Historical significance of the black granny-midwives’ legacy in America

When designing Cleo, founder and Chief Medical Officer Dr. Chitra Akileswaran took inspiration from the community health worker movement in which trained and trusted individuals are embedded in the community and follow families over time. It allows for more proactive and personal care, made possible by the authentic relationships between providers and the families they care for. And it’s proven successful.

Rooting Cleo in midwife history

The Cleo model attempts to replicate cultural traditions in which new and growing families were guided and supported by a community of expert and veteran caregivers around them. Our Cleo Guides—a mix of midwives, nurses, doulas, educators, and clinical specialists, who also receive unique training from Cleo—provide support rooted in long and rich traditions of caring for our caregivers, traditions such as that embodied and passed down by America’s Black granny-midwives.

Black granny-midwives and their legacy of community care

For centuries, Black midwives have provided expert care to their communities and served as a bulwark against healthcare discrimination.

Historically, the American tradition of Black midwives, also known as “granny-midwives,” was born out of the period of enslavement. Among those enslaved were African women trained and practiced as midwives, who continued to practice and train others. Black granny-midwives formed a class of skilled workers that provided the foundations of birth-related care in the United States for everyone.

Granny-midwives cared not only for Black enslaved birthing people but also for the white birthing people in their communities. At one point, Black midwives had attended three-quarters of births in the southeastern United States. And yet, when the field of obstetrics developed in the mid-1700s, its leaders systematically attacked and replaced Black midwifery with a medical-industrial complex that had patriarchal white supremacy at its roots.

While medical advancements—largely achieved via brutal experimentation on enslaved Black people—brought techniques that could save more birthing people and their babies from infections, blood loss, and fatally-long labor, Black birthing people were left on the margins. Hospitals became places where racist mistreatment was not only observed, but legally permitted per Jim Crow laws. And as Black midwives dwindled in numbers, Black birthing people increasingly suffered from a lack of accessible and equitable care.

The modern midwifery movement

Despite their systematic erasure from professionalized medicine, the African American childbirth traditions of of the Black “granny-gyno’s” held on in the deep South where legalized racism routinely left Black birthing people with few options. Fast forward to the 1960s and 1970s and a resurgence in midwifery, led by Black women working to reduce Black infant and maternal mortality rates, arrived on the heels of the civil rights movement.

Since the 2000s, the number of midwives, and those utilizing their care, has grown steadily. Along with the rise of midwifery more broadly has been a concerted effort to increase the presence of Black midwives to improve outcomes for Black birthing people and their families. We know that individuals and their families benefit from racially-concordant care, that is when a provider is culturally the same or similar to them. Quite simply, when Black birthing people are cared for by Black providers, like midwives, they are better seen, understood, and respected, and this results in better outcomes.

Celebrating and honoring the African American granny-midwives’ legacy

Today’s doulas, midwives, and lactation consultants pull on the thread left by Black midwives. These community-based birth and family support professionals are imprinted with the spirit of their granny predecessors, and we’re grateful to benefit from this legacy. It’s only thanks to the foundational work of others that we’re able to provide our unique style of care.

This Black History Month, we honor not only the history of Black granny-midwives, but those who have, and continue to rebuild and bolster their tradition to serve Black communities and bring Black families more equitable care. We celebrate the following visionaries and grassroots organizations, identified by our Inclusive Support Team of Cleo Guides as foundational and inspirational to their journeys in birth work and family care.

Shafia Monroe

The “Queen Mother of a Midwifery Movement,” Shafia Monroe has worked since the 1970s to reduce the high Black infant and maternal mortality rates. She is a renowned midwife, doula trainer, motivational speaker, and cultural competency trainer. Monroe developed a groundbreaking doula-training program that continues to serve as an international model for reducing infant mortality, increasing the number of doulas of color, empowering families for informed consent and physiological birth, and teaching traditional birth and postpartum practices using the legacy of the 20th century African American midwife. She co-founded the Traditional Childbearing Group in Boston and then later formed the non-profit International Center for Traditional Childbearing (now the National Association to Advance Black Birth) to increase the number of midwives and doulas of color to empower families, reduce infant and maternal mortality, and bring Black midwives together.

National Association to Advance Black Birth (NAABB)

The NAABB stands firmly on the 30-year legacy of its predecessor organization, the International Center for Traditional Childbearing (ICTC). The name change in 2018 signaled its focus on addressing birthing issues in the Black community through advocacy, programming, and building the capacity of doulas and midwives in the Black community. A marque program of the NAABB is its Midwifery Scholarship which provides up to $6,000 for Black student midwives to remove financial barriers and help provide the practical tools and education they need to improve outcomes for Black women and families.

Commonsense Midwifery

Founded by Jennie Joseph as an extension of her dedication to helping women and families have better birth experiences, the non-profit Commonsense Midwifery provides education in midwifery, advocates for patient-centered care, and through its Perinatal Task Force is on a mission to eliminate racial and class disparities in birth outcomes, and to create equity and power in maternal-child health care.

San Antonio Midwife

According to Birth Center Equity, a non-profit aimed at breaking down financial barriers to birthing center access, the San Antonio Nurse Midwife Birth and Wellness Center is among less than 5 percent of birthing centers run by people of color. Their Birth Fund covers the cost of care for Black families who might otherwise struggle to afford it.

Sista Midwife Productions

A New Orleans-based birth advocacy organization, Sista Midwife Productions provides education, training, and consultations as a part of their mission to improve pregnancy and birth experiences and to eliminate perinatal disparities by increasing the number of Black birth workers, teaching families about their rights and options; and creating transparency and accountability within childbirth education and the medical obstetrical system. Since 2012 they have also operated a national directory to help Black families connect with Black birth workers.