Participation Type
Panel
Session Title
Session 5.10 Health: Appalachian Midwifery in Thought and Action
Session Abstract or Summary
This panel examines the historic and contemporary practice of lay midwifery in the Appalachian region.
A century ago, lay midwives provided vital obstetric services to rural women. Appalachian midwives remain celebrated figures in regional literature, folk culture, and memory. But with the medicalization of childbirth, states enacted laws to either restrict or outright eliminate lay midwifery. After a resurgence of interest in midwifery in the 1970s that came from religious and countercultural impulses as well as consumer pressures, states began to recognize Certified Nurse Midwives, although their practice was typically confined to hospitals and medical clinics. This had the effect of marginalizing Certified Professional Midwives who provided home services. CPMs remain illegal in many states, including West Virginia. Because access to affordable medical care continues to trouble rural Appalachians, midwives have the potential to fill crucial gaps in obstetric care.
This panel brings together four women who approach the music of midwifery from their own respective mountains—literature, history, and medicine—but collectively provide a comprehensive look at midwives past and present. They will highlight the vital role that midwives have played in providing prenatal and childbirth care for rural residents between the depression era and now. The essays will also emphasize the need for laws that encourage, rather than restrict, lay midwifery. Finally, they will chronicle the role of midwives in challenging exclusionary laws since the 1970s. It is our hope that this panel will invite discussion about holistic approaches to rural health care, particularly related to women.
Presentation #1 Title
Midwives of the Mountains: A comparative look at fictional portrayals
Presentation #1 Abstract or Summary
Appalachian author Gretchen Moran Laskas, in her novel The Midwife’s Tale, tells a story about a depression-era midwife apprentice trying to understand her chosen profession and her life itself. Midwife/memoirist Patricia Harman’s novel The Midwife of Hope River is set in the same region and time period and looks at how a midwife confronts poverty and prejudice. In his novel Midwives, Vermont author Chris Bohjalian relates the story of a midwife in a contemporary small Vermont town who goes on trial for manslaughter. The two Appalachian authors tell stories set in the depression about how women raise themselves up and deal with an environment defined by poverty. The Vermont story shows the devolution of the respect for midwives more than 50 years after the events of the Appalachian stories. The stories emerging from these authors about the midwives have different narratives and themes that draw from their Border State and Yankee roots. And while their characters have similarities of experience, the regions they are from shape their stories.
At-A-Glance Bio- Presenter #1
Pam Hanson is a former journalist and college teacher who has possessed a love for writing since elementary school. She co-writes with her mother, Barbara Andrews, and together they have published more than thirty titles.
Presentation #2 Title
Homesteading Women and the Revival of Midwifery in Appalachia
Presentation #2 Abstract or Summary
This presentation will examine the role of “back-to-the-land” women in reviving interest in midwifery in Virginia and West Virginia during the late 20th century.
In 1975, Ina Mae Gaskin published Spiritual Midwifery, a guide to homebirth that helped to ignite a revival of the ancient practice in the United States. Ina Mae published the book shortly after she and husband Stephen moved from San Francisco to their aptly named commune, The Farm, in Tennessee. Their resettlement took place amid an unprecedented urban to rural migration, during which thousands of mostly young and white ex-urbanites fled to rural areas in search of self-sufficiency and simple living. Appalachia became a particularly popular destination because of rock bottom land prices, natural resources, and proximity to East Coast and Midwestern cities. As the newcomers settled into their communes and homesteads, they began having families. Many homesteading women felt that the medical establishment had turned what should be viewed as a “normal life process” into a medical procedure, so they opted to have midwives guide their births at home in the company of friends and family. Homesteading midwives, largely self-trained, operated in underground networks until they began lobbying for legal recognition on the state level. This presentation will draw upon memoirs, newspapers, and oral histories to chronicle this reemergence of midwifery in West Virginia and Virginia during the late 20th century.
At-A-Glance Bio- Presenter #2
Jinny Turman is an assistant professor of history at the University of Nebraska at Kearney. She received her MA in Appalachian Studies from ASU in 2001 and her Ph.D. in History from West Virginia University in 2013. Her research focuses on the 1970s-era "back-to-the-land" migration, grassroots activism, and community change.
Presentation #3 Title
The changing legality of midwifery in North Carolina and the resulting outcomes for prenatal care in Appalachia
Presentation #3 Abstract or Summary
Preface
I plan to address a brief history of the legal changes around midwifery in North Carolina and the consequences those changes have had on access to prenatal care. I would also like to include some supporting excerpts from my interview with Lisa Goldstein, who is a retired nurse midwife in western North Carolina with over fifty-three years of experience as both a lay and nurse midwife.
