Making a home visit in Leslie County, KY: The Frontier Nursing Service began in Appalachia and today serves communities around the world.

[imgcontainer right] [img:Visiting-children320.jpg] [source]Wendover Collection/FNU[/source]

Making a home visit in Leslie County, KY: The Frontier Nursing Service began in Appalachia and today serves communities around the world.


Book Review:

Rooted in the Mountains, Reaching to the World:
Stories of Nursing and Midwifery
at Kentucky’s Frontier School, 1939-1989

By Anne Z. Cockerham
and Arlene W. Keeling
Frontier Nursing University/Butler Books, 2012
Hardcover, 160 pages, $30.00

Rooted in the Mountains, Reaching to the World made me long for a time when “woman with woman” care was an undeniable experience of childbearing in the Kentucky mountains.  In this short timeline history of what is now Frontier Nursing University, Anne Cockerham and Arlene Keeling – alumnae, teachers, and nurses themselves — illustrate a course of childbirth and family health advocacy that we have yet to see come completely full circle.

The authors have documented the beginnings of the Frontier Nursing Service (FNS) and what is now Frontier Nursing University (formerly the Frontier School of Midwifery and Family Nursing) in its partial, previous role as a feeder program for the FNS and its continued and current role as an accredited and internationally known program for the training and certification of nurse midwives and family nurse practitioners to underserved communities around the world.

The stories recounted in this book were collected by Frontier Nursing University students through the Pioneer Project, which began in 2006.  Students collected the stories of FNS nurses and early graduates of the Frontier School to develop an appreciation for and a deeper grasp of the school’s history and enduring legacy.  Cockerham and Keeling began compiling the stories into book form in 2010.  It seems the primary reading audience for the book is past and present FSMFN/FNU students and those interested in the history of the school.  The book has a very nostalgic feel, and each chapter, chronicling a different decade,  stands up well on its own, so that readers can easily delve into their own eras at the school.

[imgcontainer] [img:Wendover-group530.jpg] [source]Frontier Nursing University[/source]

Every student who attends Frontier Nursing University is immersed in the history and tradition of Mary Breckinridge and the Frontier Nursing Service. All students attend a dinner at the headquarters in Wendover, KY, and pose under the portrait of Mrs. Breckinridge.


Rooted in the Mountains covers the period 1939-1989, when pioneers of the Frontier Nursing program made history with their work first in the communities of Leslie County, Kentucky, and then throughout the world, as graduates began their individual efforts and occupations.  Beginning with a forward by current President and Dean Susan Stone, the book then launches the reader into an amazing history of the Frontier Nursing Service, from the training program and school’s beginnnings to its development and evolution,  a journey that took passion, ingenuity, and resolve for all involved.

The story of Mary Breckinridge, founder of the Frontier Nursing Service and Frontier School of Midwifery and Family Nursing, has always intrigued and inspired me. As an advocate for childbearing women myself, I find tenacious and deeply beautiful her inner knowing and outward expression of the truths within the community she cared deeply for.  This isn’t just another “outsider comes in and saves the poor mountain folks” story.  Breckinridge was motivated by her own trials in accessing proper and up-to-date healthcare for herself and her family. Wealth and family connections could not provide her with evidence-based maternal and family healthcare either.

[imgcontainer] [img:mary-breckinridge530.jpg] [source]Wendover Collections/Frontier Nursing University[/source]

Nursing pioneer Mary Breckinridge moved to the mountains of Eastern Kentucky in 1925 with the dream of providing family-oriented healthcare to a rural population. She started the Frontier Nursing Service that year and later founded the Frontier Graduate School of Midwifery, today known as Frontier Nursing University.


Hers is a story of a mother who after losing her own children turned grief into a mission to bring the best possible care to the rural women and children who had even fewer resources than she, working to provide the life-saving care their families desperately needed.  Her efforts brought nurse midwifery into the United States, and the tremendous results of the Frontier Nursing Service in the mountain communities commanded the respect of physicians and medical professionals the world over.

Cockerham and Keeling chose stories representing the determination and adventurous nature of Frontier students.  Highlighted throughout the text are the accounts of the students’ misadventures navigating both the mountainous terrain and the cultural differences between their own communities and those they served.  As a native of the eastern Kentucky mountains, I was interested in the history of bringing outside human resources (in the form of nursing students) to the area and the efforts to teach those students to interact with a culture vastly different from their own in a respectful way.

In the time of the formation of the Frontier Nursing Service and Frontier School, my grandmothers were born, and my great grandmothers were adult women.  I can’t help but wonder if there were any mountain women included in training programs in the early days or if the program had been limited to trained nurses only; I know several local graduates of FNU today who are wonderfully serving within their own communities.  I wonder if Breckinridge and those who worked with her felt that the “granny” midwives serving the region were trainable; the book describes that Breckinridge came to meet and interview fifty-three “granny” midwives, women ranging “from what Breckinridge determined to be clean and intelligent to filthy and ignorantly superstitious.”  This book left me wanting to read through published autobiographies such as Breckinridge’s Wide Neighborhoods to explore further the mindsets of both Mary Breckinridge herself and the FNS nurses when it came to relating to their service populations.

