Before the advent of modern certified nurse-midwives who now work alongside physicians and deliver a great number of babies each year, there was the neighborhood midwife who often performed her service without formal training.

In 1976, the Alabama Legislature outlawed midwifery. However, for decades the midwife was the only help for most black mothers who couldn’t afford or didn’t have access to medical care.

According to “A Ritual Tradition: Midwifery Among Southern African-Americans,” posted on the Web site, northbysouth.Kenyon.edu, in 1931, there were 3,568 midwives in Alabama working for and supervised by health departments in 54 of 67 counties. Almost all black women had their babies by midwife, and black midwives served a large percentage of the white community as well.

In the 1930s and ’40s, a Social Security act provided more children’s clinics and midwife training programs. Midwives could work for the board of health under a doctor if they could exhibit “strong morals and cleanliness” and passed an exam.

Because black midwifery was so common, most of these midwives were experienced enough to pass the exam easily. However, the state issued guidelines among which was that a midwife was to have her doctor’s bag ready for inspection at any given time.

Many of the midwives, who were trained by their mothers or female family members in the use of wild herbs for pain relief and to control bleeding which were frowned on by modern medicine of the time, carried two bags—one for inspection and one that they actually used for deliveries, according to the article.

Henrietta French Hoard, wife of Thomas Hoard, of Limestone County was one of those midwives trained by the local health department. Her great-grandson, Jerry W. Gilbert of Athens, submitted a photo of his great-grandmother’s graduating class posed on the Limestone County Courthouse steps in hopes that someone among The News Courier’s readership could identify others in the photo.

Hoard is seated on the second row from the top at the far left.

From the fashions worn by the women on the right side of the photo, it appears to have been made in the late 1930s or early 1940s. The man in the upper right, apparently, is a health department official or doctor.

Gilbert said that Hoard delivered her own daughter, Abbie Gilbert’s baby girl, who grew up to be Dorothy Gilbert Malone, Gilbert’s mother.



Dr. Stanley Hand

Dr. Stanley Hand, who retired in 1990, said he worked with black midwives when he came to Athens in 1950.

“There might have been two or three still working, but they were being rapidly replaced by doctors by the time I came in 1950 when there were still some young doctors who would go out and deliver babies,” said Hand.

Hand said that doctors William Pennington and Douglas Holt began practice in Athens soon after he came here after being trained in Memphis and Birmingham.

“Sometimes I’d have to go out and finish up on a delivery when a midwife got in trouble,” said Hand. “There was this one up above Elkmont near the state line. I got a call on a night that was pouring down rain. A white neighbor had called me and said the woman needed help.

“When I got up there, her husband was standing by the road and said I’d either have to go in by tractor or walk in because my car would never make it down that path. I told him that I didn’t walk anywhere, and I drove in. There was a midwife there and the woman had been in labor for two days.”

Hand said the expectant mother hadn’t had any prenatal care and had gained too much weight during her pregnancy and was also dehydrated.

“The midwife told me she could feel the head. She had been doing vaginal examinations with a bare hand. We always used a glove and did rectal examinations. I put her in my car to bring her to Athens. I was afraid she would deliver in the back seat before I could get her to Athens. The midwife told me that she couldn’t hear a heartbeat, and when I listened, I couldn’t hear a heartbeat either.

“We got her up to the delivery room and I was sure we’d have a dead baby. But I delivered the baby and it was breathing. I turned away and the nurse called me back because she could see a foot. There was a second baby coming for a breach delivery.”

Hand said that the twins born that night both survived and apparently thrived.

“The number-one problem that midwives had was excessive bleeding caused by a retained placenta,” he said. “That was the leading cause of maternal death.”

Hand said soon after he came to Athens all doctors refused to go out for home deliveries. He said without midwives, many poor women would have had only their husbands or female family members to attend them. Hand was to deliver more than 4,000 babies in Limestone County during his 40 years of practice here.

Hand said that when obstetricians began practice it was with the assumption that they were more highly trained than family physicians in delivering babies.

“But then the obstetricians began working with nurse-midwives,” said Hand. “I guess things kind of came full circle.”



Certified nurse-midwife

Roberta Ress, a certified nurse-midwife, knows that the circle does not close back on the untrained, informally or health-department -trained midwife of a bygone era. Ress, who was trained at the historic Frontier Nursing Service in Hyden, Ky., founded by American nurse-midwifery pioneer Mary Breckinridge in 1925, strongly opposes the licensing of what she calls “apprentice” midwives who do home deliveries.

Ress works in conjunction with local obstetrician-gynecologist Oliver Carlota. Ress only delivers babies in a hospital.

Alabama is one of only 10 states that outlaw “direct-entry midwifery” – in which someone other than a nurse or doctor can accept payment for delivering a baby outside a hospital or birthing center setting.

A bill was introduced in the 2007 session of the Alabama Legislature by Rep. Laura Hall, D-Huntsville, to allow licensing of those who do home deliveries. The state medical association vigorously lobbied against the bill and it failed to gain enough support for passage.

Ress said there is a move on to reintroduce the legislation in the 2008 session. However, if such a bill is to be introduced, it has not been pre-filed.