Mary Carson Breckinridge (1881 – 1965) overcame personal and professional hardships to become one of the principal founders of organized, modern midwifery in the United States. Born in Memphis to a prosperous and politically well-connected family (her grandfather — Kentucky’s John Cabell Breckinridge — was Buchanan’s vice president), Mary’s parents discouraged her from pursuing a formal education or profession.
It wasn’t until she became a widow at age 26 (Breckinridge had also lost both of her children at an early age), that she turned to nursing. She became a registered nurse in 1910 at St. Luke’s Hospital in New York, eventually working in the slums of Washington D.C., supervising nurses there during the 1918 influenza epidemic.
After Washington, Breckinridge worked in the tenements of Boston, where she completed a short, intensive course in baby welfare work at the Boston Instructive District Nursing Association. In 1919, at the end of World War I, Breckinridge moved to France, organizing a visiting nurse program through her work with American Committee for Devastated France, a small, post-war group of American women volunteers.
She credited her time in war-torn Europe with inspiring her to bring new healthcare ideas back home. As she described it, “After I had met British nurse-midwives, first in France and then on my visits to London, it grew upon me that nurse-midwifery was the logical response to the needs of the young child in rural America…. My work would be for them.”
With this goal in mind, Breckinridge returned to New York after France, studying public health nursing at Columbia University with an eye on establishing herself and her ideas in eastern Kentucky. She reasoned that if her plans to introduce modern midwife practices succeeded in such a poor, inaccessible area — a region with few roads and no physicians — then they could work anywhere.
She spent the summer of 1923 riding horseback over 650 miles through the hills of Kentucky to survey lay midwives in the region. She found that women lacked prenatal care and gave birth to an average of nine children, primarily attended by self-taught lay midwives, farmers’ wives who relied on folklore and invasive practices. High maternal mortality among mountain women led Breckinridge to understand that children’s healthcare should begin in the prenatal period, focusing on birth and a child’s first years.
Breckinridge continued to gather the latest, best practices in midwifery, including her own studies in London and Scotland. As a result, she created the non-profit Kentucky Committee for Mothers and Babies, which later became the highly-regarded Frontier Nursing Service (FNS) in 1925, treating families in a 700-square mile area in the Appalachians of eastern Kentucky.
Still based in Hyden, Kentucky, the FNS currently operates a hospital, four rural health clinics, a home health agency, and the FNS School of Midwifery and Family Nursing. People from around the world come to Leslie County to study this model of rural health and social service delivery.
At Mary Breckinridge’s death in 1965, FNS had treated nearly 58,000 patients and delivered over 14,500 babies, with only 11 maternal deaths. I hope there’s a writer or filmmaker — or nurse! — who is as in awe of Mary Carson Breckinridge as I am!