xt7d251fkf8v https://exploreuk.uky.edu/dips/xt7d251fkf8v/data/mets.xml The Frontier Nursing Service, Inc. 1982 bulletins  English The Frontier Nursing Service, Inc. Contact the Special Collections Research Center for information regarding rights and use of this collection. Frontier Nursing Service Quarterly Bulletins Frontier Nursing Service Quarterly Bulletin, Vol. 57, No. 4, Spring 1982 text Frontier Nursing Service Quarterly Bulletin, Vol. 57, No. 4, Spring 1982 1982 2014 true xt7d251fkf8v section xt7d251fkf8v    
QUARTERLY BULLEUN  
\
        2* R   ‘. »   
  "“T¢i=* .   i   A  RR#3 g,     E , .
  lv »   ·  L   V VI K     
  in  ,,,v,      ·?;’* ., ,_\L _  
  '     V.   VR,.    U L, 4  
{ e  ` »   1 .  ,1 -   .
O ` é  RR° l y »»       ‘  
V Rs. A             R
   *'   ~ ;R-~~ ·  ° ' 4
*&.   ~R#!        M    
-)   R  R N  ’   Z `     ·   ¤
"    ~   ‘‘  * j   ·-» —;   

 US ISSN 0016-2116  
I
I
` .,
i
_ I
i .,
l
COVER PHOTO: First Place winner in the poster contest for
National Nurse Midwifery Week.
i (
  i
I~`RON'I`IER NURSING SERVICE QUARTERLY BULLI·I'l`IN  
US ISSN 00162116 e /
Published at the end of each quarter hy the Frontier Nursing Service, Incl }‘
Wemlover. Kentucky ·11775  
Subscription Price $5400 zi Yezir l
Edit0r’s Office, Wendover, Kentucky 41775 V
VOLUME 57 SPRING, 1982 NUMHEII »1 I 
  .
Second-class postage paid at Wendover, Ky, 41775 and ut aiclclitiunal mailing -{id, ¤ ‘ \,  xl`; l
,, » ~   v .
{ mi;-` il _ JY-{ig-. l
   i`e  1e  ‘`.» .   ?>*»~ "
yin.  ‘   > p   A .· ` l
· .L .»·       it ,.. a
·     >     _ ` _
.7-di _"       V l l \ i" E
)_, ' x E i· ‘ \ l /   H _
  ¤ ‘~. ro   ~ ·
I we   iii     
n   2     it     e
Mr. David Hatfield, MBA, FACHA
FNS GETS A NEW DIRECTOR
David M. Hatfield was appointed new Director of the Frontier .
Nursing Service by the Board of Governors at its April meeting. Q
Mr. Hatfield comes to us from United Hospitals, Inc. of St. Paul,  
Minnesota where he served as Executive Vice President of a 600 ”
bed hospital. With 25 years of hospital administration experience
behind him (from 350 to 1100 bed facilities) in various places l
throughout,the midwest and in the east, Mr. Hatfield will surely
find our smaller scale somewhat of a different challenge. He is a 1
Fellow of the American College of Hospital Administrators, and a {
member of the American Hospital Association. He served on "
active duty as lieutenant in the Marines and retired in 1980 as a ,
colonel in the United States Marine Corps Reserves. ;
He and his wife, Sharon, have three grown children and will is
live in Joy House near the Mary Breckinridge Hospital in Hyden.
Mrs. Hatfield, a registered nurse, is also a devotee of American _
folk culture and has expressed an interest, among many other ‘
things, in learning how to play the dulcimer.
We are very happy to have them both and welcome them
heartily to the FNS and Leslie County!

