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Nurse Midwife Jenny Luke -
Delivering a Wake-Up Call
to the American Maternal
Healthcare System

By Carin Chea

Registered Nurse Jenny Luke has delivered her fair share of babies early on in her career, but has now found something else that desperately needs to be delivered into the American healthcare system - the necessity of nurse-midwives.

Luke hits the nail on the head when she reads my mind and points out that most Americans view midwives as flower-crown-wearing hippies who solely deliver babies in remote, rustic cabins.

Writing from a historical perspective, Luke's book, Delivered by Midwives: African American Midwifery in the Twentieth-Century South, dives into the rich and complex narrative of black midwives in twentieth century south, and (quite frankly) the lost and disregarded profession of midwifery that deserves a second glance.

Delivered by Midwives: African American Midwifery in the Twentieth-Century South by Jenny Luke

Have you been a professional nurse-midwife your entire life?

No. I am a British-trained nurse and midwife, and came to America in 1990 to work as a Registered Nurse in Labor and Delivery at Parkland Hospital, Dallas. I was 25 and wanted the experience of living, working, and traveling in a different country.

I fully intended to return to the UK after a year, so when the hospital gave me the opportunity to convert my British nurse-midwifery qualifications to the American equivalent, I turned it down. Soon after, I met the person I would marry and stayed. I didn't return to nursing after I had children.

Midwifery in Britain is absolutely part of the mainstream hospital maternity care. In 1902, the British government set up the Central Midwives Board to govern the training, education, and examination of midwives and midwifery was incorporated into the larger system.

People in Britain know exactly what a midwife does and where they work. When I first came to America, I was reluctant to tell people that I was a nurse-midwife. If they had an idea of what it was, it was this sort of granola, hippie idea, which is not accurate.

In fact, today, most American midwives are certified nurse-midwives who work in hospitals. Nurse-midwifery as a profession is trying to better inform the general public about the role of nurse-midwives.

How did you get into writing and research?

After my children started school, I went back to school and got a degree in history. While doing my undergraduate work, I became fascinated by the American South and all the complexities of the region.

As I progressed into my graduate studies, I took a class on race and gender and stumbled on the legacy of black midwifery, and it went from there.

I began to explore the reasons why midwifery has struggled to get a foothold in mainstream maternity care, and the impact that race has had on its role in America.

Tell us about your book. What are some of the central messages you want to send across in Delivered by Midwives?

The African American midwives I talk about in the book achieved such great things given their time and place. The isolation of black communities in the Jim Crow South allowed traditional midwifery to last longer than in other parts of the country.

Lay midwives (different to nurse-midwives) were figures of authority in the community and they became a point of connection for county health officials. They interacted with the white doctors and nurses who supervised and trained them in modern techniques, and they adapted to the growing federal structures that were being applied to health care during this time period.

I definitely would like this history to be known, for the readers to get to know the midwives I write about, to understand the obstacles they encountered in the face of overwhelming poverty, the racial discrimination, their integrity and dignity, and their inevitable demise after a job so well done.

As well as lay midwives, I want the reader to learn about the African American nurse-midwives and the different pressures they faced as professional black women. In the 1950s nurse-midwifery made the choice to become a white woman's profession, so it wasn't just the lay midwives that were overlooked, but the professional nurse midwives, too. I want to tell their stories.

In the book, I give examples of how the lay-midwives (who inherited the work from their mother or grandmother) looked after women in childbirth because there was no alternative.

In the 1920s, state health departments across the South began to register the midwives and organized them into clubs. All the midwives in a local area would meet several times a month for training sessions where they'd learn modern methods and sterilization techniques and have lectures from public health nurses.

The work of the midwives went far beyond maternal health; the clubs organized vaccination programs, they launched campaigns to clean up the town, they encouraged better personal hygiene, they advocated for victims of abuse.

Given the fact that the current maternal mortality for black women in America today is 3 times higher than for white American women, I think we need to start asking questions as to how maternity care is delivered and why black women are at such higher risk. I'm not suggesting we go back to a time when women deliver in their homes and they have little access to mainstream care.

Nurse Midwife Jenny Luke

I would really like to emphasize: I'm not a proponent of home birth and unassisted labor. Without medical technology and assistance, pregnancy and childbirth is not safe. I would, however, like people to read my book and think: "These midwives could communicate better with their patients and the women trusted them." Communication and trust in healthcare are crucial in providing good care.

