Gertrude Jacinta Fraser, Harvard University Press, 1998
Reviewed by Gwynne L. Jenkins
As the title promises, Gertrude Fraser’s African American Midwifery in the South: Dialogues of Birth, Race, and Memory is an intimate conversation between past and present. Fraser’s subject is the role of African American midwives in rural Green River County (a pseudonym), Virginia, before and after public health officials began regulating their practice. Green River County is a microcosm of the racist public health agenda (implemented throughout the South from the 1920s to the 1950s) that vilified, “sanitized,” and finally eliminated African American midwives. The trajectory and details of this transition will not surprise readers familiar with the midwifery and childbirth literature. But the sophistication of Fraser’s narrative takes the study of midwifery and birth to new heights. Fraser expertly pieces together diverse narratives, combining clear statements, subtle dialogues, and even silence to create an elaborate vision of the past.
The ethnography is divided into three parts. Part I, “The Body Politic,” examines the intersection of home birth, midwifery, racism, and public health in the U.S. South. Through copious public health narratives, Fraser shows that the white biomedical establishment preferred to blame African American midwives for maternal-infant mortality rather than challenge the structural bases of poverty and ill health in the segregated South. Part II, “Authoritative Knowledge,” examines two subsequent relationships aimed at improving maternal-infant health through biomedicalization: white nurses training African American midwives in the classroom, and white public health administrators training African American women through prenatal care.
In Part III, “Memory and Experience,” Fraser uses data gathered during 14 months of fieldwork to explore the changing performance of pregnancy, birth, and postpartum. Fraser arrived in Green River County hoping to find an empowering history of African American midwives. Yet her inquiries into midwifery practices were greeted with a chorus of silence by local residents. When cast against the racism of public health policies detailed in Parts I and II, Fraser illustrates that the memory of home birth and midwives still reverberated with the shame of white scorn and derision. The practice of home birth and midwifery were “forgotten” by residents, for whom hospitalization was part of community uplift. This contingency limited the information Fraser could gather within the African American community (she chose not to interview the rural whites that also relied upon African American midwives.) Despite this unexpected turn of events, Fraser excises the meaning from silence and innuendo with surgical precision, and makes them speak volumes about the intersection of race, birth, and midwifery.
Fraser’s narrative style is one of the most exciting elements of this piece. Her use of reflexivity renders Fraser clearly present in the text, yet it is neither self-indulgent nor superfluous. Fraser’s presence propels the ethnography, and gives the reader an intimate understanding of her fieldwork and analysis. Fraser calls on a wide variety of specialties and theorists, making the text useful for classes on reproduction, women’s studies, American and African American studies, and public health or medical anthropology. African American Midwifery would also be appropriate for a class on ethnographic representation. It is appropriate for graduate students, but should be used with guidance among undergraduates.