Mary Carson Breckinridge

Mary Carson Breckinridge (February 17, 1881 – May 16, 1965) was an American nurse midwife and the founder of the Frontier Nursing Service (FNS), which provided comprehensive family medical care to the mountain people of rural Kentucky. FNS served remote and impoverished areas off the road and rail system but accessible by horseback. She modeled her services on European practices and sought to professionalize American nurse-midwives to practice autonomously in homes and decentralized clinics. Although Breckinridge's work demonstrated efficacy by dramatically reducing infant and maternal mortality in Appalachia, at a comparatively low cost, her model of nurse-midwifery never took root in the United States. As the granddaughter of Vice President John C. Breckinridge, who served under President James Buchanan, and the daughter of an Arkansas congressman and U.S. Minister to Russia, Mary Breckinridge grew up in many places that included estates in Mississippi, Kentucky, and New York; seats of government in Washington, D.C., and Saint Petersburg, Russia; and schools in Lausanne, Switzerland, and Stamford, Connecticut. These political and family connections that provided international travel experiences, public speaking practice, and access to influential and wealthy benefactors willing to support philanthropic causes would enable her to raise private funds that would serve the impoverished residents of Leslie County, Kentucky. Though she did not experience the quality of education of her older brother, she was educated by private tutors in Washington, D.C., Switzerland and in St. Petersburg, Russia.

Several childhood connections and experiences made a lasting impression that helped prepare Breckinridge for a career committed to family-centered public health, and to a midwifery model of continuous care that would provide maternal and child nutrition, immunizations, prenatal care, birth support, and post-natal check ups. Breckinridge's mother disapproved of her cousin Sophonisba Breckinridge's going to Wellesley College and starting a career because it meant that she would not likely return home to live. She scheduled a comprehensive tour of Scotland's public health system. The Highlands and Islands Medical and Nursing Service would become the model on which she built the Frontier Nursing Service. The decentralized and coordinated system was funded by a combination of private enterprise and public grants. Nurses were trained in public health, district nursing, and midwifery. Breckinridge paid careful attention to the quality of local committees and the nurses' living conditions. Finally, she returned to London to the Post Certificate School as a post graduate student of midwifery to supplement her four-month certificate course. The Queen's Institute of District Nursing had a maternal death rate below 2%.

Breckinridge would be able to return to Kentucky with the formal education, practical experience, and administrative connections to create the Frontier Nursing Service. In one she mentioned how much families would benefit from goat's milk. Her mother helped to organize donors and establish a goat fund. Breckinridge wrote to thank all donors, share a story of the child they had helped, and call for additional funds for beet roots to feed the goats. The goat-giver circle widened and continued to send funds. that would send nurse-midwives around the countryside and moved toward becoming a fully generalized service, caring for all ages. The American Committee for Devastated France extended their work from the Aisne to the Reims after the British unit departed. During this time, Breckinridge envisioned the service as a demonstration project, and so she kept detailed records and data to form the basis of her organizational plans.

To fully realize a visiting nurse service, Breckinridge knew there would be a need for trained nurse-midwives like those from England. On leave from France, she toured facilities in London alongside professional nurse-midwives. She observed that the United States had trained nurses but neglected midwifery; that France trained midwives but overlooked nurse training; and that England trained nurse-midwives who would best serve the needs of rural communities in France and America. Breckinridge was tasked before her departure from France to devise a plan to establish a nursing school so that the work of the visiting nurse service could carry on. Although her plan to establish a French teaching hospital for nurses was never realized, she gained knowledge from the process that would help her efforts to create the Frontier Nursing Service once she returned to the United States. She returned home in the fall of 1921, able to visit with her mother, who died a month later on November 2, 1921.

Breckinridge returned to the U.S. in 1925 and on May 28 of that year founded the Kentucky Committee for Mothers and Babies, which soon became the Frontier Nursing Service, which provided general health care, vaccinations, pre/post natal care, and birth services. She was joined by two midwives she met in London, Edna Rockstroh and Freda Caffin. They delivered the first baby in September 1925. The nurses traveled by horseback to deliver babies day and night, in all weather. She worked closely with Ann MacKinnon in setting up the Kentucky State Association of Midwives in 1930. FNS, with the generosity of Breckinridge's investment of her inheritance and many charitable donations, established The Frontier School of Midwifery and Family Nursing, a first of its kind in the U.S.

Breckinridge had a large log house, called the Big House, built in Wendover, Kentucky to serve as her home and the Frontier Nursing Service headquarters. In 1939 she started her own midwifery school. There, Breckinridge conducted Sunday afternoon services using the Episcopal prayer book. In 1952 she completed her memoir "Wide Neighborhoods" which is still available from the University of Kentucky Press. Upon her death, FNS had treated nearly 58K patients and delivered over 14,500 babies, with only 11 maternal deaths. Though Breckinridge's professional and largely autonomous nurse service demonstrated efficacy in reducing maternal and infant death at a time when reformers sought to remedy a recognized public health crisis, physician opposition, professional nursing ambivalence, and federal legislation (Sheppard-Towner Act) steered family health toward specialized interventions and rural hospitals.

In spite of her accomplishments, the Mary Breckinridge Task Force (formed by Frontier Nursing University) did acknowledge in 2021 that Breckinridge did hold a number of racist beliefs. It was disclosed that she refused to hire Black midwives, and would refuse to share a table with one. She advocated for white superiority, and wrote about eugenics and the value of segregation, emphasizing brotherhood over equality.

Honors Breckinridge received the Medaille Reconnaissance Francaise for organizing a visiting nurse association while working with the American Committee for Devastated France. In 1995 she was inducted into the National Women's Hall of Fame.

In 1998 the United States Postal Service honored her with a 77¢ Great Americans series postage stamp. In 2010 an equestrian statue was dedicated to Breckinridge in Hyden, Kentucky.