The medicalization of fertility and infertility, pregnancy, abortion, contraception, childbirth, and postpartum care has not always worked in the interests of women. It has had particularly devastating effects on African‐American women. Their fertility has been managed for hundreds of years, first as slaves forced to have children for owners, then as objects to be experimented on without anesthetics, and finally as mothers sterilized without their consent. The relatively high rates of infant and maternal mortality, along with limited access to safe and high‐quality reproductive services, are continuing signs of such devastation. This article discusses the history and consequences of the medicalization of pregnancy, contraception, and abortion in America. Attention is drawn to the ways in which the profession of medicine took control away from midwives, the traditional birth attendants and pregnancy caregivers, and the particular consequences for African‐American women. Ultimately, we posit that greater access to midwifery care could lower infant and maternal mortality rates and improve reproductive services. The reintroduction of spirituality through midwifery would also restore the important role of “wise women” in supporting women, babies, and communities.