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Birth behind the veil: African American midwives and mothers in the rural South, 1921-1962

ProQuest Dissertations and Theses, 2009
Dissertation
Author: Kelena Reid Maxwell
Abstract:
By the early twentieth century, the majority of white women living in the United States were giving birth in hospitals under the care of a physician. In 1921, the majority of women who gave birth under conditions that were indigenous, eclectic, spirit based, and not according to the standards of modern medicine, were the rural black women of the South. African American midwives and women of the South maintained the core qualities of the home birthing traditions, handed down through a matrilineal system of recruitment and training from the period of enslavement throughout the twentieth century. This occurred amidst a major program of midwife training and regulation. Public Health officials of the early twentieth century urged midwife regulation as a temporary measure. Medical professionals considered the lay midwives of the south a necessary evil. They were necessary because the population they served was left out of a medical system that operated according to the practices and laws of racial segregation. They were evil, however, because they were believed to carry disease, to be incapable and inherently responsible for elevated levels of infant and maternal mortality in the South. Yet health authorities could think of no better solution then to train and regulate the best of the practicing lay midwives and eliminate those whom they considered unwilling to follow safe practices. Despite the beliefs of the medical community, African American childbearing women of the South relied upon the services of lay midwives. The transition from home to hospital birth was not a smooth transition for rural southern women. There were socioeconomic barriers to a hospital birth for many. However, there were also cultural and spiritual reasons for their preferences. They did not appear to associate midwives with unsafe conditions. In fact, the reverse was the case. This study examines the movement from the lay assisted births of the early twentieth century through the medicalized events of the later decades. African American women of the South approached modern medicine in various ways, yet always through the multiple lenses of racial segregation, deep spiritual beliefs surrounding childbirth, and the viewpoints of their ancestors. These factors were more prominent in impacting the birth experience then the views, perceptions, and regulations of the health care professionals who were officially responsible for the birth event.

Table of Contents Abstract ii – iii Introduction 1 - 3 Chapter One: The Veil 4 - 34 Chapter Two: Traditional Practices and the Spirituality of Childbirth 35 - 82 Chapter Three: The Surveillance of Birth 83 - 115 Chapter Four: Tuskegee University and the Efforts to Transform the Pracitces of Alabama’s Traditional Midwives 116 - 153 Chapter Five: Visual and Discursive Portrayals of Midwives 154 - 180 Conclusion: A New Relationship to Modern Medicine 181 - 191 Bibliography 192 - 201 Curriculum Vitae 202

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 Introduction

There are many untold stories of the black South during racial segregation. Countless moments remain hidden from the analyses of historians and scholars of every field. However, some of the most sacred and protected events of human life are those that can reveal the most about the experiences of African Americans. Childbirth is one of these events. The following chapters are an attempt to unfold the events of the experience of birth among the childbearing women of the black south during the height of racial segregation. My objective is to analyze the complex interaction of race, class, religion, and health. In doing so I hope to demonstrate that even the most personal and passionate aspects of the lives of African American women during the twentieth century were subjected to medical and moral scrutiny. Their reactions to this scrutiny were equally passionate and complex. They reveal something of the inner lives of black women during a time and place when their bodies and souls were being dehumanized by the outside world. The first chapter provides an explanation of my use of the term, “the veil,” as well as a historical overview of the time period covered, a discussion of sources and an acknowledgment of previous publications. The second chapter is an analysis of the traditional practices and rituals of childbirth. It shows how the techniques of childbirth are a union of folk traditions, Christian beliefs, and medical procedures. This chapter demonstrates that spiritual beliefs are at the foundation of the work of midwives.

