 |
Midwifery in West Virginia
By Ancella R. Bickley Volume 49 (1990), pp. 55-68 |
The need to provide aid for women during childbirth has been a perennial one, faced by every society. To meet this need in America, a two-tiered system evolved. Medically assisted childbirth was available to those who could afford it and lived in areas where physicians were accessible, while midwife-assisted childbirth developed in areas that were geographically isolated or heavily populated by people who were poor, immigrant, or black.1 Although both models of obstetrical care were operational in West Virginia, the geography, population distribution, and economy of the state caused developments that were slightly different than those in the rest of the country.
For the most part, midwives gained their knowledge by having children themselves or working with a doctor or other experienced person. Many began to practice after they were older and their children were grown, hence the designation "granny" midwife.2 Their lack of formal training and the high infant mortality rates during the early part of the twentieth century led to great criticism and sustained efforts for professional control with the ultimate goal of eliminating the practice of midwifery.3
Some statistical information about West Virginia midwifery in the nineteenth century can be drawn from census records, but the data re incomplete and possibly inaccurate. For example, the occupational category of midwifery in the 1870 census lists only eleven practicing midwives in West Virginia, an extraordinarily low number for a state with West Virginia's economic and geographic characteristics.
After 1921, more detailed information drawn from the state's vital statistics becomes available and in 1927-28, places the birth assisted by West Virginia "granny" midwives at about 8 percent of the state's total.4 This is probably an underestimation, however, for some midwife deliveries may not have been attributed to them.
It is likely that many of the midwives did not perceive of themselves as professionals needing to report information to a centralized agency. Many were friends and relatives aiding friends and relatives. Most received no pay, and began the work without medical training or supervision; they were simply pressed into service because of an apparent need. For example, Jenny Belle Slaven of Pocahontas County reported that when she was fifteen years old, she and a friend were passing a house when a woman ran out screaming for someone to come in and help with a delivery. Thus began a career of midwifery that was to span thirty-five years.5 In like manner, Reverend Rita Emerson of Cox's Mill entered midwifery without formal training. Although Emerson, the seventh of thirteen children, worked with a doctor for a time, she learned to deliver babies from helping out at home. She served as a midwife for approximately ten years, but was never licensed and birth certificates for the babies she delivered were registered through a doctor.6
Traditional midwives were accessible and met the concern for modesty during the birthing process,7 an important consideration in areas where the use of a male birth attendant might offend an entire community. As a case in point, when Mrs. D. L. Auvil, believed to be the first baby in McDowell County delivered by a male, was born, her mother was ostracized for allowing a man to be present.8
Much of the growth of medically assisted childbirth in West Virginia is related to medical care administered through the coal companies and unions.9 The company health care model was sometimes found in other industries. For example, in the railroad industry, the Chesapeake and Ohio Railway sponsored a hospital in Huntington to provide medical services for employees and their families. As medical alternatives in childbirth care became available to women, most selected physicians rather than midwives.
Although in most places the traditional midwife could not marshal the political strength to defend herself and her practice because she was either poor, immigrant, or black this does not seem to have had an impact on midwifery in West Virginia.10 Assuredly, the West Virginia State Department of Health was not enthusiastic about the continuation of lay midwifery, as reflected in the 1938 statement:
Midwives . . . are frequently older women whose only experience has been acquired by being present at deliveries with physicians or other midwives. They often lack even rudimentary knowledge of obstetrics and its complications. Midwife practice has not been encouraged by this department but it is evident that midwives are still a necessity in certain parts of West Virginia.11
However, the counties with the highest use of midwives did not have large black or immigrant populations; it is unlikely, therefore, that this negative endorsement was related to the race or immigrant status of the midwives. In fact, some black midwives, such as Annie Jackson Monroe of Raleigh County were trained by and worked with white doctors, suggesting that race was not an immobilizing factor in their service.12 Mary Jane Trust Lawson, a midwife in Kanawha County, reputedly became the first black woman to nurse a patient in Charleston General Hospital when a white doctor demanded that the hospital suspend its racial policies in order that she might attend his patient.13 In West Virginia, both the patient and the midwife were as likely to be white and native-born as black or immigrant. Black and immigrant populations were heavily represented in the cities and the coal producing counties, which relied more on physicians than midwives by the 1930s.