 1
` QUARTERLY svumiu a
 5 BEYOND THE MOUNTAINS
 . by Kate Ireland
Under the chairmanship of Annette von Starck (Mrs. Emest),
the Philadelphia Committee held another glorious fund raising
event in April. I was the guest of former FNS Governor, Bee
f Mcllvain and her husband, Gibby, and it was fun to reminisce
V about the FNS when we were dreaming of and building the Mary
Breckinridge Hospital. On Saturday, April 24th, Bee and Gibby
 ‘ ` had some friends in for dinner including our Trustee, Mrs. Lewis
Scheffey, a dear friend of the FNS. On Sunday, April 25th, we
gathered at the Actors’ Theatre for a boxed supper packed by
members of the committee, and a production of Moliere’s Tartuffe.
It was fun to take a few words of greeting from the FNS to many
new friends and my thanks to Annette and her hard-working
committee for all they do for the Frontier Nursing Service.
'I`he following weekend, I had the pleasure of visiting our
former National Chairman, Marvin Patterson, at her home in
Washington. Friday evening, Marvin and I were guests, along
with FNS Washington Chairman, Ruth Newell and her husband,
Hal, and the former Washington Chairman, Ann Becker and her
husband, Ralph, at the Supreme Court Historical Society Dinner.
We had a private tour of the Supreme Court Dining Rooms. It was
a thrill to see the magnificent architecture and appointments in
the building that is the high Court of our land. Saturday morning,
Ralph and Ann had a brunch for a few of the committee members,
and then we all gathered for a most successful Derby Day Party at
Marvin’s. The featured speaker was Secretary of Defense, Caspar
W. Weinberger who had also addressed the FNS in 1974. He is very
supportive of our alternate methods pf health care, his wife is a
R.N., and their grandchild was recenxtly born in California with
(gra the assistance of a midwife. Rear Admiral Freeman H. Cary,
M.D., attending physician to the United States Congress, added
E his words of greeting and described his work with the "barefoot
T doctors of China". There were over two hundred people in
= attendance on the lovely May day, and Mrs. John M. Cabot was
the winner of the Derby Pool. Since she was the sole holder of the
ticket, she most kindly gave her winnings back to the FNS. What a
generous gesture! My congratulations to Nan Oldham and Page
Fleming, Co-Chairmen of the beneiit, Ruth Newell, Washington
Chairman, to all the members of the committee, and to Marvin
Patterson for making this gathering such a howling success, both
, for conviviality and for the cause of the FNS.

 4 Fnomrmz mmsmo smwrcm  ’
FAMILY NURSE MIDWIFERY GRADUATION: ·
SUMMER 1982
by Erica Goodman, CFNP, Oneida Clinic  .
There is a joy in nursing, an intimate, delicate link between
giver, healer, sharer and the receiver: often in dynamic  
equilibrium, the giver and receiver exchanging roles. It is
sometimes defined mystically, spiritually, philosophically, scien-
tifically, practically. It is always a unique exchange. ,·Y·
In the hard business of learning the profession, these thought-  
ful wanderings get set aside — replaced by the daily tasks, the 5
grind, the strains, the disappointments, the disillusionment, the [
fatigue, the burn out. r
A prospective student is asked, "Why choose nursing? What ,
are your goals?" The answer sought — and often given — "To help I
others." As the individual grows in self-awareness and self- O
assurance that answer often becomes more complex, more per-
sonal. i
Nursing itself is complex. There are multiple ways of reaching E
out to share ourselves with others. The fabric of life is made of  
many threads, woven experiences. We are each other’s threads.
A newborn cries; our delicate link begins. We anticipate its ,·
growth, the learning, absorption of the environment into this Y
being. In nursing the family we are sometimes fortunate to =
witness this process from birth through death. We counsel an 4
anxious parent; empathize with a distraught adolescent; ease an
illness, comfort a pain; reinforce the growth. The days are full of ,
common human ailments. The tedium drains us. Then a special
moment occurs — a reminder of our special link. A child that cried
with every visit greets you with a smile. A mother reports forcing .
fluids, using steam, alternating antipyretics and weathering her M
child’s cold without penicillin. She brings Jamie by just to say I;
hello to the nurse. An old man touches your arm appreciatively for '§,
irrigating his ears. A stroke victim begins her journey to recovery.  
A woman meets your eyes and asks, "Can you be there when I  U
have my baby?" Delicate silken threads woven into the coarse  p
fabric of our profession. - 
Life’s cycle that we are partners to: the passage of a child  A
through your hands, the passage of lives through our hands, and  '
the passage of life into a personal unknown. It is all delicate, all S
intimate. -
I

