Mississippi midwife Eliza Pillars teaching a room full of Mississippi midwives
Public health nurse Eliza Pillars teaches a group of Mississippi lay midwives in 1929. From the Benoist Collection in the Bjoring Center for Nursing Historical Inquiry.
Birth in the United States in the early 20th century was a dangerous proposition. The country’s maternal and infant mortality rates were highest in the developed world due to a number of factors, including unnecessary interference by obstetricians—who sometimes anesthetized laboring women and removed their babies with forceps—hemorrhage, malnutrition, and puerperal fever caused by streptococcus pyogenes.
In 1915 America, 600 mothers died for every 100,000 births; by 1920, 900 women died for every 100,000 births. And perhaps nowhere was the issue more acute than in Mississippi.


In 1930, 8 in 10 midwives practiced in the South
Caroline H. Benoist, Mississippi-born and a 1925 graduate of Johns Hopkins School of Nursing, became one of the first public health nurses in her state. Self-directed and creative, she established a prenatal program in Pike County in 1936 to assist physicians with home deliveries and teach best practices to “Granny” lay midwives.
Benoist’s collection of papers, letters, and photographs—housed in the Eleanor Crowder Bjoring Center for Nursing Historical Inquiry archives—offers a rich historical narrative about public health nursing in Mississippi in the 1930s, and a lens on rural midwifery practice and communicable diseases. Through Benoist, we see how race, class, and gender in healthcare intersected at a particular place and time.
In 1930, more than 80 percent of midwives practiced in the South, where a quarter of all babies—and half of Black babies—were delivered by mostly Black lay midwives. Mississippi had about 5,000 midwives, double its number of physicians, and the majority of births occurred at home. Benoist knew that these midwives, trained through apprenticeship and experience, were key to reducing Mississippi’s childbirth-associated mortality. Investing in their education meant better health for Mississippi mothers.
Such partnerships helped turned the tide. Between 1921 and 1942, maternal mortality fell by more than half, and infant mortality declined 40 percent. In this, the Year of the Nurse and Midwife, we pay homage to these women, their partnerships, and the progress they made together to celebrate and preserve the unique professional role these African-American women had in their communities.
View the Benoist digital collection: cnhi-benoist.nursing.virginia.edu.
Today's #Flashback Friday brought to you by the Bjoring Center for Nursing Historical Inquiry, and comes with a salute in this, the Year of the Nurse and Midwife.