From colonial days up until the early 1920’s, more women in the United States died in childbirth than all of the men in the United States that had died in wars during that same time period. The average maternal death rate was 600 women per 100,000 births in the US. In some remote, rural areas that number was higher. Eastern Kentucky's figures were closer to 800 maternal deaths per 100,000 births. Of those live births, 100 of 1000 infants died before their first birthday. One woman recognized that these staggering numbers translated into suffering of the most acute kind and decided to do something to help.
Mary Carson Breckinridge was one of four children born to a prominent and political family in Memphis, Tennessee. Her grandfather, John C. Breckinridge, was the vice president to James Buchanan. Her father, Clifton Rodes Breckinridge, was a congressman and the US Minister to Russia. Her father’s work took the family throughout the eastern United States, Switzerland and St. Petersburg, Russia. Mary developed an appreciation of different cultures during her many moves. In Washington, DC and St. Petersburg, Russia, Mary was educated by private tutors. She later attended a boarding school in Switzerland and a finishing school in Connecticut. Seeing Mary's aptitude for learning and fearing Mary would follow the lead of a female cousin who embarked on a career path rather than the traditional family path, Mary’s mother strongly dissuaded her from going to college.
In 1904, Mary married a promising lawyer named Henry Ruffner Morrison, and they resided in Arkansas. Their union was said to be a happy one. Tragically, Henry died two years later from appendicitis. As a self determining widow and no longer under her mother's influence, Mary enrolled in St. Luke’s Nursing School in New York City and graduated with a nursing degree in 1910.
After graduation Mary returned to Arkansas and in 1912, married Richard Ryan Thompson. They had two children together, Clifford Breckinridge “Breckie” Thompson and Mary “Polly” Breckinridge Thompson. Polly was delivered prematurely and died within hours of birth. Breckie died two years later at the age of four from appendicitis. During this time, Mary discovered that Richard had been unfaithful to her on several occasions. Without delay, Mary initiated divorce proceedings and when the divorce was final in 1920, she legally changed her name back to Breckinridge.
Grief stricken, anguished and betrayed, Mary put her energy into caring for others. She volunteered for wartime duty with the American Red Cross and was later assigned to the American Committee for Devastated France. In France, Mary worked with pregnant women and infants as the director of Child Hygiene and District Nursing. Upon discovering that the French and British used trained midwives to deliver babies in rural areas and that healthcare outposts in France met the healthcare needs of those living outside of towns, Mary began to envision her true vocation.
"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." Mary wanted to provide all inclusive, culturally sensitive and safe healthcare, nursing and midwifery services to an area that was poorer and more primitive than many third world countries… the Appalachia region of eastern Kentucky.
Eastern Kentucky was remote, mountainous and had few roads in the early 1900’s. Many homes were isolated shacks with no electricity, heating or plumbing. Healthcare services to the area were generally not available. Mary canvassed this area on horseback and interviewed families to see what was in place and what was needed to meet healthcare standards. She found that physicians on the ground were scarce, women gave birth to approximately 9 children over their childbearing years and these women had no prenatal care. Pregnant mountain women relied upon illiterate “granny women” as midwives. Birthing skills were handed down through generations and often had much folklore and superstition attached to them. Hygiene was minimal, techniques were crude and invasive and many women died of childbed fever.
In order to help the families in this impoverished and vast region, Mary realized she first needed to study Public Health at Columbia University in New York to gather the knowledge and skills to undertake this venture and to learn how to garner support from outside sources. From there she went to London, England and enrolled in a school of midwifery. In 1924, after graduating from midwifery school, she traveled to Hebrides, Scotland to study their models of health services and midwifery to remote areas. Then in 1925, after using her familial, political and educational connections to raise a substantial amount of money, Mary returned to Kentucky and began the Kentucky Committee for Mothers and Babies.
Recruiting nurse midwives from Britain was Mary’s first order of business, teaching them to ride horses was her second. The area the nurses covered was 700 square miles with over 10,000 inhabitants. Because there were so few roads in the mountains, the midwives often made their way to homes by means of animal trails. The harsh weather conditions of the colder months and the need to cross rivers and steep ravines made travel treacherous.
The committee provided two educated midwives per outpost district, all within a one hour ride on horseback. The nurses discovered very quickly that they had to provide healthcare for the whole family, not just mothers and infants. So the Kentucky Committee of Mothers and Babies was renamed Frontier Nursing Services (FNS).
The nurses made rounds, introducing themselves to households and encouraging prenatal care which Mary believed was integral for a child’s long term health. When babies were delivered, the nurses stayed with the women for two days after the birth to provide support and care. Services were provided to families no matter their income or ability to pay. The families often traded goods, food and services as compensation for the nursing care they received.
Through Mary’s vision and efforts, the maternal mortality rate dipped significantly below the nation’s average. In its first fifty years, Frontier Nursing Services delivered 17,053 newborns and saw only 11 maternal deaths.… which translates to about 64 maternal deaths per 100,000 births. Recall that the statistics for the area were 800 maternal deaths per 100,000 before the intervention of the FNS.
Mary started the Frontier Graduate School of Midwifery in 1939 and it remained under her direction until her death in 1965. Known today as The Frontier Nursing University, the graduate school provides Masters and PhD level degrees in healthcare specialties including Family Nurse Practitioner, Women’s Healthcare Nurse Practitioner and Nurse Midwifery.
The Frontier Nursing Service still provides healthcare and midwifery services to southeastern Kentucky. On her deathbed Mary stated, “the glorious thing about it (the FNS) ... is that it has worked!” Through Mary Breckinridge’s act of heart and willingness to do difficult things, she transformed her personal suffering over the loss of her children into a legacy of service to others and education.
A few current statistics...
In 2015, the number of maternal deaths in the US was 26 per 100,000 births, up from 19 maternal deaths per 100,000 in 1990. California had the lowest numbers at 4 maternal deaths per 100,000 and Louisiana had the highest numbers at 58.1 maternal deaths per 100,000.
Questions to ponder while letting Mary’s story sink into your depths…
Mary was in her late 30’s after both of her children had died and her divorce was final. It took her about 7 years to get the experience, education and funds she needed to begin her life’s work. Which wise woman traits do you think helped her to stay on track and gather the energy she needed to accomplish her goals?
It is sometimes known as collateral beauty… the beauty that emerges from a great loss or tragedy. How many of us have been through a personal loss that has inspired our calling or perhaps simply inspired a humanitarian act?
So many of Mary’s accomplishments came from needs she identified within the community and historical events that required some action. In 1939, when WWII was mounting in Europe, the FNS British midwives returned home to be with their families. At that point Mary needed to train more midwives and so she established the nursing school. Looking back over the arc of your lives, when has your ingenuity been the result of a necessity? How did you rise to the occasion to fill the need? What is occurring today that requires your unique contribution?
For more information On Mary Breckinridge’s extraordinary life click on the links below or consider reading her autobiography.
Wide Neighborhoods: A Story of the Frontier Nursing Service
by Mary C. Breckinridge, published 1952
https://www.cbsnews.com/news/best-and-worst-states-to-give-birth-usa-today-investigation/