Granny Midwives, License Boards, and the Archive of Black Birth Work

The archive of Black birth work is not neutral.

A midwife may enter the surviving record because a state board issued a permit, a county registrar demanded a birth report, a public-health nurse inspected a bag, a training institute took a group photograph, an official wrote a manual, or an agency suspended or retired a practitioner. The care itself—hours on the road, labor inside a private home, trust built across generations, unpaid work, food prepared after delivery, family negotiations, fear of segregated hospitals, and knowledge passed from one woman to another—may leave a thinner paper trail.

That imbalance changes how the story must be read. Permits and board files can recover dates, categories, authorities, addresses, rules, and institutional relationships. They can also make state oversight appear larger than community knowledge simply because government created and preserved more paper. A responsible CultureUp article reads the regulatory archive for what it proves, what it tried to control, and what it failed to record.

The name in the record is not the whole profession

By the early twentieth century, officials, journalists, physicians, and some communities used the terms granny and granny midwife for Black midwives in the rural South. The label can appear affectionate, respectful, dismissive, paternalistic, racialized, or all of those at once depending on who used it and why. It was not a single national credential. It did not guarantee that a practitioner was elderly, a grandmother, apprentice-trained, licensed, unlicensed, or authorized under the same rules as a woman in another county or state.

CultureUp keeps the title because it is part of the historical archive, but the article does not silently adopt the term as a current professional category. When a source says granny midwife, the source owner, date, jurisdiction, and purpose should remain visible. When the person’s own preferred title is known, that language should receive priority. When it is not known, Black midwife, community midwife, traditional midwife, non-nurse midwife, or the exact legal category in the record may be more precise.

The naming problem is evidence of the larger power problem. The same woman could be a trusted birth attendant in community memory, a permit holder in a health-department file, an untrained midwife in a federal manual, a non-nurse midwife on a later certificate, and a granny in a newspaper or oral history. Those labels describe different relationships to the speaker and the state. They should not be flattened into one identity.

A license board was often a network of offices

The phrase license board in this title is shorthand, not a claim that one identical board governed every midwife. Authority could sit with a state board of health, a state health department, a bureau of maternal and child health, a county health officer, a local registrar, a public-health nurse, a state health commissioner, or another agency created by local law. Physicians could be asked to recommend or supervise applicants. Registrars could receive birth certificates. Nurses could teach classes, inspect homes and bags, or report noncompliance.

The exact authority matters. A permit issued by the Virginia Department of Health is not interchangeable with a Florida State Board of Health license. A certificate of registration is not necessarily the same document as a license to practice. A training institute diploma is not automatically a legal permit. A newspaper description of a licensed midwife is not the licensing record itself. Before describing a practitioner as licensed, registered, certified, supervised, suspended, or retired, the researcher should identify the document, jurisdiction, issuing office, effective dates, and legal category.

Amanda Carter’s permits show a practitioner inside a changing state system

The Smithsonian’s Amanda Carey Carter collection makes the licensing structure visible at the scale of one Black midwife in Farmville, Virginia. A permit dated November 2, 1955 names Carter, her rural route, the Virginia Department of Health, a local health-department director, a local registrar, the Bureau of Maternal and Child Health, and a physician recommendation. Seven rules and two laws appear on the reverse. The document is small, but the institutional network around it is large.

Later permits classify Carter as a non-nurse midwife and authorize practice for defined annual periods in the 1980s. Read together, the objects can support a chronology of continued state authorization and changing administrative language. They do not automatically reconcile every date in the catalog descriptions, prove that every year was uninterrupted, or establish the number or outcome of births. Apparent inconsistencies between original-permit dates or categories should be recorded, not quietly harmonized. Item-level comparison is part of the method.

A Smithsonian interpretation describes Carter as a fourth-generation midwife and explains requirements that included registration, safety and hygiene classes, physician recommendations, birth reporting, and compliance with a state manual. That public interpretation helps connect the objects. The permits remain the stronger sources for their own dates and wording; the museum narrative remains an attributed synthesis rather than a substitute for every underlying file.

