History of Midwives and Doulas

In October 2024, Pennsylvania Governor Shapiro signed into law H.B. 1608, which extends Medicaid coverage to doula services in the state. This includes providing childbirth education and support services, including physical and emotional support, during pregnancy, labor and delivery, and up to one year postpartum, as written by the PA Black Maternal Health Caucus. According to Birthing Advocacy Doula Trainings, 18 states and Washington, DC have already had Medicaid coverage for doula care, and Pennsylvania is one of 9 states in the process of implementing Medicaid coverage. 

But there is a long history of at-home birth and pregnancy care. Midwives, who are trained healthcare providers today, have existed for centuries before the first recorded practice in the United States. According to the National Museum of African American History & Culture, experienced midwives were among the enslaved individuals who survived the middle passage, and continued to practice and train others. These midwives were vital members of the community, and many were allowed to travel long distances for their expertise which was uncommon for enslaved individuals - giving midwives the ability to maintain community connections that were often lost when families were split apart.

After the Emancipation Proclamation, these midwives continued their practices, often in rural communities and the South, where access to medical centers was rare. Midwives were commonly the only and best choice of care during pregnancy and birth. These midwives were known as ‘Granny Midwives,’ and even when obstetrics became more common, Granny Midwives continued to be a staple in Black communities.

Through the 1900s, the birthing process continued to be medicalized, and although obstetrics was initially shunned by the medical community, privatized healthcare and the government stepped in with policies. Uché Blackstock, an emergency physician and Founder of Advancing Health Equity, spoke on the violent policies of this time, saying that the Sheppard-Towner Maternity and Infancy Protection Act of 1921 was, “part of a campaign that essentially associated midwifery with poor outcomes, poor maternal outcomes, even though at the time there was no evidence for that… and so that medicalized the birthing process so that obstetrics and gynecologists and, at the time, mostly white men would be the ones that were caring for patients.”

The stereotypes perpetuated by the medical system against midwifery and the continued racist governmental interventions led to a decrease in midwifery. Data shows that “in 1940, there were 115,000 midwives and informally trained nurses, and as of February 2022, there are only 13,524 midwives.” During this time of medicalization, the emphasis on the emotional support that midwives provided dwindled. In the 1970s, the term doula was introduced, giving new terminology for the long practice of women supporting women during childbirth. Doulas cannot provide medical help or advice but provide emotional support and coaching during pregnancy, labor, and postpartum. 

Statistics show that having a midwife, a doula, or both, at a person’s side throughout their pregnancy journey positively impacts the process and birthing experience. The CDC data shows that “doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.” And states that have a higher integration of midwifery were shown to have “significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal deaths.”

While Pennsylvania is just beginning to extend Medicaid coverage to doula services, NNCC had the opportunity through the Jewish Healthcare Foundation to work alongside the Maternity Care Coalition and the Pettaway Pursuit Foundation to provide doula training for five nurse-home visiting clients and then doula services to clients in need. Programs like these provide culturally competent care and help “Black birthing individuals to navigate systemic racism experienced during the perinatal process.”