KNOW YOUR FLORIDA MIDWIFERY HISTORY

By Justine Clegg, MS, LM, CPM

Originally Printed in the MAF 2019 Conference Booklet 

Indigenous peoples have lived in Florida for more than 10,000 years before Europeans arrived on our shores.  Like all societies, they had their midwives, herbalists, healers and birthing customs.  The Calusa tribe, which means "Fierce People," were descendants of Paleo-Indians who inhabited Southwest Florida approximately 12,000 years ago. Paleo-Indians, believed to have migrated originally from Asia around 22,000 BC, are known as expert big-game hunters.  The Calusas were fishermen and hunters. The Tocobagas were a prehistoric community living near Tampa Bay up until about 1760.  From at least 1000 AD, the Apalachee, a wealthy farming group, lived in northwest Florida.  The Timucua peoples who resided in Northeast and North Central Florida and southeast Georgia were the largest indigenous group in that area and consisted of about 35 chiefdoms, many leading thousands of people. The Potano tribe, located in the territory of present Alachua County, was the most powerful of all the Timucua peoples. The Tequesta of Biscayne Bay were a small, peaceful tribe. They were one of the first tribes in South Florida and settled near Biscayne Bay in the present-day Miami area. They built many villages at the mouth of the Miami River and along the coastal islands. Like other South Florida tribes, the Tequesta were hunters and gatherers. Other indigenous tribes in Florida included the Ais and the Jeagas up the coast, the Keys Indians, and the Mayaimi who built large mounded villages near Lake Okeechobee. Like the Calusa, these tribes were fishermen and hunters rather than farmers. 

Florida was the first mainland territory of the United States to be settled by Europeans.  In 1513 when Spanish explorer Juan Ponce de León reached Florida’s shores, he found the Miccosukee peoples.  In the 1700s, bands of Creek Indians from Georgia and Alabama migrated to Florida, seeking to escape conflicts with European settlers and other tribes and find new lands where they could live in peace.  At that time the Florida Indians collectively became known as “Seminole,” meaning "wild people" or "runaway."  They brought their own tribal midwives with them.

On March 3, 1845, Florida became the 27th state to join the USA. Florida’s population at that time was 66,500, located primarily in northern Florida.  Up until the early-to-mid twentieth century, midwives commonly attended women in childbirth, particularly in the immigrant communities in the north and in African American communities in the south.   In 1979, when the Midwives Association of Florida introduced our first bill in the Florida legislature, many of the legislators, especially in north and central Florida, had been delivered at home by midwives. Midwives trained by going to births with more experienced midwives and later with doctors.

In 1905 Peggy Smith, who had worked as a midwife for years in Quincy, wrote to the Florida governor to explain that doctors in her community respected her and asked to be officially confirmed by the state.  Midwives had received recognition by physicians and other prominent members of their communities in the past, but the state had no official process to certify midwives at that time.

By 1920, Florida’s population had grown to 962,000.  In addition to offering homebirths for most of Florida’s pregnant women, midwives provided essential medical care and other services to many communities.  The midwives believed they were born to their profession.  They had an intimate relationship with the spirit world. This connection was central to the services they provided. They trusted that knowledge and technical information was revealed through a direct communication with God.  Midwives were advised to “put God ahead” and “take the Lord into our insides” during a birth.  Some more quotes from these midwives:

“God made me that way.”

“I was born wanting to see births and catch babies.”

“The good Lord taught me how to catch babies.”

“Knowing we were always blessed,” we had “much communication with the spirit.”

“We could always count on God to get to the birth before we did,” to “be the doctor,” and to “show us the signs before a complication occurred.”

By 1930, Florida’s population had grown by 65% to 1,471,000.  Approximately 4000 midwives were serving Florida families, including Seminole, Miccosukee, African American and poor rural White families (Fla. Health Dept. estimate).

In 1931 Florida passed the first state midwifery licensing law.  The 1931 Florida Midwifery Law required “The control and licensing of midwifery for the protection of mothers at childbirth and authorizing the State Board of Health to make regulations therefor."  The law required that practicing midwives be at least 21 years old, be able to read the Manual for Midwives, be able to fill out birth certificates, "be clean and constantly show evidence in behavior and in home of habits of cleanliness," have attended, under supervision of a physician, at least fifteen cases of labor and delivery, possess a diploma from a school for midwives, and become licensed by the State Board of Health. In 1931 about 1400 midwives (35% of the practicing midwives) became licensed.  In 1933 the Florida Midwife’s Manual was written for Licensed Lay Midwives. 

