Book Report: The Frontier Nursing Service

“There was a time when the average American woman was more likely to die from childbirth than from any other condition except tuberculosis,” reads the intro to The Frontier Nursing Service: America’s First Rural Nurse-Midwife Service and School (McFarland & Co., 2008) by Hendersonville-based writer Marie Bartlett. The story that follows is an account—culled from reports, surveys, newspaper clippings, magazine articles and oral histories—of Mary Breckinridge, the intrepid health care provider who founded the The Frontier Nursing Service (FNS) in rural Kentucky. She single-handedly lowering one of the nation’s highest maternal mortality rates to one of the country’s lowest.

If this seems a dry subject, Bartlett—who did much of the research at the FNS headquarters (today the “Big House,” or original FNS building, is both a National Historic Site and a Bed and Breakfast) and even stayed in Breckinridge’s room—manages an admirable balance of documentation and story telling. The book is equal parts collegiate and folksy, with plenty of interesting black and white photos of the nursing staff making their way to patients on horseback through rushing rivers.

Breckinridge was born to a wealthy family in Tennessee. However, through a Kentucky-born grandmother she developed a soft-spot for that state. After losing two young children—one to illness, the other to complications from a premature birth—s split from her husband and decided to devote her life to service. “By 1920, she was in France assisting villagers through the American Committee for Devastated France. Her role was to serve as director of child hygiene and educate villagers on public health issues.” During that time, she encountered European midwives who solidified, for her, a belief in that means of healthcare. Returning to the U.S., she studied public health nursing at Columbia Teachers College.

Extensive surveys into the health of Kentucky’s children in a three-county area, along with studies of the “granny midwives” of the area and “the intelligence level of the local children compared to those outside the region.” The information gathered led to the first steps toward Leslie County gaining a field nursing center. FNS opened in 1925.

After the stock market crash of 1929, when the rest of the country was already reeling, the rural counties of Kentucky were especially hard hit. Frontier recounts the hard times: “Roe Davidson, a Leslie County farmer and coal miner, recalls a period in Hyden during the early 1930s when dry goods were carefully rationed and food was so scarce, ‘you couldn’t maintain a breadline.’ ‘At the store, where there was no credit, they wouldn’t let you have a whole bag of meal, a whole can of lard, or a bag of sugar. It was divided up among everyone…’”

Frontier is meticulously researched and information-heavy, but it also turns up plenty of stories. “Up ahead at the cabin where she was scheduled to deliver a baby, [Betty] Lester arrived to find a neighbor, Sue, waiting on the porch to assist her. She was staring at the nurse’s approaching form. ‘You come by that holler alone?’ the woman asked, incredulous. Lester tied her horse to the post and stepped up on the porch.  ‘Why, of course,’ she said, ‘Why not?’ ‘Don’t you know it’s haunted,’ Sue said. ‘A man was killed there three years ago and if you pass close by you can still here him moaning.’”

Breckinridge died in 1965, in her eighties. Within a decade of her passing, government programs had moved into the rural communities replacing the midwife service. Still, Frontier captures an important piece of history and recounts the brave women who served those in need.

Marie Bartlett and actress and storyteller RoseLynn Katz present The Frontier Nursing Service at Malaprop’s on Thursday, Feb. 26. The 7 p.m. events is free. Info: 254-6734.

—Alli Marshall, A&E reporter