  ` QUARTERLY BULLETIN 5
We chose a life that elicits a responsibility. We must nurture
that ability to respond. We are predominately women. We have
 . historically been healers, nurturers. We are members of a profes-
sion that is struggling with multiple nursing issues. We must take
  our woman’s strength, our gentleness, our common sense, our
’ intelligence — our slender threads — and work firmly and with
{ understanding toward weaving a stronger fabric within nursing.
_.__ Judy Grahn symbolically demonstrates the effect a woman’s
{ strength can have on nature in this poem.
{ Here, the sea strains to climb up on the land
Y And the winds blow dust in a single direction
1 The trees bend themselves all one way
And volcanoes explode often.
? Why is this?
A Many years back
A woman of strong purpose
= passed through this section
1 And all else has tried to follow.
’ Here in southeastern Kentucky, geologic seas, ancient winds,
` dense trees and volatile emotions surround us. Here, a woman of
. strong purpose came and created a space for other women of
{ strong purpose.
, I came today to be with friends — to celebrate your strengths,
; your love, your accomplishments. I see many women of strong
purpose. Take the best of FNS with you, leave the rest.
May others try to follow you.
M Graduation ceremonies were held at Wendover on the Grassy
I; Spot at 2 p.m. on May Day. Over seventy-five people of all sizes
'§, and ages came and we were especially pleased that Brownie, who
  had been at the ACNM convention all week, was able to stay for
 H the event. Dr. Anne conferred diplomas on Pamela Florey, Donna
 p Marcella, Belinda Pendleton, Mary Ellen O’Brian, Barbara
y  Haggerty, Kathleen Haveriiled, Joy Schroeder and Roberta
 ‘ Moore as Family Nurse-lV[idwives; and on lV[ichele Heymann as
 i Family Nurse-Practitioner. Congratulations to them all! Molly
B Lee, who had recently retumed from England, also conferred
- "diplomas" on the graduates. The paper towel tubing concealed
I

 l
{
 
lovely hand towels each from a different part of her native land.  
The gifts were to remind the new professionals of two of Molly’s r
mottos: be prepared and be inventive. The tubing, you see, could
also be used as a stethescope and a hand towel can be boiled for =
any emergency a midwife might End herself in. The graduates, _¢
their friends, colleagues and families stayed and enjoyed the  
dinner they had prepared as well as their feelings of happiness  
and accomplishment.  
Catherine Thomson Davis was born to Mr. and Mrs. James  
Edwin Davis, Jr. (Julia Breckinridge, ’67, ’68 and ’69) on April 3rd. V
She weighed 8 lbs. 8 oz. Mr. and Mrs. Davis live in Charlottesville, Q
Virginia.
Zoe Elizabeth Hallowell was born to Cindall (Morrison,
FSMFN ’78) and Chris Hallowell on February 26th, "entering the
ring" at 6 lbs. 11% oz. ·
God who made the earth, _
The air, the sky, the sea, _
Who gave the light its birth, _ J
Careth for me. V
God who made the grass, Pl,
The flower, the fruit, the tree,  
The day and night to pass, {  
Careth for me.  
God who made the sun,  J
The moon, the stars, is he o
Who, when life’s clouds come on,  X
Careth for me. .
Hymns for Children —S. B. Rhodes, 1870 J;
1 
S