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Chapter three discusses the surveillance of birth among African Americans in the South. This chapter includes a discussion of the social and racial anxieties generated by public health officials in the South, and the midwife regulation programs that were influential in transforming the experience of childbirth. The fourth chapter deals with Tuskegee University programs of the 1930’s and 1940’s. Medical officials of Tuskegee were preoccupied with the practices of Alabama’s traditional rural midwives. They focused on gathering information from area midwives, training, and improving the health conditions of the surrounding community. This chapter also includes a series of profiles of lay midwives who were active in Talladega County, Alabama from the 1930’s through the 1950’s. The focus is on the transitional figures of the time period. For the first time there were midwives who were active in the South who had gained the majority of their training from their local health department, instead of from elder midwives. The final chapter of the dissertation is an analysis of the visual and discursive portrayals of midwives commonly found in medical journals in the 1940’s. It discusses the three most common methods of portraying the traditional midwife: derogatory language, photography, and use of dialect. Untrained midwives were often described as ignorant, and dirty. Medical journals of the time period often juxtaposed these images with ones of trained midwives who were often described as neat, orderly, and bearing the physical markers of a medical professional. They were making the point that state regulation had transformed the midwife. Indeed it had. But in ways that were not always publicized in these journals. African American midwives of the South began to take a more active erole in spreading health care information throughout the South. They encouraged the women under their care to be seen by a physician at least once during their pregnancies and helped increase attendance at prenatal and maternal

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clinics in their communities. There had been many changes along the way from 1921, and yet the spirit of the black midwife remained with childbearing women of the black south through the final transition to the hospital room.

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Chapter One: The Veil

I was plowing in the field, plowing cotton, when a voice within told me he wanted me to be a midwife, to take care of mothers and babies. The Lord showed me just how it was to be done. Testimony of lay midwife – Northern Florida 1

The Negro is a sort of seventh son, born with a veil, and gifted with second sight in this American World. W.E.B. DuBois 2 ,

Some superstitions which came up provoked argument among the midwives. Somebody said a baby born with a veil could foresee the future and see spirits. She said when little children stop, shiver, and “scrunch up” they are seeing spirits. Marie Campbell 3

The craft of midwifery has a long tradition of being associated with the divine. Oral testimonies of female African-American midwives are rich with descriptions of visions and direct communication with God. Testimonies, such as the one noted above, is indicative of the relationship African American lay midwives felt with a divine being. They believed they were called by God to be midwives, and that The Lord guided their work. The notion of “the veil,” which was put forth by W.E.B. DuBois in the early twentieth century is helpful in understanding the role that midwives played in the communities they served. There are multiple meanings of the “veil,” in this study. Midwives commented on the physical veil, or caul, that some infants were born with. This was a newborn who was born with part of the amniotic sac covering its face. This could be a dangerous condition for an infant. It was also a sign, among traditional 



























































 
 1 Molly Dougherty, “Southern Lay Midwives as Ritual Specialists,” in Women in Ritual and Symbolic Roles, ed. Judich Hoch-Smith and Anita Spring (New York: Plenum Press, 1978), 153. The passage is from an oral interview conducted by the author with a lay midwife in northern Florida. 2 W.E.B. DuBois, The Souls of Black Folk (New York: Bantam Books) 1989. Original edition published in 1903. 3 Maria Campbell, Folks Do Get Born (New York: Garland Publishing) 1946. P. 36.

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birth attendants of the South, that the child would have an especially close relationship with the spirit world. The following is an account from a Virginia midwife:

I had to get to work right away, because the baby was born with a veil over it’s face. At the time, I was trying to get the veil off, I didn’t know if the baby was dead or alive. I ran my fingers a the neck part and pulled it up over the head, but the baby had already suffocated. The lady there with the mother said she had tried to get it off, but she didn’t succeed. That one was the only one I have seen or delivered, being born with a veil over it’s face. But you know what they used to say, that a baby born with a veil over its face could see things that a normal person didn’t see. 4

Some midwives were themselves born with a veil. It is also meant to explain the multiple positions and viewpoints they held in their world. Religion, spirituality, and folk traditions played a central role in the experience of birth among African-American women of the South. As discussed here, the role of religion in the childbirth experience was both deeper and more complex than presented in ethnographic and social scientific studies of African-American midwives. 5 In fact, during the height of the Jim Crow era in the South, the spiritual beliefs of midwives and mothers comprised the central axis around which the story of childbirth rotated. The story of childbirth among black southern 



























































