Volume II, No. 2, Winter 1974
When hospitals were unheard of in the hills, when mothers had their babies at home and when doctors were late or not available, expectant mothers and their nervous husbands were not entirely without help, for they knew they could depend on the local granny woman or midwife who knew just what to do because they specialized in delivering or ketchin' babies.
In the early nineteen hundreds and before, it was very hard for expectant mothers to get to a doctor's office. They did not go to the office as much then as they do now because their transportation was not very good and doctors did not have any place to care for them once they got there. It was much easier for the doctors who had the best horses and were the first to get cars, to go to the homes where the mothers and babies would be cared for in the privacy of their home by the family or friends.
Of course, before a doctor could deliver the baby, he had to get where he was needed. One way to travel was on horseback. He often used pintoes because they could stand almost anything and they were fast, too. Some preferred fox trotters because of their comfortable mile-eating gait. But it was less tiring on the doctor to ride in a vehicle like a buckboard wagon pulled by a team of horses. If he could afford it, the doctor sometimes had a driver and a man who would care for one team of horses while the others were out, for confinement cases often meant he was gone all night. Belle Farthing, the widow of a doctor who began practicing in the early 1900's at Ozark, Missouri, told us, "His Conveyance to practice in was a buckboard and a horse blind in one eye."
If the doctor had enough money he would have a more comfortable horse-drawn buggy. The best buggy was closed in with curtains that buttoned on the side, but even these curtains were unable to keep out chilling breezes in the winter.
Sometimes after all of his effort the doctor would not even get paid, though people were generous in giving food and other items he needed. Some were able to pay money. Belle told us, "Oh, they didn't pay very good then. They were always good to bring to us what they had. If they had potatoes or sorghum or hams, they'd help out that way. I believe people even then tried to do the very best they could. They knew they had to have a doctor and they wanted to be as good to him as they possibly could so that he'd come again. One couple began saving pennies to pay the doctor for delivering a baby. One day he went to their home and when he came home, he handed me a wrapped half gallon jar of pennies. It took us two or three days to get those counted and wrapped. It was twenty dollars. The only way we got along was by being frugal."
Infection and death were a constant threat to mothers and babies. In earlier days the death rate was higher than now both in and out of hospitals. Then more women died after birth in the unsanitary, poorly staffed and operated hospitals that did exist than died in their homes. Infection risk was high at home, but it was not as big a threat as death in a hospital. As roads improved and automobiles became more widely used around 1920, some doctors managed their own small hospitals where they could care for more patients. Gradually civic hospitals staffed with trained people working under modern sanitary conditions were built in some of the larger towns and cities in the Ozarks. But it was not until the 1930's and '40's that women in the Ozarks used hospitals for delivering babies as a matter of course as they do now.
GRANNY WOMEN AND MIDWIVES
Before women came to the doctor's offices for prenatal care and had their babies delivered in hospitals, confinement cases were handled at home by doctors with the help of neighborhood women or by the midwives themselves.
Doctors and mothers all found these women very helpful. Country doctors rarely had nurses to help them, so they relied on a local woman. The expectant mother trusted her experienced friend and knew that she was in good hands, even if the doctor could not make it in time. The women would take care of the baby after it was born while the doctor took care of the mother.
Though it is difficult to distinguish between them, the women who helped out might be classified in three ways: neighborhood women who had a natural talent and willingness to help in any sort of sickness, including confinement cases, but had no special training; granny women who specialized only in ketchin' babies, and gained their knowledge by experience; and midwives, who also specialized in baby delivery, but received some special training by doctors or schooling. However, the terms granny woman and midwife are often synonymous.
Every community had the good neighbor. Annie Fike married into a family where the women were midwives, so because of her family connections and her own willingness to help out if needed, the women in her community felt easier when their time was up because she was close at hand. She recalled helping with several births. "I never was anyplace where we didn't have a good doctor. Usually we had two or three ladies who knew what they were doing. It was their job to take the baby and wash it and dress it."
