The Real History of Midwifery in Georgia
The Audacious History of Georgia Midwives
A deep dive into midwives of Georgia repeatedly asking to not be criminalized.
1925: “The Midwife Problem”
Around 5,000 lay midwives were serving int he state of Georgia. The State Board of Health begins to supervise them, using Public Health Nurses to train these midwives on sterilizing equipment and assisting them at deliveries. Georgia statute requiring midwives to register with the local registrar in the district they lived in was enacted, but no legal definition of “midwifery” existed at this time.
In 1925, the Maternal Mortality rate for non-white people was 160 per 10,000 and for white people was just under 80 per 10,000. (Georgia Department of Human Resources Division of Public Health, Health Assessment Services, 1961)
“I shall confine my remarks on the midwife problem to that of the midwife as we find her in the Southeast. The problem is therefore one that is peculiar to our section, as practically all midwives are negroes who have reached middle age or over. They are, as a rule, ignorant and superstitious, having absorbed many things from the traditions of the race. Most of them are unable to read; consequently, teaching them is a slow process. I shall deal with Georgia figures, but the same conditions very likely prevail in all of the Southern states.
In area, Georgia is the largest state east of the Mississippi… There was a maternity death rate of 11.6 in 1924; the first quarter of 1928 showed a rate of 8.5…” - Dr. Joe P. Bowdoin, Director of Georgia State Board of Health Division of Child Hygiene. Dr. Bowdoin practiced medicine in Adairsville and is said to have delivered over 3,000 babies in that area. He “founded the Georgia midwife program”. (1928, JAMA)
1947- Rise of the Nurse Midwife
A public health initiative to improve maternal and infant mortality rates was initiated. Physicians openly stated that midwives were their most fierce competition. The lay midwives of the 20’s were now painted as dirty and uneducated, even though they had outstanding outcomes for the families they served.
Since childbirth was taking place most often in the hospital, nurses were needed to assist in deliveries, and the rise of the nurse midwife was well underway. Mary Breckinridge, who founded Frontier Nursing University to train nurse midwives, was known to be a white supremacist who promoted segregation and eugenics and actively kept black midwives from gaining education.
A nurse midwifery pilot project was established in Walton County at the county hospital. Two nurse midwives assisted the doctors with labor and delivery and delivered 64 babies. This same year, a home delivery service was begunin Thomas County with two nurse midwives. They delivered 15 babies at home in a 6 month period.
Interestingly, data shows that the preterm birth rates for nonwhite babies skyrocketed around 1947. Prior to this, no disparity between race is indicated.
1955: A state-sanctioned definition of midwifery
“any person not licensed under the laws of this State to practice obstetrics who is regularly engaged in attending women in childbirth, or who holds herself out as such, whether for a consideration or otherwise.”
Midwives were required to apply with the local county board of health and registrar of vital statistics for a certificate to practice midwifery. Classes were required and applicants had to pass an exam with the State Board of Health.
1963
A 1963 memorandum to “All Local Health Departments” stated that “hospitalization for delivery is the ultimate desirable goal.”
1979- No more lay midwives!
It was decided by the Executive Director of the Council on Maternal and Infant Health that no new midwifery certificates be issued. Existing certificates would be continued. However, Georgia code was not repealed or amended.
1990
A lay midwife wrote to the Gwinnett County Health Department to request an application for a midwifery certificate. She was directed to speak to the Georgia Board of Nursing, even though Georgia code still stated that one could obtain a certificate this way. She was told that only nurse midwives were permitted to practice.
1991- The “Midwife Problem” Grows
A Cease and Desist letter is sent to a midwife demanding that she immediately stop attending births and calling herself a midwife without “a certification from the Department of Human Resources as required by law.” More midwives request these certificates and are turned away.
Additionally this year, the Georgia Midwifery Association worked alongside the Department of Human Resources Women’s Health Division to help create emergency rules for direct-entry midwives. Instead, the DHR repealed “the existing midwifery rules” and replaced them with emergency rules to permit only CNMs to practice midwifery.
1994- A national credential for out-of-hospital trained midwives
The Certified Professional Midwife credential begins! The North American Registry of Midwives issues this direct-entry midwifery certification to midwives who complete the required clinical training and pass a national test.
2006-”Maybe we DO need these midwives! “
HR 1341, sponsored by Representative Stephanie Stuckey Benefield and “Able” Mabel Thomas, initiated a study committee on direct-entry midwifery in Georgia. This resulted in a report that recommended a taskforce to investigate state licensure in other jurisdictions and allow for direct-entry midwifery practice in Georgia. The taskforce found that state Code and Regulations contradicted eiach other, but no action was taken.
2015- “Never mind, no direct-entry midwives allowed!”
The Department of Public Health amended regulations to clarify that no one could call themself a midwife unless they were a nurse midwife with a license from the Georgia Board of Nursing. It was at this point that all direct-entry midwives officially became illegal, even though no one told us!
2016- “And STAY OUT!”
A Senate Bill proposes that the unauthorized practice of midwifery should be penalized as a felony. Due to large public outcry, the bill did not pass.
2019- Cease and Desist issued to Debbie Pulley, CPM
Multiple midwifery licensure bills are introduced to the Georgia legislature, with good public support. However, the COVID-19 pandemic ended progress as midwives became entrenched in serving the demand for out-of-hospital birth.
2021- Another Cease and Desist. Georgia loses another midwife
More midwifery licensure introduced, but SB111 did not even get so much as a hearing.
2024- More Cease and Desists and midwifery investigations by the Georgia Board of Nursing
2025- HB520 Georgia’s First Midwifery Consensus Bill Introduced
We are stronger together, so Georgia’s midwives banned together to write our strongest licensure bill yet. We have the support of an experienced lobbyist firm, and we will not stop until we have decriminalized midwifery in our state! Follow along for updates by making sure you have signed up for email updates here.