 
 4 Claudine Curry and Mildred H.B. Roberson, My Bag Was Always Packed: The Life and Times of a Virginia Midwife (Bloomington: 1 st Books, 2003), 35. 5 For studies that have detailed descriptions of the spiritual practices of African-American lay midwives, see Marie Campbell, Folks Do Get Born (New York: Garland Publishing, 1984); Dougherty, “Southern Lay Midwives as Ritual Specialists”; Linda J. Holmes, “African American Midwives of the South,” in The American Way of Birth, ed. Pamela Sue Eakins (Philadelphia: Temple University Press, 1986); Margaret Charles Smith and Linda J. Holmes, Listen to Me Good: The Life Story of an Alabama Midwife (Columbus: Ohio State University Press, 1996); Onnie Lee Logan, Motherwit: An Alabama Midwife’s Story (New York: E.P. Dutton, 1989); Holly Mathews, “Killing the Medical Self-Help Tradition among African Americans: The Case of Lay Midwifery in North Carolina, 1912– 1983,” in African Americans in the South: Issues of Race, Class, and Gender, ed. Hans Baer and Yvonne Jones (Athens: University of Georgia Press, 1992); Debra Ann Susie, In the Way of Our Grandmothers: A Cultural View of Twentieth-Century Midwifery in Florida (Athens: University of Georgia Press, 1988); Mary P. Mathis, “Lay Midwifery in the Twentieth-Century American South: Public Health Policy and Practice” (PhD diss., Florida State University, 1990); and Beatrice Bell Mongeau, “The ‘Granny’ Midwives: A Study of a Folk Institution in the Process of Social Disintegration” (PhD diss., University of North Carolina, 1973).

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women is related to W.E.B. Dubois’s early twentieth century explanation of “the veil.” DuBois believed that African Americans had a unique perspective on American society, as they were able to see it from behind the veil of race. They understood white American society well. They had to in order to survive. They also knew that a part of their experience was unknown to the white world. In a sense, the white world would not and did not see their “soul.” This was partly for the sake of self-preservation, and partly because the wider community at this time in history would not have believed a deeper, more complex world existed among black Americans. The stories of childbirth are similarly complex, hidden, and soulful. African American mothers and midwives knew this world very well. Fragments were visible to white Americans and to southern physicians in particular. Midwives had a unique perspective throughout the twentieth century on childbirth, black systems of health care and modern medicine. They operated within all of these spheres, and seamlessly applied both traditional and modern health care to women, children, and families in their communities. This perspective is what gave them the “second sight,” as DuBois characterized it, into a uniquely divided health care system. In 1938, a midwife by the name of Lula Russeau admitted that she could “foretell the future and see spirits.” 6 Lula Russeau was born with a “caul,” or veil over her face. This meant that she was born with a piece of the amniotic sac covering her face. According to Russeau this was a sign that she was going to have the gift of second sight, and have the ability to heal people. Midwives considered it their special responsibility to handle a baby born with a veil. They believed that it required a particular set of rituals otherwise the child would suffer. Black midwife, Ella Wilson, from Arkansas, believed the caul required “special handling,” and that is should be saved until it disintegrated. Another woman, Maum Hagar, of South Carolina, made a 



























































 
 6 Fett, 53.

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special tea from the caul, which was, she believed, prevented the child from seeing “frightening supernatural forces.” 7 Others stated that if the veil was taken off backwards, the child would not be troubled by spirits. 8 For Lula Russeau, it was a special sign that marked her as a person who would be a gifted healer to her community. It was a sacred sign. “I was born one [a midwife],” she stated; “God made me dat way.” 9 She was also born into a maternal lineage of healers. She had learned about traditional healing methods, including the use of herbs and charms, from her mother. Sharla Fett states that, “the matrilineal lineage of healing abilities merged with special birth signs and the sense of divine calling to form the foundations of her legitimacy as a healer.” 10