Abstract
Pressure from the American Medical Association, as well as support from the pharmaceutical industry and medical supply companies, was a key proponent behind the legal restrictions of non-biomedical practice like lay midwifery, and since a replacement (nurse-midwifery) was available, the decision to outlaw lay midwifery was rampant across most of the United States. Unfortunately, lawmakers at the time did not fully acknowledge the limitations being placed on new nurse-midwives—forcing them to remain in hospitals or private practices as obstetrical nurses. Consequently, the system did not actually replace lay midwifery but rather eliminated it. The real key to having healthy babies and mothers is providing competent, relatively inexpensive medical care before, during and after the birth process, which is exactly what Lisa Goldstein and other midwifery supporters in Appalachia have been saying for years. Through Goldstein’s fifty-three years of experience she has provided women and families in western North Carolina a childbirth option that is not only affordable but safe, reliable and patient-centered. The tradition of lay midwifery is forever lost, but the reorganization of nurse-midwifery into a stand-alone medical specialty is vital. The United States is currently failing at providing affordable and consistent healthcare to noncritical pregnant women, and nurse-midwives should be considered among the best options for filling that gap.
At-A-Glance Bio- Presenter #3
After graduating from Appalachian State University in May 2009 with a Bachelor of Arts in Appalachian Studies, Annemarie began medical school at the Edward Via College of Osteopathic Medicine at the Virginia Polytechnic University. She is currently in her second year with a projected graduation date of June 2017. She hopes to attend a residency program for family medicine or obstetrics and gynecology.
Presentation #4 Title
Autonomy, Tradition, Midwifery, and the Homebirth Question in Rural Appalachia
Presentation #4 Abstract or Summary
Is autonomy in childbirth the answer to our modern obstetric dilemmas in rural Appalachia? With the homebirth midwifery option becoming rarer within the birthplace of nurse midwifery in the United States and fewer obstetricians choosing to serve in rural areas, it is a question we must answer.
The current climate of childbirth in the mountains of southeastern Kentucky can look dire if you are viewing it from a statistical perspective. Mothers are driving an hour or more for basic maternity care. Most counties do not have access to the homebirth option. Preterm birth is happening at high rates. There are more smoking mothers. Some rural hospitals report a cesarean rate of over 50%. Large numbers of babies are born to drug addicted mothers with very limited local resources in addressing the problem.
Yet, there are little known networks of birth professionals, midwives, doctors, mothers, and fathers working to increase awareness of local birthing options, bring forth more resources, present education on healthy pregnancy and birth, and increase access to reproductive health services. In the area where pioneers in the field of maternal and infant health, like Mary Breckinridge (founder of Frontier University and the Frontier Nursing Service) proved excellent results could be achieved in the most difficult of situations, we are once again facing a crisis. Where a solid tradition of midwifery prevailed until infrastructure brought in better access to hospitals and changing state laws all but eliminated traditional midwifery, there is now only 1% of women birthing at home and 76 out of 120 counties of the state have no maternity care provider at all. However, in our tradition of a make-do attitude, there are solutions. Would autonomy in childbirth give us the answer?
At-A-Glance Bio- Presenter #4
Kelli B. Haywood MAT, LCCE, CSBC is the homeschooling mother of three daughters living somewhat off grid in the mountains of eastern Kentucky. Through her work as a writer, childbirth educator, Sacred Birth counselor, prenatal yoga instructor, and birth doula, she advocates for mothers and babies everywhere.
Midwives of the Mountains: A comparative look at fictional portrayals
Appalachian author Gretchen Moran Laskas, in her novel The Midwife’s Tale, tells a story about a depression-era midwife apprentice trying to understand her chosen profession and her life itself. Midwife/memoirist Patricia Harman’s novel The Midwife of Hope River is set in the same region and time period and looks at how a midwife confronts poverty and prejudice. In his novel Midwives, Vermont author Chris Bohjalian relates the story of a midwife in a contemporary small Vermont town who goes on trial for manslaughter. The two Appalachian authors tell stories set in the depression about how women raise themselves up and deal with an environment defined by poverty. The Vermont story shows the devolution of the respect for midwives more than 50 years after the events of the Appalachian stories. The stories emerging from these authors about the midwives have different narratives and themes that draw from their Border State and Yankee roots. And while their characters have similarities of experience, the regions they are from shape their stories.
