Birth in Southern Appalachia
Encyclopedia
Background
Appalachian Regional CommissionAppalachian Regional Commission
The Appalachian Regional Commission is a United States federal-state partnership that works with the people of Appalachia to create opportunities for self-sustaining economic development and improved quality of life...
defines the Appalachian Region as a 205000 square miles (530,947.6 km²) region the follows the Appalachian Mountains from southern New York to northern Mississippi. It includes all of West Virginia and parts of 12 other states: Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. Forty-two percent of the Region's population is rural, compared with 20 percent of the national population.
The Region's economy was once highly dependent on mining, forestry, agriculture, chemical industries, and heavy industry. In recent times it has become more diversified and now includes a variety of manufacturing and service industries. According to the Commission, one in three Appalachians lived in poverty in 1965. Thankfully by 2008 this rate has decreased to 18 percent. The number of counties considered economically distressed had decreased from 223 in 1965 to 82 in 2011.
Currently the Appalachian region is one of economic contrast rather than widespread poverty. Some communities have successfully diversified their economies, while others still require basic infrastructure such as roads and water and sewer systems. The contrasts are not surprising in light of the Region's size and diversity. The Region includes 420 counties in 13 states. It extends more than 1000 miles (1,609.3 km), from southern New York to northeastern Mississippi, and is home to 24.8 million people.
Health in the region in 1916
Maternal deathMaternal death
Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2010, researchers from the University of Washington and the University of Queensland in Brisbane, Australia, estimated global maternal mortality in 2008 at 342,900 , of...
in Southern Appalachia was 12.7 per 100,000 births while the rate in rural US was 15.1 and the nation 16.3. Infant mortality was high; it constituted from one fourth to one fifth of total deaths in Kentucky, Maryland, and North Carolina. For the US the rate was one sixth. Prematurity and feeding infants adult prematurely some supposed causes of the higher rate. Several factors contributed to the high mortality rate for mothers: “poor nutrition, bearing children at an early age, having many children in rapid succession, unsanitary birth environments, and various folk medical beliefs and practices advocated by lay midwives."
Health in the region in 2004
Of the 406 Appalachian counties used in an analysis performed for the Appalachian Regional Commission, 108 counties have health professional shortages throughout the county, 189 counties have shortages in part of the county, and 109 counties have no shortages. Fairly large regions, identified by clusters of counties that have shortages for the whole county, are located in Central West Virginia, Eastern Kentucky, Northeastern Mississippi, and Central Alabama.Availability of hospitals
In 2004 there were 81 counties in the region that had no hospitals and 203 had a single hospital. Appalachian counties with large metropolitan areas, such as Pittsburgh and Birmingham have medical schools, teaching hospitals, and are represented by large numbers of hospitals, relative to other Appalachian counties.2006 data shows that nearly two thirds of counties in the Appalachian region lack a hospital that offers obstetrical services. More than three fourths of them lack facilities for the treatment of the mentally ill. Nearly 90 percent are without programs that address substance abuse. Distressed counties have, on average, one primary-care physician for every 2,128 persons and one specialist for every 2,857 individuals.
Infant mortality rates in white and non-white populations
A clear disparity in the level of infant mortality rates between white and non- white populations is made clear by examining the two distributions. Infant mortality rates for the white population range from 1.6 to 17.1 deaths per 1,000 live births. In contrast, infant mortality rates for non-white populations range from 2.3 to 500.0 deaths per 1,000 live births.March of Dimes statistics
The March of Dimes reports the following 2011 statistics regarding perinatal health in some states that contain the Appalachian Region:Kentucky
In an average week in Kentucky:
1,123 babies are born.
158 babies are born preterm.
103 babies are born low birth weight.
8 babies die before their first birthday
Alabama
In an average week in Alabama:
1,241 babies are born.
195 babies are born preterm.
131 babies are born low birth weight.
11 babies die before reaching their first birthday.
Mississippi
In an average week in Mississippi:
864 babies are born.
156 babies are born preterm.
102 babies are born low birth weight.
9 babies die before reaching their first birthday.
West Virginia
In an average week in West Virginia:
413 babies are born.
57 babies are born preterm.
39 babies are born low birth weight.
3 babies die before reaching their first birthday.
Health Beliefs
Many people in the region consider health to be the absence of illness as well as the ability to be physically active and are focused on the present. Many tend to delay treatment until symptoms become severe. Others turn to alternative healing systems and herbal remedies. No evidence exists, however, that Appalachians are more likely to postpone care or seek alternative methods of healing that are people elsewhere.The family is the focus as far as health is concerned. If there is a balance in the physical, emotional, psychological, spiritual, and social well-being of multiple members of the family, then the family is considered healthy. Some define health more in how family members respond to other members' needs. A family with a disable or sick member can still consider itself healthy if the needs of that person are addressed and the family cooperates to promote and protect individual health. As far as decision making is concerned, the extended family often gathers together when a member is gravely ill in order to finalize decision.
Granny Midwives
Until the middle of the 20th century, women commonly known as “granny midwives” attended most births in southern Appalachia. They were members of the community and were not officially trained; they learned how to assist in birth by watching other midwives. While the term “granny” implies that they were old, this was not necessarily the case. They attended births at home and eventually moved into clinics. Eventually obstetricians and physicians entered the scene and more births were occurring outside the home. While “granny midwives” are no longer common in southern Appalachia, direct-entry midwives still practice in certain communities.Granny midwives were greatly respected in their communities. If a family had a horse and buggy, they would send for the midwife and bring her to the home. Many families could not afford this luxury. In this case the midwife would travel by foot to the house. Granny midwives were not experts on birth only. They attended to sick members of the community, educated the people about health, and comforted the dying and their families.