Many West Virginia midwives also served as "healers" and were greatly trusted by those they helped.14 A noteworthy example, Elizabeth "Lizzie"Binns, was trained in her native country of England as a midwife. She immigrated to West Virginia to join her husband in Coalton, Randolph County. After developing a professional relationship with the local doctor, she assisted him in providing both prenatal and delivery services for community residents as a means of supplementing the family income. Mrs. Binns was also highly regarded as a friend and personal counselor to many in her community. She dispensed no medications but used herbs and natural remedies in her work.15
Although midwives were prohibited from dispensing medicines or using drugs during deliveries, many relied on folk practices and herbal remedies to ease the pain of birth and to treat sick adults and children. Castor oil was often used as an external and internal medication. Mothers were given doses to hasten labor; babies were cleansed with it after birth and also given doses for its purgative effect. Mrs. Cloie Arthur used catnip tea to soothe her patients and encourage birth. Mrs. Minnie Hammonds of Huttonsville used camphor and Mrs. Annie Brake of the Valley Head area used turpentine. Both Mrs. Brake and Mrs. Hazel Libert of the Buckhannon/Elkins area reported seating the mother over hot water to help her expel the placenta. Mrs. Mary Adamson of Onego indicated that she brought nearly a thousand babies into the world and "never lost a wife." In her work as a "healer" she made a poultice from rue, which she tied around a child's wrists to cure "fits." She also made tea from rue, catnip, and horehound. Mrs. Icie Sweeney treated new mothers' breast inflammation with poultices made of heated mullein leaves; for other breast disorders she used camphorated oil as a rub. She treated pleurisy with a poultice made of turpentine and berries.16
Mrs. Tressie Norell estimates that her mother, Mrs. Cloie Arthur (1884-1989), a midwife in Clay County, delivered over 200 babies and was seldom paid for her service. She began by working with a doctor and received some training from him; later she worked alone. As her daughter recounted, "One of the men who would come for my mother when his wife was having a baby would stand outside and shout to my father, 'Mr. Arthur, I come for your woman'." Mrs. Arthur provided assistance and support during the birth itself and stayed to help with the housework, if needed.17
Midwives usually provided a variety of services, sometimes remaining with the family for a period before and after the delivery, acting as nurse, housekeeper, and sometimes cook and laundress. Mrs. Icie Sweeney's reputation was well-known in Summers County as someone who would assist the new mother after the baby was born. "Get Miss Icie to stay with you," new mothers were advised.18 Mrs. Annie Jackson Monroe who participated in over one thousand deliveries claimed she" . . . never lost a baby." Her activities at a birth included insuring the availability of clean linens. At the time of delivery, she assisted the mother by pressing on her stomach and, if necessary, helping to ease the baby out by grasping it under the chin. Following delivery she cut the cord with sterilized scissors and tied it and then cleansed the baby with oil and disposed of the afterbirth by burial or burning.19
Clara Cogar Bender, a Braxton County midwife rarely received a monetary fee according to her grandson, Homer Bender. "Most of the time Grandma never got paid . . . . Sometimes the family would give her a piece of meat or enough material to make her a dress . . . ."20 A former patient of Mrs. Bender's also reported that when the midwife remained with a family for an extended period of time waiting for the delivery to occur, she" . . . would help the woman clean her house and help with the washing."21
India Broadwater Hogue, a farm wife from Pennsboro wrote about 1930:
I am only 46 years old but have had some wonderful experiences caring for the sick. I have been with 28 women who have had babies, acting as the doctor a great many times for the poor who could not get a doctor (I didn't do it for pay) walking in the dead of night as far as 1 1/2 miles, but that is where we get the pleasure in life doing for others as we would be done by.22
Among black women, the practice of midwifery can be traced to slavery when a slave woman would be designated as a midwife and would attend both black and white women.23 When slavery ended, the black midwives continued to assist women in their communities during a delivery.
Mary Elizabeth Rhea Johnson, called "Mollie" from her name Mary, and "Gabe" from the name of her husband Gabriel Johnson, was a former slave. Living in both Clay and Braxton counties before the Civil War, "Mollie Gabe" returned to Braxton County after the war where she served as a midwife to both black and white families.24
No real records exist of fees charged by West Virginia midwives for deliveries although it was officially recognized that they received payment. The 1924 State Department of Health Report acknowledged the existence of fees by stating, "The higher fees charged by physicians for this class of work, explains why the midwife is called in . . ."25 Frequently, midwives received payment in goods or traded services.
