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.