 l QUARTERLY suu.m·m 1
  .·_ 'M: YI (
l if  3  Q
l sf     wh
l ,/’/ ‘\.   ? .
E   K ·  'lu .  ’ 
l   I   A  · ;: I I  if      F  l l  ` A
  Mr. Ron Hallman, BA
NEW DIRECTOR OF
PROMOTION AND DEVELOPMENT
U As the Winter issue of the Bulletin ‘went to bed’, the FNS took
{ on an important new member to its staff. We are sorry not to have
il' been able to introduce our new Director of Promotion and
j Development earlier and welcome this opportunity to make
{ amends for the conflicts of time.
~ Ronald G. Hallman (Ron) came to the FNS on March 15th. He
is a recent graduate of Berea College where he majored in English
_ and studied development under Cy Young, Vice President for
 ; Development at Berea. If anything makes up for lack of ex-
  perience, it must be instinct and enthusiasm — both of which Ron
‘ has in abundance. We are pleased that he is with us, glad that he is
; living at Wendover, and extend him a belated but hearty welcome.

 w
8 Fnommn mmsmc smzvrcs Q
ACNM CONVENTION 1982 ,
When it came time to address all those assembled for the `
ACNM opening night ceremonies, Ruth Lubic (member of our
Board and from the Maternity Center Association, New York) got  
up, stood at the podium, and looked around with a mixture of V
amusement and perhaps bewilderment in her eye. "No one has to l
tell me how good you are at catching babies. I just didn’t know  
how good you were at producing them!" The remark was greeted
with enthusiasm and obvious pride by the nurse-midwives 3
(mothers and babysitters alike.)
Much time and effort had been put into all that lead up to that .
moment and what was to follow during the week. In November we
had formed the Origins and Dreams Committee to organize I
activities for and prior to the convention, publications, informa- .
tion centering around the convention, nurse—midvvifery, and the E
FNS. Radio spots were taped, articles entered in the papers, N
several of the staff were on television spots aired in both Hazard 1;
and Lexington, a poster contest was held in the Leslie County I.
schools for National Nurse Midwifery Week, the couriers made ,
signs, and on goes the list.
It seemed like continual excitement and whir in Lexington at ·
the convention itself. Our booth, engineered by Gabrielle Beasley, ,
with its display of historical pictures, saddlebags, panels of I
photographs describing the work being done today, with its ;
rockers, quilt and dulcimer music was the center of attention for  
many. We sold over sixty copies of Wide Neighborhoods and
distributed hundreds of Bulletins and information booklets. The
Forgotten Frontier, which played continually on the video, drew _
the attention of many interested in the origins of their profession R;
in this country. The booth will be set up in the Mary Breckinridge } *
Hospital lobby at the end of June to show our employees and I i
patients and to celebrate the induction of Mrs. Breckinridge into ii
the ANA Hall of Fame in Washington, D.C. .
We made arrangements for a one day tour of FNS for the
convention attendees including visits to Beech Fork, Wendover, (
the Old Hospital, and St. Christopher’s Chapel. The sightseeing Y
was followed by a panel and discussion led by Susan Baker, _
Midwifery Coordinator, and featuring Betty Lester on the history ..
of the Service; Molly Lee on the changes that have occurred in  ·