Anna Wormsley was inspired to become a nurse because of her admiration of her great-aunt Annie Roper, who helped her neighbors anytime she could. Anna wrote us suggesting we do a feature about these women who dedicated their lives to nursing others. She wrote, "I was very young when Aunt Annie Roper did this kind of work. One of her last cases was the birth of my little brother in 1938. There was lots of preparation months before his birth with all the handmade baby things that was called the layette. There were dozens of diapers, little shirts, gowns, dresses, rompers, crocheted sweaters, bootees and caps. I remember something in the layette that is not used now--they were made of flannel and were called belly-bands and had to be very snuggly kept around the baby's middle for about the first month to prevent an umbilical hernia.
"Aunt Annie came to stay with us about a week before the 'stork' was due. As with all of her other confinement cases she sort of took charge of the household until the mother was finished with the delivery and able to be up and around again. Mama hadn't been allowed to do heavy lifting for months, and she was not supposed to put her hands in cold water for that would dry up her milk.
She was supposed to be calm and serene so that the baby would not be marked and would be a good healthy baby. On the day that they knew the baby was going to arrive, my brother and I were sent over to Aunt Lola's, but we knew that there was lots of hustle and bustle about something. In those days all of the things connected with childbirth were kept big secrets. When a woman was 'in the family way', nobody knew about it except very close family and intimate friends. And as soon as she started to 'show' the expectant mother went into seclusion in her home and was not seen in public until after the baby was born.
"That must have been quite an exciting day for my parents for baby brother decided not to wait for the doctor to arrive. He was about an hour old when old 'Doc' Farthing of Ozark got there. He examined the baby and pronounced him fit. Of course, Aunt Annie had handled the delivery, as I am sure she had done other times before, for sometimes babies do get in a hurry to be born, even now. I learned after I became a registered nurse that she had even been prepared, just in case, with a supply of linen thread with which to tie the umbilical cord and a pair of clean silver scissors with which to cut it. She also knew just how to take care of the mother."
Much of the time these women were not paid, or were given produce in payment. Annie Roper's sister-in-law, Gertrude Roper, said, "They would pay her some, but most of it was just give and take. You do for me this time and I'll do for you the next time. Sometimes she would be paid in food stuff, garden fruit or material for a new dress."
Annie Fike said, "I wasn't worth enough to think about paying me for anything. I just done it because they asked me. It made me proud."
Some families did not want a doctor in attendance at all. They believed that only another woman should deliver a baby.
Other families could not afford a doctor, or could not get one in time. In these cases they called on experienced women, granny women or midwives who handled the complete delivery themselves.
Granny women had no particular technical background. Some could not even write. Their job was to go to the home, deliver the baby, care for him and the mother, care for the other children, cook for the family, do the washing, make the beds and do all of the other household chores while the mother was recuperating. This period of time was from nine to ten days long.
The granny woman had to be a good organizer. She had her own home and family which had to make out by themselves while she was gone, but she would always have food prepared ahead, a cellar full of canned food and everything in shape to be able to leave at a moment's notice. Her family was proud of her skill and grateful for the extra income she brought home. This was one of the few ways a married woman could work.
Today it is illegal in the United States for a granny woman to deliver a baby for pay. Certification for granny midwives was abolished in Missouri in 1958.
Women with special training are known as midwives. Mabel Stephens worked as a midwife under the supervision of doctors. She told us how she thought midwives were probably named. "The 'mid' meant midnight 'cause you'd have to be up all times of the night." She told us of a time when the doctor didn't arrive in time to deliver her own grandbaby. "The doctor came and said, 'I'll be back at nine o'clock.' My daughter had been sick about three days then. I said, 'It's not going to be that long.' 'Oh,' he said, 'it will.' I said, 'Oh no it won't! Now, you don't wait 'til nine o'clock to come back here.' He said, 'Yeah, I'll be back at nine o'clock.' Seven o'clock the baby arrived!"
