In December 1951, LIFE published one of the most extraordinary photo essays ever to appear in the magazine. Across a dozen pages, and featuring more than 20 of the great W. Eugene Smith' pictures, the story of a tireless South Carolina nurse and midwife named Maude Callen opened a window on a world that, surely, countless LIFE readers had never seen — and, perhaps, had never even imagined. Working in the rural South in the 1950s, in "an area of some 400 square miles veined with muddy roads," as LIFE put it, Callen served as "doctor, dietician, psychologist, bail-goer and friend" to thousands of poor (most of them desperately poor) patients — only two percent of whom were white.
Calling Maude Callen a heroic figure — especially today, when the word "hero" is thrown around like confetti — might strike some as problematic. She was, after all, not really risking her life in her daily and nightly rounds. But how else should we characterize a woman who saved so many others through her work, and who firmly, compassionately delivered into the world so many children who, without her intervention, might well have died at or shortly after birth? What else do we call someone who dedicated seemingly every waking moment to helping others — in a time and place where pain and want were the rule, rather than the exception?
The article in LIFE, titled simply "Nurse Midwife," that chronicled Callen's work and her unique role in her community is a companion piece, of sorts, to Smith's 1948 essay, "Country Doctor." Spending time with the two essays, one gets the sense that Maude Callen and Dr. Ernest Ceriani of Kremmling, Colorado — while physically separated by thousands of miles, as well as by the even broader, thornier barrier of race -— would not only understand one another, on an elemental level, but that each would recognize something utterly familiar in the other. Their lives and the landscapes they navigated might have been as different, in critical ways, as one can possibly imagine; but in the essentials, they were kindred spirits. They were healers.
Here, LIFE.com presents "Nurse Midwife" in its entirety, as well as images that Smith shot for the story but that were never published in LIFE.
The story in LIFE began this way, setting the stage for what one reader called, echoing the numerous awe-struck letters to the editor published in a later issue, "one of the greatest pieces of photojournalism I have seen in years":
Some weeks ago in the South Carolina village of Pineville, in Berkeley County on the edge of Hell Hole Swamp, the time arrived for Alice Cooper to have a baby and she sent fr the midwife. At first it seemed that everything was all right, but soon the midwife noticed signs of trouble. Hastily she sent for a woman name Maude Callen to come and take over.
After Maude Callen arrived at 6 p.m., Alie Cooper's labor grew more severe. It lasted through the night until dawn. But at the end she was safely delivered of a healthy son. The new midwife had succeeded in a situation where the fast-disappearing "granny" midwife of the South, armed with superstition and a pair of rusty scissors, might have killed both mother and child.
Maude Callen is a member of a unique group, the nurse midwife. Although there are perhaps 20,000 common midwives practicing, trained nurse midwives are rare. There are only nine in South Carolina, 300 in the nation. Their education includes the full course required of all registered nurses, training in public heath and at least six months' classes in obstetrics.
Maude Callen has delivered countless babies in her career, but obstetrics is only part of her work... To those who think that a middle-aged Negro [sic] without a medical degree has no business meddling in affairs such as these, Dr. William Fishburne, director of the Berkeley County health department, has a ready answer. When he was asked whether he thought Maude Callen could be spared to do some teaching for the state board of health, he replied, "If you have to take her, I can only ask you to join me in prayer for the people left here."
For W. Eugene Smith, work mattered. Throughout his legendary career, he sought out and chronicled the lives and the labor of people who knew their craft. Whether he was photographing a world figure like Dr. Albert Schweitzer in Africa or anonymous Welsh coal miners; a doctor in the Rockies or a midwife in South Carolina; Smith saw something noble in hard work, and something profoundly admirable in men and women who cared enough to do their work well.
But one would be hard-pressed to find anyone who ever appeared in LIFE's pages whose humble and necessary work merited more admiration than that of the unforgettable, unbreakable nurse midwife of Smith's 1951 photo essay. After the piece was published, LIFE subscribers from all over the country sent donations, large and small, to help Mrs. Callen in what one reader called "her magnificent endeavor." Thousands of dollars poured in — sometimes in pennies and nickels, sometimes more — until, as LIFE later reported, she was overwhelmed by the response.
"Halfway through a recent day's mail, [Mrs. Callen] said to her husband: 'I'm too tired and happy to read more tonight. I just want to sit here and be thankful.'"
Eventually, more than $20,000 in donations helped to build a clinic in Pineville, where Mrs. Callen worked until her retirement in 1971.
