Frontier Nursing Service

History

Mary Breckinridge founded the organization in 1925 in Leslie County, Kentucky, after observing the Highlands and Islands Medical Service in Scotland. Before selecting Leslie County, she surveyed Leslie, Knott, and Owsley counties, interviewing local midwives and recording data such as age, birthplace, literacy, years in practice, cleanliness, and number of children reared. Breckinridge, a 1910 graduate of St. Luke's Hospital of Nursing in New York, chose the region for its remoteness, lack of licensed physicians, and her family's Kentucky ties.

She established the Frontier Nursing Service after the deaths of her two young children. It was the first US group to employ nurses who were also qualified midwives. Since no US midwifery schools existed, FNS offered scholarships for American nurses to study in Britain or hired qualified British midwives. The organization was originally called the Kentucky Committee for Mothers and Babies.

Impact

During its first thirty years, all maternal and infant outcome statistics for the Frontier Nursing Service were better than national averages. The maternal mortality rate was 9.1 per 10,000 births, compared to 34 per 10,000 for the US. Only 3.8 percent of babies had low birth weight, versus 7.6 percent nationally. From 1938 to 1939, field nurses carried 8,377 people, including 4,978 children, and made 25,135 nursing center visits.

By 1959, nurse-midwives had attended over 10,000 births. From 1964 to 1965, nurses attended 10,446 patients in 12 districts, providing prenatal, labor and delivery, and postpartum care to 369 women. In 1972, the forty-bed Mary Breckinridge Hospital and Health Center opened. After years of operating in the red, FNS sold the hospital to Appalachian Regional Healthcare in 2011.

In 2017, FNS purchased a campus in Versailles, Kentucky. A 2019 social media post about board meeting minutes discussing moving the Breckenridge House caused public backlash.

Relocation of Frontier Nursing University

In 2018, Frontier Nursing University fully moved from Leslie County to Versailles, Kentucky, despite the founder's mission to serve rural mountain communities. The university's mission statement emphasizes accessible nurse-midwifery and nurse practitioner education integrating diversity, equity, and inclusion, and preparing leaders to work with all people, especially rural and underserved communities. FNU stated the new 67-acre campus in Versailles keeps the university in a rural county and is near the Lexington Bluegrass Airport and major highways.

However, Woodford County, where Versailles is located, is classified as a metro area by the USDA Economic Research Service. FNU also attempted to remove a stained glass window from St. Christopher's Chapel in Hyden, Kentucky, to install at the new campus. Congressman Hal Rogers stated the action did not align with Mary Breckinridge’s heart of service. A change.org petition calling for the window's return garnered over 3,700 signatures; return of the window has not been confirmed.

Kentucky Law

Kentucky had stopped certifying midwives in 1975, leaving no clear regulations for over thirty years. The council will establish standards for training, licensing, transfer of care, and disciplinary actions, and define conditions requiring physician collaboration or referral. The law criminalizes unlicensed midwife services but includes exceptions for traditional birth attendants for religious or cultural purposes and for uncompensated care by family or friends. How these terms will be interpreted and enforced remains unclear.

Did You Know?

• Mary Breckinridge founded the Frontier Nursing Service after the deaths of her two young children, Polly, who died four hours after her birth, and Breckie, who died four days after his fourth birthday.
• The first clinic in Hyden, Kentucky opened in 1925, and within the first month, Breckinridge and two nurse-midwives served 233 patients.
• The Frontier Nursing Service was the first group in the United States to employ nurses who were also qualified midwives.
• The Frontier Nursing Service was the subject of the 1931 documentary film, The Forgotten Frontier.
• The Frontier Nursing Service Complex was listed on the National Register of Historic Places in 1991, including four contributing buildings and nine contributing structures.