There are still many obstacles between patient and physician, especially for patients of color. The importance of early and consistent pre-natal care is critical to reducing maternal and infant death and in order to do that, a health care provider needs to effectively communicate.

The midwives I write about were masters at communication and developing trusting relationships so I'm hoping that history can remind us of the value of these skills.

It's been 100 years since the federal government first attempted to improve maternal health and good opportunity for reflection. Maybe some of the simplest things make a big difference in the way care is administered.

I think one aspect of the lay midwives role that comes to light in the book is the emphasis on effective pre-natal communication and teaching; the "messenger" is as important as the message. All midwives, the ones I write about, and today's midwives, are extremely effective in a broader role during and after pregnancy. The old lay midwives used to say their job was "catchin' babies" but that is a wild understatement!

How has midwifery changed over the decades?

The role of the certified nurse-midwife has become more established and mainstream. There are now about 12,000 nurse-midwives and the American College of Nurse-Midwives is projecting to expand and increase the number of midwives of color.

One of the issues for American midwives is that there are so many types of midwife, with many educational backgrounds. Midwifery in America is governed at the state level so there are differences there, too.

In states like California and Oregon the laws are fairly accommodating for midwifery. But, in states like South Carolina and Louisiana (and other states in the South) the law is restrictive, so it's difficult for nurse-midwives to send a clear message to the American public of what their role is.

Many states across the South made the role of lay midwifery illegal by the late 1970s, and by then African American women were used to expecting a hospital delivery.

It is interesting to unravel the transition from home birth to hospital birth for black women in the South, and their choice to have a hospital birth even though it was in a segregated hospital where they knew their care wouldn't be equivalent to a white woman's care. It is a complicated shift with many contributing factors.

Ultimately, midwifery became associated with poverty and exclusion, and childbirth in hospital was in step with progress and the hope for inclusion in society at large.

Have you seen Call The Midwife? What are your thoughts on it?

I like it. It frightens me to say that my experience as a nurse and midwife in Britain is as close to that time period (roughly 1960) as we are today! I began nursing in the mid-1980s when we all wore a similar uniform to the characters in the program.

A similar adaptation to the African American midwives I write about, would be perfect. I have no idea how to go about making my book into a movie or TV show, but my tagline for it would be "Call The Midwife meets the Jim Crow South."

As in Call The Midwife, you'd see the shift and change over time, and the American South setting would also expose the reality and far reaching impact of racial segregation in the not too distant past. It is important to promote African American history and preserve the legacy of these remarkable women.

What were some of the most fascinating things you discovered during your research and writing of your book?

I was really surprised that the work of the midwives hadn't been closely researched before. The general discussion was that black midwives were replaced by white doctors, which is true, but that statement glosses over a 50-year period of transition and that's where interesting things happen!

Another thing that drew me into the topic was the many examples of relationships between black and white people in the South, and the complexities of those relationships.

The first part of the book is focused on lay midwives, women who held a position of authority in the community. With very limited resources, they were capable, inventive, and quickly adapted and improved the new techniques to suit their needs; they prided themselves on their ability to "use hatch got." They earned the respect of the white doctors and nurses they interacted with, and the county boards of health relied on their influence and commitment.

The midwives' self-assurance meant that they didn't hesitate to demand support from a negligent doctor or challenge a police officer who issued a speeding ticket to a midwife heading to a woman in labor. While they were held in high esteem personally, as a group midwives were undervalued and were only seen as a stop gap.

I also discovered white physicians and nurses who were committed supporters of improving black women's health and managed to circumvent the discriminatory laws and customs to do so.

Are there any upcoming projects you'd like readers to know about?

It wasn't my intention to write a book when I started to research the topic, but things just kept moving towards publication. When I finished my thesis, it was suggested that I look for a publisher. I expected I'd be satisfied once the book was released, but I'm not. I want to tell these stories! I would love to see these historical characters brought to life in a movie or TV program.

One of the midwives I write about, said at the end of her life, "I've got so much experience in here, I just want to explode. I want people to realize what I am!" I want to tell Onnie Lee Logan's story.

For more information, please visit www.JennyMLuke.com.


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