The 1925 state health law directly affected the charging and receiving of fees. Mrs. Annie Brake's comment, "You weren't supposed to charge if you weren't licensed,"26 demonstrates the effect of the law's definition of a midwife as anyone
. . . other than a physician who shall attend or agree to attend any woman at or during childbirth and shall accept any compensation or other remuneration for her services; provided, that nothing contained in this article shall prevent a neighbor or friend from rendering assistance in such cases in an emergency.27
Like Mrs. Brake, some midwives chose not to become licensed and as long as they did not charge a fee, they did not meet the definition of midwife and remained within the law.
"She did it to help out, not for money," said Mrs. Marie Jackson, daughter of Mrs. Icie Sweeney, a black woman who along with her twin sister, Mrs. Ross Evans, served as a midwife at Talcott in Summers County. As a midwife for about thirty-five years, Mrs. Sweeney had no formal training, but worked with Dr. Paul Ford of Hinton. Any monetary compensation for her work was small and families often paid with produce from their gardens.28 Midwife Daisy Mae (Dotson) Cyphers of Wetzel County, first licensed in 1929, reportedly received ten dollars on a few occasions, but usually she was paid in potatoes or corn.29 Mrs. Minnie Hammonds received some payment. "I didn't charge nothing, but they mostly gave me something."30
There were no regulations governing the practice of midwifery before 1925. Prior to that year, regulations for examining physicians were set forth in the various revisions of the West Virginia Code, but explicit provisions exempting women practicing midwifery were included. Midwives were, however directed by the code to register their names and addresses with the clerk of the county court, and to report births and deaths within thirty days of their occurrence. For every report, they received twenty-five cents. A 1912 report of a state-by-state survey of midwifery by S. Josephine Baker contained no information on the number of West Virginia midwives or the number of births they attended. It gave no indication that there was any state- sponsored training for midwives or any available literature concerning them.31
During the 1920s, more information concerning the practice of midwifery in West Virginia appeared in the State Department of Health reports. The publication of this information coincides with a national interest in improved health care for women and children. Sally Austen Tom credits this concern for health, in part, as a reaction to the massive numbers of young men who failed to pass physical examinations for military service during World War I. This concern for health extended to child health and to improved maternity health care.32
Passage of the Sheppard-Towner Act, effective November 23, 1921, directed federal money to the states to help fund programs to improve health care for mothers and infants. States were required to share the cost and establish agencies to administer the funds. Tom contends that
. . .the outpouring of state and federal funds into public health programs was not prompted by the appallingly high maternal and infant mortality rates in the United States. Even though World War I was justified as the "war to end all wars," the government was insuring itself for future wars by ploughing money into public health.33
She also credits the activism of newly enfranchised women voters in obtaining passage of the Sheppard-Towner Act.
The 1922-24 biennial report of the West Virginia State Department of Health advised that legislation implementing the Sheppard-Towner Act would be considered at the next legislative session. According to the report, 8.4 percent of West Virginia birth statistics were submitted by midwives or persons other than doctors. Because of the scarcity of physicians and the higher fees which they charged, the department accepted the necessity of midwives in the state but called for their supervision and control. To control them, the department recommended that "A law requiring official registration, such registration to be based upon the passing of a simple examination in the essentials of surgical cleanliness, would be a step in the right direction."34
State regulation of midwifery first appeared in the 1925 West Virginia Code, which detailed midwives' instruction, examination, licensing, registration, listed restrictions on practice, and noted conditions leading to revocation and refusal of license. The law mandated that after January 11, 1926, no person other than a physician could practice midwifery without being licensed. Upon written application, the State Department of Health issued annual licenses to those who were at least twenty-one years of age and able to read and write. The applicants had to demonstrate habits of cleanliness in personal appearance and their homes; posses a diploma from a school of midwifery or a physician's statement verifying attendance at five births during lying-in periods of at least ten days each, and present evidence of good moral character. Midwives were expressly forbidden to make vaginal examinations, use instruments of any kind to aid delivery, assist labor by any artificial, forcible or mechanical means, or administer, advise, prescribe, or employ any dangerous or poisonous drug.35
