Before public health arrived as a department, a form, or a surveillance system, it sometimes arrived on foot with a midwife carrying her kit.
In 1941, Farm Security Administration photographer Jack Delano followed an unnamed Black midwife near Siloam in Greene County, Georgia. The surviving photographs show her at home, wrapping a kit, stepping onto a rural road, and walking toward a call. The catalog can tell us the county, the occupation, the kit, the road, and the date. It cannot tell us her name, the exact distance, the patient, the outcome, or everything she knew.
Even with those limits, the record makes one fact visible: birth care moved through place. The midwife had to travel, carry supplies, enter a private home, observe conditions, recognize when the situation exceeded her role, report births under changing state rules, and remain connected to families before and after delivery. Her work crossed the boundary between personal care and population health long before the phrase community-based public health became standard language.
Public health crossed the doorstep
A home birth was not only a private family event. It created public records and public responsibilities. State and local systems wanted births reported. Health departments sought information about mothers and infants. Training programs emphasized cleanliness, equipment, warning signs, registration, and contact with nurses or physicians. Midwives became points where family knowledge, state authority, and medical systems met.
The title of this article does not mean that every midwife performed the same tasks or held the same authority. It means that the record repeatedly places midwives inside functions now recognized as public health: reaching rural households, observing pregnancy and postpartum conditions, teaching sanitation and infant care, encouraging clinic use and immunization, notifying public-health nurses, completing or supporting birth registration, and helping families navigate a fragmented care system.
Those functions were especially visible in Black communities where segregated hospitals, physician shortages, transportation barriers, poverty, and exclusion made formal care less reachable. The midwife’s presence did not erase those structural conditions. Her labor often exposed how much the larger system had failed to supply.
Midwife-as-public-health evidence card
| Function | Records to examine | Boundary to preserve |
|---|---|---|
| Birth attendance | Midwife log, permit, birth certificate, training film, health-department record | Attendance does not prove outcome, licensure status, or every service provided |
| Home observation | House-call photographs, manuals, oral histories, public-health nurse records | A photograph does not reveal diagnosis, consent, patient identity, or the full care plan |
| Hygiene and preparation | Kit photographs, manuals, training institutes, film instructions | Training standards may improve practice while also carrying racialized surveillance and control |
| Education and referral | Clinic notices, immunization or nutrition programs, nurse correspondence, public-health histories | A referral does not prove completed care or clinical outcome |
| Vital registration | Permits, birth certificates, registrar rules, NVSS documentation | A registered field is not a complete family narrative or proof that every event was recorded accurately |
The kit was a record of preparation
Delano’s photographs include a frame of the Greene County midwife wrapping her kit. A Library of Congress research essay identifies visible items including clean cloth, baby powder, and petroleum jelly. The image should not be treated as a complete inventory or a clinical protocol. It shows preparation and portability: what she carried had to travel with her, and what was missing from the house could not be assumed to be available when she arrived.
Cleanliness became a central theme of state-sponsored midwife training. Training institutes could be held in churches, and manuals translated health-department expectations into rules about hands, supplies, reporting, and when to seek assistance. Midwives also served as educators, accompanied women to clinics, encouraged immunization and nutrition, and notified nurses. That work placed them inside expanding public-health systems even when officials described them as problems to be corrected.
Standardized training could transmit useful safety practices and create clearer connections to public nurses and physicians. At the same time, permits and supervision made legal practice subject to official authorization and rules. Public health was both guidance and regulation.
A permit documented authority—and control
The Smithsonian’s Amanda Carey Carter collection makes regulation visible at the scale of one practitioner. A Virginia permit dated November 2, 1955 certified Carter to practice and carried rules and laws on the reverse. Later non-nurse midwife permits show that state authorization continued to shape her practice decades later.
A permit can support a date, jurisdiction, category, address, issuing authority, and period of legal authorization. It cannot prove how many births occurred, the quality of every encounter, what families thought, whether a rule was enforced evenly, or what knowledge the practitioner held outside the state’s categories.
The collection also preserves a retirement certificate for Susie Carey stating that she had been a midwife for thirty-three years and returned her permit in 1952. The document records state recognition and the formal end of authorized practice. It does not turn those thirty-three years into a complete case log or outcome study.
Virginia’s Help for Midwives booklets show another layer of authority. The manuals offered legal, safety, and practical guidance. They were also connected to Walter Ashby Plecker, whose wider record is inseparable from Virginia’s white-supremacist racial-classification regime. These records document both procedural instruction and coercive state power. Neither side of that history cancels the other.
Mary Coley made the bridge visible
The 1953 film All My Babies: A Midwife’s Own Story follows Mary Francis Hill Coley in Albany, Georgia. The Georgia Department of Public Health helped produce the film as a training tool. The Library of Congress describes it as showing approved procedures before, during, and after delivery while following Coley through cases under different conditions.
Coley’s work is often remembered because the film makes the breadth of a midwife’s role visible: preparation, labor support, newborn care, continuing contact, and communication with the medical system. Smithsonian interpretation describes her as an intermediary among patients, nurses, physicians, and the local community.
The film must still be read critically. It was a government-sponsored educational project made during Jim Crow, when southern health officials often blamed Black midwives for infant mortality. Scholarship on the film shows that it carried both educational value and the power limits of medical representation. Coley was not simply an object in the frame; the public record identifies her as a collaborator and practitioner. Yet the film also placed her work inside a system that could praise an exemplary midwife while narrowing the authority of midwives as a group.
From community midwife to nurse-midwife
The history of Black midwifery includes both community midwives and formally educated nurse-midwives. Those categories should not be collapsed. Nurse-midwifery developed through public-health nursing, obstetric reform, physician relationships, and professional education, while community practice faced changing state rules.