   QUARTERLY BULLETIN 9
L midwifery practice since she has been here (and that’s almost
I thirty years of experiencel); Brownie, our second director, on the
§ practical advantages and problems of running a nurse-midwifery
service coupled with an education program; Arlene Bowling, our
Q only Leslie County CNM, on the cultural aspects of her practice;
  and Ellen Hartung, Project Director at Beech Fork, on what it
  means to be a family nurse practitioner in the districts. Here we
  quote some of the highlights.
L Dr. Anne: I don’t have too much to say to you today because there
are people on the podium here who have wonderful stories to tell
' you about the Frontier Nursing Service and who are your
midwifery leaders. But I would like to welcome you all as the
r Director of the Frontier Nursing Service to Leslie County and [to
the FNS]: to touch and feel what you’ve been hearing about [for the
· past week] .... I think that from what I heard at the convention
I you need to reflect on working together and about gathering more
to your numbers wherever you can .... We all need your help. We
all need you to help gather together and train those who come
  beyond you . . . . You need to teach others and that should be part of
_ your aim and your practice.
I Betty Lester: I’m going to tell you about the beginning of the
i Service because it’s so different now and I think if I tell you how it
Q was in the beginning you will understand how much progress has
g been [made.] When I came in 1928, the [Service] was just in its
I infancy. The Old Hospital up on the hill which you’ve just been to
1 see had just been dedicated ten days before that, and there were two
  outpost centers, and that was all. We hadn’t so much midwifery. We
: hadn’t a doctor, and we hadn’t very many nurses. If you’ve read
Wide Neighborhoods, you’d realize what Mrs. Breckinridge had
[ really done. . . . Leslie County had no roads, no railroad, no
I industry, no coal, and practically all the families were farmers.
g, They didn’t have much money but . . . they were very hard
[ij working, and very friendly. If you did something for them, they did
I 5 something for you in return. . . . The one thing that they didn’t have
, was medical care. There were no doctors, no nurses .... They had
Kr" their own home remedies, but they had a lot of typhoid and a lot of
dyphtheria, and smallpox . . . The women when they were going to
 X have their babies had no one to take care of them except a neighbor
 » woman who had perhaps finished having her own children and
 , was quite willing to go and take care of anybody else who was
going to have a child. They had no prenatal care, no postpartum
_` care. She knew that that was where she was going to be able to help
{ . . . . She made up her mind [after the death of her son Breckie] that

 10 FRONTIER NURSING SERVICE E
she was going to take care of children for the rest of her life .... ‘
There was a doctor at Hazard [who could help,] although it was a l
five hour trip on a horse, so if you were going to have an  l
abnormality, you had to realize it early. . . . She came in May of ’25  V-
already to start. They had a little house over by the Presbyterian .
Church, two nurses were there, and she was there. The mother of , 
one of the nurses came to help with housecleaning and Major Q
Breckinridge came up to see that the horses were well taken care of Q
. . . She said: "Here we are. Here are our hands. Use us. We’re nurses  
and we’re midwives. We want to help you all we cn. We want to
help your children. If you want us to come and visit you in your
homes, you’ll invite us." Well, that was it, and everybody wanted to
know what these quar women were doing up in here, so they came ,
to visit . . . In those days it was very much simpler than it is now. I
We took temperature, pulse, respiration, urinalysis, blood pressure, g
abdominal palpations, and external measurements. . . We did that
first examination and saw the mothers every month until they ?
were six months pregnant. In the seventh and eighth month we
saw them every two weeks, and the last month we saw them every .-
week. If they didn’t come to the clinic, we had to look them up. We ¥
were not allowed to leave them at all . . . . We always had to do one
home visit to make sure that they’d got everything ready. Plenty of I
hot water and pads for the beds .... And then one night you hear: I
"Hullo!" outside your window . . . You gave the man your keys; he
went down and saddled your horse, and you’d leave a note on your _
desk of where you were going, the name of the woman, and the I
creek she was on, and the time. We never rode alone at night . . .
because if your horse fell with you, you could lie on the trails for I
hours and nobody would come anywhere near you. When we got to *
the house, we never left the woman until she was delivered. We let »
her walk about during the first stage. She could do anything she
wanted to except for hard work. Then we would deliver the baby, ,
separate it, and do the mother, and we had to wait one hour at least it
— an hour and a half to two hours — after delivery so that there’d be 5
no complications that we wouldn’t be there to [take care of.] You  i
never left the house without having breakfast and if you wanted to
go home by yourself, you had to wait for the first crack of dawn.  4
When you saw the first light of dawn, you’d ask the man to go .
saddle the horse. You’d ride home through the morning — believe H
me it was beautiful! . . . We had to take everything out of our bags,
. . . special bags for midwifery . . . . We carried everything we  V
wanted with us: our rubber sheet, our cotton, our mother’s bag, our
baby’s bag, our emergency kit, our bowls, our towels. They weighed `
about thirty pounds. . . . We weren’t asceptic, but we were

