In Defense of Granny Women
by Janet Allured
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Physicians were poorly trained, inept and even dangerous through most of
the nineteenth century. Civil War doctors, for example, had no knowledge
of germs, did not endeavor to keep their hands clean, and might explain away
disease as the will of God. The quality of their education varied widely,
and states lacked uniform licensing requirements. But even well-trained doctors
were often powerless in the face of disease, since few effective drugs were
available for them to prescribe. Having no idea what caused diseases, they
often dosed patients with purgatives and emetics, believing whatever the
cause of illness, it could be forced out through the gut. Small wonder, then,
that rural Americans preferred the gentler and more familiar herbal remedies
prescribed by family women and by the more specialized "granny women."
Folk medicine, especially knowledge of healing herbs, was a largely feminine
art though male "yarb" doctors were not unknown in the Ozarks. Typical remedies
used staple household ingredients, and their descriptions read like recipes
for food preparation. Here is one mother's remedy for whooping cough:
For whooping cough:
1 ounce fresh red clover blossoms
1 pint boiling water
1 cup honey
Boil blossoms in water and strain. Add honey; bottle. Dosage: 1 teaspoon
twice daily.
Recipes for remedies were handed down from generation to generation. Women
learned to doctor the same way they learned to cook. The preparation might
begin with hog lard or honey. Plants were then added, gathered from hillsides
or grown in the garden. Most mothers had some knowledge of natural pharmaceuticals,
but some were more accomplished herbalists than others. The most knowledgeable
were termed "granny-women." Many years of growing herbs and dispensing remedies
made granny-women indispensable assets to their communities, which they served
not only as pharmacists, but as obstetricians and nurses as well.
A granny-woman's several health care roles required much skill and wisdom.
She was the possessor of a store of information about local pharmacology.
She may have learned her art from another granny woman. If she were literate
she probably consulted home medicine guides and herbal handbooks. She usually
learned about native plants from her own mother and grandmother, who may
have been granny women themselves. Her female line may have been first taught
by neighboring Indians. She knew how much of each ingredient to use (often
measured by the pinch or the handful), how long to boil (till soft, or till
all water save a pint had boiled away), and how much to administer. She knew
whether the herb should be decocted (boiled), infused (steeped but not boiled),
or demulcified (used in an ointment). She knew to use the leaves of a plant
for one ailment, its roots for another, and its berries for still another.
She also knew that the seeds of some plants could be medicinal though their
flowers were poisonous. She knew how to treat each herb so as not to destroy
its healing power, and precisely when to harvest the plant. Most roots had
to be gathered in February or March, before the sap began to rise. Roots
lost their value after the sap rose. Some plants--sassafras and poke, for
example--became poisonous at certain points in their growth cycle.
Seldom did the granny woman's remedies cure the patient; instead, they alleviated
the symptoms. But since it seemed to be the symptoms which were fatal, this
was a highly effective type of medicine.
Engraving showing fetal position during a breech birth from Charles D. Meigs,
The Philadelphia Practice of Midwifery (Philadelphia, 1838).
During complicated deliveries, midwives consulted books like Meigs' for assistance.
Meigs' advice to the midwife in cases of breech delivery concluded, "It is
best.., to permit the breech to descend, and not in any manner to interfere
with the feet until they are spontaneously born."
~Washington University
School of Medicine Library,
Archives and Rare Book
Division, St. Louis.
[9]
The pharmaceuticals administered by granny women consisted of a variety of
organic and inorganic compounds. Among the most commonly used medicinal plants
were those with astringent qualities, such as sweet gum, myrtle, and yellow
dock, which grew wild in the Ozarks hills. Taken in a tea, such plants would
shrink the swelling of a sore throat. Used for tonsillitis or diphtheria,
they would leave the patient considerably more comfortable and also lessen
the danger of asphyxiation. Packed into a poultice and applied to the skin,
the astringent properties of these plants helped to close open wounds and
stem bleeding. The selection of herbs for use in medicines was hardly random;
many food plants were never used to treat the sick because they had no medicinal
value. Only remedies which brought relief were retained.
