
By the early 20th century, the medical field had begun to shift childbirth from home settings to hospitals. The 1921 Sheppard-Towner Maternity and Infancy Protection Act aimed to improve maternal and infant health but also played a role in regulating midwifery, leading to the widespread dismissal of midwives in favor of obstetricians (Library of Congress, 2024). This shift, combined with a growing emphasis on “modern” medical care, effectively began erasing the legacy of Black and Indigenous midwives who had long been community caregivers.
In the mid-1900s, formalized medical training programs excluded Black women, while hospitals and healthcare providers positioned midwifery as an outdated and dangerous practice. Many states passed laws that either outlawed or severely restricted the practice of midwifery, effectively reducing the number of Black midwives who could legally practice. As hospital births became the norm, the role of Black midwives and doulas diminished, and with it, a generational knowledge that had been passed down for centuries.
Racial Disparities in Maternal Healthcare
Today, the legacy of exclusion continues to be reflected in racial disparities within maternal healthcare. Black women are more than three times as likely to die from pregnancy-related causes compared to white women (CDC, 2021). Factors such as systemic racism, implicit bias, and lack of access to quality care contribute to this alarming statistic. The absence of Black midwives and doulas, once integral members of maternal care, has played a role in these disparities. Black mothers, particularly, report feeling unheard and dismissed by healthcare providers, leading to devastating outcomes (Horton, 2022).
For many Black women, the lack of representation in maternal healthcare compounds the challenges they face. The disempowerment and marginalization of Black midwives have directly impacted the quality of care that Black women receive today. As highlighted by the Kaiser Family Foundation, current healthcare systems fail to adequately address the unique needs of women of color, contributing to higher rates of maternal and infant mortality (Hill, Artiga, & Ranji, 2022).
Resurgence of Black Doulas and Midwives
In recent years, there has been a growing movement to reclaim and revitalize the legacy of Black midwives and doulas. Organizations and individuals across the United States are working to provide culturally competent care and reduce racial disparities in maternal health outcomes. This resurgence seeks to restore the cultural practices and community-centered care that were once foundational to Black midwifery (Generate Health, 2024).
Today, Black doulas and midwives are not only reclaiming a space from which they were historically excluded but are also addressing a maternal health crisis within their communities. They offer holistic and personalized care, focusing on advocacy and education. By amplifying the voices of Black mothers and honoring traditional practices, Black doulas and midwives are working to reduce the maternal mortality rate for women of color (Walker, 2023).
The history of women of color, particularly Black women, in the midwifery and doula space, is one of resilience in the face of systemic exclusion. Their forced removal from this space, coupled with the medicalization of childbirth, has had lasting consequences on the maternal health outcomes of Black women. However, as the recent revival of Black doulas and midwives shows, this legacy is far from forgotten. By reclaiming their role in maternal care, Black midwives and doulas are providing culturally attuned, compassionate support that is instrumental in addressing the health disparities facing women of color today. The historical significance of their contributions is an enduring reminder of the vital role they play in the well-being of their communities.