Some midwives did not charge for their services. Others had a sliding scale depending on the income of the family. Many families who could not afford midwifery
Midwifery
Midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding....
services paid the midwife in other commodities such as food.
Prior to the 1940s the midwives were not officially trained. In the latter half the century, however, physicians entered the scene and began offering workshops and classes for these birth attendants. In 1939 the Frontier Graduate School of Midwifery opened in Kentucky. After the opening of the school granny midwives began to be replaced by formally trained women.
Today there are very few granny midwives left. They are the last generation, aged now, and unable to practice legally due to restrictive legislation. Midwifery, however, continues to be popular and certified nurse midwives who were trained in nursing schools across the country and then received their master’s degree in midwifery at an accredited university often attend births.
Frontier Nursing Service
In 1925 Mary Breckenridge founded the Kentucky Committee For Mothers and Babies which three years later became the Frontier Nursing Service. Breckenridge created the organization to address the inadequate health care access throughout the isolated areas of Appalachia. She focused on community involvement and brought midwives from England and Scotland to provide prenatal and maternal care to all who needed it. Her nurses wore blue uniforms and traveled on horseback to deliver care. She originally reached out to nurses abroad because few Americans had the requisite training. Breckenridge founded a hospital in Leslie County, Kentucky as well as the Frontier Graduate School of Midwifery which opened its doors in 1939. The organization struggled after Breckenridge's death in 1965 but it continues to provide services to the area. Current efforts of the staff concentrate on operating its small rural hospital, running the midwifery school, and providing community-based educational programs.Prenatal care
In the first half of the century (and prior) prenatal care was practically unheard of in the region. Midwives were not called on until the due date was approaching or labor pains started. In the 1940s and 50s midwives began to be officially trained by outside physicians and were told by physicians to encourage women to come in for a prenatal checkup.Herbal healing
Granny midwives often used herbs for healing and soothing. Use of herbs in general is a large part of Appalachian culture. Raspberry leaf tea is believed to have effects on the uterus and to be high in vitamins and minerals. It was often recommended for pregnant women and laboring mothers. Nettle tea is recommended for its vitamin K and calcium content, which helps contain bleeding.Expected Due Date
Long ago, the expected date of delivery was determined by taking the phase of the moon into consideration. A delivery during a full moon was considered dangerous to the child and the mother. The arrival of the midwife at the home of the expectant mother varied. Sometimes the family would call the midwife when the labor started and sometimes she would arrive at the home a few days before the anticipated birth. This was probably dependent on the proximity of the midwife to the woman’s house. The midwife and her assistant would assist with chores around the house if they were able to arrive early.Place of birth
Until the 1940s most births in the region occurred at home. The birth of a child was considered an opportunity for family to gather and socialize. Some considered it akin to quilting or corn shucking. Women attended to the birthing woman while men socialized in a different room in the house or out on the porch. Family and friend would come and go throughout the labor, especially if labor was long.Examinations during labor
Midwives performed intrauterine examinations to inspect if the child was appropriately head first in the birth canal. If the child were not in a proper position midwives would attempt to manipulate the child by hand. Women were allowed to labor in a sitting position if they felt that was comfortable for them.Speeding up labor
The following were believed to speed up childbirth: ingestion of guinine, turpentine, gunpowder, tansy tea, flaxseed, or slipper elm. Sneezing, which was also believed to hasten labor, would be induced by blowing red pepper or gunpowder through a quill into the mother’s nose (a practice known as “quilling”). Labor could also be quickened by placing a snakeskin around the thigh. A sharp object placed under the bed was believed to “cut” the labor pains or stop hemorrhaging. If an ax was used, one that has cut many trees was considered to be the best.Birth practices
Folk beliefs dominated the region in the past and continue to influence birth practices. Bad luck during labor could be caused by a number of things such as the mother raising her hands above her head, a dove mourning outside the window, or a member of the household sweeping the steps after sundown.The practices related to the placenta varied. Some midwives believed the woman would pass the placenta faster if she blew with great force into her fist or clasped her hands together really tight (Encyclopedia). Some women were encouraged to sit on a pot filled with hot water to pass the placenta faster. Placentas were buried deep enough so that they could not be dug up by a human or an animal. If the placenta were dug up, this would bring bad luck, illness, or death to the mother and child. Sometimes the placenta were buried or disposed of in a stream of running water to prevent fever in the mother.
Postpartum practices
Early midwifery in the region was rather reliant on what was found in the house. String was used to tie cords and oven sterilized cloth was used for diapers. One midwife who practiced in northeast Tennessee mentioned that sometimes there was only enough water to wash her hands after birth, and none to wash the baby. Some midwives refused to attend to unmarried women due to their own religious beliefs.While midwives did not typically offer prenatal care, postnatal care was more common. Midwives sometimes stayed in the house to care for the woman and child, especially if the delivery had been a difficult one.
Soft masses such as milk and bread, onion and cornmeal, cow dung, pancakes, or potato scrapings were used to treat mastitis
Mastitis
Mastitis is the inflammation of breast tissue. S. aureus is the most common etiological organism responsible, but S. epidermidis and streptococci are occasionally isolated as well.-Terminology:...
. A cloth soaked in camphor
Camphor
Camphor is a waxy, white or transparent solid with a strong, aromatic odor. It is a terpenoid with the chemical formula C10H16O. It is found in wood of the camphor laurel , a large evergreen tree found in Asia and also of Dryobalanops aromatica, a giant of the Bornean forests...
was applied to engorged breasts to draw out milk. Since breast pumps were not available, puppies, piglets, and goats were encouraged to suckle the breasts to also draw out milk.