 3 QUARTERLY BULLETIN 11
$ surgically clean, and we never once had a case of cross infection . . .
. Everyting had to be all boiled up and put back in the clean white
1 bag and put away in the cupboard for the next delivery. . . . We had
 ‘ to keep very careful records . . . Then we saw the patient everyday
_ for the first ten days, every week for the first month, every month
_, for the Hrst year, and between one year and six years, we saw them
*2 every three months. Then we did school clinics and so we kept a
[ record of all our patients until they were grown. . . .All our babies
  were born at home, and all the babies were breastfed.
i Molly Lee: I’d like to welcome you from the old and the new ....
j First of all, you’ve just come down on the Daniel Boone Parkway
, and that was my happy hunting ground on a horse. It’s hard to
believe that that was all creek bed travel. . . . In my time of coming,
there were still horses in use for district travel and the jeep had been
_ in for a little while. . . . We had these little clinics that were general
° nursing and midwifery. We did the whole lot together. And I think
my one thing in life, if you really knew me, is doing without. . .I’m
· afraid we have gotten a little bit too sophisticated sometimes for me
3 .... In travelling to home deliveries, I most always went by jeep,
and as Betty says, it was all times of the day and night, in all
weathers . . . We once got stuck in a snow drift and [the other nurse]
s had to jump up and down on the bumper to free me, and let me go to
the delivery which happened before we got there on this multip.
_ This is just an example of the things that happened and I’m sure
I you’d like to know them. The lady bled; she was under control when
we got there but she needed blood. We came back to the hospital
with her sample, cross-matched her blood, and took back the bottle
Y of blood and gave her in her own home, and stayed all night with
T her. That was a one, little instance of something going wrong. The
travel up that same area in Bull Creek, just beyond the toll gate,
there were three miles of creek bed . . . we had to drive in four wheel
ly drive in tractor gear up the waterfall that was halfway through the
{ju creek, and on up, and again the baby ws born before we got there.
W The lady had a constriction ring and we had no doctor in Hyden
i and nobody nearer than Hazard. So we decided we would load her
 ‘ on a door into the jeep and I drove at no miles per hour down that
I creek bed. We sent a boy ahead on a mule to phone the ambulance.
The ambulance picked us up at the then dump and loaded the lady
_ in the ambulance. The only funny thing that happened about that
· was that the baby landed up in Hyden and the mother landed up in
Hazard. But they did get together again afterward .... One of the
i other interesting things that happened to me was a Christmas Day
baby born on Hell-for·Certain. My partner went out and delivered

