When History Is Not Kind

While the historical aspects of early nurse-midwifery are portrayed as brave and heroic, on a superficial level, there are additional historical issues to consider. In 1925, Mary Breckinridge, a member of an affluent, politically prominent family in Kentucky, became concerned about the plight of poor, rural families living in the Appalachian Mountains.

Supportive Healthcare in Appalachia

She developed a demonstration project to prove that a midwifery model of care could improve child survival in impoverished mountain areas, and it became her mission to bring supportive healthcare to this underserved, remote region. In 1940, after 15 years of effort to improve medical care in the region, the Frontier Nursing Service was established, and, eventually, Frontier Nursing University was established to train nurse-midwives and confer academic degrees. *

Historical Beginnings For Nurse-Midwifery

Practically every certified nurse-midwife today is aware of these historical beginnings: British nurses on horseback, living in log cabins, and the many notable contributions of Mary Breckinridge. What has not been widely known were her views on race, equality, and the select segments of society she considered deserving of support. Her beliefs regarding humanity and her unique version of altruism may not have been considered problematic in 1925, but they raise critical issues now. Unfortunate views from the past have been perpetuated, creating a particularly unwelcome and negative impact on the status and reputation of certified nurse-midwifery in the present.

Segregationist Family

Mary Breckinridge was raised in a segregationist family in Kentucky and was well-known as a white supremacist and eugenicist. She published articles on eugenics and demonstrated a conviction that the white people living in Appalachia were “pure” Americans of “superior breeding stock”. Apparently, like cattle, white human livestock was needed to develop a feeder population. In 1940, she founded the Frontier Nursing Service as a midwifery educational program, but only white nurses with Anglo-Saxon heritage were admitted.

American Academy of Medicine
unsplash-image

White Nurse-Midwives, Only

In addition to improving the health of Appalachian families, the White nurse-midwives were also tasked with interfering with and denouncing the work and reputation of established, Black, local “granny” midwives who had cared for White, as well as Black families, for generations. The goal was to replace the pre-existing (Black) birth attendants in the region. The problem with this campaign was that the White nurses would not provide care for the Black families in the area, leaving this segment of the population without health care. The Frontier Nursing Service did not admit any Black nurses to its program until Mary Breckinridge died in 1965.

Exploring the Racism of Mary Breckinridge

In 2018, Frontier Nursing University developed a task force to explore the history and legacy of Mary Breckinridge. Findings of the task force acknowledged that their founder held racist beliefs and believed in white superiority. Frontier Nursing University issued a public apology to Black, Indigenous, and People of Color for failing to “honor the inherent right of all individuals to equitable treatment and opportunity”. FNU is committed to applying what they have learned to become a truly inclusive university.**

Mary Breckinridge was not the only individual to influence the enduring whiteness of nurse-midwifery. As previously outlined, the Maternity Center Association of New York developed the first nurse-midwifery education program. This effort was founded by influential White women in New York City, and the MCA trained hundreds of nurses to become nurse-midwives to attend women in hospital maternity wards. Although this program proposed oversight and support for lay midwives, Black midwives, in particular, were excluded and characterized as unclean and unprofessional. In its first 20 years, MCA trained only 8 Black nurses as nurse-midwives.

From its beginnings, nurse-midwifery has been associated with nursing education programs in the United States. Currently, approximately 46 graduate-level programs educate certified nurse-midwives and certified midwives. Unfortunately, a mere fraction of Black program directors and disproportionately few Black certified nurse-midwives/certified midwives participate in the education of nurse-midwives. In modern American society, where Black women are overwhelmingly more likely to die of pregnancy and childbirth complications than their White counterparts, this is now acknowledged to be unacceptable.

Among proposed solutions to this healthcare crisis, one obvious choice can be found in finally acknowledging that enduring racism is the primary causal factor for pregnancy complications and maternal deaths in Black women. It has been suggested that encouraging, educating, and recruiting more maternity care providers of color, particularly Black nurse-midwives, can help alleviate the adverse maternity outcomes associated with generations of societal stress and anxiety. In addition, every health care entity involved in the care of Black women must establish specialty healthcare protocols to screen, identify, and carefully follow this unique and potentially high-risk population of women.

*Constructing the Modern American Midwife: White supremacy and White Feminism Collide. https://nursingclio.org/2020/10/22.

**A Message to Our Community Mary Breckinridge Task Force (MBTF) Update/Frontier Nursing University. https://frontier.edu/news/mbtf/

Mary Breckinridge and the Color of Nurse-Midwifery

Crocodile Court

Sometimes The Meek Won’t Inherit The Earth - Part 1