Mary Breckinridge (1881-1965) and the Frontier Nursing Service

Profiles in Nursing

Mary Breckinridge (1881-1965) and the Frontier Nursing Service

Midwives on horseback

By Elizabeth Hanink, RN, BSN, PHN
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An aristocratic woman who found her calling in nursing, Mary Breckinridge established Kentucky’s pioneering Frontier Nursing Service and today is known as the founder of American nurse-midwifery.

Mary Breckinridge was born in Memphis, Tenn., to one of America’s most illustrious families. Her father, Clifton Breckinridge, served in Congress and as the U.S. ambassador to the court of Tsar Nicholas II of Russia. Her childhood included travel, private tutors and finishing school. When she was 23, Breckinridge moved to Arkansas and married a prominent lawyer, but he succumbed to appendicitis only two years later. Afterwards, she worked for a time in a settlement school in North Carolina, where she witnessed the death of a child with typhoid fever. The experience inspired her to become a nurse.   

After graduating from New York’s St. Luke Hospital School of Nursing in 1910, she worked for a time as a nurse, but then returned to Arkansas and remarried. Her marriage was strained by the deaths of the couple’s two young children and in 1920, she divorced her husband, reclaimed her maiden name and immersed herself in nursing and service.

In 1919, Breckinridge had traveled to Europe with the American Committee for Devastated France, where she administered a much-admired visiting nurse service for a district of 72 small villages. Breckinridge had long been interested in child welfare and her time in Europe introduced her to the work of British midwives.

Although professional nurse-midwifery was not practiced in the U.S. at the time, she concluded that the profession could provide valuable assistance for women and children in impoverished rural America. Since no school in the United States then offered midwifery training, Breckinridge studied in London and obtained certification from the U.K.’s Central Midwives Board. She also studied public health at Columbia University.

In 1925, Breckinridge established the Frontier Nursing Service (FNS) to provide professional nursing care to residents of Appalachian Kentucky, one of the poorest and most medically underserved areas in the country. She chose Kentucky in part because she knew her family’s prominence in the South would help her find funding, but she also decided that if she could succeed in the bleak, hilly terrain of Appalachia, her ideas could succeed anywhere.

In a 1927, Breckinridge wrote an article for the American Journal of Public Health extolling the importance of supporting rural mothers and combating maternal mortality. Thanks to the efforts of FNS nurse-midwives, the maternal mortality rate in Appalachia, which had been among the highest in the country, dropped well below the national average. That feat was accomplished through the combination of a decentralized nursing service that visited clients in their homes, a collection of district nursing centers and a hospital serving an area of 700 square miles.

FNS nurses spent much time on horseback; house calls often required many hours in the saddle. Breckenridge herself would ride half a day to reach a center, spend half a day there reviewing cases with the resident nurse and then ride on to the next center. Clients’ houses rarely had telephone service and frequently had no electricity or even running water.

The service, which was established using Breckinridge’s own money, received no government funding until the ‘60s, instead relying on private donations and later the income from Breckinridge’s 1952 book, Wide Neighborhoods. “Rarely have we had money even one month ahead,” she wrote. Nonetheless, no client was turned away for inability to pay and nurses often accepted payment in goods rather than cash.

Early on, FNS nurses had to travel to England for midwifery training, but in 1939, Breckinridge established the Frontier Graduate School of Midwifery. Today, the school is known as Frontier Nursing University.

Although she later suffered a serious fall from a horse and had to use a brace, Breckinridge continued as head of the FNS until her death in 1965. She had a forceful personality and was an excellent organizer, but her work was often shaped by her reactionary attitudes about race and class, including her strong belief in eugenics.

Nonetheless, the service she founded has an impressive legacy of cost-effective rural healthcare that continues to this day. For her work, she was inducted in 1982 into the American Nurses Association Hall of Fame. 

Photo above: Mary Breckinridge commuting to work in 1933. She often spent hours riding to appointments in rural Kentucky. The rocky, rugged terrain made horseback the most efficient form of travel. Photo: Marvin Breckinridge




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