The women discussed in the following chapters, like Russeau, have a special relationship to the history of medicine in this country. They had a second sight into the world of race and medicine in the twentieth century. Some were gifted healers. Others were deeply imperfect and at times a risk to the women under their care. In order to understand the lives of African American women of the rural South during the twentieth century we must fully account for the contradictory and complex nature of the experience of childbirth. The first several decades of the twentieth century is the period of rapid decline for lay midwifery nationwide. In 1921, a major phase of midwife education programs began in most Southern states. The 1930’s and 1940’s are also critical decades and periods of transition for African American childbearing women. While some critical information preceding and following these decades is included, the focus of the present study is on the 1920’s through the 



























































 
 7 Marie Jenkins Schwartz, Birthing a Slave: Motherhood and Medicine in the Antebellum South (Cambridge: Harvard University Press, 2006), 150-1. 8 Campbell, 36. 9 Fett, 53. 10 Ibid.

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late 1940’s. African-American midwives were very active during this time, and were central to the experience of childbirth in the South. This was a time when dramatic demographic shifts were taking place in the rural south. Between 1910 and 1930, more than 1.5 million African Americans migrated out of the rural south. The people who left were primarily agricultural workers who were fleeing the devastating effects of the boll weevil, extensive poverty, and racial exclusion. 11 “Between 1910 and 1920, 10.4 percent or 200,400 African Americans left Alabama and Mississippi alone for the promise of a better life beyond the South; and an additional 2 million departed from the region between 1930 and 1950.” 12 The social impacts of World Wars I and II were central to the migrations of African Americans out of the South. “Pushed by wretched agricultural conditions and pulled by war industries that offered jobs with high and regularly paid wages, more African Americans fled the land.” 13 This study begins immediately following the first wave of the Great Migration and proceeds through the second. However, in many ways it is a story of the people who stayed behind. The women included in this study were rural agricultural workers of the Deep South. They were part of the diminishing population of black farmers. By 1950, 25 percent of southern farmers were black. In this decade almost 2.5 million more African American farmers left the South. By 1960, African American farm workers were “nearly irrelevant.” 14

The black farmers who remained in the South during these years lived under very harsh circumstances. In 1918, William Edwards, an African American educator who worked in Alabama spoke about the conditions of black people in the South: “These people are hungry, 



























































 
 11 R. Douglas Hurt ed., African American Life in the Rural South, 1900-1950 (Columbia: University of Missouri Press, 2003), 2. See also, Stewart E. Tolnay, The Bottom Rung: African American Life on Southern Farms (Urbana: University of Illinois Press, 1999), 14. 12 Hurt, African American Life in the Rural South, 1900-1950, 2. 13 Ibid, 3. 14 Ibid, 4.

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they are naked, they have no corn and had no cotton; so they are without food and clothes.” 15

Most African American farm families who lived in the South in the first decades of the twentieth century lived in dilapidated houses and without indoor plumbing, window screens, or electricity. In 1934, one in three houses of black farmers in the Eastern cotton states had no sanitary facilities. In his survey of 916 rural families living in eight counties of the rural South, sociologist Charles Johnson noted that, “the majority of houses were more than twenty-five years old and had major physical defects, including leaking roofs, broken porches, and defective floors.” 16 Families were crowded in these two or three room structures. Their diets were also lacking in nutritional value. One observer noted that, “food is scant in quantity and poor in quality, and a diet too largely composed of meal, salt pork, molasses results in high sickness and death rates.” 17 Economic hardships and the difficulties of farming were some of the factors that contributed to the steady movements of African Americans in this period. Movement is a prominent theme of accounts of black southern life during the first half of the twentieth century. Many men and women fled rural areas for the urban centers of the South and North. However, some studies indicate that the scope of much of the movement was limited. A 1926 study of Southampton County, Virginia, found that while almost all tenant farmers moved at some point during their lives, the majority of them stayed within the same county. They moved from farm to farm, but the majority (81 percent) maintained the same church, school and store as before their move. 18 “Another 1924 study of tenant farmers across ninety-three southern plantation counties found similar levels of farm-to-farm mobility among both blacks and 



























































 
 15 Louis M. Kyriakoudes, “’Lookin’ for Better All the Time:’ Rural Migration and Urbanization in the South, 1900- 1950.” In R. Douglas Hurt ed, African American Life in the Rural South, 12. 16 Tolnay, 31. 17 Tolnay, 130. Hurt, 4. 18 Kyriakoudes, 15.