The midwives' practices often had counterparts in the methods taught expectant mothers by a State Department of Health correspondence course. In preparing for the birth, the correspondence course advised the mother-to-be to assemble supplies, among them sanitary napkins which could be made at home. Once the napkins were made they were to be ironed with a hot iron and packaged.36 Similarly Mrs. Jenny Belle Slaven said that she never had a problem with blood poisoning because "I never put a napkin on a woman that I didn't put it in the oven and roast it."37 When the birth was imminent, the correspondence course advised the parturient woman that all washable supplies should be freshly laundered and gave her specific instructions about how her bed should be made. In like manner, midwives Jenny Belle Slaven of Pocahontas County and Annie Jackson Monroe of Raleigh County were careful about cleanliness. Mrs. Monroe remembered, "I'd see that there were clean linens . . . and see that the bedclothes were clean, you know, and that the woman was clean and ready for the baby. We'd make sure everything was sterile, you know."38 "I'd always change the bed so everything'd be clean," Mrs. Slaven said. "I'd put clean bed clothes on and everything."39
A survey of twenty-eight of West Virginia's fifty-five counties carried out by a public health nurse between July 1926 and April 1928, reported that midwives attended about 8 percent of births. The nurses making the survey gave midwives a copy of the law governing licensing and provided a little instruction. Plans for group instruction of midwives were difficult to implement because of geographic isolation and transportation problems. A pamphlet of simple instructions for midwives was developed and distributed with the licensing permits.40 During the first year of required licensing, 372 midwives were recorded.41
The highest number of licensed midwives ever recorded, 558, was in the second year of registry. Thereafter, the numbers declined reaching a low of 77 in 1959-60, the next to the last year for which information regarding licensing under the 1925 law is available.42 It is likely, however, that the number of practicing midwives was larger than the figures reveal. Discussions with midwives and their relatives indicate that many continued to deliver babies during this period and simply did not apply for a state license.
Mrs. Annie Jackson Monroe recalled how the 1925 law changed the birth registration process for her. Before 1925 she registered births through the doctors with whom she worked or through the census taker; after 1925, she filed the registration papers herself. Mrs. Monroe served as a midwife in Raleigh County for over sixty years. She was trained by Dr. Sheppard and Dr. McRae Banks and served with them and other doctors as well as delivering babies alone.43
Although the total number of births handled by midwives remained at 8 percent for several years, percentages in several counties were considerably higher. Problems of isolation, economics, and scarcity of physicians were responsible for the greater numbers in these areas. Some coal producing counties and those with urban areas such as Charleston, Huntington, Wheeling, and Parkersburg recorded the lowest number of midwife-assisted births, suggesting that medical assistance for childbirth was available through company doctors or city hospitals.
The State Department of Health developed training for midwives by 1938. Conferences were held where enough midwives could be gathered to justify the training program. Midwives were advised about the limitations of their practice, taught to recognize abnormal birth conditions, and urged to call in physicians when difficulties arose. Motion pictures were used as instructional tools.44
The modern tradition of nurse midwives, registered nurses with additional training in midwifery, began with the Frontier Nursing Service of Kentucky founded by Mary Breckinridge in 1925.45 The term "nurse midwife" was coined by Frederick J. Taussig in 1914 in a paper in which he proposed a system of nurse-midwifery schools patterned after the training system available in England.46 His idea was not attempted by those responsible for providing medical education or medical services. Not until Mary Breckinridge put her "nurses on horseback" did the combination of nursing and midwifery become a reality in America. After receiving training in England, Breckinridge returned to the United States and founded the Kentucky Committee for Mothers and Babies which later became the Frontier Nursing Service, carrying skilled nursing aid to remote areas in the Kentucky hills.47
Breckinridge also developed an outpost nursing service which stationed nurses in six areas some distance from her main headquarters at Hyden, Kentucky.48 Similarly, West Virginia established an experimental nurse-midwifery service in Wetzel County on July 19, 1939. Selected for the demonstration project because of its rural nature, tradition of home births, and scarcity of physicians, Wetzel County was divided into two districts. A nurse was assigned to each district, with each serving about fifty-five hundred people. The nurses were". . . on call to assist physicians at the time of delivery of their patients, in the home, and also to carry on a generalized public health nursing program in the area assigned." These experienced public health registered nurses completed an additional". . . four months of training in obstetrical nursing which included a home delivery service."49