The granny woman's most important role was as a midwife. By the 1890's, some
Ozarks babies were being delivered by male doctors; but probably most rural
women continued to rely on the traditional practice of being attended by
a granny woman. Furthermore, even when a doctor was called, the baby sometimes
did not wait for him to make the arduous trip over muddy roads, across creeks,
and up steeply sloping hills. Thus, mothers usually had both a granny-woman
and other female neighbors in attendance during delivery in case the doctor
was delayed. Granny-women were not formally trained, but many carried a "midwife's
book" to assist during complicated deliveries. If a granny woman's own children
were grown, she was free to stay with a woman for days at a time. A doctor
could of course not do this. And finally, even if a doctor were present,
he often relied upon the assistance of the midwife since there were no trained
nurses available.
Granny-women might perform a number of rituals which doctors found silly
and irrational. Some were designed to give the mother psychological, if not
physical, relief from her pain. She might give the woman her husband's hat
to hold during the ordeal, thus bringing him symbolically into the delivery
room. If the labor were particularly severe, she would place an axe or knife
under the bed to "cut" the pain in two. Sometimes, weather permitting, she
would throw open every door and window in the house, in a symbolic representation
of opening the birth canal.
But psychological support could only go so far to relieve childbirth pain,
and granny women also kept the staple nineteenth century drugs laudanum,
morphine, and quinine--in their pharmacopoeia. Before the creation of the
Food and Drug Administration in 1906, which began restricting the sale of
drugs except by doctor's prescription, these medicines were readily available
in local drugstores. When the mother's pain grew too relentless, the midwife
would simply give her a morphine tablet.
A granny-woman's techniques involved ritual, some superstition, and effective
and creditable pharmaceuticals. She combined manufactured pills with her
own tried-and-true home remedies. She would give a mother blackberry tea
(an astringent) both during and immediately after the birth to prevent hemorrhaging.
She might also dose the mother with raspberry tea, which relaxes uterine
muscles and improves the efficiency of labor. Another therapeutic drug in
her arsenal was slippery elm bark to speed delivery (used also, by the way,
as an abortifacient). When labor was protracted, the mother might be "quilled":
a turkey quill filled with snuff was blown into her face. The resulting sneezes
helped expel the baby!
Though some 90% of births were normal, the other 10% were often fatal to
the infant. A midwife could address some delivery problems; others she could
not. If a baby were in a breech position, the granny woman usually did not
intervene. A breech delivery was long and painful, but the child would likely
survive. A facial presentation or a crosswise presentation (in which the
arm or foot presented first) was another matter. The baby could not be delivered
in any of those positions, so the midwife reached into the birth canal and
tried to turn the baby. This technique sometimes succeeded; but when it did
not, the child usually died in the birth canal. In such a case, it was common
practice among both doctors and midwives to save the mother by dismembering
the dead baby, or by performing a "craniotomy." All experienced midwives
carried a special iron hook with them for this procedure, in which the baby's
skull was perforated and its contents evacuated. The skull was then crushed,
and the mother was either allowed to deliver naturally or the baby was pulled
out.
In most cases, however, the midwife found it unnecessary to intervene, and
she allowed nature to take its course. Midwives were far less likely than
doctors to use forceps. Physicians, who did not have time to stay with a
laboring woman for days on end, often resorted to forceps simply to speed
delivery. It was a dangerous practice. Forceps could introduce bacteria into
the womb and cause puerperal fever.
Puerperal fever, not childbirth itself, was the leading cause of maternal
death in the nineteenth century. The most dangerous time for the mother was
the ten to thirty days after the birth, when bacteria introduced into her
womb multiplied and spread throughout her system. By the late 1800s, however,
as the germ theory of disease became understood and antiseptic techniques
were taken up by physicians and many midwives, the risk of dying from a post-birth
infection declined radically.
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While a doctor perceived his job to be finished once he had delivered the
child, the midwife stayed to care for the newborn and the recovering mother.