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whites.” 19 The same pattern continued throughout the Depression era years. Additionally, the “typical move” of southern farm couples in the 1940’s did not cross county lines, and “those that did covered a distance of only thirty to forty miles.” 20

The African American population that is the focus of this study constituted the group that remained in the South, while perhaps moving from farm to farm. What is also critical for our understanding of the experience of birth is that those who remained, maintained relatively high levels of fertility during the period covered. The fertility rates among African American southern women declined between 1900 and 1940 yet remained high, relative to other populations. The ratio of children younger than five per one thousand women ages fifteen to forty-nine was higher among southerners, than that of the national average during the first half of the twentieth century. In addition, the rural population of the South grew during these years despite the heavy out migration. It rose from 17.8 to 22.7 million from 1900 to 1940. 21 At the turn of the century, the average black woman of the rural south was likely to give birth to about seven children. In 1940, the average number was five. 22 Large families were a social and economic necessity of southern farm families, who expected their young children to contribute to the household economy. In addition, black farm families lived in isolation of the fertility trends of women in other areas. They were not impacted by the fertility trends of women in urban areas of the North and South. 23 The African American midwives and mothers, who are at the center of this study, were concerned with caring for the large numbers of births that remained typical among families of the rural south. While they did not face social dislocation from a move to an 



























































 
 19 Ibid. 20 Tolnay, 141. 21 Kyriakoudes, 19 22 Tolnay, 17. 23 Ibid, 17-18.

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urban area, they did confront issues of modernity and negotiated the shifting landscapes of childbirth regulation. The traditional African-American midwife, or the “granny” midwife, was considered a danger to women and babies by medical professionals in the early twentieth century. White doctors who sought entry into the growing field of obstetrics launched a campaign against midwives in the first decade of the twentieth century. Photographs of elderly midwives were published to promote the idea that these women were diseased, ignorant, and superstitious, and thus a danger to childbearing women. A frequently used set of images shows a “granny” midwife next to a photograph of a “typical Italian midwife” and an Irish-American midwife. The Irish woman is quoted as saying, “I am too old to clean, too weak to wash, too blind to sew, but thank God, I can still put my neighbors to bed.” 24 The caption goes on to compare the immigrant women to the “granny of the far South.” The African-American midwife is described as “ignorant and superstitious, a survival of the ‘magic doctors’ of the West Coast of Africa.” 25 The medical professionals who distributed this material intended to scare women of the urban Northern United States away from the traditional childbirth attendant and toward the services of physicians. The midwives, who represented folk methods of healing that were considered dangerous and backward by medical professionals, were targeted as the cause of high infant and maternal death rates. In the case of the African-American midwife of the South, physicians were unsure of what their position should be. They believed that the traditional midwife was a menace, but were unwilling to take on the large population of childbearing women of the South. Segregation laws, 



























































 
 24 Richard Wertz and Dorothy Wertz, Lying-In: A History of Childbirth in America (New Haven, CT: Yale University Press, 1989), 216. 25 Wertz and Wertz, Lying-In: A History of Childbirth in America, 216.

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racial stereotypes, and the economic devastation of the cotton economy made it unlikely that rural black women would be attended by white physicians. Instead of using these photographs to convince black women to seek a physician, they were used to illustrate the difference between a midwife who was supervised and trained by the local health department and one who was of the “Olde Type.” A midwife who was unsupervised and practicing according to traditional beliefs was assumed to be life-threatening to the mother and baby. Public outreach and changes in medical education carried out by medical professionals throughout the century were reactions to laypeople’s concerns about high mortality rates of infants and mothers in the early part of the century. According to J.H. Mason Knox, head of the Maryland Department of Health’s Bureau of Child Hygiene, these changes were due to the “interest and vision of lay groups of interested, socially minded men and women, who became aroused by the suffering and loss incident to the excessive mortality among mothers and infants and took practical steps to improve conditions.” 26 Knox told his audience in 1934 that the medical profession as a whole was not sympathetic to the plight of mothers and babies, but was reacting to public opinion. He stated that “city boards of health generally followed the paths opened by the volunteer organizations and later depended upon lay support for help in the enactment of milk ordinances and of other measures which have furthered child hygiene.” 27