Midwives were trained by doctors or at schools. Their duties were much the same as the granny woman with the same pay. Some were paid three dollars and some five, depending on the family they were helping and the economy of time. In the past the woman that wanted to become a midwife worked under a doctor who took her into homes where babies were expected. She could see him work and learn the techniques and knowledge she needed to work on her own. When the doctor thought she was ready, he would rely on her to deliver babies unassisted. Then she could start her own practice. A few midwives had some nurse's training in schools.
Today there are some schools that have special programs for women training to be nurse-midwives. These are registered nurses who take graduate courses in the field of obstetrics. They are trained in obstetrics, prenatal care, delivering babies, postnatal care, home visits, child care and family planning. There is an International Confederation of Midwives.
Nurse-midwives obtain enough credits to equal a master's degree. Schools that offer this type of training include University of St. Louis, University of Cincinnati and the University of Louisville. These schools have a limited number of students because there are not enough teachers. Professional nurse-mid-wives were made legal in 1932.
Although nurse-midwives want to deliver babies alone, they can do so in Missouri only for normal births in a hospital under certain conditions. If there is a high risk, she must work as a member of an obstetrical team with doctors present. The high risk cases are those where the baby has a high birth weight, the mother has had over six children, the baby is the first child, or the woman is under seventeen or over thirty-five years of age.
The modern nurse-midwife is not the complete housekeeper the older variety was. But she does have more contact with the homes than the doctor usually has because she often makes home visits working with the mother before and after birth.
However, babies do not seem to understand the workings of the law and come into the world whether there is a certified person there or not. Nothing is to stop a granny woman or midwife from delivering the baby. The law can only prevent them from receiving pay for it.
Doctors claim the care provided by granny women and midwives was sometimes dangerous. Midwives did not have very effective tools. They did not have scales or anesthesia. They could not transfuse blood or use x-rays. A breech birth usually meant trouble. Some babies bled to death because their navel cord was cut too short. Often the conditions of the birth were not sterile and sometimes caused infection or death for the baby or the mother. Prenatal care of the mother was usually lacking for the midwife was not called until the time of birth. She did not give vitamins and calcium during the pregnancy to help insure a strong, healthy baby. Doctors also objected to many of the superstitions and home practices of the uneducated granny women.
In Europe and England midwives are widely accepted. They are less expensive than doctors and sometimes more experienced in delivering babies. In London there are delivery homes run by midwives where mothers go to have their babies. The midwives visit in the homes after their babies are born. Generally midwives are approved in most countries except the United States.
Here even the nurse-midwives with five years or more of specialized training are not accepted readily by doctors and the public. The decline of midwives was due partly because of the poorer maternity care and the ignorance of some granny women who carried on dangerous superstitions and home remedies, partly to the building of good hospitals where midwives are not allowed to practice, and partly because of the power and influence of the medical profession to keep obstetrics in the hands of physicians.
Granny women and midwives did the best they knew how, performing a service that was badly needed. Recognizing their service in the '20's and '30's the state health department developed kits for granny women and sent trained nurses to teach them modern practices. But in spite of this some granny women honestly believed in handed down superstitions and used home remedies and practices with the best of intentions. Some of these practices are amusing to us today, some are repulsive, and some we know now were actually dangerous.
Some believed that if you put an ax under the bed of the woman in labor, it would cut the pain. Some thought that the woman should not have a bath right after giving birth for several days. Various teas were prepared for the mother and baby. Pepper teas would induce labor pains and catnip tea would quiet the baby. We heard of another tea used to quiet a baby made of the white off the dropping of chickens. Another story was using the urine to wash out the mouths of babies that had sore mouths and throats. A dangerous practice was that of putting cow dung on the navel cord. That often caused tetanus, but was thought to be a good dressing to stop bleeding.