 12 FRONTIER NURSING SERVICE  
the baby in the jeep I think, and I rode the horse out (just for fun ,
anyway because it was Christmas Day). She had just finished the
delivery, so we went in and rejoiced with the family. She rode the  i
jeep back and rode back the other way, and at any rate, it was
interesting and it was ‘hell—for-certain.’ . . . The fathers did tend to  
run off and you got left with a neighbor. This time we got left with  I
nobody. It was an icy, cold night, icy in and icy out. We had a little ?
tiny fire going and we spent the laboring period going to the well  
and drawing water and stoking the fire to try and keep the mother l 
warm. The other thing we thought at the time was rather amusing ‘
there were a few bottles of moonshine around there which — we
wanted a hot water bottle for the mother, so we threw out the
moonshine and filled up the jar with hot water. And the doctor said l
when we came back: "Why on earth didn’t you give her the `
moonshine?" . . . I wanted to give you some little idea ofthe present
day home deliveries because we still have some. Of them we had
one in the last couple of years, Susan and I went out fairly near ·
here, on the highway. The lady had ruptured membranes and was ·
not progressing. So, we were getting to the end of the time limit .
whereby we should bring the patient into the hospital according to
protocol. But instead we took her up a bumpy ride in the jeep, along
the bumpiest road we could find, which was very near. By the time
we got back she was much more active .... A lot of you who are
doing home birthing or birthing centers, have gone back to the idea
which is if you live long enough, everything comes back the same
as it was fifty years ago. The people used to always walk around in Y
labor, as Betty was saying. Later on, as people got more sedation, `
they stayed in the bed more. . . . All of those things, we’ve done, and
all of those things we’re coming back to .... [There was another
woman] who wanted as little interference as possible. This is a sign
of the times that women are not wanting interference in their ,
labors, their membranes ruptured, etc, unless it’s really necessary.
And that’s what we believe as midwives — not to interfere unless _;
we have to.  
Brownie: In 1927 Yale University had a visit from Sr. George  ,
Newman of England, and he at that time pronounced the greatest °
physiological problems for any nation are the making and  
safeguarding of its mothers. He then went on to say that problems  .
associated with maternity including deaths ‘abound in America.’ P
He stated that there was reduced fertility among women in modern
civilized communities, a relatively high maternal mortality, and a =
heavy burden of invalidity among the surviving mothers. He went .
on to say how much better the maternal mortality rate was in

 { UARTERLY BULLETIN
. 13
L , » , ’  s     K
F   V V ‘ V v¢<    
~ * . ?
i , [ ’
L;       V / YK   I i   I
V {pi   :.4   V  * M   7 A
  ’ “ Q' ’*     " ,
Y T    , N .    ‘  ” 4 e
L J V/[ij W_,tx_.M, 4.l, __ ;_ V {
’, ,4/ ° WY V : i #,.1  ·
  y   Vg 2     e        
~            ¢ ·V”   € ‘    · _   A
·     · — / 4 i K i¢   »’V’ " W  
    Pggzv ` ng i f   V W7     ';;r  
ir, fw; » » V Q ,` ~ {  rl   rk ?L
  5   r e        M.
· e `  "¤; /     e  /' /    /A > *      v»..
2 ,? , ,g3»     Jr   ’; Q ;
I       T i   » ij   V V
q '* : ' " , V ' ' 1 V V M? Y   j
r" ’ ’ ' ,, (.Z·’ ,   Z  {
Y »   1   2*   ‘   r/ , ;   V 4  
$1.   . ~   .   ; ~;¢  e   e   ~ J »    JJ;
*1. ’ ~ — A ; :5 ._   ,
» . 4 . ~ . , ,,, `··. . — , ,.,
~ W s   esi? e   W? ,§ ,2 e      
» _   ~           i ·     V  
»'“ ' A Vw *?;.e,   [ I *’ ~       $1 V  ` "'”“'*··   _ .;,Y"‘?‘·;
i         e g         Fi L *  e i   _    
, V,   V   , : A J _   ~, ‘ <   re: =»;1¢n.,~  — ; — , ,   ' 6  2:;;
·°' M    »%"’% V  . ¤—¤1¥‘*—# `;.°   —4 _   ’°` ’”§*r   `   ', —» ”   
L G   i   ' <·*  i‘°` kw `   M I e?.  4   ur    
r         ’‘VV‘`  4**   " '“          ¤·  "  §"‘f"~      
  ,     X ·/  ·_ { »   JM    `   * », ` V      M   2; ·  
   ~   ~_ R, ,’ ’  ,  _ ,1 A,       ' ‘ V5-· {e —      .    . J 
, ’   . ~’  ‘·.·V,V   vv  ,   iw  , . V / “     ..   i— , ’   4s; ‘  *·*?f  *    L   ‘
M 4*  ;,y‘~»  V V . —  JT, ~_  ~» ,,  ##7*- :A/.2ML-  %·31;.’*    ·  ·. V  ,
 Z · ` _ _ W 4 .,  V y 4 M5}  V LI L  y j ix  ",,,:\- Z "   {lh  lk} ,    "·L   V
U · .   dri: L F*v:! Viv.  J ;/.~ ;,,    {   V I   > ‘g§§:'    SJ  ·
` Helen Bro  Md; " W
_ wne, OBE, RN, 5CM

