For this paper I chose to delve into the history of nurse-midwifery in the United States and how Mary Breckinridge sparked a change in not only nursing, but in childbirth as well. I chose this topic because I have worked alongside nurse-midwives for the past year. Each shift I am continually amazed by the work these women perform and the knowledge they have that their practice is based upon. I want to explore what childbirth practices were prior to formal training of nurse-midwives, how Mary Breckinridge influenced a change in the way people gave birth, were trained to assist in birth, and what lasting impacts she has on today’s practice of nurse-midwifery.

What is a Midwife?

According to the World Health Organization, midwifery is “skilled, knowledgeable and compassionate care for childbearing women, newborn infants, and families… throughout pre-pregnancy, pregnancy, birth, postpartum and early weeks of life”. Some more major components of being a midwife go further than just delivering a baby, they include being capable of assisting women through all of the factors that could affect her ability to conceive a child. Conceiving a baby, while it may seem fairly straight forward, can often be influenced by factors that we do not see coming or did not think we would encounter. Being a midwife also means having respect for each woman’s views, decisions, and circumstances while she is in your care as a medical professional. Most importantly, though, being a midwife means working with women to help strengthen and reinforce their own capabilities to care for herself and her family.

Colonial Midwifery

In contrast with our modern day society, a formal education was not always required in order to practice legally as an assistant to childbirth. Midwifery was originally brought to the America aboard the Mayflower. Two women, names Martha Ballard and Bridget Lee Fuller, weathered the two-month journey to America aboard the ship. During this time, the women assisted in multiple childbirths and continued on the chronicle their experiences in journals. Once the voyage reached America, Fuller continued to provide midwifery care to women in Plymouth for another 44 years leading up to her death in 1664. For years midwifery was a service that many women provided to their communities for no charge, however, in 1660 the town of New Amsterdam was the first town in America to pay a midwife for their services. The amount of 100 guilders, which factors out to 52 dollars, was paid to a midwife to serve the community’s poor for one year. Although women did not have to attend a formal institution to become a lay midwife, they often spend large amounts of time shadowing and working alongside an older and more experienced midwife before venturing out on their own. Once on their own, it was common in colonial America for a midwife to act under the supervision of a Protestant bishop due to the fact that, at this time, the infant mortality rate was over fifty percent. Working under the supervision of a bishop allowed for less of a delay between birth and baptism.

In the early 1900s, larger communities often had at least a single midwife that would assist women in giving birth as much as she was physically capable of doing. However, in more rural areas of America, there was minimal access to health care which meant that women were often left to deliver their own children with the help of a few untrained family members and neighbors. Due to the lack of training in these areas, the maternal deaths per 100, 000 births were as high as 800 while 100 out of every 1, 000 children died before their first birthday.

Mary Breckinridge

Mary Breckinridge was born in Kentucky in 1881. She was born into a privileged family and received an education in both Europe and the United States. Breckinridge’s decision to attend school at St. Luke’s hospital in New York at the age of 26 came shortly after the death of her husband and two young children. She became a registered nurse in 1910 after deciding to devote her life to improving the lives and wellbeing of women and children. Breckinridge spent some time working in France during World War II where she met multiple British nurse-midwives who sparked her interest and ultimately led her to believe that “nurse-midwifery was the logical response to the needs… in rural America”. Since nurse-midwifery was not formally practiced in the United States at this time, Breckinridge returned to the United States after the war and attended Columbia University where she devoted her studies to public health in order to take on the health problems that rural eastern Kentucky faced. She figured that if her plans could succeed in such a secluded area, that they could be successful later on in other areas of America, as well. In order to survey the families in such a spread out area, Breckinridge set out on horseback in hopes of determining what these family’s needs were and what lay-midwives practices were like. Her travels brought to light that there was an overwhelming lack of prenatal care and she found that many families were made up of an average of nine children each. During this period of time, births were more often attended to by farmer’s wives who were self taught and in turn heavily relied upon folklore, holistic measures, and superstitions when it came to childbirth practices. Due to the overwhelming need of the communities and lack of formal midwifery training, in 1925 Mary Breckinridge established the Frontier Nursing Service (FNS) in order to provide a place for formal midwifery training. Once established, she wrote an article to the American Journal of Public Health in 1927 stating that thanks to the nurse-midwives from FNS, Appalachia Kentucky had risen from the region with the highest maternal mortality rate to one of the regions with the lowest mortality rate among mothers.

Today, Breckinridge’s Frontier Nursing Service is known as Frontier Nursing University and is amongst the most popular institutions for nurse-midwifery education. Changes in Practice For centuries, women have sought pain relief in different forms when it comes to childbirth. For hundreds of years women viewed the pain of childbirth as just another challenge to make it through when it came to child rearing. For centuries women solely relied upon nonpharmacologic pain relief measures such as hydrotherapy, patterned breathing, relaxation, and visualization. It wasn’t until the 1850s that anesthesia was utilized as a form of pain relief during birth. In those days, however, anesthesia was considered any type of drug that would cause unconsciousness and the dosage was whatever amount it took to achieve that affect. It wasn’t until around 1920 that another form of pain relief became popular state side.

Twilight sleep was a form of pain control in which a medication was administered to not only ease the pain of childbirth but it also erased the memory of the experience completely. Morphine, which is a narcotic, and Scopolamine, which is a medication that acts on neurotransmitters, are the two medications that are combined in order to create Twilight Sleep. Although the thought of a “painless birth” was appealing to women, the choice to partake in such did not come without consequences. More often than not women would experience severe behavioral effects such as thrashing around, banging their heads on walls, clawing at themselves and staff, and screaming constantly. As a result of these actions, women would be restrained to their beds by their wrists and ankles in order to prevent harm to themselves, the staff, and their baby. Unborn babies also experienced the effects of Twilight Sleep. These medications could cross the placenta and resulted in babies being born unable to breathe properly due to depressed central nervous systems.

The popularity of Twilight Births began to dwindle after the death of Francis Carmody, one of the most widely known supporters of the drug. She died giving birth to her third child while in Twilight Sleep. Medical professionals tried to deny that the drug had any play in her death but it did not stop the decline in demand for the experience. The popularity began to further diminish once women began to remember their experiences during their Twilight Sleep and ultimately led to the demise of the practice all together in the 1970s.

Today’s practices for pain relief have made many advancements when it comes to safety. More often than not, women enlist the help of pharmacologic pain relief alongside nonpharmacologic pain relief measures during childbirth. Women frequently use hydrotherapy, relaxation techniques, rhythmic breathing and other techniques still today. An epidural is the most popular method among women today when it comes to pain relief measures during childbirth. This form of anesthesia is a regional anesthesia that is aimed at relieving pain in the lower section of the body. An anesthesiologist inserts the small catheter into the epidural space of the spinal column where it remains for the duration of its use. Another form of spinal anesthesia is a spinal block. With this method a needle is inserted into the epidural space of the spine, a premeasured amount of anesthetic is injected, and it slowly wears off over a period of time.