“You could count on midwives”

Listen to Me Good
The Life Story of an Alabama Midwife 

by Margaret Charles Smith and Linda Janet Holmes

A note: If you reading this are a fellow care provider for pregnant and postpartum women/pregnant and postpartum people and their families, and you are white, I think it’s important to learn about the legacy and history of traditional black midwives, because what happened to them intersects with modern day racism that shows up in the medical field today, and how that disproportionately impacts the lives and health of the black community. I’ll drop some more resources after the book review, as well as link to two exciting black midwife led projects that are happening NOW, one of which is in Mrs. Smith’s home state of Alabama.

The Southern states of the United States was once a place with a thriving population of black homebirth midwives. Who where those midwives? What happened to them? Listen to Me Good is about one such midwife, Margaret Charles Smith. Listen to Me Good is both a history book and an auto-biography. Published in 1996, the book is told through the eyes of Mrs. Smith as she narrates her life story and work as a midwife in rural Alabama to interviewer and co-author, Linda Janet Holmes. Holmes rounds out the story by writing about the history and context of what was happening in Alabama at the time. Thus, as Mrs. Smith tells her story the reader sees the racism and unjust conditions in the Jim Crow South that Mrs. Smith and the people she served and lived with were constantly up against.

“The frustration and hostility of the white medical establishment toward black midwives stands in sharp contrast to the respect these women earned in their own communities. White doctors ignored the problems midwives faced in aiding neighbors struggling in poverty and oppressed by the social, political, and economic conditions of the Jim Crow South. Throughout her youth, Mrs. Smith witnessed hard times and endured strict disciplinary measures. She spent most of her childhood working. She says, “We worked our ass off all through the week and we had no money and no clothes to show for it.” But she also remembers the strength of women in her community with pride:  “People care about each other back then.” (23)

At just 178 pages including the index, this is a book you can read over several evenings, or over a weekend. It’s an enjoyable read, due in great part to the first hand tellings of Mrs. Smith. Her natural way of speaking comes through, and though certainly it’s not as rich as it must have been to hear her tell these stories in real time, it’s easy to hear her voice and heart shine through the written page. I bought my second hand copy from Alibris books, which I where I typically buy most of my used books. I wound up with an autographed copy too!
Mrs. Smith was born in 1906 in Eutaw, Alabama, where she lived all her life, working hard, growing food, raising and butchering chickens, raising her children, and working as a lay midwife and for the AL health department for a time. After years of helping out with the births of family members, she became an official midwife, obtaining her permit from the health department in 1949. She attended her last birth in 1981. At first Mrs. Smith did not want to be a midwife. Another midwife in her community, Ella Anderson, is the one she credits with steering her to the work. “I took training courses, but the midwife had already trained me, Ella Anderson. I I learned everything, learned how to ask the mother if she was ready— does she have all the equipment ready? You know— the newspaper, something to boil the water in, something for the baby.” (75)  Thus, she continued on in a legacy of one midwife training the other.

This book is filled with struggle, resilience, tenderness, determination, honesty and humor, as Mrs. Smith doesn’t hold back. She speaks with candor and clear self-reflection about the complexities of her life, informed by old time traditions, practices inherited by her ancestors, her own black community as well as the white doctors she worked with and for, and the rural whites whose babies she also helped to deliver, as most rural women not have access to other options besides midwifery care at home, the money to pay a doctor (much less their midwife), but also (and rightly so evidenced by the growing epidemic of obstetric violence and surgical birth we see now in the United States) feared giving birth in hospital. One such passage highlights some cultural practices the midwives sustained in spite of everything:

“Their connection to their ancestral roots meant that some older black Alabama midwives never relegated their practices to superstition or abandoned them.  Practices that paralleled West African traditions included:  abdominal massage and palpation during pregnancy; beliefs in marking babies with prenatal impressions; soups highly seasoned with pepper to encourage uterine contractions; medicinal baths at the onset of labor; maintaining a birth fire into the postpartum period; burial of the placenta near a tree; placing a sharp knife under the birthing bed or baby’s bed (also practiced by white women in Appalachian regions; giving the baby an oil bath right after birth; naming the baby on the seventh or ninth day because its spirit is unsettled before then; and guarding against the future use of the placenta by medicine men or others who wished to harm the mother.” (40)

This passage stood out to me as here it is evidence of pregnant and postpartum practices that continue to be practiced today- burying the placenta under a tree, using hot baths for labor pains, and massage and palpation during pregnancy. I’ve been researching pregnancy and postpartum rituals on and off for the last year, so any time I read a first hand account of something I get excited. Also intriguing here is the parallel of a birth practice of putting a sharp knife under the bed where the laboring woman would be, which the white women in Appalachia also practiced which makes me curious to know more about the origins of this ritual, which is explained below:

  “The midwife would slip a knife, sharp fork, or scissors under the bed, between the bed and the mattress, but you didn’t have to let the person know it was there.  You had to put it in there the day after, when they were asleep. Open the scissors and point them down or point them up. That helps ease the pain.  In her absence, just catch her. Like I’m tucking in the sheet and just stuck those scissors under there and let them be open, and it helps a whole lot. It soothes those pains down.” (99)

While certainly some of the superstitions and practices Mrs. Smith employed raised my eyebrows more than once, using turpentine for example to soothe a perineal tear, or having a bottle of oil on hand on hand to wipe down (supposedly) clay covered babies from mothers who ate so much dirt while pregnant (a practice called “geophagy,” also found in West Africa), it is not my place to judge practices that came about from traditions Mrs. Smith picked up, as well as the plain and ugly fact of the pernicious racism in Alabama that kept blacks from accessing basic necessities like adequate housing, running water, linens/clothing/shoes, and other resources like health care supplies. Mrs. Smith was a practical rural woman who made do with what she had. She often delivered up to 4 babies a night, serving families who lived in rustic uninsulated wood cabins papered in newspaper. Infant clothes were made out of the sacks their flour came from.