She might wrap the newborn in its father's shirt or its mother's petticoat
for luck. Many midwives washed the newborn's eyes in the mother's milk or
even the mother's urine. A woman from Alpena, Arkansas, explained that urine
"was what they always used when she was young and in her mother's time too.
They used this instead of silver nitrate that they use now." Most midwives
also gave the child a weak catnip or onion tea to make the infant break out
in hives, considered essential for the child's health. Having doctored both
mother and baby, the midwife would then depart, leaving the mother in the
care of her female neighbors and kin. They would see that her household chores
were taken care of for the next few days, allowing the new mother to remain
in bed.
Granny women, it is clear, rendered a kind of care that physicians could
not reproduce. It involved far more than simply dispensing a drug: It meant
giving psychological support, material comfort, and empathy -- something
that only another woman who had undergone the same experience could provide.
But by 1900, doctors were beginning to resent midwives, whom they looked
upon as their main competitors for business. The developing medical profession
had begun to insist upon better education, standard examination procedures,
and licensing requirements for all practicing physicians. Throughout the
United States physicians waged a campaign to run midwives out of business
by portraying them as ignorant and dirty. It is true that antiseptic techniques
were probably not practiced by most midwives in the nineteenth century. However,
granny women did not go from one laboring mother to another, as obstetricians
might, and so did not spread germs in the way that doctors had done before
antiseptic practices were introduced. Furthermore, midwives--like all women--routinely
cleaned and scrubbed their homes, dishes, clothing, and utensils. They certainly
washed their instruments after attending a delivery, and the first thing
they did after every birth was clean up the bed and the mother as well as
the infant. Some even hung the birthing room walls with clean sheets while
the mother labored. Perhaps their attire was not a sterile garment; but granny
women as a group were not nearly as dirty as physicians made them out to
be.
As for the charge that they were ignorant, it was certainly true that granny-women
had little, if any, formal training. But physicians made efforts to deny
it to them! While European countries were establishing schools of midwifery
and making a place for midwives in the practice of medicine, American doctors
were refusing to admit women to medical schools and demanding, simultaneously,
that all people practicing medicine be trained and licensed. "Regular" physicians,
in other words, offered no compromise to the midwives. State after state
bowed to the wishes of the AMA and required licensing, which in effect put
midwives out of business. Thus, by the 1930's, except in the most remote
and inaccessible districts where no doctors were available, few midwives
were in practice anymore.
Adopting the scientific method in the field of medicine obviously brought
many advances. But in forcing midwives out of practice, doctors did a great
disservice. By refusing to admit that midwives had anything to offer the
practice of health care, regular physicians denied the profession the granny-woman's
kind of nurturing, holistic care which, too often, the science of medicine
neglected. To the trained physician, the patient became a number on a chart,
whereas to a granny-woman the patient was a neighbor down the road. As women
began to enter hospitals to give birth, they lost the multi-faceted support
and psychological help that the traditional practice of midwifery and home
birth had provided.
Medical science today, ironically, is re-discovering how important community
and family support are to people recovering from any kind of illness. Recent
studies have shown that new mothers sent home from the hospital with no help
or guidance are more likely to suffer post-partum depression, and are more
likely to abuse--even kill--their infants. Formerly in the Ozarks, as in
most traditional communities, a birth mother was never expected to fend for
herself. In the Ozarks it was believed to be bad luck to leave a mother and
her infant by themselves after the birth an axiom some dismissed as "an old
wives tale". No midwife would have tolerated sending a new mother home from
a hospital one day after a birth to deal alone with the responsibility of
keeping a home and caring for an infant. Midwives saw to it that a new mother
had proper psychological, social, and material support.
Modern physicians have often been oblivious to such components of health
care, focused as they may be upon microbes and body parts. But since the
1970's, when medical schools opened their doors to women, the situation has
been changing. Medical schools have begun to soften the "masculine" emphasis
upon technology and adopt a more "feminine" nurturing style, now understood
to be of great benefit to patients. Doctors are now being trained to see
medicine, as granny women did, not just as a science but as an art. It is
now apparent that doctors had something to learn from the techniques of the
granny-women after all. If only they had recognized this sooner, granny-women
might be among us still.
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