The mothers had a hard time preparing for and having a baby. There was no way of birth control then and it must have been frightening to a new wife to know she would probably have eight or ten children. Many girls reached their wedding nights with very little knowledge of reproduction. Just before marriage the mother would tell her daughter she could expect to have a child every two years until she was forty! So when she did become pregnant, knowing a helping neighbor was always near must have been a comfort to her. Even today knowing someone is around to help makes lots of things easier. Annie Fike told us of a rather recent time when a neighbor meant a lot when outside help was cut off. "It was an awful stormy night. The creek was up. The husband had tried to go to Lebanon and couldn't cross the creek. He finally went to Grovesprings after Doc Hough. But he was too late. I had the baby in its crib and asleep when he come. I didn't want to leave until Doc looked at the baby. So he went and examined it and said it was just all right. So he was."
Home conditions were not always the best for an expectant mother. Belle Farthing explained, "I would feel awfully sorry for lots of those people where they were having babies, because that was the best they could do. Sometimes you would go and see that some women had tried so hard to make preparations. Some of them didn't. They'd just let it come on with no preparation whatever. And the homes so often were just two rooms, so many of them with a lean-to maybe.
"But the thing I have thought of as much as anything--we had a case one night and I went with my husband. He wanted me to go to dress the babies, because he felt like I knew what to do with those children. They had two grown girls. The mother and this one girl had gowns that were made out of unbleached muslin, made gathered on to a yoke. They were clear down to the floor. The girl had on one and the mother had on one. The mother's baby was born. She had a hemorrhage and her gown had to be changed. She wasn't going to change it at first when the gown got so soiled, but she called the oldest girl in and said, 'Give me your gown, honey.' The girl took hers off and let her have it. It was pitiful, really."
In the winter the cold was a threat to women giving birth. Belle told of another time when a husband tried to keep his wife warm while she was in labor. "One night we went to a case. It was cold and the woman was in the bed, back in the corner of the room. The man was trying so hard to keep the room warm that he put too much wood in his old King heater. The room was lined or papered with heavy paper and it came up right around the flue and it got afire. And oh, he grabbed buckets of water and threw the water, and some of it would land on the woman."
Before her time was up the woman usually made preparations to keep things as sterile as possible. Some women had things all ready for the doctor or midwife. That meant having clean sheets and extra cloths. To sterilize the sheets some women put them in the hot oven for five minutes. Others ran a very hot iron over them. Then they covered the mattress or bed tick with several layers of newspaper and put the sterile sheet over that. The clean cloths were wrapped in newspaper and then stacked together ready. The clothes were made from clean rags, towels or pillow cases. There were no rubber sheets.
All of the instruments used were boiled in a pan of water on the stove. When it was time for the baby to be born the midwife or doctor asked for a pan of boiling water. They would let it cool, then wash their hands in it so they would be clean. Dr. Ruth [see p. 48] said, "The midwives usually got some clean towels or clean rags ready to use around the bed and they'd see to it the mother had a hot foot bath and her feet were c lean."
After the baby was born the woman enjoyed a period of confinement, the lying-in of the woman that has had the child. Everyone thought this quiet time was necessary to allow the organs to go back in place. The woman was kept in bed very quiet and not allowed to do any work for nine or ten days. The importance of lying flat in bed is evident even in some of the practices. Granny women would not allow the feather bed of a new mother to be turned for ten days. Usually the bed is turned every day to fluff up feathers for more comfort. Many times this period was the only vacation a mother ever had. Myrtle Hough still thinks that was a good idea. "I've had six babies and I stayed in bed every day until the tenth day. I got along fine. I think maybe that's the reason I'm so strong."
As soon as the baby was born the midwife cut the naval cord. Annie Fike, remembering what she did on that stormy night before the doctor got there, said, "We read up what to do before the doctor comes. It said to wait two hours after a baby was born and if the doctor doesn't get there to not wait any longer to tie the naval cord. So we fixed the cord, got us some crochet thread and made a string.
Then we scalded the scissors and the thread, cut and tied the cord. We tied it first seven inches from the baby's body, then tied it again two inches back towards the body and then cut between the ties. That would leave a little stub on the cord. Then we would take a piece of cloth and burn it on the stove--scorch it. We'd cut a hole in it and put it over the cord, then put cotton on the cloth, then put the band over that. That held the cord in place, they claimed. We'd do that just at birth. If it got irritated, we'd do it again."
