A brief look at midwifery in Southern Appalachia

In the heart of Appalachia, the tradition of midwifery has long been a cornerstone of maternal care. Midwives, often known as "granny women," have provided essential birth support for generations, blending folk medicine, spiritual traditions, and practical knowledge passed down through the ages. However, despite their invaluable role, Appalachian midwives have faced significant challenges—legal barriers, systemic oppression, and the encroachment of medical institutions that sought to displace them.

Midwifery in Appalachia has deep roots in both necessity and tradition. Before hospitals became widely accessible, midwives were the primary caregivers for birthing women, relying on herbal remedies and community wisdom to ensure safe deliveries. These midwives did more than deliver babies; they provided emotional support, postpartum care, and guidance on newborn care, embodying a holistic approach that modern medicine is only beginning to reclaim.
The early 20th century brought a shift in how childbirth was perceived and managed. As hospitals and obstetricians gained prominence, midwifery was increasingly marginalized. The introduction of strict licensing laws made it difficult for traditional midwives to continue their work, forcing many out of practice. While these regulations were often framed as efforts to improve maternal health, they disproportionately impacted rural and Black midwives, effectively erasing a rich and effective tradition from mainstream healthcare.

One of the most striking examples of midwifery’s suppression in Appalachia was the exclusion of Black midwives from formalized healthcare systems. Despite their extensive experience and trusted role within their communities, these midwives were denied opportunities for certification and employment in emerging medical institutions. The legacy of this exclusion persists today, as Black maternal health disparities remain alarmingly high, highlighting the ongoing need for culturally competent and community-based care.
Mary Breckinridge, founder of the Frontier Nursing Service in 1925, is often credited with revolutionizing maternal healthcare in rural Kentucky. Her work undeniably improved access to trained midwives, but it also reinforced racial barriers, as she refused to hire Black midwives. This complex legacy is a reminder that while progress was made, it often came at the expense of marginalized communities who had long provided quality care outside institutional settings.

Despite past setbacks, midwifery is experiencing a resurgence in Appalachia. Families seeking personalized, low-intervention births are turning back to midwives, recognizing the benefits of continuity of care, reduced medical interventions, and cultural sensitivity. However, challenges remain. Many states still impose restrictive laws on midwifery practice, and access to midwifery care is often limited by insurance policies and systemic biases favoring hospital births.
Organizations and advocates are working tirelessly to address these issues, pushing for policy changes that expand midwifery access and integrate traditional practices into modern healthcare frameworks. Efforts to preserve Appalachian midwifery traditions, including oral history projects and midwife-led training programs, are ensuring that this vital knowledge is not lost.

Midwifery is more than a healthcare practice—it is a testament to community resilience and self-determination. In regions where hospitals are distant and healthcare resources are scarce, midwives provide a lifeline, offering safe, compassionate, and culturally relevant care. The return to midwifery is not a step backward; it is a reclamation of wisdom that has sustained generations.
As we move forward, it is crucial to honor and support midwives in their fight for recognition and accessibility. Whether through policy advocacy, education, or direct support, uplifting midwifery means investing in healthier families and stronger communities. The hollers of Appalachia still echo with the stories of the women who birthed generations in their homes, guided by the steady hands and unwavering dedication of midwives. It is time their contributions are fully acknowledged and their practices embraced as a vital part of maternal healthcare.

The story of Appalachian midwifery is one of endurance, wisdom, and advocacy. By recognizing its history, addressing systemic challenges, and supporting midwives in their essential work, we can create a future where every mother has access to respectful, skilled, and compassionate care—no matter where she lives. As the mountains stand steadfast, so too does the legacy of midwifery in Appalachia—rooted in tradition, strengthened by struggle, and flourishing once again.