Around a century ago, in the steep slopes of the Appalachian Mountains, health care was a foreign luxury. People relied on the elements, local apothecaries who made salves and other makeshift medicines out of plants and other materials that could be cultivated from the earth, and wives’ tales for healing.
Not only were health care access and resources scarce, there were conventional rules that dictated who could play what role in society. Unfortunately, that meant that men were destined to become the sole breadwinner for their families, hold all authoritative positions and were the only people allowed to pursue higher education and/or a career, whereas women were thought to exist for only a few simple purposes; reproduction, homemaking, etc. I grant that society had to start somewhere to have evolved to our current world, but the women of past times suffered more than history would like to admit.
Because men were the only people who worked or had specialties due to education, that encompassed health care too. The male model was the example of medicine for a very long time, meaning that women’s health was practically invisible in the eyes of practitioners until equality movements began to take root and women joined the medical field.
Access to health care in early Appalachia was even more limited due to the topography of the area. It is hard to drive a horse-drawn wagon up one rocky slope and down another to get to help quickly in an emergency. Because of this, the people of Appalachia had no choice other than to educate themselves via trial and error on how to heal or provide care – at home, with the tools and medicines they crafted themselves.
One of the riskiest situations for women’s health is childbirth. To this day, despite all the advancements of modern medicine, women die attempting to give birth. It is so simple for a baby to become breech or get dislodged in the birth canal, for a woman to have a massive hemorrhage during a powerful contraction, or labor pains to become so intense the body cannot continue and the bodily processes shut down, leading to shock and or heart failure. Imagine what it was like having no one to guide you through the process or to be on stand-by in case something went wrong.
As Appalachia started to become populated, people began to understand the complexities of childbirth and the threat it posed to expectant mothers. Men were still voicing objections to treating women while their perineal areas were exposed, so childbirth sparked a definite refusal. Meanwhile, women were relying on other women who had no education on the subject, to help them through birth. Those heroic women received little recognition for their services.
My great (x2) grandmother was somewhat of a hero in the Western North Carolina area of Appalachia. She was born in the summer of 1901 and was known as “Granny” to everyone in and around WNC although her given name was Susie Cook McMahan. Susie and her husband, Lawrence McMahan, made Caney Fork their home after they married in 1919. She did not have thorough public education but took it upon herself to study and learn to practice midwifery. Eventually, she was able to attend learning sessions at the Jackson County Courthouse in Sylva. She served her community for decades, delivering more than 2,000 babies and saving the lives of many.
There were no stores at her convenience for supplies. She had to get creative and use her mind and hands to create the things she needed, being well-known for her “big white bag” that consisted of her handmade equipment she carried to every delivery. Inside the bag she had two metal pans for water, cloths of various sizes, usually made from old clothing, a homemade mask and gown for sanitary isolation, and homemade soap that had natural disinfectants from plants and other materials that grew wild in the area. Once the state became aware of her services, they furnished her eyedrops to put in the baby’s eyes after birth, and a set of shears and box of bands to help sever and tourniquet the umbilical cord.
In some cases, when Susie worried a baby was too small or frail to live, she would create a homemade incubation system using a hand-weaved basket and wool blankets to secure warmth in and around the child, instructing the new mothers that the baby needed to remain in the “incubator” for several weeks until it could gain significant weight. In the case of a baby becoming stuck or dislodged in the birth canal, Susie knew to have the father-to-be help hold the mother upside down so she could get the baby to turn, by hand.
Because the women and families of the region were almost always impoverished, they could usually not pay her with money. She would usually receive compensation consisting of textiles, odd and end materials, various livestock, or foods like potatoes or pieces of cured meat. If a family was struggling, she would often refuse payment and return after the birth with resources, food and clothing to help the family stay afloat and to keep their new baby clothed and fed.
As I previously stated, Appalachia is not the easiest place to navigate, the peaks and foothills of our beautiful mountains would have made travel a treacherous task in earlier times. Grandma Susie would travel many miles in any direction through the mountains, in any weather, on horseback or on foot, to get to a laboring mother in need. She filled out a handwritten birth certificate for every baby to send to Raleigh and kept very accurate records in her own home in case they were needed. She understood the fear the mothers felt in their situations and acted as a guardian angel during their delivery. She did not seek recognition for her work, she performed for no fame, simply to help others and benefit the greater good, as a true hero would. She was truly a revolutionary force of nature.
Grandma Susie accomplished many impressive midwifery-related tasks that would still intrigue the health care employees of today. Performing all her births completely naturally, using raw fundamental nursing and healing skills to help her patients psychologically grip the task ahead and to be convinced they were physically able to push through the immense pain of labor for a successful birth.
Out of 2,000-plus births, only one baby died during delivery. The mother went into labor during a flash flood and the baby developed a “placental veil” and ultimately suffocated before she could get him out of the birth canal. Another case that she reported as being memorable was the birth of twins, Harold and Carroll. The two babies were born and were blue due to asphyxiation, they were unable to breathe on their own. Susie went back and forth for nearly an hour breathing oxygen into their little lungs until they became stable enough to breathe on their own.
In 1985, Susie was reported to have had 123 total grandchildren, great-grandchildren and great (x2) grandchildren. Those numbers are obviously much higher now, because there is about to be an entire generation undocumented in the research, as I am her great (x2) granddaughter and in a few years, it will be time for me to have children, her great (x3) grandchildren.
She had 11 children herself and subsequently delivered every one of her grandchildren. She retired from midwifery in 1966, after 40 years of practice, claiming to feel fulfilled having “done her duty.” She reported that her decision to retire was based on the fact that she was getting older, and as time had come and gone, women could now much more easily access health care, and that doctors would agree to treat women. She later died in 1991, a hero.
I find it interesting that someone in my lineage answered her calling and decided to become a midwife, and that her sole purpose was to save the lives of women and children, the silent majority, in a time where the odds were against her. I feel an urge to follow in her footsteps and ultimately preserve her legacy, continuing her work. It is in my blood.
I am currently well on my way to graduating with my Bachelor of Science in Nursing degree, and I plan to attend graduate school with the hope of becoming a Certified Nurse Midwife (CNM) or Women’s Health/Neonatal Nurse Practitioner (WHNP/NNP).
I hope to impact as many lives as she did, and I will continue to research her as I continue my path into the career that she helped to found and revolutionize so long ago.
Morgan Hooper is a nursing student at Western Carolina University.