The Tuskegee School of Nurse-Midwifery opened on September 15, 1941, to educate Black nurses in midwifery for communities facing high maternal and infant mortality. A recent historical study identifies thirty-one graduates before the school closed in 1946. The study’s abstract reports large declines among women served in Macon County during the program’s early years. Those figures are historically important and should remain attributed to the study’s defined local population and period. They do not prove that the school alone caused the change or that the same result would occur elsewhere.
Tuskegee makes a larger point visible: Black women were not only being regulated out of traditional practice. They were also creating and entering professional pathways in nursing and midwifery under segregation. The public-health story includes displacement, adaptation, formal education, professional authority, and institutional closure.
Birth reporting turned household events into population data
In Georgia, births had to be registered, and the registration system assigned responsibilities to birth attendants. A midwife's work could therefore enter public records as well as a family's memory. Later national vital-statistics systems compiled information supplied through state registration. What a birth record includes depends on its jurisdiction and period; it cannot tell the whole story of care inside a home.
Linked birth and infant-death files connect information from birth certificates to infant death records for population analysis. That linkage makes it possible to study relationships among conditions present at birth and infant mortality. It does not authorize public identification of families or allow one record to explain every cause. Public-use and restricted-use files follow different geography, date, and confidentiality rules.
Historic midwife permits, birth registers, manuals, and certificates should therefore be read as parts of a growing data system. They can reveal who the state recognized, what it demanded, and what it counted. They can also reveal absence: births not registered promptly, names spelled differently, fields imposed by officials, and community knowledge that never entered the form.
Mortality decline was real—and multi-factor
Maternal and infant mortality declined dramatically across the twentieth century. CDC’s historical account attributes that change to many developments: environmental interventions, nutrition, clinical medicine, health-care access, disease surveillance, education, and standards of living. Antibiotics, blood transfusion, safer surgery, professional training, sanitation, and vital-record systems changed what could be prevented and treated.
The decline cannot honestly be credited to one profession or one policy. It is not evidence that traditional midwives caused earlier mortality. It is not evidence that replacing midwives alone produced improvement. It is not evidence that midwifery by itself could substitute for emergency obstetric capacity. The responsible history asks which changes occurred, where, for whom, and how the evidence separated training, referral, transport, hospital access, public investment, and social conditions.
Present-day disparity also requires precise definitions. NCHS’s 2024 maternal-mortality report uses a definition centered on deaths during pregnancy or within forty-two days from causes related to or aggravated by pregnancy or its management. It reported an overall rate of 17.9 maternal deaths per 100,000 live births and a rate of 44.8 for Black non-Hispanic women. CDC’s pregnancy-related-death surveillance uses a broader period extending to one year and a different review process. Those measures should not be mixed.
Maternal mortality review committees examine clinical and nonclinical information to determine whether deaths were pregnancy-related, preventable, and shaped by patient, community, provider, facility, or system factors. Their work demonstrates why a death cannot be explained by a birth attendant alone. Transportation, respectful care, timely diagnosis, insurance, referral, facility capacity, chronic conditions, mental health, and postpartum support can all enter the review.
The historic midwife is not a modern credential
A historic permit, family memory, or photograph does not determine who may legally practice today. Current midwifery categories, education, scope, licensure, collaboration requirements, and birth-setting rules vary by profession and jurisdiction. CultureUp does not recommend a practitioner, birth setting, or care model.
The phrase the midwife was public health is an institutional and historical claim. It does not mean that every historic practice meets current standards. It does not mean current midwives are interchangeable with historic lay midwives. It does not mean a family should choose home, hospital, or birth-center care based on an archival article.
Privacy begins at the threshold
Birth work generates intensely private information: home addresses, pregnancy history, labor notes, diagnoses, birth certificates, infant records, family relationships, photographs, and memories. An archive may preserve some of that material without making every detail appropriate for public display.
CultureUp does not publish private birth certificates, patient charts, midwife case notes, home addresses, medical images, pregnancy outcomes, or unpublished family evidence as public proof. It does not identify the unnamed Greene County midwife or the families she served. It does not use graphic birth imagery as routine illustration.
The public source trail should favor permits, manuals, released films, institutional histories, aggregate statistics, public archives, and permissioned oral history. Even then, item-level rights, dignity, consent, currentness, and source limits remain visible.
Birth-work source ladder
| Claim | Preferred public evidence | Do not substitute |
|---|---|---|
| A person was authorized as a midwife | Permit, license register, health-department record | Family story or photograph alone |
| A midwife attended a birth | Birth certificate, public case log, film record, permissioned testimony | A permit by itself |
| A program changed outcomes | Defined population, denominator, period, comparison, methods, corroborating records | A testimonial, encounter count, or before/after number without context |
| A death was pregnancy-related or preventable | Authorized vital records and MMRC/PMSS methods | Obituary, family plot, midwife record, or CultureUp inference |
| A historic image shows public-health work | Catalog title, visible content, date, location, photographer, rights | Unrecorded identity, diagnosis, outcome, or symbolic medical status |
What this article does not do
This article does not diagnose pregnancy, interpret symptoms, recommend prenatal or postpartum care, select a birth setting, evaluate a practitioner, determine licensure, explain emergency warning signs, or advise a family about labor, delivery, medication, transport, or infant care. Current questions belong with qualified licensed professionals and official current guidance; emergencies belong with emergency services.
It does not claim that all Black midwives were the same, that every community trusted them, that regulation was only beneficial or only harmful, that hospital birth was one uniform experience, or that returning to historic midwifery alone would resolve present maternal mortality.
The records show a public-health system that relied on midwives while regulating their work. Restoring Black midwives to that history requires keeping care, vital registration, professional education, emergency capacity, and family memory distinct. This is historical reporting, not present-day pregnancy or licensure guidance.