After that the baby was given a bath. Myrtle recalls her one experience when a midwife delivered one of her children before the doctor could get there. "When she brought the baby back to bed, why its little face was just so yellow and I said, 'What have you done to my baby?' She said, 'Oh, we washed it in egg.' She had whipped up an egg and had washed the baby in an egg. And I said, 'Oh, please take her back and clean her off.' So she did. She said the egg would make my baby's skin soft."
After the bath the baby was dressed. Usually the mother had prepared the clothes before and had made long gowns out of soft material or used garments. But first the naval band was put on the baby. Myrtle had a band her husband and all of her babies had worn. It was made from white cotton and went on like a little shirt. Most bands were about three inches wide and long enough to reach around the baby to tie or pin in place. These bands were worn until the cord dropped off and healed up which was about three weeks.
Diapers were homemade out of cotton twill, outing or cotton flannel and muslin. Some were made out of old shirt tails or skirts or any material available. Mothers would have anywhere from a half dozen to two dozen diapers. Rubber pants were not heard of, so people would just pile on extra diapers for more absorbancy.
Diapers did not always stay white. Washing was difficult and many times the busy mother dried the wet diaper and put it back on the baby without washing.
Diapers were square pieces of material folded into a triangle. The three ends were pinned together in the middle front of the baby with one big pin. For older babies without rubber pants or other clothing to hold them in place, for boys and girls alike wore long dresses until toilet trained, the diaper would often fall down. Gertrude Roper remembers, "They slipped down. I can remember, oh way back, seeing those little diapers drop down and the children would be walking around playing and the diapers would trip them, come clear down around their feet."
Then as now there were many ways of doing things. Some women were very particular about the baby's clothes and washed and boiled them in a big black kettle outside or on the stove. They hung them outside in the sunshine and ironed them with a good hot iron, even ironing each diaper carefully.
The nutrition of the baby depended entirely on the health of the mother. Nursing used to be the only way of feeding a baby for the first year or two. Gertrude told us, "Women nursed their babies so much longer than now. It wasn't anything to see a child three years old run up and nurse. The mother would be sitting there at the picnic, and away he would go. People were taught to nurse their babies, until after the second summer because there was always a diarrhea here. You had to nurse them through the second summer, until their teeth started to develop, so they could eat. Children were not fed scarcely anything at all. I marvel at the way they even stood up under it all." Women also believed that as long as they nursed a child they would not become pregnant again.
If the mother of the baby didn't have enough milk or died, there wasn't much to do unless there was a wet nurse available. The wet nurse was a woman who had had a baby and produced enough milk to feed two children.
Without a wet nurse, if a mother died or if the mother was sick so that her milk was bad or dried up, the baby was fed diluted cow's milk. Before bottles and nipples, the mother dipped a cloth in the milk and the baby would suck it out. This was very unsatisfactory and could hardly nourish a baby.
The same method was used with sugar water to appease the baby. These cloths became known as sugar tits--sort of old-fasioned pacifiers.
Babies were weaned by feeding them some milk in a spoon. Gradually they were fed solid food such as thick gravy, mashed potatoes and other soft foods until they could eat the food at the table. There was not any prepared canned food for babies.
Babies come into the world now the same way they did years ago. The difference is we have better facilities and greater knowledge. In past times people thought they knew what was best and they did everything they could to assure a safe delivery and a healthy child. Doctors, midwives, granny women, and neighborhood women all worked toward the same goals. Helping people who were sick and caring for mothers and new babies was what their whole lives evolved around.
[Ed. note: We would like to thank Freda Parks, R.N., and A.I. Bealer, M.D., for help in writing this feature.]
Researched by Melissa O'Kelley, Karen Mulrenin, Rita Saeger and Teresa Reed
The selection on the next page was contributed by Annabelle Whobrey. We appreciate receiving from our readers first-hand experiences from the past.
Copyright © 1981 BITTERSWEET, INC.