During its first year of operation, the nursing service was responsible for 123 of the 240 deliveries in the designated area. The retention of trained nurses was difficult, however, and trainees working under the supervision of the local health officer and public health nurse were utilized. From 1942 to 1943, the service delivered 121 of the 224 births in the designated area, seventy-five of which were home deliveries. Despite satisfaction with the service, the state Department of Health's Division of Maternal and Child Health discontinued the Wetzel County Program on June 30, 1943. Elimination of this service resulted from a lack of trained nursing personnel and doctors' preference for sending patients to the local hospital.50
In its ongoing commitment to upgrade the quality of care provided by lay midwives, the State Department of Health in 1955-56 supervised them through public health nurses and furnished them with silver nitrate (instilled in the newborn's eyes to prevent gonorrheal infection) and cord to tie off the umbilical cord. Mrs. Ruth Barco, a retired public health nurse from Petersburg, recalls that the bags which the midwives carried in Grant County in later years were equipped with a snap-in lining which had loops in order to hold supplies. Each midwife had two of these linings so that one might be washed while the other was in use. Contained in the bag were green soap, toothpicks with which to make swabs, safety pins, alcohol, cord scissors, thumb forceps, tongue blades, an apron, paper towels, a brush for cleaning the hands, an orange stick to clean nails, a thermometer and a spring scale which could weigh up to ten pounds. Midwives were also taught to use items available in the average home such as newspaper which could be folded into bags for waste disposal.51
The West Virginia law regulating midwives remained unchanged for nearly fifty years, during which the number of licensed midwives steadily declined. Reasons for the decline are difficult to determine. Certainly, there was a greater availability of physicians in some areas. The published statements of the Department of Health and the more stringent licensing requirements reflected an official uneasiness about midwives. It may have been that these attitudes and events were helping to close out midwifery in West Virginia. On the other hand, the statements of several midwives suggest that the practice continued and was simply not reported, although official statistics show a decline.
While some midwives worked with doctors, a full partnership between midwives and physicians never really occurred. "Granny" midwives were tolerated but not really accepted, although they served poor populations in difficult to reach areas of the state. Nationally, the American Medical Association presented an organized and powerful lobby which influenced regulatory legislation. Midwives had no equivalent organization to speak in their behalf. Through legislation, licensing controls on midwives, and the promotion of the medically assisted childbirth, midwives were soon overshadowed.52
Apparently the shift from midwives to doctors did not improve conditions for mothers and children. Historian Judith Litoff suggests the increased use of doctors during childbirth has not resulted in decidedly lower mortality rates for mothers and infants. She refers to studies which demonstrated problems with the physicians' care, yet midwives were still blamed for the mortality rates.53 During the 1940s, West Virginia's maternal death rage was generally lower than the national rate. For example, in 1942, 2.5 per 1,000 live births as compared to 2.6 nationally; however, the infant mortality rate was consistently higher, registering over 50 per 1,000 live births each year from 1940 to 1944 compared to figures in the 40s per 1,000 live births for the nation.54
In this same period with United States entry into World War II, the State Department of Health, anticipating a shortage of trained medical personnel, particularly in child and maternal health care, sent a staff nurse to the Frontier Nursing Service to attend the full course in midwifery. When she returned, she introduced classes in midwifery in counties without an organized nursing service.55 No information is available about the impact of this activity. In spite of the success of the Breckinridge program and the Wetzel County experiment, nurse midwifery made no gains in West Virginia until the 1970s and lay midwifery lost ground until the home- birth movement began during the 1960s.56
In 1973, qualifications of nurse midwives as defined by the American College of Nurse Midwives became part of the state code through a bill introduced by Delegate Ervin S. Queen of Logan County. Mr. Queen sponsored the bill to upgrade midwifery to meet federal standards, thus making the state eligible for federal funding for certain programs of maternal care. There was little public debate or opposition to the bill.57 Specifying the granting of licences only to those persons who were registered professional nurses and graduates of midwifery programs approved by the American College of Nurse Midwifery, the new legislation brought an official end to the traditional lay midwives.
