AbstractThis paper concerns black midwives who practiced traditional medicine in six central Texas counties, mostly located on the Brazos River. During the years of hospital segregation following the Civil War, the black midwife performed two major functions. Through formal connections with white physicians who taught them the basics of obstetrical care, black midwives were able to provide a better level of health care for black women than otherwise would have been available. The same ties enabled the black midwife to secure assistance from whites for the rural black community. These arrangements improved the health and productivity of rural black families and lessened the severity of the caste system. A sharp decline in the use of black midwives occurred when desegregation reduced training opportunities and the market for their services.