[imgcontainer right] [img:jean-fee-320.jpg] [source]Frontier Nursing University[/source]

Jean Fee (right), a 1959 Frontier School graduate, worked as a district nurse for the Frontier Nursing Service. Today, Fee, a native of Canada, is a nurse practitioner in McKee, Ky.


Throughout the book, the authors come back to the word “exigencies.”  Cockerham and Keeling  do not tread lightly in describing the hardships and the pressures that serving in the mountains placed on the FNS nurses and Frontier students.  In both humorous and distressing ways, the obstacles of terrain and culture are repeatedly discussed.  We read of the nurses with saddlebags trudging through all manner of weather bravely to attend to the needs of the community.  As time progresses, the horses give way to jeeps.  I am reminded of how our current mobility in the mountains is so very recent.  I am also struck by the many misunderstandings the nurses had with the people they served, raising more questions in my own mind about how those who chose work and training in Appalachia viewed what they were doing.

One scene from the 1960s that especially roused my mountain spirit was when a Frontier Nursing Service midwife, after a prior communication misunderstanding with a father, clearly warned the family to “Do NOT put the (premature) baby IN the oven!”  The authors previously had described the need for clear communication and “not taking anything for granted when discussing plans for events in mountaineers’ homes.”

It was a revelation to me that FNS carried out clinical trials of the first oral contraception pill, Enovid, on the mountain women, also in the 1960s, and that acceptance of the pill was widespread.  While family planning was a much needed option among mountain women and the results were positive, I am intently interested to learn more about the conversations held before deciding to conduct the clinical trials with mountain women. What were the motivations behind this experiment?

[imgcontainer] [img:fnuclass-of-1957530.jpg] [source]Luree Wotton Collection/FNU[/source]

The 1957 graduating class of nurses, shown in their Frontier Nursing Service uniforms, gathered around an FNS jeep. They posed next to Haggin Dormitory, a building still in use today on the campus of FNU.


Despite misunderstandings and miscommunications driven by cultural differences, I have to admit that this book leaves the reader with complete respect and reverence for Mary Breckinridge, Frontier Nursing Service, and the school.  Breckinridge chose the perfect location for her program when establishing it in the Appalachian mountains.  I am left feeling proud of the mountain women who were still so very close to the natural function of their bodies and unwavering in their capacity as birthing women.  At a time when the majority of the country was giving birth in “twilight sleep,” Breckinridge and the FNS were attending drug-free births in humble mountain homes with better results than physicians of the day were seeing in hospitals, using drugs.

We in the mountains were an integral part of proving that women are not lacking when it comes to childbirth; it’s the support women are given in childbirth that most often needs to be addressed. Rooted in the Mountains gives me an admiration for well supported and empowered birthing women and inspires me to further my work as a birth advocate in the hills of eastern Kentucky.  I, too, wish for the dream of Mary Breckinridge to come full circle, to see more women birth in all settings. As alumna Kitty Ernst asserts, “There is something very special about a home birth.  The mother is in total control, she is in her sphere of power; she is in charge.”

[imgcontainer] [img:delivery530.jpg] [source]Suzanne Deaton[/source]

Students work with faculty on clinical simulations at Frontier Nursing University before starting clinical practicum experiences in their home communities. FNU now has more than 1,500 students. The university continues to emphasize training primary care providers to work in rural and underserved areas.


The book ends with an account of the current placements and efforts of the Pioneers and the goals for students at Frontier Nursing University in regards to this almost magical legacy.  The relationship between the Frontier Nursing Service and the mountain women and their families has become one a mutual respect, something I was honored to witness in my advocacy work before the closing of Mary Breckinridge Hospital’s maternity ward. It is a legacy for all of us.  Pioneer Edie Anderson, “who saw the differences between herself and the locals in a positive light,” best sums up the pride I feel in my foremothers and this exchange: “I respected the philosophy of the mountain women.  Most of them had their babies without noise or fuss and just expected things to proceed naturally.  The system of support offered by having family members present helped contribute to natural births.  I learned that the hospitality, kindness, and helpfulness of the mountain people were unsurpassed.”

Rooted in the Mountains, Reaching the World is an enjoyable read and will be of interest to anyone wanting a clear example of how we can bring positive change to our communities.  It will challenge you to pick up a torch.

Kelli B. Haywood, MAT, LCCE, is a mountain woman born and raised, homemaking mother to three daughters, and a Lamaze Certified Childbirth Educator, doula, and women’s and children’s health advocate.  She lives in southeastern Kentucky with her husband and three daughters.  See her weblog about childbirth and prenatal care: Birth True.

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