 14 FRONTIER NURSING SERVICE
Britain and what was the reason for this. The answer at that y
conference was: those countries that have qualified nurse ’
midwives have lowered the mortality rate. _
When Mary Breckinridge was setting up the objectives of her I
work in 1925, she wrote to the readers of our Quarterly Bulletin: ‘It T
is well to keep in mind that we are embarking on a piece of research, *i
and to advance at the outset a few questions which our adventure  
must answer or fail. Will our maternal and infant death rate in ii
rural sections of Kentucky be lowered by this system of nurse  
midwives to figures comparable with those of the old world? What  i
area and population can be served by each nurse, combining ,
midwifery with generalized public health nursing? What part of \
her time is claimed by midwifery?’  ·
The primary purpose was to do something about maternal and `
infant care, and she knew full well that this had to include broad .
public health nursing principles . . . . And, of course, the other
important thing is: what will the cost be? T
In order to answer these questions she had to keep very careful "
records of every aspect of the work. The other thing was: will the  
people accept it? Will the nurses do it? These questions [were
already being] answered at the end of the first year. ‘Is it
economically possible to provide for this service and from what ·
sources other than local support? Educational work is largely met Y
by endowments, perhaps we are coming to an era when health will ,
be as well-endowed as education. ‘Can the service extend in-  ‘
definitely with nurses only or must the nurses eventually be used _
for the supervision of small groups and a class of midwife  I
attendants trained to work under them? Time will tell.’ And it still ·
hasn’t told us. V
This is why what Molly says is so terribly important. We have .
all got to be willing to share our knowledge and experience ....
The explosion in medical technology has made midwifery a ‘
very complicated thing . . . . Think of the patient as a human being  
and not as an autonomous machine that’s about to have a baby . . .  
Here, remember, this is fifty-seven years of midwifery service. lf
. . . If we kept these very careful records, what were we going to do ;
with them? Metropolitan Life did tabulate our records — the first "
thousand, the second thousand, the third thousand, and then a
combination of the fourth thousand and the whole first four .
thousand, and then again, after we had completed ten thousand ,
deliveries of registered mothers. The first four thousand certainly  _
created a great stir among the obstetrical profession and the New
York Academy of Medicine in 1933 published the report of the
causes — in New York City 61% [of maternal deaths] were due to

 QUARTERLY BULLETIN is
' incompetence of physicians, 16% were due to the patients, only 2.2%
 i were due to incompetence of midwives. Most of these midwives
would have been European trained midwives who came over with
  the various groups of immigrants that came to live in New York
I City ....
·i However, we do have a problem with lay midwives today ....
  It’s a problem for all of us. The majority of these women is
l dedicated to the improvement of maternal and child health care,
  and for that reason, we should do everything we can to help them
 ’ . . . We cannot fight them. They want to do something. Many of
I them are doing good work, but I still think it is extremely
I dangerous to face the public with untrained midwives. . . .If we are
 i willing to share our experience and knowledge with other people we
‘ should be able to double our numbers [of trained nurse-midwives] T
_ in five years .... Enrollments are down and schools have closed.
We’ve got to prevent this happening. We won’t make an impact on
` this country if we can’t have more numbers .... I am convinced
’ that nurse-midwifery is here to stay and lots of you in this room can
  help it stay . . .
. . . We have always combined education and service .... You
couldn’t possibly teach midwifery [without the experience.] . . .
· Arlene: I’m going to change the focus here and talk about the
, Appalachian culture and how it affects the health care of women
 ‘ . . . I’m going to start out by talking about some of the barriers to
. health care . . . Women, and many