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KAREN KRUSE THOMAS:

You mentioned midwives a minute ago. What were some of your experiences with the midwives? Were most midwives at that time black?

JAMES SLADE:

All the ones I knew were black. In Plymouth, particularly, they had midwives, because one lady in the clinic worked as an aide, but she was also a midwife. You'd see these children in the clinic, three or four pounds, and you'd think they should be in the hospital, but they were doing pretty good. Chowan County has not had a lot of midwives in recent times, because the physicians that did deliveries weren't all that enthusiastic about midwives. They had a project in the early '90s with a couple of midwives at Chowan Hospital. They stayed about six months, and then kind of petered out. These particular ones, I think one of them made an error, and that didn't go over too good. With Medicaid, they have access to the physicians, and unless they've got a real good rapport with the midwife, they prefer to go to the physicians. For many years, we didn't have any midwives in Chowan County, and the physicians did all of the deliveries. We had four obstetricians, but one has retired. When I started out, all the physicians in town, except for myself, were doing deliveries. With the advent of malpractice suits, and increasing rates for malpractice insurance, all the physicians except those who are strictly OB/GYN have ceased to do deliveries. No primary care physicians except OB/GYNs now do deliveries, where all the family practitioners were doing them before. When it got to be $18,000 for malpractice insurance and you didn't do but one delivery, it became financially noncompetitive.

KAREN KRUSE THOMAS:

You say there were quite a few midwives when you first came?

JAMES SLADE:

Maybe not "quite a few," mostly in Washington County, not in Chowan County.

KAREN KRUSE THOMAS:

Do you have a sense of why midwifery died out?

JAMES SLADE:

Two reasons. She mentioned transportationߞif these ladies can get in the rescue squad and be in Chowan County or Washington County Hospital. But Washington County has not had the medical coverage that Chowan County has. We now have three OB/GYNs who do deliveries, and are fully board certified, whereas Washington County only had one, and they lost that one. We see a lot of people from Washington County who come to Chowan County for deliveries. So transportation is no problem now. They had a choice of staying home with the midwife, but if they got in trouble they'd have to go to a physician anyway. Now, I think midwives have to have so much certification.

KAREN KRUSE THOMAS:

Had those midwives when you came in been through certification courses?

JAMES SLADE:

I don't think soߞif there was any such thing at that time. Did they even have certified nurses aides at that time?

CATHERINE SLADE:

No.

JAMES SLADE:

Maybe their grandmother taught them, but certification came later.

KAREN KRUSE THOMAS:

I know a long time ago, especially in rural areas where doctors couldn't get out to people, a lot of people of both races did deliver with midwives. It seems to me from what I've read that midwifery became more and more a black profession, and that mainly black women were using them. Do you know when or why that happened?

JAMES SLADE:

I've never known a white midwife.

CATHERINE SLADE:

There was that lady who was going to go to schoolߞdid she go?

JAMES SLADE:

I think she finally decided to be a lawyer! She was an RN that used to work in the public health clinic, and she decided she wanted to be a midwife.

CATHERINE SLADE:

One reason people used midwives was because they didn't have to pay as much money. It probably was easier to get her than to get a physician.

JAMES SLADE:

Once they have one or two successes, that's all they need.