In 1933, Florida began offering classes at the Midwife Institute established at Florida A&M University in Tallahassee, and the Institute held other midwifery trainings regionally in cities such as Tampa and St. Augustine.  Classes taught care of the mother and the newborn, and emphasized basic principles of hygiene such as the importance of hand washing, sterilizing equipment and what supplies and equipment to pack in their birth bag to bring to a birth. Each midwifery student received a midwife’s birth bag upon graduation. A tag was attached to the bag that listed the necessary items that they should always have in their professional bags, including sharpened razors, sanitary solution, linens, and bandages. The tag concluded with the advice that “The Safe Midwife keeps her bag clean and ready at all times.”

Midwives with their birth bags at graduation standing on the steps of the Midwifery Institute at Florida A&M College in Tallahassee, Florida, 1935

The Florida Health Department actively recruited and trained midwives to take care of those women who did not have access to medical care due to poverty, segregation and living in rural remote areas.  Florida Licensed Lay Midwives attended women in labor and birth.  Prenatal care was provided by public health nurses in county clinics which supplied the midwives with birthing supplies, eye ophthalmia, birth certificate forms and other items, and offered physician consultation and training.  The midwives were expected to attend births in women’s homes when summoned by a family member.  They served their community in many ways, bringing medical supplies, clothing and other aid to needy families.  Many were paid in produce, canned foods, eggs, chickens, pigs and livestock, or barter and trade, whatever families could afford.

By the 1920s and 1930s, as a result of the American Medical Association’s misinformation campaigns targeting midwives and legislative action to restrict access to education and practice, midwifery had begun a rapid decline in the Northern states. Immigration restrictions limiting the influx of new midwives, resistance by physicians to the use of midwives, a decreasing birthrate in the non-immigration population and propaganda by the AMA portraying midwives as ignorant, dirty and dangerous were contributing factors to the decline of midwifery in the US. In the South, however, midwives continued their practices into the late 1960s, when state health officials began their initiative to eliminate a profession that they believed was no longer needed.

After training hundreds of women from around the state to become educated and licensed as midwives, and in spite of its continued popularity, in 1946 the Midwife Institute at Florida A&M College in Tallahassee was permanently discontinued 13 years after it had opened.  Midwives were then trained via apprenticeship by attending births with other midwives. To become licensed, the midwife had to attend a minimum of 15 births with a physician who had to attest to their competence. Each County Health Department was responsible for reviewing midwife applicants, giving an exam, checking their birth bag, and approving them for state licensing.

Licensed Lay Midwives (“granny midwives”) were supported by the state and county Health Departments until the 1960s. Florida’s Licensed Lay Midwives were regulated by the Florida Department of Health and Rehabilitative Services (DHRS).  In 1965 the Medicaid program passed the US legislature and became law; poor women and women of color who had been denied access to segregated hospitals, now became desirable clients for physicians.  In 1969 Florida licensed the first nurse-midwife, regulated under the Board of Nursing.  In Florida, once you have a license you are allowed to keep that license as long as you comply with renewal requirements.  By the 1970s The Florida Health Department decided that Licensed Midwives should be phased out and sent letters to the midwives thanking them for their service, telling them their services were no longer needed and asking them to turn in their licenses.  Many complied but others continued to practice.

It seemed that direct-entry midwifery was headed for obsolescence.  But several factors came together in the 1970s – a young generation of hippies challenging the existing hegemony, the antiwar movement, the feminist movement, the resurgence of holistic health, and increasing consumer dissatisfaction with existing medical care.  Women wanted to control their births, to be “awake and aware,” have their loved ones by their side and keep their newborns with them.   Unable to get what they wanted from doctors and hospitals, encouraged by books like Ina May Gaskin’s 1975 “Spiritual Midwifery” and women-centered birth practices in Europe, women were choosing to have their babies at home, and when others turned to them for help, a new generation of midwives was born, learning from one another, the clients, textbooks, more experienced midwives, supportive doctors and nurses.  We practiced primarily “underground” because, although a licensing law was on the books, County Health Departments headed by doctors routinely denied applications. A few midwives sued the state in the 1970s and became licensed.  Although some doctors were willing to back up these underground midwives, when transport was needed, the midwives risked delaying care to our clients and putting ourselves in legal jeopardy. The goal was to open up licensure.