In the seventeen years since the requirements of the American College of Midwifery were made the basis of licensing requirements, only a few certified nurse midwives practice in the state.58 Lay midwives continue to practice but are not licensed. Unlike the "granny" midwives who entered the profession accidentally, contemporary lay midwives are women of all ages and backgrounds who made a conscious decision to follow the practice.59 While the "grannies" had little group identity, many contemporary lay midwives are members of the Midwives Alliance of North America and its local counterpart, the Midwives Alliance of West Virginia.
The history of midwifery in West Virginia shared some of the same basic characteristics as midwifery in other parts of the country, but it had some important divergences. Although midwives attended the poor in rural areas, black and immigrant women were not the largest populations served as was the case in other states. The West Virginia Department of Health had reservations about the practice, yet individual doctors both trained and worked with some of the midwives. The acrimony of the national debate was not documented in West Virginia. The roles that midwives assumed were individually defined and highly dependent upon the opportunities and circumstances of the instant. Their history is scarcely reflected in the literature of the state, but it vividly exists in the minds of the women who received the service, provided it themselves, or were related to someone who did.
Ancella R. Bickley is Visiting Professor of Black Appalachian Studies at Marshall University. Formerly, she was Vice-President for Academic Affairs at West Virginia State College and earned the Ed.D. degree from West Virginia University.
1. Judy Barrett Litoff, "An Enduring Tradition: American Midwives in the Twentieth Century," The American Midwife Debate (New York: Greenwood Press, 1986), 4.
2. Dana S. Perry, "The Early Midwives of Missouri," Journal of Nurse Midwifery 28(1983): 15-22.
3. Litoff, "An Enduring Tradition," 6.
4. West Virginia Dept. of Health, Biennial Report, 1926-28 (Charleston, 1928), 53.
5. Jenny Belle Slaven, interview with Sarita Bennett, May 1988, Pocahontas County, WV, in possession of Sarita Bennett.
6. Rev. Rita Emerson, telephone interview with author, Cox's Mill, WV, 17 April 1969, author's possession.
7. Perry, "The Early Midwives of Missouri," 20.
8. Daughters of the American Revolution, Andrew Donnally Chapter, Trustees: Mrs. Samuel Solins and Mrs. Paul W. Jones, "Early Medical Practice," McDowell County History (Fort Worth, TX: Univ. Supply and Equipment Co., n.d.), 120-25.
9. For details of life as a company doctor in a West Virginia coal mining community ca. 1940s, see D. Bonta Hiscoe, "Hey Doc," unpub. mss., West Virginia State Archives, Charleston, WV, 1986.
10. Sally Austen Tom, "The Evolution of Nurse Midwifery: 1900-1960," Journal of Nurse Midwifery, 27(1982): 4-13.
11. West Virginia Dept. of Health, Biennial Report, 1936-38 (Charleston, 1938), 165.
12. Betty Bare, "82-year-Old Midwife Ready to call It Quits," Raleigh Register, 21 May 1968.
13. Elizabeth Lawson Jackson (Daughter of Mary Jane Trust Lawson), interview with author, 8 June 1989, Charleston, WV, author's possession.
14. Linda Johnson, "Our History: Mt. Midwives and Headers," Mountain Life and Work: The Magazine of the Appalachian South, 50(June 1974).
15. Carmelle Binns (Granddaughter of Elizabeth Binns), interview with author, 21 May 1989, Huntington, WV, author's possession.
16. Tressie Norell (Daughter of Cloie Arthur), interview with author, 30 March 1989, Cross Lanes, WV, author's possession; Ruth Belanger, "Midwives Tales," Goldenseal, 5 (Winter 1979): 42-46; Mary Adamson, interview # 22, WVU Oral History Collection, 20 November 1959; Marie Jackson (Daughter of Icie Sweeney), telephone interview with author, 13 June 1989, author's possession; Eddie Sweeney (Son of Icie Sweeney), telephone interview with author, 7 June 1989, author's possession; Joyce Mann (recipient of Mrs. Sweeney's midwifery services), telephone interviews with author, 2 February 1989 and 15 June 1989, author's possession.
17. Norell interview, 30 March 1989.
18. Marie Jackson, interview, 13 June 1989.
19."Midwife Remembers Her Career," Raleigh Register, 26 April 1977.
