Brown physician salutes Mary Breckinridge and her "indomitable nurse-midwives"

January 23, 2006 -- Today the Providence Journal ran a glowing profile of nurse-midwife Mary Breckinridge by Stanley M. Aronson, MD, dean of medicine emeritus at Brown University. The piece, "Kentucky's intrepid nurses on horseback," gets off to a bit of a slow start, with detail about Breckinridge's ancestors' Scottish roots. But we soon hear about many of the key elements of Breckinridge's globally influential work in founding and leading the Frontier Nursing Service, which has provided skilled, life-saving care to poor mothers and children in rural areas since 1925. The final line of the piece notes that today, fourth-year Brown medical students "may spend up to three months in rural service supervised by these indomitable nurse-midwives." We thank Dr. Aronson and the Providence Journal for this valuable profile of a true nursing pioneer. For more on Mary Breckinridge and FNS, see the Center's 2003 online profile, which makes some remarkably similar points, and lists materials for further reading.

Dr. Aronson begins with a discussion of the Scottish town of Brechin, where Breckinridge's ancestors resided before setting out for the New World in the early 18th century, arriving in Kentucky, and achieving prominent political positions. Scotland would ultimately play a role in Breckinridge's health innovations, but this initial focus may reduce somewhat the number of readers who stick with it to learn about Breckinridge's work. Mary, born in 1881, appears in the third paragraph. Then we hear about her privileged upbringing in the U.S. and Europe. After her first husband died of acute appendicitis when she was 25, Mary went to nursing school in New York, becoming a registered nurse in 1910. She married again and had two childen, but sadly, both died young of infectious diseases. She "devoted the remainder of her life to the nursing care of women and children." While serving with U.S. troops in France during World War I, Breckinridge met highly skilled British nurse-midwives, and came to feel that "nurse-midwifery was the logical response to the needs of the young child in rural America." After the war, Breckinridge studied public health nursing at Columbia in New York.

Aronson notes that Breckenridge then went to Kentucky to "confront the formidable health problems of this rural, mountainous region. Eastern Kentucky was then an impoverished territory, with few roads, no licensed physicians, and no hospitals." The area was inaccessible to cars, so she rode on horseback or hiked through the region, finding that "most Appalachian women lacked prenatal care and were delivered by self-taught local midwives." (Presumably he means that the babies, rather than their full-grown mothers, were delivered by lay midwives.) The hill country women averaged nine children, and the children lacked good quality neonatal and pediatric care. Fathers, most of whom worked in coal mines, suffered from tuberculosis, malnutrition and alcoholism. Breckinridge studied nurse-midwifery in London. In Scotland, she observed a "decentralized community midwifery system" that provided most maternal and neonatal care in the rural Highlands.

Aronson explains that back in Kentucky, adapting the Scottish model, Breckinridge founded the Frontier Nursing Service (FNS) in 1925. At its core were nurses who would visit families on horseback, providing maternity and pediatric services for a vast part of rural southeastern Kentucky. (And here we were thinking, based on all the recent mainstream press for the Nurse-Family Partnership, that nurses' rural home visits were started by a clinical psychologist in 1978.) Using her connections, Breckinridge raised millions of dollars and built a hospital in Wendover. FNS charged a $2 annual fee, "to be paid in cash or groceries." Aronson notes that the "nurses on horseback" achieved maternal and infant survival rates rivaling the impressive rates of the cities of western Kentucky, recording only 11 maternal deaths in 17,053 deliveries in the first 50 years of FNS. He states that Breckinridge also established the first U.S. school of nurse-midwifery in Kentucky 1939; actually we believe another FNS nurse started the first such school in New York in 1932, but that the Kentucky school is the oldest continually operated one. Breckinridge led FNS until her death in 1965.

Today, Aronson notes, "sturdy SUVs have replaced the horses." There is an "elegant" FNS hospital, and four regional maternity health centers. Aronson concludes: "Nurses and public-health officials from other countries regularly travel to Wendover, to learn how to design rural-district health centers. And fourth-year medical students at Brown University may spend up to three months in rural service supervised by these indomitable nurse-midwives."

On the whole, this is an impressive tribute, capturing the essence of Breckinridge's major achievements and influence on public health. Dr. Aronson might have added that FNS staff also started the American Association of Nurse-Midwives, a precursor to the American Academy of Nurse-Midwives. And he might have noted that nurse-midwifery has grown to be a huge positive force in maternal and child health in every corner of the U.S., with well over 13,000 nurse-midwives (most of them masters-prepared) practicing as of early 2004, providing care that research has shown is as good as that provided by physicians. In any case, it's not every day that we find a prominent physician making a real effort to publicly recognize the community-oriented achievements of a great nursing leader. Dr. Aronson's pointed end note about Brown medical students training with the nurse-midwives shows the piece's primarily lay audience that nurses are skilled health professionals with things to teach Ivy League medical students. This is not a message that will be familiar to readers raised on a steady diet of Hollywood programming and the mainstream news media.

We commend Dr. Aronson and the Providence Journal for this valuable profile.

See the article "Kentucky's intrepid nurses on horseback" by Stanley Aronson in the January 23, 2006 edition of the Providence Journal.