Wangui Muigai is the winner of the inaugural Nursing Clio Best Journal Article Prize for “‘Something Wasn’t Clean’: Black Midwifery, Birth, and Postwar Medical Education in All My Babies,” Bulletin of the History of Medicine, vol. 93, no. 1 (2019), 82–113.
An assistant professor of history and African and African American studies at Brandeis University, Dr. Muigai’s research focuses on the history of health, race, and reproduction in the United States. “Something Wasn’t Clean” tells the story of the irresolvable tensions inherent in postwar healthcare practice in the rural Jim Crow South. It details the production, circulation, and consumption of the medical-training documentary All My Babies, which showcases the Black midwife “Miss Mary” Coley in 1950s Georgia. Although white officials directed the film, Coley also exerted significant influence over its production. Its circulation both upheld rural midwifery and argued for its obsolescence.
What is it like to work with visual sources in relation to the history of medicine? You contextualize the film with deep archival research, but I was particularly interested in how you chose which still shots to include as images in the article and why.
As a historian of medicine, I’m interested in how people have understood their health and bodies, and when faced with a health crisis, where they turn for help. Visual materials are incredibly rich sources for exploring how our ideals and anxieties about health are communicated.
Analyzing films in terms of what happens on screen and off – casting decisions, the scenes that are cut – in some ways it’s analogous to reading a published book and also having access to the rough drafts, the editorial comments, the discussions over chapter titles or cover design. You walk away with a much richer understanding of the text as the culmination of an iterative process. I watched All My Babies so many times, often because something I came across in the written archives sent me back to re-view a scene or reexamine certain aspects, such as the musical score or cast. For example, when I uncovered details about the African Americans featured in the film – Dr. William Mason, Mary Coley’s children and grandchildren, college students from the local HBCU – it made clear that this film wasn’t just shaped by white authorities. It was the product of a collaborative and fraught process that relied on black professionals and community members for it to be successful.
When it came to deciding which still shots to include, I wanted images that highlighted those tensions. Seeing the black newborn baby squirming in Miss Mary’s lap is a striking contrast to the shots of lifeless, white cloth dolls laying on tables for midwives to practice on. The classroom scene fascinated me because here are multiple generations of black midwives coming together and demonstrating their knowledge, all while under a white gaze. Taken together, the vignettes demonstrated how the film drew on a range of cultural narratives to represent health and different forms of care.
How do you teach the film as a historical source to today’s students?
When I bring this film into the classroom I’m engaging students with a range of interests – some are on a pre-health track, others are studying history, black studies, or gender studies. Across these interests, students really respond to Miss Mary’s character. I use the film to show that there is a long history of black women as healthcare providers, and that midwifery is not naturally women’s work, but a specialized form of knowledge and labor. The film also provides an opportunity for students to reflect on what healthcare looked like during a time of legalized racial segregation. I’ll ask, why are the black women in the film giving birth at home? Why does Miss Mary have to bring an incubator into a laboring mother’s rural home, rather than take the mother and her premature baby to a hospital? Hopefully, students come away understanding the inequities, and devastating consequences, of providing health care on a “separate but equal” basis.
And, like other public health films I teach with, I emphasize that the primary aim of All My Babies was to educate. So in class we consider the role of audience, as well as the intended and unintended messages embedded in the film. Looking at it as a primary source also allows us to ask whether the film’s lessons are fixed, or if they evolve depending on the context in which the film is viewed. By the end of the conversation I hope students see that learning about Mary Coley means there is more to studying medical history than chronicling the achievements of white doctors, and that there is more to understanding black people’s experiences with healthcare than viewing them only as victims of experimentation and exploitation.
You highlight a fascinating tension between exploitation, agency, and representation in the making and distribution of the film, in which (white) public health officials’ goals to improve Black maternal-infant health were intertwined with their efforts to more effectively surveil and control black midwives. Can you talk about these tensions?
The tensions emerged for me in piecing together different archives and perspectives. The government records showed how, faced with an embarrassing maternal-health situation, public health officials at the county, state, and federal levels implemented a range of tools – from certification to coercion – to try to bring death rates down. Mary Coley lived through these changes; it impacted how she did her work and under what terms. But the young white filmmaker George Stoney was an outsider to these reforms, so when he was brought on to the film project, the conflicts that had long been simmering between midwives, public health nurses, and doctors now had to be explained, and sometimes defended, and we see that in the correspondence surrounding the film’s making.
These tensions didn’t go away once production ended. We can look, for example, at the ways subsequent generations have encountered and reacted to All My Babies. In the early 1950s, the film was often shown in spaces segregated by race and gender. In the 1970s, it was screened in avant-garde venues like the MoMA in New York City, drawing in crowds that sought out experimental and socially taboo cinema. Today, families and tour groups watch a short clip when they visit the National Museum of African American History and Culture in the nation’s capital. Across these periods, the film has been a vehicle for discussing changing views about birth, women’s health care, and representations of black people in popular culture.
How does this article fit into your broader research?
The article ties into my larger book project on the history of black infant mortality in the US. The experience of losing a baby has affected so many families and communities, and in the US blacks have long suffered from higher infant mortality rates than other groups. My current research project asks how parents, as well as health experts and other authorities, have understood and responded to the death of black infants over time. Digging into basic questions – where black births and deaths have taken place, who has borne witness to these events – yields surprising answers. Until the mid-twentieth century, much of this story didn’t take place in hospitals with doctors in attendance, but in homes with black midwives and family members at the bedside. In my research, I consider the role that a range of health practitioners have played in bringing black babies into the world and caring for them. At the same time, I ask: when an infant dies, what happens? Where does the blame fall? In investigating infant death through this historical lens, I have realized that whether a black baby’s death is considered an economic concern, a criminal incident, or a public health issue often hinges on this question of blame and responsibility.
It was hard for me to not think about current events when reading your article. What does your research tell us about the current state of maternal-infant health in relation to race in the US?
It’s important to point out that the higher mortality rates plaguing black mothers and infants is, unfortunately, not a new or emerging issue, but one that has persisted for well over a century. In looking at the historical challenges to lower these statistics, and ideally, to prevent these deaths, there’s an underlying tension between responses that have focused on changing individual behaviors and responses that have addressed the structural factors that determine health outcomes. Developments like hospital closures are part of a larger story of how underserved communities access and experience health care. Here I’m thinking about access in a broad sense – geographic, social, economic, as well as political forms of capital to secure needed resources.
Coley lived and practiced in Albany, Georgia, the capital of Dougherty County. Dougherty is an epicenter of the COVID-19 outbreak in the state, a disaster that is disproportionately hitting Black residents. How do you think Coley would approach the pandemic in her county today? What can her life and practice teach public officials currently battling the disease?
One of the reasons why so many people respected Coley was because of her commitment to help and advocate for those most in need. Her involvement in the film, in creating something that would benefit her community and have a broader impact, is a testament to how she saw her role as a health care provider and community leader. Even when faced with limited resources, she didn’t compromise the care she provided.
We are only beginning to grapple with the COVID-19 pandemic’s sweeping effects. Once the pandemic subsides and we are no longer operating in a heightened state of emergency, to what extent will we allow our current healthcare system to remain unchanged and to what extent will we confront the gaps in public health funding that made places like Albany a COVID hotspot?