20. Dolly Woodell, "Clara Cogar Bender (1857-1942)," Missing Chapters: West Virginia Women in History (Charleston: West Virginia Women's Commission, 1983), 8-19.
21. Ibid., 14.
22. India Broadwater Hogue, "Master Farm Homemaker Work Sheet," Pennsboro, WV, ca. 1930, West Virginia University Extension Service, Morgantown, WV.
23. Herbert M. Morais, The History of the Negro in Medicine (New York: Associated Publishers, Inc., 1967), 15; Marie Campbell, Folks Do Get Born (New York: Rinehart & Co., Inc., 1946), 22; Lucille Clifton, Good Woman: Poems and a Memoir 1969-1980 (Brockport, NY: BOA Editions, Ltd., 1987), 237.
24. Ada Lou Hyer, "Mollie Gabe," Journal of the Braxton County Historical Society, 7(1979): 7-9; Mary Lacey (relative of Mollie Gabe), telephone interview with author, 4 April 1989, author's possession.
25. West Virginia Dept. of Health, Biennial Report, 1922-24 (Charleston, 1924), 175.
26. Belanger, "Midwives Tales," 43.
27. Uriah Barnes, ed., West Virginia Statutes, 1925 Fully Annotated Containing Laws of 1923 and 1925 (Charleston: Tribune Printing Co., 1925), 609.
28. Marie Jackson interview, 13 June 1989.
29. Wetzel County Genealogical Society, History of Wetzel County West Virginia, 1983 (Marceline, MO: Walsworth Publishing Co., 1983), 39.
30. Belanger, "Midwives Tales," 43.
31. S. Josephine Baker, "Schools for Midwives, " The American Midwife Debate (New York: Greenwood Press, 1986), 153-66.
32. Tom, "The Evolution of Nurse Midwifery," 4-13.
33. Ibid., 7.
34. Health Dept., Biennial Report, 1922-24, 89.
35. Barnes, West Virginia Statutes, 609-10.
36. Gertrude Wuesthoff, "No. 5 Prenatal Series," in Health Dept., Biennial Report, 1922-24, 168-73.
37. Slaven interview, May 1988.
38. "Midwife Remembers Her Career," Raleigh Register, 26 April 1977.
39. Slaven interview. May 1988.
40. Health Dept., Biennial Report, 1926-28, 45.
41. West Virginia Dept. of Health, Biennial Report, 1928-30 (Charleston, 1930), 3.
42. West Virginia Dept. of Health, Annual Report, 1959-60 (Charleston, 1960), 44.
43. "Midwife Remembers Her Career." Raleigh Register, 26 April 1977.
44. Health Dept. Biennial Report, 1936-38, 1938), 165.
45. Litoff, "An Enduring Tradition," 10-11.
46. Fred J. Taussig, "The Nurse Midwife," in The American Midwife Debate (New York: Greenwood Press, 1986), 227-31.
47.Mary Breckinridge, Wide Neighborhoods: A Story of the Frontier Nursing Service (New York: Harper & Brothers, 1952), 159.
48. Ibid., 228-42.
49. "Wetzel County Nurse Delivery Service," in West Virginia Dept. of Health, Biennial Report, 1938-40 (Charleston, 1940), 33-34.
50. West Virginia Dept. of Health, Biennial Report, 1942-44, (Charleston, 1944), 127.
51. Ruth Barco, Retired Public Health Nurse, interview with Debra Harr, 1989, Petersburg, WV.
52. Litoff, "An Enduring Tradition," 7-9.
53. Ibid., 6.
54. "Comparison of Maternal and Infant Death Rates for West Virginia and the United States Registration Area," in West Virginia Dept. of Health, Annual Report, 1944-45 (Charleston, 1945), 56.
55. Health Dept., Biennial Report, 1942-44, 128.
56. Belanger, "Midwives Tales," 42.
57. Ervin S. Queen, Telephone interview with author, 7 May 1989, author's possession.
58. Midwives Alliance of West Virginia, "Position Paper on 'Building for a New Century: The Carnegie Report on Higher Education in West Virginia'," March 1989, 3; telephone inquiry by author to the WV Board of Examiners of Registered Professional Nurses, 7 May 1989, author's possession.
59. Shay Huffman and Santa Bennett (Greenbrier County Midwives), interview with author, 18 March 1989, Lewisburg, WV, author's possession.