Appalachian Midwifery
I will lift up my eyes to the hills—Whence comes my help? My help comes from the Lord. Ps. 121:1-2
Serving Southern VA & WV
30 Years of Experience
Appalachian History
Mountain Healing
Before 1925, the United States did not have widespread health services for pregnant women and young children. Mary Breckinridge, born in 1881, was a woman dedicated to creating a service for American women and children beginning in Leslie County Kentucky. As a child, Breckinridge travelled around the world which influenced her to later receive an education in England for midwifery in 1925. When Breckinridge returned to the United States, she established the Committee for Mothers and Babies, which eventually developed into the Frontier Nursing Service. The Frontier Nursing Service provided midwifery along with public health services to Leslie County and the surrounding area. The Frontier Nursing Service went through one final transformation into the Frontier Nursing University to teach midwifery in Hyden, Kentucky. Breckinridge had a lasting impact not only on the local community of Leslie County, Kentucky, but on the rest of the United States as well, by creating and operating the first school for midwifery in the United States while revolutionizing rural health care.
Mary Breckinridge (far left) along with other nurse-midwives in the Frontier Nursing Service
"Several reasons contributed to the continuance of midwifery in early 20th century Appalachia. Typical of most Southern highlanders, these midwives—often referred to as “Granny women”—were willing to help those in need, and served their neighbors and relatives living within a few miles of their homes. Doctors or physicians were scarce, and therefore often too far away from laboring women. By the time they could have called for a doctor, and waited for him to traverse the mountain and arrive at her bedside, a mother would have typically already delivered. In eastern Kentucky at this time, midwives outnumered doctors 14 to 1."
Susie Cook McMahan was a legendary midwife who delivered more than 2,000 babies in Jackson County and surrounding environs. She was featured in this 1985 Sylva Herald article.
My great (x2) grandmother was somewhat of a hero in the Western North Carolina area of Appalachia. She was born in the summer of 1901 and was known as “Granny” to everyone in and around WNC although her given name was Susie Cook McMahan. She served her community for decades, delivering more than 2,000 babies and saving the lives of many...
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There were no stores ... She had to get creative and use her mind and hands to create the things she needed, being well-known for her “big white bag” that consisted of her handmade equipment she carried to every delivery. Inside the bag she had two metal pans for water, cloths of various sizes, usually made from old clothing, a homemade mask and gown for sanitary isolation, and homemade soap that had natural disinfectants from plants and other materials that grew wild in the area. ...
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In some cases, when Susie worried a baby was too small or frail to live, she would create a homemade incubation system using a hand-weaved basket and wool blankets to secure warmth in and around the child, instructing the new mothers that the baby needed to remain in the “incubator” for several weeks until it could gain significant weight. In the case of a baby becoming stuck or dislodged in the birth canal, Susie knew to have the father-to-be help hold the mother upside down so she could get the baby to turn, by hand.
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Because the women and families of the region were almost always impoverished, they could usually not pay her with money. She would usually receive compensation consisting of textiles, odd and end materials, various livestock, or foods like potatoes or pieces of cured meat. If a family was struggling, she would often refuse payment and return after the birth with resources, food and clothing to help the family stay afloat and to keep their new baby clothed and fed.
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As I previously stated, Appalachia is not the easiest place to navigate, the peaks and foothills of our beautiful mountains would have made travel a treacherous task in earlier times. Grandma Susie would travel many miles in any direction through the mountains, in any weather, on horseback or on foot, to get to a laboring mother in need...."
In Appalachia, three in ten households lack access to broadband internet and almost 9 percent of people don’t have access to a vehicle, making researching faraway care options—and executing on them—often impossible. Pregnant women and infants are some of the most vulnerable people in modern Appalachia, where the infant mortality rate is 16 percent higher than the national average, according to the Appalachian Regional Commission. In addition to rampant hospital cutbacks and closures—which have been exacerbated by Covid-19—women are experiencing life-threatening complications during childbirth at an alarming rate. In Harlan County, for example, a 2019 USA Today investigation found that almost one out of every 10 women who gave birth at the local hospital experienced a life-threatening complication—seven times the national average.
But over the past few years, a handful of dedicated Kentucky midwives and advocacy groups have been working to change the region’s perinatal and postpartum health trajectory by advocating for a wider range of safe, accessible local birthing options and support systems for pregnant women in the state’s maternal health deserts, improving birthing practices in Appalachian Kentucky, and empowering women in a way that speaks directly to the region’s lauded midwifery heritage.
Founded in 1925 by Mary Breckinridge, the Frontier Nursing Service (FNS) provided primary health care services to remote areas of southeastern Kentucky, with a special focus on midwifery. Motivated by the loss of her two young children, Breckinridge dedicated her life to serving mothers and children across a 700 square mile area of isolated mountain communities where infant and maternal mortality rates were high. Serving areas with little road access, nurse-midwives often traveled on horseback to tend to the births of thousands of children and to treat countless ailments.
The history of this remarkable organization is documented through 212 oral history interviews, conducted largely in the late 1970s, that feature the stories of doctors, nurses, and the Eastern Kentucky residents that they served. The interviews detail the workings of the FNS, from house visits and daily operations to the development of national philanthropic networks that supported the organization.
Granny women. Appalachia’s midwives. They are usually elder women in the community, the ones people come to with their problems. They do not wear any special garb or have any physical attributes, other than being elderly, that a person can identify them by. The Granny women are recognized throughout the community by their actions. For example, Granny women do not expect to be paid for their services. Furthermore, they are expected to be ethical, and never do harm to another human being. Many Granny women are fundamentalist Christians and are looked to as religious leaders in their communities. Yet they are not in control over anyone. Instead, they are just looked at as wise, good women who unselfishly help the community.
“Theirs was a hardy race, and seldom did they rely on a doctor. They applied many home remedies for injuries and brewed herb teas. Childbirth was a casual matter, usually attended by mountain midwife. Babies, as a rule, grew and thrived without any pretense of comfort or sanitation.
“Their religion was of the simple Protestant type. They often attended their neighbors’ churches, and occasionally had a patriarch-preacher in their group. They learned some of the old ballads and gospel songs from memory, for few of them could read or write.
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