The Medical Mission
Mary Breckinridge

In the early 1900’s in many rural areas around the world, there was no access to maternal health care. Women gave birth to their children at home, often in a chair with the bottom cut out. Untrained midwives, neighbors, or older daughters assisted. For every 100,000 births, over 800 resulted in maternal death. All of that changed dramatically beginning in 1925 with the establishment of the Frontier Nursing Service in Leslie County, KY, a professional nurse/midwifery and family health service, founded by Mary Breckinridge, R.N.

Mary Breckinridge was born on February 17, 1881 in Memphis, TN of an aristocratic southern family. She was the granddaughter of John Breckinridge who served as the Vice President of the United States under President James Buchanan and was later a General for the Confederate Army and Secretary of War for the Confederate States, and the daughter of the United States Ambassador to Russia under President Grover Cleveland. She was educated by private tutors and traveled extensively with her parents abroad, and became acquainted with many cultures and lifestyles. She was a skilled horsewoman from early childhood.

Her early adulthood was marked by the loss of her first husband by age 26 and the death during her second marriage of two children under the age of five, Breckie and Polly to whom the FNS is dedicated. Left with her grief and only a desire to serve humanity, Breckinridge became a registered nurse in 1910 at St. Luke’s Hospital in New York City, and served in war-torn France following the First World War “After I had met British Nurse-Midwives first in France and then on my visits to London,” she often said, “it grew upon me that nurse-midwifery was the logical response to needs of the young child in rural America.”

Mrs. Breckinridge became a graduate Nurse-Midwife at the British Hospital for Mothers and Babies in London and spent time at the Highlands and Islands Medical and Nursing Service of Scotland to observe the kind of decentralized health care that would become the model for the FNS. Following that, she studied Public Health Nursing at Columbia University.

At an approximate age of 40, she formulated two goals: 1) to improve the health of rural women and children in the U.S., 2) to pioneer a system of rural maternal healthcare that could serve as a model for remote regions of the world.

She chose eastern Kentucky for her demonstration nursing mission project. In the summer of 1923, traveling on horseback with one companion, she initiated a study of the health needs of people in Leslie, Clay, Harlan, and Perry counties. Traveling over 700 miles interviewing families and lay midwives, she found that women lacked prenatal health care and gave birth to an average of nine children. There were high rates of maternal mortality and she came to believe that children’s healthcare must begin before birth with care of the mother, and follow that care throughout childhood with care of the whole family.

The Frontier Nursing Service was established in 1925 as a private charitable organization serving an area of approximately 700 square miles in southeastern Kentucky. It was the first organization in America to use nurses trained as midwives under the direction of a single medical doctor/obstetrician, based at their small hospital in Hyden. Women considered to be at great risk during their pregnancy would be brought to the hospital for delivery. Using the Scottish Highland concept, the nurses were also expected to serve as public health nurses. Originally the staff was composed of nurse-midwives trained in England. They traveled on horseback and on foot to provide quality prenatal and childbirth care in the clients’ own homes. The service charged $2.00 per year for family medical care and $5.00 for prenatal care and delivery, payable in eggs, meat, service, or cash. No one was ever turned away.

As the Frontier Nursing Service grew, Breckinridge became an unstoppable fundraiser. Through her influential connections and speaking engagements, Mary Breckinridge raised over six million dollars for the FNS. In its first eighty years, over 25,000 babies were born with fewer than 25 maternal deaths. Infant and maternal death rates are consistently lower than the best American hospitals. Over 1600 nurse/midwives have been trained. An FNS trained nurse-midwife founded the first American school of Midwifery in New York City in 1932, and the FNS founded its own school in Hyden, Kentucky in 1939. Mrs. Breckinridge directed the FNS until her death in 1965.

Today her legacy extends far beyond eastern Kentucky. Her concept of natural childbirth with a nurse-midwife in attendance has become a standard procedure in large cities across America, often preferred by affluent women. The Frontier School of Midwifery and Family Nursing now offers a Master of Science in Nursing degree with tracks as a nurse-midwife, family nurse practitioner and women’s health nurse practitioner. Nurses trained in these programs carry their nursing skills around the world. Mary Breckinridge’s dream has materialized beyond her imagination.