Susie Carey’s retirement certificate records authority and family continuity

A 1952 Midwife’s Certificate of Retirement issued by the Virginia State Department of Health to Susie Carey states that she had been a midwife for thirty-three years, returned her permit, and would attend no further cases. It carries the signatures of the state registrar of vital statistics and the county health officer. The certificate makes visible how the state marked both the duration and the formal end of practice.

The museum object also preserves a memorial poem written by Amanda Carter for her mother. State certification and family remembrance therefore survive together, but they are not the same evidence. The certificate supports the stated years and retirement action. The poem supports a public act of remembrance. Neither is a complete birth register, patient history, or private family archive. Their pairing reveals something the license file alone cannot: professional authority and family continuity occupied the same life.

Manuals made Black birth work legible to the state

The federal Children’s Bureau’s 1941 Manual for Teaching Midwives was written for supervisors teaching practicing midwives whom the foreword described as lacking formal education and adequate training. The manual organized lessons, demonstrations, equipment, personal cleanliness, asepsis, physician referral, record books, birth certificates, and lists of registrars. It instructed that a certificate be sent for every baby delivered so the state would have a record of the birth.

The manual is valuable primary evidence because it shows the federal hierarchy of expertise and the administrative system officials wanted to build. It is not a neutral description of every midwife. Its language carries assumptions about intelligence, literacy, cleanliness, danger, and authority. It can show what supervisors were told to teach and what records departments wanted. It cannot show whether every lesson occurred, how midwives interpreted it, or what families believed about the care.

State manuals adapted the broader model. Alabama’s archive preserves The Alabama Midwife: Her Book. Mississippi manuals and Virginia’s Help for Midwives show similar efforts to standardize equipment, behavior, reporting, referral, and supervision. A 2026 historical analysis argues that manuals did more than transmit procedures: they codified literacy and documentation requirements, inspections, and supervisory oversight that shifted authority toward state-approved and nurse-led systems while narrowing pathways for apprentice-trained Black and Indigenous midwives.

That interpretation should not turn every rule into proof of malicious intent or every training program into proof of benevolence. Handwashing, clean supplies, birth registration, and referral expectations could have real safety value. At the same time, the power to define cleanliness, literacy, acceptable knowledge, physician sponsorship, and legal entry could be applied through racial and class hierarchy. The archive must preserve both the practical instruction and the institutional displacement.

Virginia joined birth regulation to racial classification

Virginia’s manuals cannot be separated from the Bureau of Vital Statistics led by Walter Ashby Plecker. The Library of Virginia documents Plecker’s public-health work and his white-supremacist leadership. Under Virginia’s 1924 Racial Integrity Act, doctors, midwives, and other officials were required to classify children on birth records as white or colored, and Plecker threatened officials when he believed a child had been categorized incorrectly.

This is why a birth form cannot be treated as a transparent family identity record. The same office that taught or supervised midwives also enforced racial categories created by law and interpreted through a registrar’s ideology. A midwife’s signature or report could enter a system that counted births while also imposing official identity. CultureUp can use such records to document state classification; it should not adopt the classification as the full truth of a family or use private certificates to certify public identity.

Florida’s files show the machinery of licensing

The State Archives of Florida describes a Midwife Program Files series covering 1924 through 1975. The series includes correspondence, legislation reports, essays, manuals, photographs, administration records, licenses, applications by African American applicants, speeches, transcripts, and artifacts. It is an unusually clear example of how one state built an archive around licensing and supervision.

Florida’s State Board of Health began a licensing program in 1931. A 1942 license record describes requirements that included minimum age, the ability to read the manual and complete birth certificates, cleanliness standards, a diploma from a school for midwives, and supervised attendance at a specified number of labor cases. Those are Florida requirements in a particular legal period. They should not be generalized to every southern state or every year.

Photographs from midwife institutes at Florida A&M College show Black women gathered for classes and, in one record, women assisting with bag inspections. These images document an institutional setting, state program, date, place, and visible activity. They do not reveal what each participant thought about regulation, whether enforcement was equal, how training affected practice, or what happened in every home after the institute ended.