In later years, Maude Callen was still (rightfully) being celebrated for her life's work. She was honored with the Alexis de Tocqueville Society Award in 1984 for six decades of service to her community, and in 1989 the Medical University of South Carolina (MUSC) awarded her an honorary degree, while the MUSC College of Nursing created a scholarship in her name.
Maude Callen died in 1990 at the age of 91 in Pineville, South Carolina, where she had lived, and served, for seven decades.
Liz Ronk, who edited this gallery, is the Photo Editor for LIFE.com. Follow her on Twitter @lizabethronk.
From photo essay to photo book
The making of The Family Imprint and lessons learned along the way
As a freelance photographer, I often feel like a one-woman show. You learn to be an extremely self-reliant, self-motivating expert in PR and marketing—truly a jack-of-all-trades. You have to be all of these things to survive in this industry because no one will advocate for you and your work better than you. No one will care about your story as much as you do, and your passion and drive will amplify the work as long as you are willing, able and brave enough to share it. This became very clear to me as I worked on my Cancer Family project, which later became known as A Life in Death and (to make things more confusing), ultimately published as a book called The Family Imprint. (Note-to-self: Choose one title and stick to it, as it will avoid some unnecessary confusion down the road).
Publishing a book is no small feat. Looking back now, book in hand, I realize how naïve I was about how much work it would be, how much money it would cost, and how rewarding it would all be in the end. I hope that by sharing my experience and the lessons I learned along the way, I will de-mystify the process a bit and save others from coming up against similar hurdles in the journey of producing a book.
(It is important to note that many of my earlier steps were taken while I was planning to self-publish my book. Later on in the process, however, I decided to approach, and ultimately work with a publisher because I realized I wanted a partner. I will speak about this later on).
So I will start by asking you three questions:
- Why do you want to make a book?
- Can you make a book?
- Who will care about your story and will they want to own the book?
Before sprinting full-speed down this unfamiliar book path, I asked myself the above three questions because I knew I needed to manage my own expectations and be smart about a decision this huge.
Why do I want to make a book?
I knew I wanted to make a book for my family, to honor and remember my parents and the lives we shared together. Secondly, ever since they passed away, I felt a responsibility to continue to share their story—our story—in a purposeful way to hopefully help others in similar situations. The story, in book form, could be a tool others could use to better understand their own experiences. Maybe it could even inspire others to document and engage with their loved ones and face their fears the way I tried to do. I knew that a book required important things like time and money, but I could not have imagined exactly how much of both I would need. (I will revisit this later.)
Can I make a book?
I had to figure out if my story really made sense as a book. Did I have enough content? Was a book the right medium to communicate the content I had? Someone once told me that there are certain projects that may not make sense in a book form, no matter how beautiful or important they may be. I had to ask myself, “What does this book bring to the table that all of the previous publications of the work could not?”
Who will care about my story and will they want to own the book?
Finally, when it comes to publishing a book, as photographers we have to put on our businesswoman hats and think about our audience. Books are expensive, so it is important to strategize and think about the end game. For me and my story, the obvious audience was the photography market, but I was encouraged to think outside the box for a much broader and diverse audience. (Thank you, Frank Meo!) I did this by looking at some of the themes my book touched on: health, family, care-giving, relationships, and cancer, just to name a few. By considering those themes, suddenly my potential audience grew ten-fold and I could not have predicted the types of opportunities and connections that would develop as a result of this slight perspective shift.
So, you’ve decided to make a book. Now what?
My next step was to visualize what I wanted this book to look like. Maybe it seems obvious, but at this point, I had only a theorized concept. It was time to start making moves.
As with all projects, it is important to know what else is out there so you can know what options are available. You don’t know what you don’t know, so seeing examples of how others have worked before you can be insightful and inspiring. The book world speaks in its own language, just as the photography world does, so research and education are vital. By flipping through the pages of dozens of photography (and non-photography) books, I quickly learned what I liked—and what I didn’t, and made many notes along the way.
I began to think about narrative, editing styles, and use of text. From there, I began to envision and create my first dummy. I knew I wanted to weave old family photographs and found family objects in and around my images, and asking someone to “visualize” this book with these concepts proved difficult without a physical example to show. I made this mistake, and learned from it, after meeting with a big publisher. I showed him my photo essay and asked him to “imagine” what the book could be (yikes)! After this, I bought a simple scrapbook and printed 800 of my selected photographs on 4x6 photo paper at the local pharmacy, including some with fake text to use as place holders. I didn’t have the whole thing planned out yet, but I could start to play with ideas and put something down on paper to get the ball rolling.