In 1979 the Midwives Association of Florida was founded for that purpose. An initial attempt to establish a midwifery apprenticeship program through the Department of Labor was unsuccessful.  With the help of Terry DeMeo, a lawyer and homebirth mom, we wrote legislation, secured sponsors in the Florida House and Senate, and went off to Tallahassee to lobby.  Finally in 1982 the bill passed and the Midwifery Practice Act became law.  The law required 3 years of formal education.  Finding no educational institution willing to start a midwifery program, we started our own schools – the North Florida School of Midwifery in Gainesville and the South Florida School of Midwifery in Miami.  We wrote our curricula, got our schools licensed by the Florida Dept of Education and approved by the DHRS Midwifery Advisory Council, hired our faculty and preceptors, enrolled ourselves and started our formal education.  A 2-year sunset review provision inserted into the 1982 bill at the last minute by the Florida OB Gyn Society meant the legislature had to reconsider the law in 1984.  Reassured by our supporters that this was just a formality, we were shocked to discover the Florida OB Gyn Society and Florida Medical Association had maneuvered to amend the law to limit licensure to only currently licensed midwives and those already enrolled in the two schools.  Those of us who were in these schools finished and became “Licensed Lay Midwives” in 1986 and 1987. 

Once again the Midwives Association of Florida took on the challenge of passing legislation, this time with the help of two consumer groups Florida Friends of Midwives (Bradenton) and the Midwifery Access Project (Miami), Tallahassee Birth Center owner Beth Swisher, a political science major at FSU, and lobbyist Bob Cerra.  Finally in 1992, under the sponsorship of freshman legislator Daryl Jones, our bill passed and became the law which we all practice under today.  Along the way MAF was able to get legislation passed to mandate reimbursement by private insurance companies, and later on mandating Medicaid reimbursement for homebirths.

Gladys Nichols Milton (1924-1999) was a Licensed Midwife in northwest Florida and an advocate for women's health.  She was the mother of 7 children. In the 1950s, the Walton County Health Department recruited Gladys, who was an LPN, and sponsored her midwifery training by physicians in Florala, Alabama. Gladys was licensed to practice midwifery by the state of Florida in 1959. She delivered approximately 3000 babies during her 40 years practicing midwifery in NW Florida.  From 1959-1976 Gladys attended home births in Fort Walton County. In 1976 she established the Eleanor Milton Memorial Birthing Center (MMBC) in Laurel Hill, Florida, which she named in honor of one of her daughters who had died.  Gladys’ son Henry became a physician and her daughter Maria attended the North Florida School of Midwifery and became a Licensed Midwife in 1987.  In the 1980s Gladys served on the Florida Midwifery Advisory Council under DHRS and was active in the effort to keep traditional midwifery legal in Florida; as a result of her visibility, her clinic and home were the targets of arson.  In the late 1980s the Florida Department of Health closed her clinic temporarily and suspended her license, charging Gladys with several violations in an effort to get her to relinquish her license.  Members of MAF came to her defense and arranged for attorney Tom Sherman to represent her pro bono. Gladys successfully fought off the challenge by the Department of Health and continued to practice midwifery until her passing in 1999.  In 1992, Gladys was honored with the Sage Femme Award by the Midwives Alliance of North America (MANA). In 1994, Gladys was inducted into the Florida Women's Hall of Fame while Lawton Chiles was Governor of Florida.  Her portrait hangs in the state capitol in Tallahassee.  She is listed in NAABB’s Black Midwives Hall of Fame.  In 2001, she was posthumously inducted into the Okaloosa County Hall of Fame. In 2015, she was named a “Woman of Light” by the DeFuniak Springs Women’s Club. Maria Milton still practices midwifery in the Milton Memorial Birthing Center in Laurel Hill, in NW Florida. 

References:

Access Genealogy: Florida Indian Tribes. http://www.accessgenealogy.com/

Florida Memory, State Library and Archives of Florida. https://www.floridamemory.com/