Once the causes of infant deaths were identified, interested laypeople and those in the public health field set out to rectify them. In the early twentieth century, diarrhea and respiratory diseases were major causes of infant mortality in the first year of life. At this time, contaminated 



























































 
 26 J.H. Mason Knox, Jr., “Reduction of Maternal and Infant Mortality in Rural Areas,” 70. 27 Ibid., 70.

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water supplies were identified as a major public health issue contributing to high rates of infant mortality. 28

In 1921, Congress approved the Sheppard Towner Act, which provided the funding for local and state health departments in the South to develop programs for dealing with the midwife “problem.” The national Children’s Bureau conducted a series of studies in the first decade of the twentieth century that were intended to determine the causes of infant mortality. In these studies, low family income was the most common denominator in infant deaths; specifically, the father’s income was directly related to infant mortality. 29

Other studies concluded that low income was not a determining factor; rather, the mother’s inability to breast-feed her newborn was the primary factor contributing to infant death. For instance, in a paper read to the National Conference of Social Work in 1919, Julius Levy, M.D., director of the Division of Child Hygiene in the New Jersey Department of Health, stated that, “among the social and economic conditions affecting infant mortality I would not give a very important place to poverty.” 30 Levy found that certain social groups who were very poor had a lower infant mortality rate than other groups with a higher family income. He found that it was the mother’s ability and willingness to nurse that had the highest impact on infant mortality in the first months of life. He concluded that “maternal nursing and ‘mothering’” were the most critical factors contributing to infant health. The infant mortality rate among African-Americans at the time of Levy’s study was two to three times higher than that of the white population. He found that higher infant mortality was 



























































 
 28 Julius Levy, “Maternal and Infant Mortality,” American Journal of Public Health 19, no. 2 (February 1929): 227. 29 Richard Meckel, Save the Babies: American Public Health Reform and the Prevention of Infant Mortality, 1850-- -1929 (Baltimore: Johns Hopkins University Press, 1990), 182. 30 Julius Levy, “Reduction of Infant Mortality by Economic Adjustment and by Health Education,” American Journal of Public Health 9, no. 9 (September 1919): 676.

Full document contains 208 pages
Abstract: By the early twentieth century, the majority of white women living in the United States were giving birth in hospitals under the care of a physician. In 1921, the majority of women who gave birth under conditions that were indigenous, eclectic, spirit based, and not according to the standards of modern medicine, were the rural black women of the South. African American midwives and women of the South maintained the core qualities of the home birthing traditions, handed down through a matrilineal system of recruitment and training from the period of enslavement throughout the twentieth century. This occurred amidst a major program of midwife training and regulation. Public Health officials of the early twentieth century urged midwife regulation as a temporary measure. Medical professionals considered the lay midwives of the south a necessary evil. They were necessary because the population they served was left out of a medical system that operated according to the practices and laws of racial segregation. They were evil, however, because they were believed to carry disease, to be incapable and inherently responsible for elevated levels of infant and maternal mortality in the South. Yet health authorities could think of no better solution then to train and regulate the best of the practicing lay midwives and eliminate those whom they considered unwilling to follow safe practices. Despite the beliefs of the medical community, African American childbearing women of the South relied upon the services of lay midwives. The transition from home to hospital birth was not a smooth transition for rural southern women. There were socioeconomic barriers to a hospital birth for many. However, there were also cultural and spiritual reasons for their preferences. They did not appear to associate midwives with unsafe conditions. In fact, the reverse was the case. This study examines the movement from the lay assisted births of the early twentieth century through the medicalized events of the later decades. African American women of the South approached modern medicine in various ways, yet always through the multiple lenses of racial segregation, deep spiritual beliefs surrounding childbirth, and the viewpoints of their ancestors. These factors were more prominent in impacting the birth experience then the views, perceptions, and regulations of the health care professionals who were officially responsible for the birth event.