Once you have a dummy of some kind, the next step is to share it with those whose opinions you trust. Feedback is key, but always take advice with a grain of salt, or you will lose sight of your personal perspective and end goals. I owe an enormous amount of gratitude to the many people who offered me advice and guidance along the way, helping me to avoid mistakes and make smart decisions. (Special thanks to Alison Morley for her genius editing and generous patience).
During this time, I made a lot of lists. Keeping yourself organized is so important as there will be many balls in the air at the same time during this process. Here are some of the next steps I took, and key things to think about, when moving forward at this point:
- Make a timeline: Start from book dummy and go all the way to published book. One of the most useful resources for me was the book Publish Your Photography Book by Darius Himes and Mary Virginia Swanson.
- Build a team: Put together a good team of people you trust, including a designer, editor, social media guru, etc.
- Gather your resources: Think about resources you have at your disposal, such as other photographers you may know (or don’t) who have published books. Ask them what they would have done differently or about mistakes they made.
- Create a budget: Create a checklist and crowd-source information from others about some of the potential and unexpected costs involved in a book, such as printing (estimate from printer, match prints, proofs), shipping (postage, shipping materials, labels, taxes), labor (design, editing), and promotion (mailers, exhibit prints).
- Consider your funding options: Decide how you plan to raise money for the project. Whether you are self-publishing or working with an established publisher, you will most likely need to bring some of the capital to the table. This will allow you a seat at this table, however, should you choose to go that route. There are a few different routes you can take, and mine included crowd-funding with Kickstarter and later partnering with publisher Hatje Cantz. Some other partners to consider are organizations and universities (and their respective presses).
- Decide the size of the print run you are planning: I decided to use my Kickstarter funds to pre-order copies of the books, which would greatly subsidize the cost of the overall production, thus allowing us to raise the print run to a larger number. Some photographer-authors want small runs so their book will be more exclusive and limited, but I was the opposite. I felt that the more books out there and available, the more opportunities it would have to share the story, help others and offer a sense of community and understanding for those who may need it.
- Plan for promotion: Consider different types of media outlets for promotion of the book. I approached some to help highlight my crowd-funding campaign and saved others for when the book was actually finished and available for purchase.
Once my funding goals were complete, however, I stood at a crossroads: proceed forward as planned and self-publish or seek out a partner. I called some friends who had previously self-published books and asked them what their biggest regrets were. The main complaint: distribution. Distribution of one’s book is possible when self-publishing, but I was warned of the enormity of the task and decided that instead of reinventing the wheel and spending the next decade shipping books out of my garage, it might make sense to find a partner who already had a well-oiled machine in motion. After all, I am a photographer and I was eager to get back to shooting and working on projects.
Once I decided to take the publisher path, I had some new things to consider:
- What type of publisher do I want to work with? Did I want one that was art-specific or a more general-themed house?
- Is a big or small publisher best for me? Alarge house haswide distribution, but less one-on-one attention, whereas a small house will havemore personalized attention, butnarrower distribution.
- What is the demographic of the intended audience? Do I want to go international or domestic? Some books may be stronger with certain demographics over others depending on the subject matter and other factors.
- What is my publisher’s reputation? Talk to other authors who have worked with these publishers to get a better idea of what to expect if you choose to work with them.
It is important for me to note that I did not go down this path alone. I decided to hire a book agent (the amazing Joan Brookbank) who specializes in negotiating author contracts. Through her years of experience and understanding of the business, she was able to hold onto every one of my wish list items for the book (make sure to make a wishlist of what YOU want for this book). This was an expense, however, I didn’t plan for, but knew would be imperative to the process.
The final steps in this process began to take shape soon after a contract was agreed upon and signed. Text was edited (and edited some more), match prints were perfected and sent off to the printer (Thank you Carl Saytor at Lux Labs), and proofs flew back and forth (and back again) around the world. Did I mention that my designer Bonnie Briant is in New York City, my publisher Hatje Cantz is in Germany and I live on the tiny Pacific island of Guam? Bless you, Wi-Fi!
From concept to completion, this book took a year and a half to complete. Early in this process, I envisioned a much shorter timeline. Luckily I ran into my dear friend Laura Roumanos of United Photo Industries who reminded me of the importance of slowing down, taking my time, and making thoughtful decisions, ones I will be okay with for years to come. By heeding her advice, mistakes were caught, important changes were made and I could not be more proud of the end result.