The period of 1920-40 in North Carolina saw some of the strictest regulation related to midwives in the South. Midwives had been a fundamental part of the birthing process for African American women from very early on in American history into the twentieth century. The progressive health department established in the early part of the century targeted midwives in order to reduce high infant and maternal mortality. The key part of their strategy was the implementation of instruction and supervision through public health nurses. Notably, many of these nurses were African American, and they approached midwife regulation and public health care in a way that addressed not only inadequate systems of care, but the entrenched racism that was present in most aspects of public health intervention