Disciplinary records require more caution than ordinary chronology

Licensing archives also preserve accusations, suspensions, revocations, warnings, and official ridicule. Such records can be essential, but they concentrate the state’s voice. A file may document that an agency alleged a violation or revoked a license. It may not preserve a practitioner’s response, patient testimony, local custom, unequal enforcement, an appeal, or the final disposition.

CultureUp should not lift sensational language from a caption or disciplinary memorandum and repeat it as a complete medical fact. The researcher should seek the governing rule, original file, notice, response, hearing record, decision, and any appeal. If those records are unavailable, the article should say that the archive preserves the administrative action but not a complete adjudicated account. Dignity does not require hiding state power; it requires refusing to let an accusation become the whole person.

Birth registration turned care into data work

Midwives did not only attend births. In many jurisdictions they also supplied information for legal registration. The National Vital Statistics System remains a federal-state cooperative system built from records filed in state and local offices. Current NCHS guidance says the professional attendant—generally a physician or midwife—is responsible for completing the birth certificate and filing it with the local registrar under state-specific deadlines.

The historical system developed unevenly. The national birth-registration area began with ten states and the District of Columbia in 1915 and included all states by 1933. A missing certificate before complete coverage can reflect nonregistration, delayed reporting, record loss, jurisdictional gaps, spelling variation, or access restrictions. Absence from a database is not automatic proof that a birth, family, or midwife did not exist.

Birth certificates are also protected records governed primarily by state and local law. The National Archives does not hold ordinary state vital certificates, and the federal government does not distribute identifying certificate files. Public-use natality data are different from certified records. A Black birth-work article may explain forms, variables, registration systems, and aggregate data; it should not publish a private certificate or identify a family because the document survives in personal hands.

What the board archive leaves out

Government files are strongest where government acted: issuing, inspecting, counting, teaching, warning, disciplining, or ending authorization. They are often weaker on the ordinary texture of care. The records may not preserve nights without sleep, miles walked, food accepted instead of payment, children watched while a mother recovered, prayer, conflict with a physician, discrimination at a hospital, a family’s trust, or a practitioner’s disagreement with a rule.

Oral histories, family papers, church records, newspapers, photographs, and community memory can recover some of that texture. They bring their own limits. Memory changes over time. A family story may contain private health information. An interview can be copyrighted or restricted. A photograph can show a person and room without showing consent, diagnosis, outcome, or the meaning of the encounter. The answer to an incomplete state archive is not an uncritical private archive. It is a layered source trail with permission and restraint.

How CultureUp should read the archive

Begin with the exact person, place, period, and record. Preserve the source’s original legal category while using respectful public language. Identify the issuing authority and distinguish permit, registration, certificate, diploma, and license. Compare the state’s rule with evidence of actual practice. Record contradictions instead of smoothing them away. Separate birth attendance from outcome and state allegation from adjudicated finding. Protect private certificates, case notes, addresses, and patient identities.

Then ask what the state had reason to preserve. A board kept the permit because it governed permission. A registrar kept the form because it counted a vital event. A public-health nurse kept an inspection sheet because supervision required documentation. A family may have preserved a poem, photograph, or bag because the life meant more than the license. The archive becomes more truthful when those different purposes remain visible.

What this article does not do

This article does not determine whether any person may practice midwifery today. It does not interpret current licensing law, recommend a midwife, choose a birth setting, assess a practitioner, diagnose pregnancy, explain symptoms, provide prenatal or postpartum care, plan delivery, or give emergency instructions. Current questions belong with qualified licensed professionals, responsible licensing authorities, and official current guidance.

It does not treat every Black midwife as a granny, every state program as identical, every regulation as either protection or persecution, every permit holder as clinically equivalent, or every disciplinary file as complete truth. It does not blame midwives for maternal or infant deaths, promise that historic practice would solve current disparities, or turn population history into individual medical advice.

It does not publish private birth certificates, patient charts, midwife case notes, home addresses tied to pregnancy, medical images, identifiable birth outcomes, family health files, genetic or lineage information, restricted mortality-review records, or unpublished oral histories as public proof.