“Listen to me good. Back when I started, it was kind of poor. At that time, the people didn’t have nothing. You couldn’t get nothing. They had to do the very best they could. Some of them didn’t have places to sit. They didn’t even have a piece of white sheet, clean or nothing. I’d have to get up sometime and go to the next-door house and ask her to give me some clean rags, if she had ‘em. Just barely living.” (73)
Mrs. Smith had very little resources to rely on other than her wits, her skills, her faith in God and spirituality, her faith in physiologic birth, and her greater community of Eutaw. There was more than once while reading this book that her wisdom as a midwife stood out to me in direct contrast to practices that modern day high paid OB/Gyn’s still insist on doing in the delivery room- like tugging on the cord to “help” a placenta be delivered. Here’s what Mrs Smith has to say about waiting on the placenta:

“Now a whole lot of places you go to, the afterbirth didn’t come right on behind. Some of them do. Some of them don’t. Sometimes the afterbirth takes twelve or thirteen hours to come loose. If you going to pull and jerk on it, you’re going to leave some in there. That’s going to cause a problem. If you just give it time, you work with after the baby come. If it don’t come a-loose, leave it alone. If they are tense, they need to go to sleep and relax. That makes the afterbirth come loose. Let her stretch her feet out or turn on her side or whatever she wants to do.” (93)

The chapter entitled “Civil Rights” is key to understanding what happened to black midwives, not only in Alabama, but all across the South, and how it is informing the culture of systemic medical bias and racism that causes black women to die from childbirth more than any other demographic in the United States now. Although the 1954 Supreme court case, Brown V Board of Education of Topeka, Kansas established that “separate but equal” did not belong in public education, white supremacy continued to inform policy especially in small town rural Alabama (and it remains that way today- the state of Alabama continues to rank high in poverty and low in Education, as do most of the Southern states- a direct consequence of republican dominated states run by racist white men who refuse to fund health care and education and take care of their citizens). This chapter talks about legislation regarding hospitals, and how the increase of funding towards hospitals and clinics, though meant for the public, were often situated too far for rural blacks to travel too, and continued to practice illegal segregation. While some of the rural white doctors very much respected and befriended midwives like Mrs. Smith, the power of the other doctors who perceived the black midwives as a threat, were greater. Eventually, due a variety of factors, Mrs. Smith was forced to take on more and more work as a domestic in-home nurse and caregiver for white families.

“By the 1980s, little remained of the much maligned institution of black midwifery.” Due to a law passed in 1976, Act No. 499, which governed the practice of nurse midwives, it also foretold the end of traditional midwives. Now, traditional midwives had to have a “valid health department” certificate, which became increasingly hard to come by, since physicians were the ones who signed off on those certificates. And those physicians were dominated by white men. Despite being required to sign the certificates, many of the white doctors flat out refused, and multiple health departments effectively went ahead and simply “retired,” due to a clause that stated no midwife could practice after the age of sixty-five. “After decades of practice, more than 150 Alabama midwives, all black, abruptly received letters and visits from physicians and nurse informing them that they could not longer work.” (135)  

It’s important to understand how legislation is so tied to the structure of systemic racism. What would the South look like if black midwives had not only been pushed out, but supported and funded? While Mrs. Smith’s work as a midwife was an immense contribution to her community, her work was exactly valued in the sense that it afforded her a high quality of life. She faced discrimination, racism, and poverty every step of the way. And still her outcomes for maternal and infant well being would be considered incredibly high for the times when compared today. Right now her home state of Alabama is not faring well in terms of infant and maternal mortality rate.

Not only is Listen to Me Good a remarkable story about a remarkable person, it’s a testament to birthing at home, and the midwife’s skill in supporting physiologic birth. It does not seem far fetched to say that had the traditional midwives been allowed to keep practicing without the racism they faced from the white controlled health department, hospitals and government, what would the maternal and infant health outcomes be today in the year 2022?

Mrs. Smith lived at home in Eutaw until she died. I love what she had to say here about here life:

“I’m worth millions for what I’ve done done. I thought I was doing a big thing. I was proud of it. The Lives that I’ve saved going to deliver all these babies, till I got something to be thankful for.” (156)

Additional Resources

Buy and read the book, Listen to Me Good

Pre-order Linda Janet Holmes’ latest book, Safe in a Midwife Hand’s: Birthing Traditions from Africa to the American South  coming out in 2023!

Margaret Charles Smith in an interview

All My Babies, Old documentary short film about a traditional black midwife in Georgia. This video was produced by the GA health department, and definitely seems to me to illustrate how the white gaze and white fronted health department intersected with the black midwives and their patients.

Midwives of SC, Short clip from a documentary on traditional black midwives in my home state produced by SC Educational Television (I’m trying to track down a full length copy but have yet to do so)

Aftershock, 2022 documentary film about the crisis in black maternal care, black women dying from pregnancy/childbirth/postpartum complications due to racism, and the growing birth justice movement catalyzed in part, by the grief and rage of the husbands and families left behind in the wake. Streaming now (as of December 2022) on Hulu.

The Birth Sanctuary in Gainesville, Alabama is led by black midwife Dr. Stephanie Mitchell, DNP, CNM, CMP. Donate here to support this project.

Jamaa Birth Village is Missouri’s first black owned free standing birth center founded in 2015 by Okunsola M. Amadou, CPM, a Fulani-American Midwife. Donate here to support this project.