Midwives and doulas, past and present, in WNC

Before the turn of the 20th century, the Swannanoa Valley was an isolated place. Among the many services it lacked was health care. Those in need of hospitalization had to travel into Asheville — a trip that was often out of reach for the area’s poor. So expectant mothers depended on local midwives to deliver their children.

Two of the prominent midwives of the Swannanoa Valley were Mary Stepp Burnette Hayden and Annie Daugherty, both African American. Daugherty “was the midwife of the entire town. She delivered most of all the children in [Black Mountain] for the people who couldn’t afford to go to the hospital or have a doctor, no matter if they were Black or white,” Katherine Daugherty Debrow, Daugherty’s granddaughter, told director Jerry Pope in 2001 for the theater production Way Back When. 

On Monday, June 20, 6-7:15 p.m., historian and educator Kelly Dunbar and Cindy McMillan, co-founder and executive director of Sistas Caring 4 Sistas, will present “African American Women’s Midwifery and Doula Work in Buncombe County: Then and Now.” The talk is part of the Swannanoa Valley History Café series, a project of the Swannanoa Valley Museum & History Center. The Monday event will be hosted online via zoom.

Putting the care in health care

“As the South attempted to rebuild after the Civil War, newly restored state governments did not prioritize support for the formerly enslaved,” writes Dunbar in a brief of her 2021 M.A. thesis, Pioneers in Community Building and Racial Uplift: Black Women in Buncombe County [1865-1930]. “By the 1880s, disenfranchisement affected Southern African Americans’ access to adequate health care, education and other social services.”

In Buncombe County, Black midwives provided health care services that were otherwise unavailable in their communities — a need that remains relevant to this day. According to the 2019 Buncombe County Community Health Improvement Plan, in 2017, Black infants were 3.8 times more likely to die within their first year of life compared with white infants. Sistas Caring 4 Sistas, a community-based doula program, has worked to address the crisis since its 2016 launch.

Nikita Smart — who co-founded the organization alongside McMillan, Wakina Robertson and Sade Mustakem — says racism is at the heart of such a statistic. Explains Smart: “There were social determinants of health — lack of access, lack of insurance, lack of transportation — a number of factors” that influence high infant mortality rates.

Through relationship-building with clients, Sistas 4 Sistas staff are able to recognize and address some of the social determinants mothers are facing. “We know that if this mama’s got other concerns going on at home, the last thing she’s worried about is making it to a doctor’s appointment,” Smart notes. “She might have other kids at home who need food or she can’t pay her rent.”

The organization, adds Smart, helps connect mothers with appropriate agencies to address unique concerns. Over its initial six years, Sistas Caring 4 Sistas has supported more than 200 women on their pregnancy journeys. “I know we’ve made a difference in the lives of the moms we’ve touched,” Smart continues — a fact that the 2019 county report supports. Sistas Caring 4 Sistas is among the organizations listed in the county’s findings on approaches that are currently working to improve birth equity in Buncombe County.

Agents of change 

Doulas and midwives are not synonymous. Doulas provide a mother and her family with emotional, informational and physical support during pregnancy, birth and postpartum. Midwives provide medical care during pregnancy, birth and postpartum.

But like today’s doulas, the midwives whom Dunbar studied also became agents of change within their communities. During the Reconstruction era, when Black men were striving for political power, “Black women looked for other ways to gain influence,” Dunbar explains. Midwife Tempie Avery, for whom the Tempie Avery Montford Community Center is named, “was so important as an intermediary between Black and white society.”

In fact, so key a figure was Avery that in 1899, the local newspaper’s social column reported that the “professional nurse … is very ill at her home, No. 4 Madison Street.” Still, Dunbar says, Avery had to seek work as a laundress in her 60s because the money she earned as a midwife wasn’t enough to support herself. Avery was also referred to as a “‘mammie’ — an inferior construct in white society,” Dunbar says. “There are so many layers to [the midwives’] lives. They had to navigate not only their gender but their race and past history. I can’t imagine having to do that while still being able to do so much for your community.”

Despite those hurdles, Dunbar says the most significant barrier was through state legislation, such as the 1921 National Maternity and Infancy Protection Act, also called the Sheppard-Towner Act. Passed to address infant mortality rates, the ruling targeted the work of midwives. “That became really tricky for [Avery, Hayden and Daugherty] because they were older at the time and they had to become a registered midwife,” the historian explains. Registration required money to attend school in the middle of the state. Still, Hayden was able to get her license, Dunbar notes.

Support a mom

In 2018, Mary O. Burnette spoke to local historian Anne Chesky Smith about Hayden, her grandmother: “She used to tell me how she would have to outsmart a catamount that picked up her scent as she walked home through the mountains at night, carrying a chunk of fresh pork [and] her payment for a new delivery.” Hayden learned to deliver and care for babies from her mother, Hanah Stepp, who had served as a midwife from a very young age while enslaved.

“I feel like [midwifery] is a tradition that everyone should be connected to,” says Smart. “I love the medical society. I love health care. But I also feel like the best births happen with midwifes. We’ve had granny midwives in the past, and those women did excellent jobs. Then we got these doctors with letters by their names, and they decided they knew best.”

Smart says Sistas Caring 4 Sistas took on the charge of serving mothers and babies in Asheville’s communities of color because “we all had our adverse childbirth stories, and we wanted to do what we could to save moms who look like us and to save babies who look like us.” Besides providing doula services, the group has tables at various events, partners with other local organizations and runs the support group Mother 2 Mother.

Others can help, too, by donating time, talent and financial support. “Everything we do right now is grant-funded, and we know that doesn’t always last,” Smart says. “Support a mom so that she can have a doula.”

This ongoing work, notes Dunbar, reflects the vital role midwives and doulas have and continue to play in the region. The legacy of these women, then and now, she continues, “is the way they’re able to navigate the system to provide services to their communities.”

WHAT: African American Women’s Midwifery and Doula Work in Buncombe County: Then and Now
WHERE: Zoom, avl.mx/bo1
WHEN: Monday, June 20, 6-7:15 p.m. $5 general/free to Swannanoa Valley Museum & History Center members

Editor’s note: This story was revised June 15, reflecting updated information about the event’s location.